Editor ’ s Note
The crisis that gripped the healthcare sector since devolution worsened in September as medics in about six counties downed their tools over labour disputes with the decentralised governments .
The medics , protesting against poor working conditions , lack of proper remuneration , and lack of promotion among many other things swapped their tools of trade for twigs and placards .
Despite leading to pain , compromised quality of healthcare and even death of patients , the Kenya Medical Practitioners , Pharmacists and Dentists Union ( KMPDU ) and the Kenya National Union of Nurses ( KNUN ) were relentless on their call to mobilize their members to go slow as they demanded better working conditions , salaries , and promotions .
This has seen services in hospitals and health centres in many parts of the country paralyzed , with patients and their families sinking in deep agony as they seek services in national referral hospitals and private facilities .
Contrary to expectations that devolution would improve healthcare , it has staggered from one crisis to another .
In the place of a calm transition , the public health service in nearly all counties has been marred by claims of ethnic profiling , job stagnation , salary delays and withholding of allowances and poor working conditions .
With an average of four counties being affected with the rampant strikes at a time , the situation has opened a lid of doubts over the county governments ’ commitment and competence to run the healthcare services .
While it may be argued and rightly so that the health docket was fully devolved to the counties away from the national government , perhaps it ’ s time to evaluate whether devolution of human resources was the right way to go ; it may be time to relook at the issue of human resource for health at the counties .
In an interview , KMPDU chairman , Samuel Oroko maintained that devolving the health docket was the last “ lethal injection ” on the health system .
According to him , the management of county health services has been designated to non-professionals , who do not have the basic skills to handle the issues that the medics are constantly complaining about .
Dr . Oroko further pits that whereas doctors are complaining of poor remuneration , those who have “ rudimentary qualifications ” are earning more than the medics .
“ We have repeatedly said that devolution of health was an experiment that was not properly thought out and therefore , while medics fight to have their issues addressed , the patients will continue suffering ,” said Dr . Oroko .
He goes ahead to add : “ Counties are clearly not prepared to handle workers ’ employment and clearly it is time to accept that devolution of healthcare has failed .”
We contend that human resource for health is a central pillar to a well-oiled and functioning health system ; without adequately staffed , trained and experienced human resource for health , investment in health financing , health information , technologies and other elements of the health system will count to naught .
So , what exactly is happening at the counties ?
In all these strikes , doctors have raised the following issues among others as reasons behind the industrial actions : poor remuneration , delayed salaries , poor working conditions , inadequate staffing , lack of promotions as well as tribalism .
According to Dr . Oroko , there is need for the central government to “ urgently ” take over operations of the more than 94-county run hospitals in the country to ensure there is an even distribution of doctors .
“ Hospital administrations have been reduced into tribal issues , where competent medics are whisked off to pave way for the ethnically correct individuals much to the disadvantage of the ailing patients ,” said Dr . Oroko .
KMPDU Secretary General , Ouma Oluga , on the other hand claims that some county governments had deliberately withheld names of doctors to be promoted where only the ethnically correct individuals were promoted . There are claims that some doctors are openly discriminated on ethnic grounds and are not allowed hold positions even when they are best suited for such roles , which end up benefiting less qualified but “ ethnically right ” counterparts . This , if it holds any water , demoralises doctors . The 253 Nairobi county doctors , for instance , were compelled to strike on realizing their employer had failed to remit statutory deductions to the National Hospital Insurance Fund and National Social Security Fund for the past eight months . While the Nairobi County government successfully challenged the doctors ’ strike before court and obtained a court order declaring it illegal , no one took interest to interrogate the doctors ’ claim creating a numbing discontent that is now blamed for ongoing exodus of doctors from public service .
Similarly , 48 Migori doctors downed theirtools demanding promotions and remission of their statutory deductions , while their Nakuru counterparts serving at Nakuru General Hospital , Naivasha and Gilgil , Molo sub county hospitals totaling to 179 remained unpaid for the past four months .
There are concerns that devolution has denied healthcare professionals freedom to work in locations of their choice because as it is , counties exist on their own . For instance , getting transfers for doctorsacross counties is unlikely since individual counties handle their issues in their own preferred way thereby denying doctors a voice on their preferred location according to the specialty and patient ratios .
4 November-December 2016