{"id":13584,"date":"2020-08-30T18:41:47","date_gmt":"2020-08-30T18:41:47","guid":{"rendered":"https:\/\/www.africa-press.com\/kenya\/?p=13584"},"modified":"2020-08-30T18:41:47","modified_gmt":"2020-08-30T18:41:47","slug":"devolution-has-not-improved-provision-of-health-care-services-medics-now-say","status":"publish","type":"post","link":"https:\/\/www.africa-press.net\/kenya\/community\/devolution-has-not-improved-provision-of-health-care-services-medics-now-say","title":{"rendered":"Devolution has not improved provision of health care services, medics now say"},"content":{"rendered":"<p><strong>Author:\u00a0Graham Kajilwa\u00a0<\/strong><br \/>\n<strong>AfricaPress-Kenya:<\/strong> Was devolving health functions a good decision? That is the question stakeholders are grappling with amidst systemic challenges facing the sector.<\/p>\n<p>While devolution in itself has seen some improvements, the progress has been a case of two steps forward one step backward with emerging issues from medical supplies, insurance to human resource.<\/p>\n<p>Dr Daisy Korir (<strong>pictured<\/strong>), the treasurer of the Kenya Medical Practitioners and Dentists Union, notes that the situation is actually worse compared to how it was before devolution even\u00a0though there are improvements in infrastructure and resources.<\/p>\n<p>Korir says in terms of health services, it is worse off as there is no improvement in Level One and Two hospitals. \u201cI would have expected that the dispensaries and health centres be the places well-staffed,\u201d she said.<\/p>\n<p>\u201cIt is like we created 47 other governments.\u201d The union official said unrest among health workers actually increased once the health functions were devolved with the main issue being emoluments.<\/p>\n<p>\u201cWhat happened was once devolution took off, we no longer had control of how health workers were treated despite there being schemes of services and other human resource guidelines,\u201d Korir says.<\/p>\n<ul class=\"list-group readmore my-3\">\n<li style=\"list-style-type: none\"><\/li>\n<\/ul>\n<p>Instead of counties adopting these guidelines, Korir says they developed their own.<\/p>\n<p>\u201cSome even asked for suitability interviews for lower level medics like medical officers which never used to happen when we were in the national government because there was one scheme of service,\u201d she says.\u00a0As such, there is a disparity in how medics are treated and some would go for months without pay.<\/p>\n<p>\u201cThis has also affected how we negotiate since now we have 48 governments and each one of them is unique and we can no longer control the health workers,\u201d she says.\u00a0These challenges may also be playing a role in the employment of medics which should have increased.<\/p>\n<p>In 2010, the ratio of doctor to population was 1.7:10,000 according to Kenya National Health Accounts 2009\/10. In 2015, the ratio was 1.5:10, 000 as per the Kenya Health Workforce report.<\/p>\n<p>As much as health is devolved, the docket appears still firmly in the grip of the national government.\u00a0This is, however, what medics are pushing for, as Korir says, only a Health Service Commission can resolve the human resource challenge.<\/p>\n<p>Allan Maleche, a human rights lawyer heading Kelin, an NGO that advocates for health rights, says the national government was at first unwilling to let go of the health function.\u00a0This is while counties failed to take proactive measures in readiness to take over the functions.<\/p>\n<p>\u201cAnd the haggling \u2013 the Ministry of Health treating counties like infants and the counties waiting to be guided by the ministry\u00a0\u2013 caused a lot of turmoil among healthcare workers.<\/p>\n<p>\u201cThis led to the first ever nationwide strike of health care workers that had devastating effects on the health sector,\u201d Maleche says.\u00a0He adds that there is also lack of transparency and accountability both in the counties and national government where the roles and not clearly stated.<\/p>\n<p>\u201cLike the case of Cuban doctors, no one really knows the kind of agreement that was signed between the national and county governments, or between the national government and the Cuban doctors,\u201d he says.<\/p>\n<p>The wrangles over control have also been seen in procurement of medical commodities through the Sh63 billion Medical Equipment Services that has since become a black hole roping in the Kenya Medical Supplies Authority.<\/p>\n<p>A recent push from the Executive also saw the Health Law Amendment Act contested in court by Council of Governors because of the provision that all counties should buy\u00a0medical commodities from the Kenya Medical Supplies Authority and not from any other suppliers.<\/p>\n<p>For health care to improve, more funding is required for the sector.\u00a0In the 2018\/2019 budget, 5.1 per cent (Sh90 billion) was allocated to health while counties\u2019 average their budgets at 30 per cent.<\/p>\n<p>While this seems substantial, up to 80 per cent goes into recurrent expenditures, mainly salaries.\u00a0The top counties with the highest health\u00a0allocation were Elgeyo Marakwet, Laikipia, Kiambu, Tharaka Nithi and Machakos.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Author:\u00a0Graham Kajilwa\u00a0 AfricaPress-Kenya: Was devolving health functions a good decision? That is the question stakeholders are grappling with amidst systemic challenges facing the sector. While devolution in itself has seen some improvements, the progress has been a case of two steps forward one step backward with emerging issues from medical supplies, insurance to human resource. [&hellip;]<\/p>\n","protected":false},"author":84,"featured_media":13585,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,3,8],"tags":[1201,5450,5447],"class_list":["post-13584","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-all-news","category-community","category-homepage-english","tag-devolution","tag-health-services","tag-katiba-at-10"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v26.1 (Yoast SEO v27.0) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Devolution has not improved provision of health care services, medics now say - kenya<\/title>\n<meta name=\"description\" content=\"Was devolving health functions a good decision? 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