Private sector can play role in managing county health

The defunct District Health Management Teams (DHMTs) were part of the District Focus for Rural Development, a President Daniel Moi era unit tasked with spearheading the reach of the central government’s health policy to the grassroots.

Now replaced by the Sub-County Health Management Teams (SCHMTs), the structure still remains stiff and unyielding to the realities of the post-devolution health system.

Two new developments since independence demand a modification. The first is devolution and economic growth of counties, and the second is the dwindling role of the government in both healthcare financing and delivery.

Without a doubt, the private sector commands the lion’s share of health services provided as well as the overall share of expenditure on healthcare.

From human resource, infrastructure, equipment, logistics and other metrics the story is the same. And this is not just in urban areas. In many villages the three-decade monopoly of local dispensaries is now being challenged by two entrepreneurs: small nursing clinics and pharmacists.

This scenario is replicated across many townships. There is a reason why this is so and why it will continue.

Rising incomes and inefficiencies in the public health sector have created demand for back-up health services.

High populations and slow construction of public facilities endear patients to private clinics.

Yet in all these dynamic changes, the SCHMT remains a crucial body in aligning government policy and ensuring its take off at the grassroots.

However, as structured currently, the SCHMT does not rope in the private sector as a partner. Here, partner means a peer involved in decision making, strategising and forging new paths to walk on together. Two quick wins from a better relationship would be data sharing and collection as well as human resource training. Both sides dispense health services and quality care is needed. Of particular, skills, resources and partnerships that the government enjoys from donors rarely trickle down to the private sector.

Donor funded training on key areas like immunisation, HIV/Aids, tuberculosis care, vaccination etc remain largely public-side focused.

Yet small clinics are often in need but are overlooked. While for a long time access to health facilities has been a determinant of healthcare, quality has now emerged as a requirement too.

Here private sector bodies such as the Kenya Medical Association, the Nursing Council of Kenya, and the Kenya Clinical Officers Association should forge partnerships through their private sector members and the SCHMT.

Strong representation of the private sector in policy making and providing thought leadership can also pay dividend.