Doublespeak on devolution of health services insincere


Medical practitioners who have sworn to uphold the Hippocratic Oath, reaffirming that life is worth living, and that they shall ensure “utmost respect for human life from its beginning” have a duty to safeguard life. However, the moving accounts in the media that deaths are being recorded daily in public hospitals across the country are mind-numbing, to put it politely.

That medics have legitimate grievances is a moot point for those screaming for attention in hospital. That government is tone deaf to their pleas for dialogue is an argument lost to the relatives of patients who have been denied medical attention at the altar of the Minotaur that devolution has become.

The Constitution of Kenya clearly states in the Fourth Schedule that spells out “Distribution of functions between National and the county governments” that health facilities and promotion of primary health care will be sole preserve of the county governments. National government is only supposed to stick to policy formulation and co-ordination, with minimal financial implication to county budgets and priorities for the health sector function.

That is what the supreme law says. It appears, however, that there is an element of double-speak when various actors claim the Transition Authority erred in devolving the health function to the counties. But on the flipside, should national government want peace of mind to enjoy Kenya@50, it will have to bend over backwards to ensure the State guests that are in town do not see the pitiable and heart-wrenching photos and news clips of suffering patients in abandoned hospital corridors.

The crisis in the medical sector following the strike of hospital staff led by doctors is an unfortunate chapter in Kenya’s history that requires a permanent solution. Devolution is a reality that Kenya has to live with and its implementation is not an option but something we must do.

And while industrial action is recognised by our Constitution, it is also important that all workers also respect the rights of others. In particular health workers should recognise that they have a duty to ensure patients, young and old, are taken care of.

It is unfortunate that the workers decided to go on strike as we head to the festive season and celebrations to mark the 50th anniversary of Kenya’s independence. It is imperative, however, that National Government and the Council of County Governments must continue engaging the unions of health professionals (Kenya Medical Practitioners and Dentists Union, Kenya National Union of Nurses, and Kenya Health Professionals Union).

The recent meetings have come up with possible solutions. The discussion on the issues facing the health sector and especially the transfer of health functions to County Governments must continue. This conversation is key to ensuring the heart of the health sector continues beating until a permanent solution is found to the issues raised.

It is understandable that the health professionals are making demands, which are, in the interest of the country’s health sector, important. While the demand by health workers that the management of their personal emolument be retained by the national government, it is important that this be done in the spirit of devolution. It is critical that there is no rush for this to be done without enactment of the Health Act and Health Policy.

The two levels of governments should also be proactive by engaging the health workers’ unions when developing policies and laws both at the National and County levels. This will ensure there is inclusion when the laws are formulated and that they are acceptable to all players.

The engagement of the Public Service Commission in the process of developing a policy on harmonised schemes of service for county and national health workers is also critical for the health sector.

Also crucial is standardisation of job groups, job descriptions, training and development, promotion, career progression guidelines, salaries and other remuneration. This will ensure no worker loses out when they move across counties and between the two levels of government.

Health services are not a favour or privilege, they are now a basic human right. Start the discussion with this in mind.

(The writer is a political and communications consultant. Twitter @MachelWaikenda)

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