Friday, 15 November 2013

County Governments are incapable of managing healthcare



A couple of months ago the Nairobi County Council workers went on strike after the County government failed to uphold their end of the collective bargaining agreement struck between the workers union and the Ministry of local government. 

The most devastating result of the strike was the babies who died after being transferred to Kenyatta National Hospital. At the time, well wishers had organized a rescue baby service to step in and assist the vulnerable mothers and babies stuck without assistance at Pumwani Maternity hospital. It took about 2 weeks of negotiations for the crisis to come to an end but by that time, the damage was done. It was clear from the seriousness of the situation that devolution of certain services was being done in a haphazard manner with absolutely no consideration for both the workers and consumers of the services.

No other situation is more susceptible to the danger in unsystematic devolution of services than the healthcare sector. So far, there has been little to no consultation with the doctors and health care workers, and instead the practitioners have been subjected to bullying, intimidation and harassment. It’s become the propaganda piece to claim that doctors are selfish and only wish to retain their private practices rather than be part of the devolution process. 

It’s no secret that the Ministry of health has not upheld its end of the bargain as far as the Collective Bargaining Agreement struck between them and Kenya Medical Practitioners and Dentists Union. This lack of commitment to an already agreed upon service contract has led to several doctors’ strikes and this chaotic devolution will certainly lead to yet another nationwide doctors’ strike.

Let’s not believe the propaganda against the medics – there is no group more willing and keen to see healthcare and services reach the most marginalized parts of this country as several previous strikes have proven. The doctors have repeatedly stated the hazardous, unmanageable and difficult conditions under which they are forced to work, the lack of resources and the devastating effect this has on the welfare of the public. As both consumers and providers of the health services in this country, it is the medics who are most keen to see that these services are improved significantly and managed better.

The key phrase being better management of health care services through devolution and not what is actually happening. Instead of the hoped for strengthening of current services what is happening is county governments are drastically cutting down the required funds allocated for these services. Already this system is poor, under-resourced and under-funded. The impact this poor system has had on healthcare practitioners is emotionally, physically and mentally draining to say the least.

Kenya only has about 2300 doctors for about 40 million people. That means that each doctor is expected to see to the overall needs of about 17,000 people, but unfortunately is not able to reach all of them. There are not enough medics, not enough facilities or resources and very poor management of the system that has severally been described as on its death bed.

The Abuja declaration states that health funding should constitute 15% of the total government budget in a financial year. You can tell how little thought has been put into devolution of healthcare funding when a county government allocates 50 – 80 million out of a total 3 bn in the budgets which adds up to only 2.7%.  That means that in a county with an estimated 1 million people the county government intends to spend only 50-80 kshs the entire year per person. Meanwhile they will spend lavish amounts on their governor’s residences, vehicles and salaries.

It’s even more revealing when you consider the pay roll of health care workers in a county. Each county is estimated to have at least 2 district hospitals and maybe 6 sub district hospitals. Each district hospital will then have 4-8 doctors and a specialist in each of these specialties - pediatrics, internal medicine, obstetrics and gynecology, surgery. If you thus pay each specialist about 300,000kshs for his services that amounts to about 3.6 million per specialist per year and 5 specialists come to 18 million. Therefore allocating 50 million to an ENTIRE county is plain idiocy. 

But our crafty county assemblies have come up with a solution to this. While they have managed to strong arm Sarah Serem of the SRC into giving them more mileage, mortgage and living allowances, they in turn have determined that healthcare salaries can indeed be illegally slashed. What is being kept from the public is the fact that the Collective Bargaining Agreement they signed with the Doctors’ union is legally binding and was to be effected as from July 1st of 2013. The SRC in cahoots with the government have since trashed the CBA and have passed on figures with a significant reduction in salaries to the County governments. In some cases salaries have been slashed by as much as 50%. This makes the impending industrial strike justified for the sake of the CBA if nothing else.

This is the source of the doctors’ strike; we have a collection of arrogant, insensitive and oppressive county officials who seek to even break labor laws with the intention to wield power and control over the healthcare sector.

 This attitude and approach has nothing to do with any REAL desire to ensure that healthcare is a social amenity available to all within the counties, but it has everything to do with gaining dominance over some of Kenya’s best educated professionals. The devolution of healthcare needs to come to a stop until and unless these grave issues are resolved systematically.

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