In the midst of a crisis in the health sector, the Government has often resorted to alternative measures to mitigate the crisis.
Recently, the ongoing doctors’ strike in Kenya saw the Government deploy military doctors in the Kenya Defence Forces (KDF) to handle emergency cases. The Government is also reported to have mooted plans to hire doctors from India and Cuba.
Presently, the health sector in Kenya does not have a representative commission. The health sector was devolved to county level under the responsibility of governors in liaison with the Public Service Commission.
To strengthen this interrelationship between the national government and county government, a Health Bill was passed in the National Assembly in March 2016.
The Act of Parliament seeks to establish a unified health system, to coordinate the inter-relationship between the national government and county government health systems, to provide for regulation of health care service and health care service providers, health products and health technologies and for connected purposes.
The unions’ leaders in the health sectors have been advocating for an establishment of a Health Service Commission (HSC) in the lines of the Teachers Service Commission to represent the health workers.
This advocacy is motivated by myriad challenges and issues witnessed in the sector and which have been raised by the health workers through their respective unions.
As a result, various Task Forces and committees have been instituted to address these issues and strengthen service delivery in the sector. For example, since the doctor’s strike in December 2011 and September 2012, recurrent and related issues affecting the sector have been floated by the union.
These issues include: inadequate facilities most of which are old and dilapidated and do not meet the required current norms and standards; unfair remuneration and compensation for the workers; inequitable distribution of health workers leading to poor staffing; poor training hence shortage of specialists as recommended by World Health Organisation (WHO); inadequate supply of medicines and other non-pharmaceuticals due to insufficient funds allocation in the sector.
The aforementioned challenges and issues could be interpreted in three-fold: a gap in the management of workers in the health sector; inability or reluctance of the Government in provision of comprehensive health care and service delivery; and lacks an established competent body that keeps the Government in check regarding its constitutional obligation on health matters.
With the recurrent crises and challenges in the nation, there is need to competently handle the health sector, this calls for establishment of a body which is not limited to advisory mandates only.
Currently, health care workers in the public health facilities are regulated under the Public Service Commission (PSC). The functions and powers of the PSC and the proposed HSC are significantly different.
Hence, the PSC may not adequately handle all issues in the health sector. In Uganda, the Health Service Commission endeavours to build a fundamentally strong and competent human resource base or efficient and effective health service delivery.
The functions of the Commission include advise to the President on his constitutional functions in relation to health services.
In addition, the commission has the power to appoint persons to hold or act in any office in health service, including the power to confirm appointments, to exercise disciplinary control over those persons and to remove them from office as well as reviewing the terms and conditions of service, standing orders, training and qualifications of members of the health service.
From the cited case study, the mandates and powers of the Health Service Commission in Kenya would be to: ensure provision of quality health care; advise the Government on matters relating to health service delivery, health professions; set and review standards of education and training of health workers; register; recruit, transfer and promote; discipline and terminate health workers; among others.
It is recommended that the HSC be established as a Constitutional Commissions that is governed and regulated by the relevant provisions in the Constitution.
This will empower the body and eliminate discretional authorities of other commissions on the advices of the Health Service Commission.
This amendment will also lead to an establishment of frameworks for coordination and implementation of policies in the health sector at the different levels of government.
HSC will release the ministry responsible for health to focus on formulation of policies, standards, guidelines and regulations while the commission focuses on health service delivery.