Comprehensive health devolution – a really bad idea

devolving health

Tucked away on page 6 if today’s Daily Nation (3rd Sept 2013) was this very interesting piece. Bodies representing medical practitioners nationally are seeking to stop the gazetting of the comprehensive devolution of health services to the counties.


Now this may be dismissed by some as a jubilee ploy to stall devolution….. but this is an extremely simplistic, thoughtless way of looking at things.
The plan to comprehensively devolve all health services to the county is insane. The education sector was extremely careful to avoid comprehensive devolution and those in the health sector ought to have worked equally hard to convince the nation that devolving health comprehensively is a bad idea.
When the current breed or governors and senators were MP’s a bill was tabled in parliament that would have enabled all county hospitals (then provincial and some District) to be nationalised – receiving support from the central government, like Kenyatta National Hospital. But feeling that their power was being reduced, the MP’s refused to pass the bill- they wanted to be future governors with our health in their hands.
Health programs which include infant vaccinations, family planning…. all the way to equipping theatres has been left to the county governments to decide. The county government will pay salaries, buy drugs and equipments for all health facilities within their county….. how will this work?
How will programs like NHIF or HSSF work in this devolved system?
Would you rather listen to governors banging tables, wanting more power or the Kenya Medical Practitioners, Pharmacists and Dentists Union along with Kenya National Union of Nurses as well as the Kenya Health Professionals Society, who have filed this petition? The later are associations of people who know how the health systems in this country operate.
This is not party politics but the health of the ordinary citizens at stake. Let us not politicise it into anti-devolution etc shenanigans and look deeply into the issues at hand.

One comment

  • consolata

    After visiting the star, these are the issues I managed to pick. Daily nation seems to not present any issues of why the resistance and i was just about to dismiss the doctors.

    -the unions were NOT INVOLVED in the process prior to the transfer of the health services.
    -there is no ‘LEGAL AND INSTITUTIONAL FRAMEWORK for a CO-ORDINATED transition to devolved Government while ENSURING CONTINUED delivery of services to citizens’.
    -“Article 175 of the Constitution required County Governments to have RELIABLE SOURCES OF REVENUE and to deliver devolved services effectively, he said.”
    -TA has failed to ascertain that a CLEAR SYSTEM OF EFFECTIVE AND EFFICIENT RATIONALIZATION OF MEDICAL HEALTH PERSONNEL system of effective and efficient rationalization of medical health personnel has been set up, contrary to Section 7 (2) (m) of the Transition to Devolved Government Act.
    -TA acted “irrationally and in abuse of its statutory powers and the medical practitioners’ risked GREAT HARDSHIP AND LOSS.

    this devolution issue has its pros and cons. i am pro devolution of health services, with coordination left at central government. I would put better planning not only how many of the level five hospitals Kenya should have, but also the geographic spread- we need a teaching and referral hospital at the coast. we probably need another one this side of Luo-Kisii area ( the population and the fact that other surrounding areas can be tapped into- maasai, kipsigis, even luhya). The issue needs less politics and more health economics and financing logic.

    Public health programmes like vaccines will need closer coordination, which is not rocket science as it is being done regionally and globally so between counties is really not such a big issue. But vaccination schedules and what vaccines should be in the EPI needs debate at national level and probably even regional level (Aka EAC)- decisions being driven by epidemiology and cost-effectiveness studies.

    I think doctors are afraid that there will be no salaries- most likely if funding is not adequate- you can’t devolve the doctor and not his salary. So pesa mashinani please if we are devolving services.

    then the way services are being devolved lacks planning and coordination. creates confusion. Like a relay race, even as you start running you need to get the batton in your hands after a certain distance- how far should counties be running before it is in their hands truly.

    on the hardship and loss thing, I hope it is not something once the real issues are sorted shall continue being an issue. because the point is people need doctors and nurses mashinani. it is an injustice to crowd in one area while some areas are underserved and thus county governments should control how many they hire (which will be a factor of how much money they get per capita for health and I hope also that there shall be affirmative action so as to have ‘catch-up’ for the more disadvantaged populations). If governors are given funds equitable based on health needs then for a doctor/ nurse, you stay in a place where you cannot be hired by the government because of cash, you either go private or move to the other county which needs you.

    etc etc