Rather than bring services closer to the masses thereby increasing efficiency through disaggregation of government functions, it is now feared that devolution might actually have the direct opposite effect. And this is despite the fact that the process is set to get under way in just a matter of days.
But nowhere is this more apparent than in the health sector. And now rather than champion for the process, healthcare providers are up in arms clamouring that the process be delayed, until such a time as proper structures have been instituted in all 47 counties.
“We believe that the rush to devolve all functions of the government does not favour the counties nor does it favour the health sector. The counties will soon discover that they have accepted liabilities that they will be hard placed to meet, out of their limited budgets,” says Dr. Victor Ng’ani, the chairman of the Kenya Medical Practitioners, Pharmacists and Dentist Union (KMPDU). The trade union represents all doctors in the country.
Doctors and other professionals in the health sector are less than impressed by the manner in which the whole exercise has been conducted; citing consultations with the concerned parties were ignored by the transitional authority.
And as an indication that all is not well, stakeholders in the health sector were holed up in a meeting with the cabinet secretary for health the entire day on Wednesday trying to iron out contentious issue. This meeting began at eight in the morning, but by 4O’clock no agreement had been struck.
One of the main sticking points has been the devolvement of salaries to the counties, which the stakeholders in the sector are against to a man. They are saying that the counties are just too ill equipped to handle payroll matters.
They feel that the responsibility of paying salaries should remain with the central government, because the prerequisite structures at the county level are simply non-existent.
“The planned transfer of pay point is happening in the absence of both manpower and capacity to accomplish the highly sensitive task at county level,” says Dr. Boniface Chitayi, who used to be the health affairs secretary for The National Alliance (TNA) party just before the elections.
These sentiments are echoed by Mr. Musundi Jophinus, the chairman of the Kenya National Union of Nurses.
“Personnel emolument should remain with the central government and that is the position of my union. We are seeking recognition so that contributions by the employer should not be going elsewhere,” he maintains
On the other hand, they are quick to point out that other functions should be devolved, because the mechanisms to do so are in place. These include the procurement of medicines, supplies and equipment and the co-ordination of the health workforce within the county.
Even so, concerns are rife that some county health facilities will be overwhelmed by an influx of patients from neighbouring counties, especially if their own lack adequate healthcare services.
“We can therefore foresee a situation whereby some form of discrimination will begin to emerge, to block citizens from other counties from accessing healthcare in the neighbouring health facilities,” says Ng’ani.
But the host’s healthcare facilities will be stretched by the added burden of having to accommodate patient traffic from other counties.
Funding is another challenge. None of the recommendations suggested by the Musyimi Task Force Report have been factored into the health budget.
Led by Mr. F.K Musyimi, in the Ministry of Public Health and Sanitation, the task force signed last December, was to look into strengthening the healthcare service delivery across the country.
For instance the Report recommended that KSH 1billion be allocated for each county for putting up of high level county referral hospitals over the next three years.
In addition, another similar hospital over the subsequent four years was also recommended for establishment.
These hospitals would be equipped with a set minimum intensive care unit beds, theatres, laboratory and radiology equipment.
The report recommended another KSH 15.94 billion which was to be set aside annually, for the procurement of drugs and medical supplies by the central government. Only KSH 2 billion is allocated for this purpose under the current health budget.
What this means is that the county governments will be facing pressure to deliver health services albeit on limited budgets.
However, all indications imply that this will not happen; setting the stage for industrial action that will bring the less than adequate healthcare services to a grinding halt.
Dr. Chitayi proposes a grace period of one year, prior to devolving the salary issue to the counties.
“Parliament should move with speed to enact legislation that will retain the pay point of health workers in the country at Afya House, until such a time when the counties will have the requisite systems in place in no less than a year,” says Chitayi.