Medical students opposed to devolution of health, says study

The next generation of medical doctors does not want to be devolved to the counties, a new survey has shown.

Their biggest fear, they say, is the meddling of politicians in health affairs and most believe devolution will reduce efficiency and effectiveness of health care services.

The study carried out by the School of Medicine of the University of Nairobi from February to May last year sampled 384 of the institutions’ 1,500 medical students and is published in the current issue of the Pan African Medical Journal.

A majority, 90 per cent, thought devolution will promote local political interference, 73 per cent thought efficiency will decline, 63 per cent said health-care funding will decrease, 58 per cent believed infrastructure will deteriorate while about 50 per cent said fewer people may opt to utilise public health facilities

Only about a quarter of the respondents thought devolution would bring services closer to the people or increase disease control in the community.

However, the students did not mind if all other aspects of healthcare are devolved including finance, leadership and medical products but not human resources. “Most respondents would prefer working in a private or mission hospital than in public institutions,” says the study.

Teething problems

The study was carried out by Henry Nyongesa, Cecilia Munguti, Christopher Odok and Winstar Mokua of the University of Nairobi. They say despite the envisioned benefits of healthcare devolution, there is a low opinion among medical trainees concerning these reforms and their implementation.

“Nevertheless, it is early to speculate whether such viewpoints will be carried to the future once teething problems are dealt with,” they write.

Of concern to the students is the lack of a standard framework concerning employment, deployment, transfer and remuneration of healthcare personnel, with each county purporting to come up with county tailored policies. “There is clearly an apathetic attitude towards the devolution process from the students’ standpoint,” says the study.

The authors attribute this negative response to devolution to many years of institutional and personnel neglect by the Government.

The authors also argue that since almost all the knowledge the students had on devolution is accessed from the popular media this may have influenced their negative outlook. “The reliance on a sensational media that highlights the Government in the negative may be a stimulus for the given responses.”