Address concerns over devolved health services

Kenya: It is regrettable that Kenya finds itself among countries worst hit by the exodus of health workers to the West and inadequate state funding.

According to a new report ‘Stop the health worker crisis’ by UK-based NGO Health Poverty Action, health spending in Kenya has never exceeded 10 per cent of total public expenditure  — it actually stands at 5.9 per cent —  which is far below the 15 per cent Abuja Target agreed by African countries.

 The consequence is that Kenya has only around 1.8 physicians and 7.9 nurses and midwives per 10,000 people and is, therefore, classified by the World Health Organisation (WHO) as one of the countries that has a critical shortage of health workers and is unable to even cover essential health services.

 Yet health is one of the services being devolved to the counties, despite its being in urgent need of restructuring and increased funding. The result could well be that many doctors currently working in public hospitals would be pushed into the private sector, at best, or out of the country, at worst.

This would defeat the core of devolution.  Fears that devolution of these services would accelerate the exodus of health professionals from the public service are borne out by some templates from counties that suggest doctors’ salaries would be reduced by more than half, which would be against the existing labour laws.

 This means the government should move quickly to clarify its stand on the devolution of health services because the continuing uncertainty is pushing the professionals, especially the doctors who are more mobile, out of the public service.

Some doctors may already be at advanced stages of leaving the service, and continued delays in addressing the uncertainty could seal the fate of many public hospitals and clinics, especially those in counties where they are most needed.

 It is intolerable that further shortages of health workers in these counties would translate into higher maternal, infant and under-five death rates. A more prudent state policy would be to leave these services’ management at the national level and then embark on a massive re-structuring programme in tandem with increased funding.