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