As the health sector paralysis spreads further, attention has shifted from the courts to the negotiations chaired by the Kenya National Human Rights Commission and the Law Society of Kenya.
Arguably, the agreement that will be birthed from these negotiations will be critical in resetting the country towards access to quality healthcare regardless of one’s earning power, residence or ailment. It is therefore important to advance a foresight approach that will guide the process towards sustainable reforms.
Two aspects are perhaps important when developing a foresight framework within the health sector. First is ways of limiting the corrupting influence of privatisation and second the need for the President to establish a new health reforms secretariat with a three-part agenda.
One of the hallmarks of the Narc regime in 2003 was the professionalisation of the Public Service. Key reforms included the recalibration of job groups, review of policies on promotion and transfers (whether these are adhered to or not is a subject for another day) and crucially, the introduction of the Results Based Management approach that perhaps led to the now prevalent practice of performance contracting.
However, inasmuch as these reforms were necessary, a silent reorganisation of the public sector in the image and likeness of the private sector was taking place. Shielded by the desire for quality of service and efficiency, this new approach entrenched deal-making and brokerage of public goods and services to such an extent that new power holders in ministries and state corporations are no longer the Principal and Cabinet Secretaries, but a cabal of persons who could control tendering committees.
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These persons wielded such influence and power not only on the names that could appear on the next gazette notice, but also who would be axed in the event they lose out. It is this privatisation of access and influence over policy decision-making that has crippled Government efficiency despite established policies and institutions.
It is therefore not surprising when the Health sector is paralysed for over 70 days and the silence coming from the upper echelons of the Executive continues to compete with the palpable sense of public anger and frustration.
Simply, the Executive is hostage to the ‘tenderpreneurs’ who have to restructure their profit margins and factor in the demands placed by the 2013 Collective Bargain Agreement. It is perhaps the interference of this private cabal of profiteers as was recently seen by revelations of the inflated costs within the Ministry of Health that has created an impasse that has lasted this long.
It is instructive to note that whenever members of the National Assembly have attempted to raise their allowances or other emoluments, the Executive through the Treasury has been one compliant client, which begs the question - are doctors and medical professionals lesser ‘public servants’?
But closely associated with the mess of unrestricted privatisation of the healthcare is the fact that the present regime never found wisdom in restructuring the entire health sector besides merging of the ministries of public health and that of medical services.
They simply allowed more private players to take advantage of the poor facilities and below-par services in public health spaces.
One wonders which policy paper or strategic review note informed the hurried devolution of the health sector without a dedicated team of specialists attached to the Ministry of Devolution, the Council of Governors, the Kenya Medical Association, the Kenya Dentists and Medical Practitioners Union and allied professional bodies. It speaks of a very reactive approach within Government that is thin on leadership skills and heavy on using quick wins in every catch-22 situation.
Yet this is not the only country that faces or has faced a health crisis and so, plenty of case studies abound on how similar critical situations can be better handled without reliance on private medical providers or flying out of the country as is the norm with the elite. While most of the suggestions have been provided within the CBA 2013 that KMPDU is pushing for full implementation, it will also be useful to provide the right policy framework. An essential step that the President should consider therefore is the establishment of a health sector reforms secretariat with a 3-point agenda.
First, the review of existing working conditions of all medical practitioners as licensed by their respective professional bodies. Second, a critical reappraisal of devolution of health to county governments and how the same requires a new reorientation.
Third, a costing review of healthcare in the country that will expose the ‘rip-offs’ currently being orchestrated by ‘tenderpreneurs’ through their various front establishments along the health sector chain. Only when equipped with such a report and the commitment to implement the same can the President be in a position to provide long-term care and support to this ailing sector.
