Devolution causes a storm in Kenya’s health sector

Health workers kept their profession top of the national agenda for the second year in a row with calls for strikes that caused intermittent paralysis of services throughout the year.

At the centre of the strikes are labour disputes pitting doctors against the workers that have their roots in the national government’s handling of the devolution of health services which, they claim, left them a poorly paid lot working in horrible conditions.

Dr Ouma Oluga, the secretary-general of the Kenya Medical Practitioners Pharmacists and Dentist Union (KMPDU) told the Business Daily that this year alone, 800 doctors had resigned from the public sector.

“These are patriotic doctors who would have liked to work with the government, but the working conditions are terrible and they couldn’t take it anymore.”

That number has, however, been disputed with official statistics showing that some counties like Tana River have for the first time since independence employed and retained qualified doctors thanks to devolution.

Under the centralised system, the majority of the doctors preferred to work in Nairobi and surrounding counties like Kiambu that enabled them to remain on government payroll while at the same time earn extra income working in private hospitals.  

Dr Oluga reckons that despite the high level of support for devolution among doctors the chaotic manner in which the services were devolved left a bitter taste in their mouths.

“We know that some counties are trying. But others keep frustrating us. They don’t understand the nature of our work and the history behind the salaries we get,” he said.

KMPDU has recently decided to petition the council of governors asking them to address the many challenges in the public health system to avert disruption of services in 2015.

READ: How devolution has changed national healthcare

The union has now issued an ultimatum to the government, warning that doctors will down their tools if the Collective Bargaining Agreement (CBA) it signed with the Ministry of Health is not registered by December 27th.

“This time round, doctors in both the public and private hospitals will go on strike,” Dr Oluga warned adding that one and a half years had since elapsed with the Salaries and Remuneration Commission sitting on the CBA without effecting or even registering it.

“We have always had challenges but devolution only made them more apparent,” he said insisting that the CBA offers sustainable solutions to all the challenges.

Among other things, the CBA proposes a Sh300 per cent salary increase for doctors, a risk allowance of Sh70,000 and the establishment of a health insurance scheme for doctors.

Kenyans are thus closing the year with a heavy cloud of uncertainty hanging over the country’s healthcare system.

Health secretary James Macharia is however convinced that the Ministry has put in place measures to address health sector’s many challenges.

Mr Macharia said that an intergovernmental Sectorial Forum – comprising national and county governments – has been formed to tackle the challenges.

“It is there that we are now discussing all the issues affecting health in Kenya including doctors’ unrest and shortage of medical supplies in various parts of the country,” he said.

Mr Macharia added that MOH was reaching out to the health workers’ unions with the aim of finding amicable solutions to looming human resource challenges.

“So we are optimistic that the situation will tremendously improve in the coming year,” he said.