As the doctors' strike enters its fourth week, public hospitals are literally on their knees. Doctors resorted to industrial action to try to push the Ministry of Health to honour a collective bargaining agreement (CBA) made in 2017.
Their grievances include the delayed posting of interns, fair remuneration of interns, postgraduate training, employment of more doctors and comprehensive health coverage for all medical practitioners.
The expectation of many Kenyans was that devolving the health system to county governments would lead to improvement of service delivery, stimulate innovation in the wider sector, improve access to and equity of available services, and promote accountability and transparency in service delivery. However, a decade after its implementation, a litany of challenges continues to impede progress in healthcare and jeopardise the well-being of millions of Kenyans.
A report by the Ministry of Health, Sector Working Group for the Period 2023/24-2025/26 identified infrastructure and human capacities as the main constraints hindering the ministry from achieving its goals, inadequate legal and policy framework to regulate the sector, inadequate funding, and climate change issues.
Various studies have highlighted existing regional disparities in healthcare access and quality in Kenya. Some counties, typically urban or economically prosperous, boast relatively robust healthcare systems, while others, predominantly rural or marginalised, grapple with inadequate infrastructure, understaffing, and insufficient medical supplies.
While devolution granted counties autonomy over budgetary allocations, many are still struggling to mobilise adequate resources for healthcare amidst competing priorities.
Limited revenue streams, coupled with overreliance on government capitation and challenges in revenue collection, have constrained counties' ability to invest in healthcare infrastructure, human resources, and essential medical supplies.
The lack of standardised protocols and coordination mechanisms between counties has impeded efforts to address national health priorities and respond effectively to emergencies such as disease outbreaks as was seen during Covid-19 outbreak.
Ambiguities in the delineation of roles and responsibilities between national and county governments in healthcare have bred jurisdictional conflicts, policy inconsistencies, and regulatory gaps.
The absence of clear guidelines and mechanisms for collaboration has impeded efforts to harmonize healthcare policies and standards across the country.
Inadequate institutional frameworks, weak governance structures, and instances of corruption have hampered effective planning, implementation, and oversight of healthcare services, undermining public trust and confidence in the system.
Britain established clear governance structures for its devolved healthcare systems units in Scotland, Wales, and Northern Ireland, with each unit having its own administration and budget.
The UK has ensured adequate funding mechanisms, including block grants and revenue-raising powers, ensure financial autonomy for the devolved administrations to manage their healthcare systems effectively.
To achieve the much-coveted Universal Healthcare Coverage, policymakers must comprehensively clarify the roles and responsibilities of national and county governments in healthcare, streamline regulatory frameworks, intensify efforts to strengthen intergovernmental coordination mechanisms, foster collaboration, and harmonize healthcare policies and standards to ensure seamless service delivery and equitable access across counties.
PAYE Tax Calculator
Note: The results are not exact but very close to the actual.
