Challenges in devolving healthcare pointer to poor county leadership

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#Sickat50 was a Twitter campaign initiated during the health workers strike in December 2013.

Though Twitter-based campaigns seek to highlight issues that affect a concern or the rights of workers, #Sickat50 became a conversation that went further than the immediate crisis of health workers on strike, with participants taking the opportunity to discuss what challenges, opportunities and decisions we were making as a nation celebrating 50 years of independence in 2013.

It is no secret that our county governments refuse to prioritize their expenditure when it comes to healthcare. By mid March 2014, Parliament demanded stripping of health roles from county governments after the shocking resignation of 189 doctors. The House Departmental Committee on Health recommended the creation of a special taskforce seeking to reverse the devolution of health services to county level, stating that it should be phased and should take three years rather than the immediate manner in which it was initially conducted.

During this confusion, there was no letting up on the name calling – doctors were consistently being blamed for the crisis, and the public perception was always skewed in favour of the county governments. The common misconception was that the doctors wanted more money than was available and were greedy in this demand, despite the clear guidelines created by the national government on allocation of resources, funding and pay scales. Needless to say, the stakeholders were at each other’s throats.

By mid 2014, we still had a crisis in the healthcare sector, a lack of consistency in the hiring and remuneration of doctors across the country and the devolution of clear ethnic bias added salt to the wound – doctors unable to serve in areas where they are considered ethnic “outsiders”.

In August 2015, again a series of strikes over health workers pay sent county governments reeling into crisis. By October, the government pledged to form a unit to address health crisis in counties, working in tandem with the public service commission, addressing the crisis of perennial strikes by health workers and also seeking to smooth over relations with the county governments.

The then Cabinet Secretary for Health, James Macharia, emphasised the need to improve relations between the Ministry and the county government for the sake of the public.

“I would like to extend an arm of goodwill to other stakeholders. I know it appeared as if the Executive was fighting the Council of Governors but our desire is to promote adequate healthcare to the client,” he said.

Every county in Kenya now struggles to provide health care services for its constituents. In addition the workforce, which remains completely inadequate in numbers, is still expected to live as saints, never receiving their pay on time, and never getting enough to live on. In fact during the first few months after the devolution of health began when resignations from doctors created a crisis so vast that it compelled the National Assembly to hold a special session on the same in March 2014 there was a clear standoff, as doctors could not in good conscience continue working under the conditions that the county governments had created.

The challenge in healthcare provision at county level indicates that devolution is not simply a matter of enacting legal measures or implementing policies; it is also about bringing the different county governments into unity of purpose with national government whereby whenever they take over a function, they do to improve performance beyond what national government used to do; not just to ‘own’ the budget lines that goes with the function.

This means it will take concerted effort from county governments, and an interdependent relationship with national government, for counties to deliver on the expectation that the ordinary Kenyan has, from both levels of government; not only in the healthcare sector but in infrastructural provision, security, education and economic development. County governments must resolve to place their client; who is the public; at the centre of their duties. This means they must tap into the experience of national government, which has been performing the functions they have taken over for the last 50 years; and accept to be guided as they input their own specialized focus on each service.

At national government level devolution certainly remains on course. They have completed the implementation phases as required in the constitution and the transformation being witnessed especially in previously marginalized regions speaks on the immense potential in progress and development that a successful implementation of devolution will have on ordinary Kenyan lives.

County governments must accept to work with national governments to develop their respective spaces in our lovely country, as part of a whole rather than seeing themselves as independent entities answerable only to themselves. It remains the express responsibility of the county governments to live up to the expectations of devolution; development that locals can see; and to commit to this fully. This must result in building of infrastructure, accruing of sufficient human resources and creating paid work and tangible benefits, for county constituents.

(Mbarire is the chairperson of Kenya Women Parliamentary Association – KEWOPA)

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