Devolution Issues in Healthcare

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.