health care in a devolved system

8/13/2019 Health Care in a Devolved System

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THE HEALTH WORKERS’ PERSPECTIVE

(A functional, devolved healthcare service delivery for all Kenyans)

Presented to

THE PRESIDENT,

Republic of Kenya

His Excellency Hon. Uhuru Muigai Kenyatta

Prepared by

Kenya Health Professionals Union-KHPU

Kenya Medical Practioners Pharmacists and Dentists Union - KMPDU

Kenya National Union of Nurses- KNUN

A functional devolved healthcare service delivery for all Kenyans



Kenya Health Professionals Union KHPUKenya Medical Practitioners! Phar"acists! and #entists! Union KMP#U

Kenya $ational Union of $urses K$U$

NOVEMBER 2013

PREAMBLE

%&e the health 'orers of Kenya support de)olution.Health care 'orers )oted for this constitution *ust

lie any other Kenyan.&e acno'ledge that Health is one of the functionsthat ha)e been de)ol)ed to the counties under the

constitution.Ho'e)er, the constitution gi)es a broad guideline.

+he specifics and i"ple"entation 'ere to be 'ored

out in a structured and secure "anner that ensuresthe continuity of health ser)ices.

&hereas the constitutional pro)isions are fa)orable toall Kenyans, the interpretation and i"ple"entation

ha)e been exclusi)e and inaccurate leading toconflict 'ith the health 'orers and disruptions in

health care ser)ice deli)ery.







STATEMENT OF POSITIONS

&e the health 'orers share the follo'ing )ie's 'ithregard to de)olution of hu"an resources for health-

. Health 'orers in the public sector should be

considered a $ational resource that should be

e/uitably distributed a"ong all the counties.

0.+he responsibility of hiring, retaining and deploying

health 'orers ought to be "o)ed fro" the centralgo)ern"ent to an independent statutory body. +he

county go)ern"ents should ha)e an authoritati)e

say in this independent body charged 'ith the

responsibility of e/uitably distributing health

'orers throughout the country.

1.2nce deployed to the counties, the health 'orers

ought to be under the authority of the countygo)ern"ents 'ho 'ould be in charge of deploy"ent

'ithin the county according to ser)ice need and can

initiate disciplinary procedures against the errant

officers.Kenya Health Professionals Union-KHPU






CONCERNS

2ur concerns 'ith the alternati)e "ethod of de)olution

currently being i"ple"ented is that it has been exclusi)e

rather than inclusi)e (lea)ing out )aluable input fro"

health 'orers3, has not follo'ed the la', and has put

"any li)es at ris by disregarding the pri"ary goal of

ensuring continuity of health ser)ices.

&e note 'ith concern, that-

.+he process follo'ed so far in de)ol)ing health has

been inconsistent 'ith the constitution and the

rele)ant acts of parlia"ent. 4or exa"ple, Article 055

(3 of the constitution says %parlia"ent shall enact

legislation pro)iding all "atters necessary or

con)enient to gi)e effect to this chapter. Part (03says, %in particular, (b3 %+ransfer of po'ers fro"

one le)el of go)ern"ent to another.







6ection 07 (3 of the transition to de)ol)ed

go)ern"ents act says, %the criteria for the transfer

of functions applied for shall include8 (a3 the

existence of legislation relating to the functionapplied for. Up to this day, no legislation has been

enacted to guide de)olution of health. $o existing

health la' as "uch as "entions the 'ord

%de)olution.

0.A noncollaborati)e, e)ery county for itself approach

to the deploy"ent of the fe' health 'orers

a)ailable puts se)eral counties, especially the"arginali9ed, at an inherent disad)antage"any of

these counties 'ill be hard pressed to attract health

'orers. :ntercounty transfer of personnel has

e"erged as a real challenge in such an approach.

1.+he sustainability of e)en standards of practice and

/uality of care across the counties is not guaranteed

due to the absence of appropriate regulation.

7. :nade/uately structured de)olution of health is

leading to the loss of $ational )alues and principles

in the deploy"ent of health 'orers. As 'e spea,

health 'orers 'ho do not originate fro" particular

counties ha)e been re*ected and sent bac to the

Ministry of Health for redeploy"ent to their nati)ecounties. +ribal, clan, and county of origin

considerations are no' "a*or factors in the

e"ploy"ent of staff.







;. As a result of the e"erging challenges, 'e are

'itnessing the ree"ergence of health 'orer brain

drain that had significantly slo'ed do'n o)er the

last t'o years. 4or exa"ple, bet'een <une and2ctober 051, ;= doctors resigned fro" go)ern"ent

ser)ice 'hile the $ational Asse"bly 'as copied to

> resignations in the last one 'ee alone. +he

sa"e trend is obser)ed across the other cadres of

health 'orers.

?.A nonconsultati)e reclassification of hospitals,

'ithout the bacing of policy instru"ents orconsonant legislation has created "a*or challenges

especially 'ith respect to the regional hospitals

including the for"er Pro)incial hospitals.

#egradation of these hospitals to the nati)e county

bears the follo'ing conse/uences-

a. +he other counties in the region that used to

share o'nership of the hospital find the"sel)es

suddenly dispossessed of the rights to the only

"eaningful health institution in the region.

b.+he nati)e county is faced 'ith the burden of

catering for patients fro" all counties as

patients 'ill continue to cross the county

borders in pursuit of health ser)ices.c. As a country, 'e 'ill 'itness the )iolation of

consu"er rights for patients 'ho need to be

referred to higher facilities existing only in other

counties.Kenya Health Professionals Union-KHPU






@.+he need to ensure the continuity of health ser)ices

has not been prioriti9ed in current i"ple"entation of

de)olution in the health sector and the patient "ay

ha)e been o)erlooed.

RECOMMENDATIONS

2ur hu"ble re/uests are8

.+hat 'e 'ithhold the ongoing de)olution of Hu"an

Resource for health until instru"ents and "odalities

for the de)olution of health care are in place.

0. +hat an independent statutory body, 'ith

authoritati)e representation fro" the county

go)ern"ents and charged 'ith the responsibility ofhiring and e/uitably deploying health 'orers to all

the counties be established.







1. +hat a Presidential "ultidisciplinary tasforce,

dra'ing "e"bership fro" all staeholders, be set

up to address the "odalities of de)ol)ing health

'ithin a specific ti"e fra"e.

CONCLUSION

As 'e do all this, the one person 'ho re"ains at ris-

'hose life is at stae is the ordinary Kenyan citi9en our

patient and your electorate. &ith the current discussions

on de)olution, it is easy to loo at e)ery senti"ent as

being either pro or antide)olution. :n the process, thebotto" line in this case the pro)ision and i"pro)e"ent

of health care in tande" 'ith the <ubilee Manifesto "ay

be forgotten. Bou as the country!s top leadership should

not forget this botto" line. &e are offering suggestionsKenya Health Professionals Union-KHPU




health care in a devolved system

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