Monday, August 5, 2013

Retain national control over health workers

By Lukoye Atwoli
Sunday Nation 04 August 2013

The health sector has been in the news once again, for all the wrong reasons. After a delay in payment of salaries for doctors, nurses and other workers in the ministry of Health, doctors threatened to “march to Afya House to look for their salaries”, while nurses have issued a strike notice due to certain shortcomings in their terms of service.

Apart from subpar remuneration, health workers have raised a raft of issues which, if addressed, would not only improve their own working conditions, but would benefit every Kenyan’s health. A key bone of contention is the move by government to operationalise the constitutional injunction to devolve certain functions to the counties.

According to Part 2 of the Fourth Schedule of the Constitution, the functions to be devolved include “County health services, including, in particular, county health facilities and pharmacies, ambulance services, promotion of primary health care …” among others.

Of course it is impossible to devolve a function without ensuring that the resources for implementing the function are available within the county that is supposed to carry it out. In this regard, the national government has indicated that soon, all health workers’ salaries will be paid by county governments, which will also run all the county hospitals and health services.

Therein lies the rub.

Human resources for health are, for the time being at least, scarce. There are not enough doctors in the public or private sector to serve the needs of all Kenyans. Although they are available in larger numbers, other cadres of health workers including nurses, clinical officers, physiotherapists, social workers and clinical psychologists are still too few to effectively address our nation’s health concerns.

It is therefore difficult to envisage a situation where a county with a health worker shortage advertises positions for doctors and gets enough applications to fill its health facilities. This was spectacularly illustrated during a doctors’ strike last year at the Kenyatta National Hospital where an advertisement for dozens of positions elicited almost no response despite the relatively lucrative nature of a Kenyatta National Hospital posting.

It is with this in mind that one would urge caution as far as devolution of health functions is concerned. It is prudent to devolve the management of health facilities, procurement of medications, primary health care functions and promotive health activities to the counties, while retaining some sort of national control over the health workforce.

Registration of health workers, setting and enforcement of standards and ethics, recruitment and deployment on secondment, discipline and even termination of service ought to be a national function, given the nature of the health professions. Due to scarcity of human resources for health, centralised recruitment and deployment would ensure that even the most remote counties benefit from access to qualified health workers and services.

To address the fear of an overbearing national government inequitably distributing this scarce resource, we have recommended a Health Service Commission to manage Kenya’s human resources for health, much in the same way as the Teachers’ Service Commission does for teachers.

A proposed Bill for the Health Service Commission has already been developed and delivered to the Attorney-General’s office.

One hopes this initiative will become a reality for the sake of our national well-being. 

Dr Lukoye Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s school of medicine Twitter @LukoyeAtwoli

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