The realization of the new constitution had been the dream
of every Kenyan in the progress towards reforms and reconstruction of the
public sector. One of the proposed restructures was the devolution of various
government functions from the central government to the county governments.
Health was one of the central government functions that were proposed for
devolution. Technically, the move to devolve health functions was welcome,
since it is a way of enhancing access to health care services to Kenyans. This
move was also aimed to reduce inefficiencies that accompany centralization of
services.
Right move or not
The much-anticipated benefits of devolution of healthcare to
the counties seem to be a mirage. Devolution of healthcare has shown declining performance
of the health systems, bringing in questions on whether the country needed a devolved
system or not. The public health sector has been faced with numerous human
resource unrests that have led to many deaths and disruptions in service
delivery. Matters concerning unfair employee appraisal systems, poor working
conditions, inconsistency in remuneration and benefits among other grievances,
have triggered these strikes.
Structures for healthcare devolution
All these challenges point towards poor health management structures
in counties. The counties lack adequate structures in management of human
resources and health finances. These inefficient or non-existent structures
have brought about delays and confusions in release of funds for health
facilities and workers.
Capacity
Most counties lack health managers who have done health
systems/services management. Most of the persons served in the previous centralized
health system where they could maneuver around without the requisite skills,
since they had fewer responsibilities. Now that healthcare has been devolved,
they face greater responsibilities, which they may not handle due to inadequate
skills in health services management.
What needs to be done?
Devolution of healthcare is a very beneficial aspect of
service delivery, through enhancing access to care and increasing efficiency of
health systems. However, these benefits are clearly not achievable since Kenya is
inadequately prepared for this. Since this is an issue of law, a referendum is necessary
to revert the functions back to the central government until counties are well equipped
to handle the health functions. Counties also have to insist on recruitment of
persons trained in health services/systems management to handle managerial
responsibilities in healthcare.
