Why Senate team is rooting for a health commission

Patients pass by a tent at Kakamega County Referral Hospital where doctors deserted their duties due to lack of personal preventive equipment.  [Benjamin Sakwa, Standard]

The Senate Standing Committee on Health has called for the establishment of a commission to address challenges bedevilling the health sector. 

This follows complaints by health workers in public hospitals over what they termed as poor working conditions that have exposed them to workplace hazards, especially during the Covid-19 pandemic. The committee, which is chaired by Trans Nzoia Senator Michael Mbito, recommended the formation of a national commission to manage human resources and timely response to medics' concerns.

"Having carefully considered submissions by health workers, the Committee on Health is persuaded that it is now clear that there is a need for a centralised, coordinated mechanism for the management of human resources for health," Dr Mbito said in a statement.

The committee noted that most of the concerns raised by healthcare workers were initially attributed to the manner in which the health function was devolved.

“The committee is highly concerned that seven years since the inception of devolution these challenges continue to persist, frequently disrupting health service delivery due to industrial action. This has resulted to persistent calls for centralised human resource management in the sector,” said Mbito.

Longstanding grievances

The committee noted that in response to the rise in the number of deaths among health workers, unions had issued strike notices due to unresolved and longstanding grievances.

Some of the issues raised included lack of a comprehensive medical cover for all health workers under the National Health Insurance Fund (NHIF) and poor remuneration.

Medics also complained of lack of priority testing of health workers for Covid-19 despite the high risk of infection that they face and inadequate personal protective equipment (PPE).

The Mbito-led committee also took issue with the long-standing labour disputes in some counties, which have resulted in poor health service delivery, citing Laikipia and Kirinyaga counties.

The issue of delayed salaries also featured and failures by county governments to remit statutory deductions, welfare contributions, bank loans and trade union dues in a timely manner, thus embarrassing health workers, and limiting their access to credit facilities.

The lawmakers criticised the lack of guaranteed access to treatment and care for health workers through specially designated isolation and ICU facilities.

“Inadequate training and capacity building for health workers particularly in the counties, unfair and exploitative employment terms for health workers on contract, the undue intimidation and harassment of health workers, especially those who have tested positive for Covid-19, should be addressed,” Mbito said.

“For the avoidance of doubt, having carefully considered all the issues that have arisen from the various submissions that were made to the committee by health workers, we are persuaded that it is now clear that there is a need for a centralised, coordinated mechanism for the management of Human Resources for Health (HRH).”

Push for the formation of a constitutional Health Service Commission has however been marred by controversy over fears that it would undermine the Constitution particularly the devolution of health.

The formation of the commission also hit a snag after a team tasked with the formulation of The Kenya Constitution (Amendment) Bill 2020 struck out a clause proposing the establishment of the commission at the last minute.

The clause was struck out after medics threatened to oppose the looming constitutional changes being pushed by the Building Bridges Initiative.

“It is the persuasion of the committee that the establishment and institutionalisation of a constitutional Health Service Commission will enhance rather than undermine devolved health services. The committee calls for cooperation between national and county governments for efficient service delivery,” said Mbito.

"The medics also complained of a severe shortage of critical health staff to run Intensive Care Units (ICUs) and isolation facilities. Thousands of health workers are still unemployed despite the critical and acute need during this pandemic period."

Two weeks ago, health workers issued a 21-day strike notice after the number of doctors who had succumbed to Covid-19 rose, a matter largely blamed on low quality and inadequate PPEs. The medics faulted counties for not conducting adequate training and capacity building for health workers, adding that they continue to face unfair and exploitative employment terms.

Unions' submissions

The committee drew its recommendations from submissions made by the health workers through the Kenya Medical Association, Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) and Pharmaceutical Society of Kenya.

Others that made a submission are Kenya Pharmaceutical Association, Kenya National Union of Nurses, National Nurses Association of Kenya, the Kenya Progressive Nurses Association, Kenya Union of Clinical Officers and Kenya Clinical Officers Association.

Kenya Health Professionals Association, Kenya National Union of Medical Laboratory Officers, the Environmental Public Health Association of Kenya and National Union of Biomedical Engineers of Kenya were also represented.

[Kennedy Gachuhi, Mercy Kahenda and Roselyn Obala]