Healthcare is currently experiencing monumental challenges in county governments across the country. There seems to be trust deficiency between healthcare workers and county governments.
From delayed salaries to lack of coherent administrative structures that can oversee performance, effect promotions and enforce institutional discipline, it seems healthcare infrastructure in the counties is facing imminent collapse.
Even healthcare workers’ unions appear to lack faith in the county governments’ capacity to manage healthcare services. They seem to be supporting return of healthcare services from the management of county governments to the national government. Perhaps the strongest indication that the national government is anticipating to reclaim healthcare services was elucidated by Health Cabinet Secretary James Macharia, who warned county governments against mismanagement of resources. Dr Macharia fallaciously threatened governors that the national government may retake healthcare services.
In my opinion, centralising healthcare will not solve the challenges that include, but are not limited to, remuneration issues, poor skills among medical practitioners, lack of professionalism and inadequate facilities and tools. Despite all the challenges, healthcare must remain a function of the devolved government. In fact, in my opinion, all government functions including education, security, etcetera, should be devolved in the interest of decentralising services from Nairobi to the grassroots, where a majority of Kenyans can access them without unnecessary bureaucratic hurdles. Perhaps the national government should be demystified and relegated to the background as a mere symbol of national unity.
Kenyans gave devolution a strong vote of confidence in the new constitutional dispensation against the backdrop of failures to deliver services that was the hallmark of the centralised government. In most cases, the central government disenfranchised the minorities. Its decisions were influenced by cronyism, nepotism, tribalism and corruption; evils that have ruined our past and continue to arrest the prosperity of our nation.
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In a nutshell, the centralised government failed Kenyans. In fact, what the Constituency Development Fund and the county governments have achieved in a few years is a clear testament of tremendous development that the devolved system of governance can achieve as opposed to the central government. Today, more than ever, I believe the prosperity of our nation lies not in centralised government, but in a devolved system of government.
But by failing to release funds for healthcare services in counties on time as alleged, the national government is not only fuelling disputes between healthcare workers and county governments, it is also sabotaging the success of healthcare services; derailing the foundations of devolved government and putting at risk the lives of Kenyans.
The national government must realise that the responsibility of ensuring smooth transition of healthcare services from Nairobi to the county governments rests squarely on its shoulders and it must play that role in an honest manner.
On the other hand, county governments and particularly governors should do everything within their capacity to ensure healthcare services are running smoothly to avoid crises and unnecessary strikes that jeopardise the lives of Kenyans. We desire a successful devolution. But when devolution seems to falter, it paints county governments in bad light.
More importantly, to turn around our healthcare industry, serious reforms are mandatory. First, healthcare workers must acquire adequate training that corresponds to international standards, which will enable them to perform their duties with standard professionalism. Second, hospitals should be furnished with modern and sufficient equipment required in the diagnosis and treatment of different diseases.
Third, terms and conditions under which healthcare workers perform their duties must be spruced up to inspire them to get the job done. Fourth, corruption, theft of medicine, mismanagement of medical facilities should be highly frowned upon.
Finally, the Government should end the conflict of interest in which government healthcare workers run personal healthcare businesses at the expense of their official work; it’s unethical and contributes to the detriment of government institutions.
