OMETE: Referendum calls spark debate on devolution of health services
Patients at the Coast General Hospital after nurses and doctors went on strike on August 11, 2014 over delayed salaries. PHOTO | LABAN WALLOGA | NATION MEDIA GROUP
What you need to know:
Aggrieved health workers should see that the best way to ensure their needs are met is through joining those advocating for more funding to the county governments.
The ongoing calls for a referendum have rekindled interest in many interested parties. Last week, the umbrella bodies for nurses and doctors issued threats of a strike to commence on Monday protesting recurrent salary delays for health workers in the counties.
While they have issues with many other problems of devolving healthcare, the salary issue in particular is dear to them. It is for this reason that they are suggesting inclusion of a health services commission amongst other agendas to be in the referendum.
Many health workers argue that the current inability to pay them is an example why healthcare shouldn’t have been devolved in the first place.
The true reasons why these hiccups are persisting are perhaps not understood by many. For those who have been keen to follow the fight between the Council of Governors and the national government, the fact is that counties are underfunded from the central government.
As a result what many are doing is firefighting with the limited budgets they have.
For supporters of devolution, it is imperative to note that its success hinges only on two premises: that it receives adequate funding and has good management teams on the ground.
Without money even the best management teams will still not deliver. At the moment all counties still rely on the central government’s allocations to fund their programmes.
The current salary problems suggest two things either the money is in the counties but has been used to do other things, or secondly there is no money.
I believe in many instances the latter has tended to be the reason while low revenue collection for counties and channelling of donor funded programmes through the central government also contribute to the problems.
The Council of Governors has been consistently vocal regarding the underfunding. In a newspaper advertisement last week, it was quite obvious from the breakdown of the funds they received from the Treasury why this crisis persists.
Another example was Parliament’s allocation of about a third of the funds requested in the supplementary budget to run referral hospitals based in counties.
Healthcare as a social investment is a guaranteed but necessary drain of public funds with little tangible financial returns. Thus, while investing in roads is associated with innumerable economic gains, a direct correlation cannot easily be made for healthcare.
For this reason initially more county funds will be put in the revenue generating sectors.
A comparison on the failure of devolution cannot be informed by weighing 50 years of the national health system versus one year of devolution.
A better evaluation should be the percentage of the budgets going to healthcare, the quality of services offered and the outcomes of health interventions.
Counties have not been good at sharing some of their few successes in their short time in office.
For the believers in devolution, the answer to these teething problems lies not in returning healthcare to the central government, but in making the Treasury cede more funds to counties.
Aggrieved health workers should see that the best way to ensure their needs are met is through joining those advocating for more funding to the county governments.
