Counties 'to lose' Sh4.2b health kitty

A Senate committee has supported a Bill to revert some health functions to the national government.

A Sh4.2 billion conditional grant is part of allocations counties would lose if Parliament passes the Bill.

The Bill, which seeks to address some of the thorny issues in the health sector, would have governors surrender control over health human resource, procurement of drugs and management of level five hospitals in their counties.

The Senate Health Committee has given the nod to a petition by the Kenya Medical Practitioners Pharmacists and Dentists Union (KMPDU) and Boresha Maisha, a non-government organisation advocating better health systems. This is a boost to the proposed changes to the law.

Former Nyeri woman representative Priscilla Nyokabi, an advocate with Boresha Maisha who presented the petitione before the committee, said counties did not have the capacity to manage referral hospitals.

District hospital

Besides, she said, almost every county is converting their former district hospitals to referral facilities to tap into the Sh4.2 billion kitty, whose accountability at times cannot be traced.

Kiambu Governor Ferdinand Waititu recently upgraded the Kiambu and Gatundu Level Four (district) hospitals to level five (regional status).

“It should not be you (governors) who decide which facility becomes a referral hospital. How can you have a referral hospital that does not have drugs or equipment for some simple procedures?” asked Ms Nyokabi.

As detailed in the petition that was accompanied by the Health Amendment Bill (2018), which will be redrafted to become the National Referral Hospital Bill (2018) to avoid conflict with the Health Act, which has yet to be operationalised, the two advocacy groups have proposed the formation of an authority, similar to the Kenya National Highways Authority (Kenha), to certifying if a facility is to be upgraded to a referral hospital.

The authority will also have an oversight role in terms of the Sh4.2 billion - about Sh380 million on average for every hospital - that is distributed to 11 referral hospitals through their respective counties.

This money, said Nyokabi, should instead be disbursed directly to hospitals so that they can be independent, with their respective chief executive officers or medical superintendents being accountable.

“We do not need a governor to struggle with functions that they cannot deliver. The Constitution provides for transfer of such functions, what we lack is just the law,” said Nyokabi.

She gave the example of Nyeri, which she noted had 66 other health facilities that do not have enough beds, drugs and health personnel because the county now has a referral facility that it is struggling to keep running.

Senate Health Committee Chairman Michael Malinga (Trans Nzoia) said he acknowledged the concerns and added that a forum would be created to bring on board county assemblies and governors.

“It is true some of these roles should be given back to the national government but if (we) senators say that, they (governors) will start saying we are fighting devolution. But we will spearhead these changes,” said Mr Malinga.

According to President Uhuru Kenyatta’s Big Four agenda on universal health coverage, the Health ministry is under instructions to put up 10 national referral hospitals.

Currently, there are just four - Kenyatta National Hospital, Moi Teaching and Referral Hospital, Mathari Hospital and the National Spinal Injury Referral Hospital

“The question is do you build new ones or upgrade? But if you improve 10 referral facilities into national status then you would automatically have the necessary facilities, as per universal health coverage,” said KMPDU Secretary General Ouma Oluga.