Friday, November 22, 2013

How to resolve crisis in the health sector

A late post on this blog, but...

By Lukoye Atwoli
Sunday Nation, 17 November 2013

A standoff looms due to a disagreement between government agencies on the one hand, and public health officials on the other, over the speed and extent to which health services are to be devolved to the counties.
Since this matter is now in court, I will not discuss the merits of arguments by either side in this standoff in any detail. Instead, I will rehash suggested solutions that we have advised government to implement over and over again to no avail.

First, it is impossible to stop the train of devolution much less in health services which was conceded as the prize catch for counties during constitutional negotiations. However, it is important to ensure that in meeting the constitutional requirements, human life and dignity is safe-guarded, and service is guaranteed no matter who is paying for it.

In this regard, my view is that the writers of the constitution did not intend that health services be hastily handed over to the counties regardless of their state of readiness. This is why they built in transitional arrangements to allow a phased transfer to prevent just such a crisis.

Second, the extent of devolution of health services is open to interpretation. How far does policy guidance by the national government go? Does it include policy on human resource management? Does it include regulation of the health professionals? The answer to these questions is an obvious yes, given that no county can carry out these functions.

This being the case, one may argue that due to the scarcity of the human resources for health, the national government must be involved in its distribution in order to ensure that all Kenyans have equitable access to healthcare all over the country. This function cannot at this time be ceded to the county governments.

For instance, it is currently estimated that there are about 0.14 doctors for every 1,000 Kenyans against a recommendation of one doctor per 1,000. If Nairobi County, with a population of about three million people, were to be free to hire all the doctors it needs, it would hire the entire public complement of about 3,000 doctors, leaving none to be shared by the other counties! The same problem obtains for other cadres of highly skilled health workers.

It is, therefore, very dangerous for the national government to leave each county to its own devices, given the resource constraints that preclude making each county attractive to health workers. Further, even if all counties had enough money to hire all the doctors and health workers they need, we would need to import almost 40,000 more doctors and hundreds of thousands of other health workers in order to attain the recommended ratio. The numbers currently in the country would simply be insufficient to supply all needs.

The solution lies in devolving most of the healthcare services to the county, but having a national body to organise registration, recruitment, deployment and remuneration of these scarce human resources for health. Such a body, in the form of a Health Service Commission, has been postulated countless times, and perhaps the time has come for central government to implement this recommendation and end the unnecessary health care crises. 

Dr Lukoye Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine.

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