Blame game as Kenya’s health crisis hurts

Patients continue to suffer countrywide as the impasse between county governments and health practitioners hits hard Kenya’s most vulnerable populations.

Government data shows more than 420,000 people seek treatment from public hospitals on a daily basis.

The ongoing crisis in the health sector continues to jeopardise the well being of Kenyans as many are turned away from public hospitals and forced to seek treatment in costly private facilities.

And, health union officials say, if a long-term solution is not found, the faces of Kenyans in pain and agony seeking treatment and instead being turned away from government hospitals, will just be another burden the country will have to bear in the foreseeable future.

A combination of factors including meager allocation of funds, an inept county government system and ego, on the part of Governors have since devolution of health held the wellness of Kenyans hostage.

“The counties cannot manage the health sector. They have neither the expertise nor the capacity to run a sector as vital as this one,” said Seth Panyakoo, Secretary General of the Kenya National Union of Nurses.

This is not the first time that health practitioners have gone on strike in the brief history of devolution. “We told them then that they were not ready to take on the burden of the health sector. We were right then. And we remain right today,” Panyakoo says.

According to the 2013 Kenya Household Health Expenditure and Utilisation Survey over 58 per cent of outpatient hospital visits by Kenyans in 2013 were to public health facilities, with public health centres and dispensaries accounting for about 40 per cent and public hospitals accounting for just over 18 percent of these visits.

It is these facilities that have been hardest hit by the ongoing impasse. In 2012, the government threatened to sack more than 25,000 striking workers before the two sides reached an agreement.

On Friday, Nyeri County Government officials threatened to sack all striking health workers if they do not resume work.

Health Executive Secretary Charles Githinji said on Friday afternoon that the county government is taking disciplinary action-which includes sacking up to 450 striking nurses.

In Meru, County Health executive William Muraah has threatened nurses intending to go on strike with the sack. “If anyone does that they should show cause why their employment should not be terminated. It is not an empty threat, we mean it. It is policy,” Dr Muraah said, adding that the county had already paid the August salaries and was processing more that would be in the bank accounts by Monday.

In Nandi, Governor Cleophas Lagat said a delay in the release of funds caused the recent uproar in the health sector.

“Delay in release of cash to the county caused the problem that we had in our county, we have however, solved the situation,” said Dr Lagat.

In Nakuru, just like in other parts of the country, health practitioners on their part led by the South Rift Kenya Medical Practitioners and Pharmacists Dentist Union (KMPPDU) Secretary General Oruko Sitima said delayed salaries, promotions, payment of arrears, missing allowances, lack of training and lack of inter-county transfer mechanism were the major causes of the issues beleaguering the health sector.

Dr Sitima observes that poor human resource management has been major cause of seven strikes experienced in Nakuru since devolution.

Approximately 38 doctors in Nakuru and another 126 have resigned from public facilities to take up more rewarding offers in private hospitals. Early this month, 2,400 health care workers and 150 doctors downed their tools, a move that caused deaths of 12 patients who were not attended to in public hospitals.

However, through consultative meeting, doctors and nurses have agreed on return to work formula calling off the strike that had paralysed operations. So far, the Nakuru County Government has agreed to effect the promotion of doctors in September and arrears of the officers already promoted by the Public Service Commission of Kenya (PSC) in October payroll.

Deputy Governor Joseph Ruto said the county has been able to promote 144 staff, 169 ESP that have been absorbed and fully in payroll, permanent and pensionable. The employees were however interns sent by PSC to the county for promotion, he acknowledged.

Pressure from the striking workers has forced governors, who have vehemently fought to have the health sector devolved to them, into a corner. Their only way out of this gross injustice to their populace has been to apportion blame to the national government.

On Friday Deputy President William Ruto responded in an interview with the media. “The health sector is facing many problems but claims that national government is undermining devolution because we want to take over health facilities are not true,” Ruto said.

Although governors are keen to hold on to the docket in accordance with the principles of devolution, some professionals outside the medical field believe health, just like security, should be a prerogative of national government.

Among the holders of this line of thought is Central Organisation for Trade Unions Secretary General Francis Atwoli. “The Cabinet Secretary for health just like the governors have failed in this issue and its time health was taken away from county governments,” he said. As the leaders engage in blame game, Kenyans continue to suffer.

“And the crisis shall go on. The counties do not have the capacity to run our public health system. We are signatories to the Abuja declaration that demanded the health sector gets a minimum of 15 per cent of the national budget. Currently we are getting 2.8 per cent of this budget,” Panyakoo said.

The Director of Medical Services Nicholas Muraguri however says that funding is not an issue. “The World Health Organisation recommends that we spend a minimum of 60 USD per patient per year. Right now, Kenya spends 67USD per patient per year. So funding is not an issue. The issue is how the county health funds are utilized,” Dr Muraguri said.

For Panyakoo, the solution lies in the formation of a body that will be charged with handling the human resource aspects within the medical field.

— Reports by Jacob Ngetich, Mercy Kahenda, Daniel Wesangula