KENYAN HEALTH CRISIS SINCE DEVOLUTION

The debate about healthcare is raging on. A misconception is being built by governors that the clamor by unions is that the whole healthcare should be re-centralized. Let me make it clear, unions only want the Human Resource aspect to be re-centralized.  Unions have constantly advocated for a central body to be set up to handle this aspect of healthcare. And this, they have always advocated for with very good reasons. Contrary to what has been said, more than half of doctors have resigned from public service.This has been due to poor working conditions. Both welfare related and improper facilities. For example, doctors had a collective bargaining agreement(CBA) with the government four years ago which was not honored. It is now in court awaiting a ruling. In addition there has been meddling, unprofessional and unqualified supervision from some county bosses. This has raised ethical issues most times and endangered work security for employees.At the end of the day, the person who suffers most in all this is the ordinary Kenyan. And most health indicators continue to deteriorate despite the efforts from the first lady.

 Now, yesterday  a friend of mine took her mother who had a disfigured face to Kenyatta National Hospital for treatment. This was due to previous accidental burns causing ectropion ( hypertrophic scars around both eyes making it impossible to blink). The mother is from Murang'a. There are no plastic and reconstructive surgeons from there, so they had to be referred to Nairobi. This specialized service can only be found in two public institutions in the country, Kenyatta National Hospital and Moi Teaching and Referral Hospital in Eldoret. She was seen and booked to see the surgeon after six months.  This kind of scars caused by burns predispose patients to a risk of cancer or even  permanent eye damage. The number of patients who require surgery are many, so she had no option but to wait.

  No single County Government has the ability to provide this service to the public. There is lack of both the specialists, facilities and requirements for management of such cases. Specialists have to be trained. Hospitals have to be upgraded to necessary standards. And this cuts across all fields, surgery, general medicine, pediatrics, obstetrics, radiology, oncology and pathology. Most counties have been struggling to attract the few said specialists to no avail. This is because they have not accepted that these are professionals who work with standards, unique requirements and need well equipped facilities. They would not waste there skills in places that are not conducive and does not nurture them. In addition they need proper remuneration commensurate with the services they provide.

A specialist aka consultant has to keep learning, he has to keep training and read widely to know the new management options in the market. The same applies to any General Practitioner(Medical doctor, Clinical officer or Nurse) in the market. Otherwise they will practice witch craft and cling to practices that have even been dropped. This are skills and services that have to be nurtured and upgraded accordingly. 

Therefore healthcare human resource needs a consistent, persistent and constant appraisal that cannot be managed by counties. The frustrations and mistreatment meted upon health workers in counties is nothing but an inexcusable and a colossal manifestation of ignorance by county bosses. Lack of knowledge exhibited by some Members of County Assemblies, there executives and a few employees trying to supervise this  profession is a kin to a cow teaching fish how to swim. Its forced mismanagement of both our facilities and patients.

 That is why it is the position of unions and healthcare workers to refuse and oppose any attempt at encroachment into there roles. Any manager understands that professionalism has to be respected. And this sector is a very sensitive one with its own guidelines on supervision and management. The attempt at making mediocre the lives and health of Kenyans by Governors should not be allowed.

The unions in this sector have made it very clear, they don't oppose devolution. Infarct healthcare workers supported devolution at its inception, during the referendum and promulgation. The only voice that was silently being ignored throughout this period was the need for a Health Service Commission. Which the unions have always presented, though it has never seen the light of the day. It is good that now majority are seeing its need. It is important to note that from the above narrative, counties are irreparably mismanaging the gains that were being achieved in this aspect. The counties still have no capacity to handle the various faces and needs in Human Resource. It is clearly more than paying salaries. Its about a constant need of career updating and progression. It is about maintenance of standards and undivided work ethic. County governments cannot provide this.

Let the Governors not trivialize this to a talk about money and salaries. That is a very simplistic way of looking at the issue. And time for blame games need to stop.

 The governors have paid my learned good friend Ahmednasir Abdullahi obscene amount of money to scuttle this noble quest.They should change there minds and be objective.