By Lukoye Atwoli
Sunday Nation 31 March 2013
On Wednesday, newly elected governors were sworn into office across the country. Most will have lofty dreams about what they intend to do for their people, and the next five years will be a study in prioritisation and prudent policy implementation.
However, most will need to reread the Constitution to clearly understand where their mandate ends and that of the national leadership begins. For instance, some have talked about boosting the capacity of security agencies while others are keen to improve the performance of primary and secondary schools.
But the Fourth Schedule of the Constitution clearly provides that these roles are in the exclusive domain of the national government. The county government has no role to play in the areas of policing or defence, and their role in education is restricted to “pre-primary education, village polytechnics, homecraft centres and childcare facilities”.
This is not to say that their roles are trivial or inconsequential. Governors shall have almost exclusive control over county health services and the transport infrastructure. Handled intelligently, these are services that will make a real change in the lives of the citizens.
While infrastructure needs can be assessed by almost any layperson, the health needs will require experts to determine and provide strategies for implementation. Health is a complex matter which when mishandled can result in death and disability, crippling the county economy and even necessitating intervention by the national government.
Clever governors, therefore, will already have assembled teams of formal and informal advisers. The formal advisers will be presented to the county assemblies for vetting, and appointment as members of county executive committees. The informal advisers will not necessarily hold any position in the county government, but will be instrumental in advising the governor on important policy initiatives.
Governors must identify health policy experts to help them draw up a health strategic plan, perhaps even in tandem with the national health policy. These experts will identify the county health priorities and help develop innovative ways of dealing with these issues effectively. The national government can assist by maintaining a record of best practices that can then be adopted by other counties with similar profiles.
Professional societies such as the Kenya Medical Association have a presence in most counties, and governors must take advantage of the experts who are members of such associations. A formal relationship can be developed between the county governments and the county divisions of these associations, ensuring that professionals can be relied upon to give advice whenever the need arises.
Due to the challenges the county governments will encounter in administering health resources, it is foreseeable that management of the human resources for health will be problematic. This is likely to be even more acute in resource-constrained counties, and it is therefore prudent for the government to seriously explore the proposal to establish a Health Services Commission to take care of this end of business.
Unless this is done, skewed distribution of the health workforce will continue to plague our health sector.
Dr Lukoye Atwoli is the secretary, Kenya Psychiatric Association and a senior lecturer at Moi University’s School of Medicine firstname.lastname@example.org; Twitter @LukoyeAtwoli