Saturday, 7 December 2013

#Sickat50 - Right of Reply: A medic's view on devolution By Dr. Samson Mutanda

In a recent publication in the Business Daily, an article written by Dr Edward Omete brought to light all the merits of especially captured the apparent benefits awaiting Wanjiku and Onyango as far as healthcare provision is concerned.
Dr Omete arguing from a policy point of view clearly listed the direct benefits that people in far flung areas are set to get from a devolved healthcare and other social amenities.
I couldn't agree with Dr Omete more. That a robust and functional approach health system needs a proactive approach and mentality and not conservatism.
Dr Omete goes ahead to declare that we must endure teething problems for us to achieve a robust and functional health system. I laud him for that, at least it indicates that he is thinking and dreaming of a better healthcare system.
But I must say that Dr Omete's line of thought is entirely skewed. He in fact misses the point altogether! KMPDU and other HCW unions are not opposed to devolution. In fact we highly welcome it. HCW have the best interests of this nation at heart. 
Before devolution kicked in, doctors were already on the streets clamoring for a better healthcare system, singing of the MDGs and quoting the Abuja declaration among other policy papers. HCWs welcome every effort aimed at improving the system; after all they are the custodians of the system. Every ill and rot within the system affects them directly; both as service providers and consumers of the system. The impact that the poor system has had on them; physically, economically, emotionally, and socially is so negative that they would dare not oppose efforts to make the system better.

What Dr Omete fails to note is that the structures needed for the practicability of a devolved healthcare are not in place. He also fails to tell the readers of the direct negative impact that a hurried process would have on this cadre of workers. Dr Omete claims that the reason why the National government and other state organs may be opposed to devolving health is because of an intent to consolidate and wrestle power and control. The reverse is also true: the reason why the counties are are so eager to take over these functions has nothing to do with service delivery but a strong urge to consolidate power and control!

Dr Omete selectively fails to mention that most, if not all counties have put plans to cut down the salaries of these workers,some by almost 50%! If the figures released by Kakamega and Kitui counties are anything to go by, then doctors have every right to oppose these process and are justified to take whatever measures available, including industrial action and civil disobedience if need be. Who on earth would support a process that aims to reduce his "Kenyan peanuts" by half?
What of the widespread harassment of HCW by county officials? HCW are working in chaos, receiving  threats and intimidation from county reps, county executives and anyone affiliated to the county authorities. Are these the teething problems that Dr Omete wants his colleagues to endure?

A government needs and must attract and retain its human resource pool. Its the key to service delivery.What my colleague fails to mention is that the process, hurried as it is, has no plans to attract nor retain its workforce. He also fails to realize that its futile and all vanity to plan a system by antagonizing the very people in the system, the people who run the system, and are in fact the system! Its more like engaging the reverse gear expecting the car to move forward.

Dr Omete is not the only one from a rural county. Its unfair for him to allude that we have no interests of these counties at heart. HCW persevere in some of the most horrid of conditions in poor rural counties to render services to the common mwananchi. Forgive me if I sound personal,and may be I do. Allow me to argue as a medic and as someone who has worked in the "rural counties" for a while. I clearly understand the origin of the current fears and anxiety. All HCWs are justified to resist a process that if not handled properly will subject them to modern day slavery and economic atrophy.
Let me emphasize that HCW are not opposed t devolving health. They are strongly opposed to the way the process is being mishandled, and the dreaded aftermath that affects them at a personal level.

I dare challenge Dr Omete to say how he would react; should he wake up one day to the realization that his employer was being devolved, with the effects being a reduced take home figure, arrogant and intimidating immediate supervisors, with no clearly outlined personal benefits?
Are we telling these workers who offer essential services to accept and move on? To accept that they are a collateral damage in the process of devolution? Have we reduced them to pawns on this chess board?
I dare say that no county should declare it ready to offer essential services. If they cant manage basic things like garbage collection at county markets what makes them think they are ready to oversee healthcare provision?
The whole process of devolution if not properly handled may just turn out to be the worst mistake ever in post-independent Kenya. Its bound to exacerbate corruption, nepotism and tribalism to a very lethal level.
What the government is not telling Kenyans is that it signed a legally binding Collective Bargaining Agreement with the doctors' union, which was to be effected as from July 1st 2013. In collaboration with the Salaries and Remunerations Commission, the government has silently trashed this legal document and instead, under cover of darkness, has gone ahead to publish some measly figures with a significant reduction in salaries and passed them to the counties for adoption. The impending industrial action is very much justified, if not for devolution then for the implementation of the CBA.
Devolution is highly welcome but shouldn't be to the disadvantage of the doctors, physiotherapists,nurses,dentists, pharmacists, clinical officers, lab techs, pharmtechs, plaster technicians and all other HCWs!

Dr Samson A.Mutanda., Medical Practitioner-Kisumu

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