With Kenya's General Election, excitement of victory and swearing-in ceremonies over, the realisation of the magnitude of work ahead has just began.
A quick perusal of the dailies recently has captured a number of governors expressing shock and disappointment at the state of county health facilities, and the plight of patients. Sample these: Governor Benjamin Cheboi of Baringo County in an article in one of the dailies on August 30, 2022 said "the deplorable state of health services" at a particular hospital to low morale among staff caused by mismanagement of the health docket.
The same daily, Governor Kiarie Badilisha of Nyandarua County issued an order for immediate release of patients detained in one of the county hospitals for failure to settle medical bills.
Governor Abdi Ibrahim Guyo of Isiolo in yet another story a day earlier, described as being "shocked" to have found the main county referral hospital devoid of staff, "with only one doctor on duty" after an impromptu visit; while Governor Cecily Mbarire of Embu vowed to deal "ruthlessly" with corruption cartels, expressing concern about the poor state of the health sector.
Evident from these accounts is that per the new governors' perspectives, the problems in the healthcare sector are a potent (and toxic) mix of firstly, mismanagement of healthcare resources (human, infrastructural, and financial); secondly, complicity in conflicts of interest that rope in healthcare workers as well as external players who are seeking financial benefit; and thirdly, an absence of respect for the person and human dignity. A few recommendations are thus in order.
Governors must now act fast to ensure that healthcare facilities have sufficient numbers of qualified, well-remunerated healthcare workers who are accountable to management and county health executives and the populations they serve.
Governors should seek to mend relationships which have been severed owing to past disagreements with staff, and work collaboratively to ensure that healthcare workers continue to receive the necessary training and advancement (which the county ought to benefit from); while not leaving staffing gaps in the health facilities.
An abundance of good faith from all involved will be necessary, even as healthcare workers continue to push for a commission to handle human resources at the national level.
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Procurement processes for goods and services must be strictly adhered to in accordance with the law. Strict vetting, and continuous and meaningful oversight, must be given to all successful bidders to ensure they are not proxies of county employees or public officers; and that they have the experience to execute given tasks to completion.
Prudent allocation and use of funds will be critical here; as will accountability for lapses and failure - a sword that cuts both ways. A county cannot under-allocate or divert funds for projects and hope the projects will succeed; or fail to pay salaries on time (or at all), and expect seamless services from healthcare workers.
Respect for persons, and the acknowledgment of human dignity, require that each healthcare worker treat patients and their colleagues with consideration. Listening to patients, seeking to understand their contextual circumstances and giving them treatment options, should be the bare minimum at healthcare facilities.
Of course, this does not preclude healthcare workers from offering advice (whether medical or otherwise) to patients; besides consultations with colleagues, and offering constructive input to management, will be a part of a functional county.
The attitudes of both the givers and receivers of constructive criticism must be respectful. Nobody knows everything, and the ability of each one is crucial if the best interests of patients and healthcare workers are to be given their due regard. With the state of the economy being what it is, both national and county governments must work together to ensure that Universal Health Coverage (UHC) becomes a reality as many people are just an illness away from falling into poverty.
For our governors, we wish you well. Remember that this is an opportunity you each fought hard for, and so must deliver. As the Kiswahili saying goes, "Maji ukiyavulia nguo, yaoge!"
-Dr Esther Muiruri is a Bioethicist, lawyer and visiting course facilitator at Aga Khan University Medical College, EA.