Wednesday, 20 March 2013

WHY DEVOLUTION IN HEALTHCARE SECTOR IS DESIGNED TO FAIL




The promulgation of the new constitution aroused the hitherto buried hopes of Kenyans to a reality of a new dispensation of governance where management of services was perceived to be brought close to the recipients.



This from the frame outlook of it gives an impression of efficiency and paints a picture of bliss. It conjures a false silhouette of better management and proper service delivery
Is this true all across the board or  are we as a nation getting ourselves trapped by our very own enthusiasm for positive change; doing too much for a case scenario that in the end we end up being harmful, in the medical field some would call this ‘over prescription’. Where we think more is better and that we have to do something about everything to bring about change.


The design of devolution in the healthcare sector is designed to fail. Have the negative faith of banking that forecast. In the next few sentences I intend to paint a picture to put my above conclusion into perspective.
Kenya’s design for healthcare is a such that we have the ultimate referral hospitals. Currently the only two such referral centers are Kenyatta National Hospital and Moi Teaching and Referral  Hospital. There  is also a spiraling series of other levels down to the dispensaries. The current constitution recognizes just the two referrals as those under control of central government. This means all the other peripheral hospitals and their equivalents are effectively left to the dispensation of county governments through the county assemblies. I do not mean to paint a grim picture or prematurely declare the county governments inept at their inception, but allow me my skepticisms. Being a keen student on our recent history on governance and as someone whose hopes have been dashed over and over again, allow me to caution you, I pray I be wrong.
From the out start, I hope you have noticed that doctors and other healthcare workers will be the sole responsibility of the county government. To recruit. To employ. To discipline. To suspends. To sack.
I have serious reservations about all this, and you would too if you agreed that healthcare is too important a sector to be left to the unchecked powers that be. Dissecting through the model we find ourselves with we cannot help but ask poignant questions.
What will happen to counties that are too poor to recruit enough doctors and health personnel?  Bear in mind too that these are the areas that can be termed as hardship areas too hence they magically will need to pay their personnel more in terms of hardship allowances in order to compete with the rest.
On discipline, you would agree, while the doctor would objectively try to define an emergency, to thepatient or relatives/ caretakers, the only emergency they know about (and this is all about the self preservation nature of human instincts) is their own conditions.  From this I foresee a situation where doctors and healthcare workers will be forced to play the tune by the obvious panels that pay the ‘piper’.  In addition, it would also be a helpless situation for these workers as dismissal from one county would imply they reapply afresh in a different county or wait for the ‘next government’.
A county government would dictate or vet who becomes CEO of the various hospitals. What would prevent them from pushing through their agenda? This point draws just one conclusion from it, that we as a matter of fact have relegated healthcare autonomy to the whims and claims of political suave.
During the Nyayo era, a program was piloted to try this kind of semi autonomy, where through the District Focus for Rural Development, hospitals at the peripheries were allowed their own  procurement of drugs. The then government went further ahead and made the  purchase of these medical and non medical supplies incredibly affordable from a central body. Various district foci in astonsishment went against  the moral  and economic norms and purchased the essentials from the most  expensive of outlets.  The result for that was a total collapse of the system with near apocalypse of the sector.  What measures have been put in place to correct that which happened then or are we as a people too keen to kick out caution and replace it with convenient collective amnesia?
While the proponents would argue in support postulating that a devolved healthcare system would draw a tailored solution to the unique area to area problems in the sector, this argument can hold just so much water. In the long run, the reality of having a completely run down system through metastasis of political interests far much outweighs our faith on this experiment of hope.
From the inception of our country, we recognized health as an important aspect of development. The current happenings emanating from overlooking the fine print of our constitution and partly blinded by the promise that we could pass the constitution and allow changes later, will prove to be an Achilles heel for the healthcare sector. The Doctors’ Union has recently been putting up a spirited fight to award this country a Health Service Commission. Many challenges are being experienced to that end though hope should see us right this wrong.
In conclusion, we would only hope that for a sector that is said to offer essential services, we should not climb down and hand it over to experiments of hope. Change would be good but in this case it must be graduated with caution, this sector is too important to fail.
DR. ABIDAN MWACHI
THE WRITER IS A MEDICAL DOCTOR PRACTISING IN KENYA AND DEPUTY SECRETARY GENERAL OF THE DOCTORS UNION.

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