False start as devolved units in once marginalised region fail balance test

By Paul Wafula

Kenya: It’s Thursday, September 26, 2013. I quickly learn why Tharaka Nithi Governor Samuel Ragwa would not pick my calls as soon as I arrived in his backyard.

The election fever is yet to die down.

Ragwa is waiting for a ruling of an election petition to be delivered the following day at the High Court in Meru. He has no time to discuss his administration’s health priorities at this time with a journalist.

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His phone goes unanswered, but he responds to text messages.

“My ruling is tomorrow,” he texts back. That is all he says. 

This is understandable. What is not clear is his refusal to delegate this function to his deputy or health secretary.

Eight months after the election, none of Tharaka Nithi’s county executive officers, have officially reported to work.

Not even newly appointed health secretary Magdalene Njeru is ready to speak on the health strategy of the county or offer an explanation as to why Tharaka Nithi is among the counties that has budgeted to spend least in health in the entire country healthy.

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A summary of Tharaka Nithi’s budget shows that the county has set aside Sh10 million on health services including general administration and the planning of the executive office and the sub-county units. With a population of 406,413, this translates to about Sh24 per person, making the county the least spender on health in the country. The county plans to spend Sh2.3 billion in total this financial year.

Isiolo County is the best spending county in the Eastern region, which has eight counties. It allocated Sh1,484 per person.

Marsabit and Makueni counties came in at number two and three respectively in the Eastern region, having allocated every citizen Sh988 and Sh362 on health development respectively.

Machakos County has set aside Sh318 per resident while Meru County will spend Sh278 per citizen this financial year. Embu (Sh234) and Kitui (Sh93) come in next in the region.

Expenditure trends

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An analysis of the planned health expenditure in the three counties in the North Eastern region showed that the status quo will remain, as Garissa, Wajir and Mandera counties appear to have copied the same expenditure trends by previous regimes.

At the end of 2012, Ministry of Health data showed that Garissa County had just 44 nurses serving every 100,000 people, 12 clinical officers and just 10 doctors on a similar number of people.

This means that every doctor in Garissa County was expected to serve about 10,000 people by close of last year.

Wajir County was running on just one doctor, 21 nurses and five clinical officers for every 100,000 people. When the county governments took charge, Mandera County was running on the least number of medical professionals.

Mandera County inherited just nine nurses for every 100,000 people and three clinical officers were serving a similar number of people. It is also the only county in Kenya where one doctor serves more than 100,000 people.

Ironically, the counties in the North Eastern region with the least number of medical professionals have also set aside the least amount of money in developing health, in what confirms the continuation of an investment trend that saw these counties marginalised by previous regimes.

Garissa County led the pack in spending on health in the North Eastern region having set aside Sh609 on each of its citizens this year, followed by Wajir’s Sh319 while Mandera came in last with Sh140 expenditure on each of its 693,125 residents.

Governor Samuel Ragwa health services devolved government