On doctors’ strike and devolution of the health sector


As the world commemorates the International Human Rights Day 10th December, 2016 Kenyans should have a look at the milestones we have achieved over 50 years since independence. This has been quite an experience specifically with the promulgation of the 2010 constitution, which has seen the sovereignty power exercised in two levels. Besides, chapter 11 of the constitution provides for a devolved government and therefore, establishes county governments to work in tandem with the national government. As we ponder on the constitutional rights stipulated in chapter four of our constitution, among others, the right to health with regards to devolution of the health sector will have to be fast tracked with the recommendations in line with the ministerial task force including automation, supply chain reforms and organizational restructuring. This will definitely compel the need to engage with the county governments on the plans for county health strategies and services. However, the main challenge is on how to galvanize the minds of Kenyans especially those in authority to appreciate the re-organization of the state in line with devolution. Health Service Commission (HSC) has to fully pronounce its mandate since there already exists disparities in the level of professionals and this is quite evident on how health is termed to be difficult under devolution. On Human Resources for Health, there is a gap in some of the core mandates for instance on employment and deployment, staff welfare and equipment for the given facilities. From the on-going doctors strike, among the demands is county governments to address disparities in human resources management.

There has been anticipation on the gazettement of the same from the national government. This will give clarity on the roles and responsibilities to be assigned at the county level. It will equally create adequate information on the health plans as dictated by the county governments. Also, it will increase awareness on devolution in the health sector through capacity building for proper planning and implementation. In the recent past, there have been concerns that the funds required in managing health institutions have not been devolved yet. Sometime back, as highlighted in the newspapers, the Council of Governors (CoG) was on the war path with the national government over Sh. 2 billion free maternal health care arrears and yet the national government was said to be planning to take the free maternal health care from counties to the National Health Insurance Fund. (NHIF)

At the county assembly, health committees need to be involved in the budget making process that will see full participation to enhance accountability and transparency. This will be geared towards monitoring the progress on HSSF funds for improved health services at the county level. Besides, issue- based advocacy and the mechanisms therein has to be emphasized in the health sector devolution. It will include proper communication to be disseminated at the county level on the functions that have been devolved, that is; schedule (iv) on the functions between the national government and the county government. Among the areas of concern for advocacy will be to focus on; policy i.e. what has been drafted with regards to the law abiding relevant issues, finance i.e. is the cash flow adequate or inadequate to enable the implementation in  certain areas of interest, and lastly on the capacity and the need for better working apparatus.

Besides, on capacity at the county level, there’s need to be the involvement of some relevant dockets for instance Transitional Authority, to assist in looking into the county functions and advice accordingly on the capacity therein at the given counties. The CRA needs also to define its role in participation on health and devolution to the counties. On the other hand the CSOs need not to be left out, since they have always been very instrumental in spearheading some of these processes by strengthening people’s capacity and work in tandem with the government through research and dissemination of their policy briefs as key stakeholders.

The persistent strikes by health workforce is disheartening to health services a healthy workforce also means a better labor market. The government should stop spending indiscriminately and show the striking doctors commitment to solving the endless doctors’ strikes as they come up with new ways of dealing with boycotts and work stoppages in essential services.  There ought to be protection of third parties (citizenry) who suffer in the process since the greatest obligation is ensuring they enjoy their rights. The state ought to respect the public’s right to health; protect and take steps to ensure third parties do not interfere with the enjoyment of the right to health and to fulfill in taking steps to progressively realize the right to health.

Digital Media and healthcare


Courtesy of: Digital Trends

You wake up feeling ticklish in your throat, you try to shake it off and drink lots of warm water or the honey and lemon concoction. After a day, it’s still there, instead of seeking a doctor’s appointment, you head to the internet. Today, anyone with a digital device with connection to the internet can access a variety of health information on-line ranging from a simple sour throat to the more serious like bronchitis and Asthma.
Everybody consumes and talks of e-health but not many people have come up with a clear definition of the term. In this digital era, it’s used to describe essentially everything related to computers and medicine. E-health was initially coined and used by business leaders and marketing teams rather than scholars. The private sector devised the term e-health with reference to other e-words” such as, e-business and e-commerce in an attempt to compress the viewed merger of electronic commerce to the health sector, and provide a possible identify that the internet was opening up in the health sector. For instance, to Intel e-health was a concerted effort embarked on by leaders in health care and hi-tech businesses to fully harness the benefits available through convergence of the internet and health care.” (Eysenbach, 2001)
In the early 1990s, the internet had brought new opportunities and challenges to the traditional health care information technology industry; and the coining of e-health to address these issues seemed appropriate. In the academic environment, G Eysenbach defined e-health as “an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the internet and related technologies. He added that in a broader sense the term characterizes not only technical development but also a state of mind, a way of thinking, an attitude and a commitment for networked, global thinking to improve health care locally, regionally, and world-wide by using information and communication technology.” (Eysenbach, 2001)
With the digital era, where most individuals have a digital device, health information is often said to be one of the most searched content online. (Eysenbach, 2007)These claims have been mostly based on survey data, for instance the Pew Internet & American Life Report, which found that “80% of adult Internet users have searched for at least one of sixteen major health topics online. With such an online demand for heath information, medical practitioners have had to adapt to the changing times; social media is being embraced by more medical practitioners who use it to share health information and providing patient care.
Health information in relation to online platforms has seen drastic improvements with the recent advances in digital media where we have 4G, motion gaming, digital TV and smart phones.

This information has progressed with the changing Cyberculture which is the electronic environment where various technologies and media forms converge: the Internet and email, personal homepages, online chats, personal communications technologies, mobile entertainment and information technologies, bioinformatics and biomedical technologies.

Health information on social media has improved with regards to the features of Cyberculture (Convergence, Remediation, Consumption, and Interactivity) where by health information can be accessed on various digital device, it also contains videos and not only content, it is highly sought by various individuals and has enabled patients communicate with their doctors while online.
Despite the switch by medical practitioners in embracing the changing digital era, the participatory nature of social media entails an open forum for information exchange, therefore increasing the possibility of wide dissemination of non-credible, and potentially erroneous, health information. (Chou, 2009). In accessing health information online, most individuals may not consider other Internet tools such as e-mail, chat, instant messenger, or social networking sites, which may actually help them to identify credible information on the Web (Eysenbach, 2008).

The fact is that there is a great deal of high-quality information on the Web that is published by trusted organizations. It is important for these organizations to appear credible enough to initiate a behavior change in consumers.
The world we leave in ensures that almost every individual is able to find and provide medical solace online, but, just because we can, it doesn’t mean we must. Without the knowledge on where to access legitimate e-health, it is not a good idea to consider social media as a source of healthcare since this cannot be subsituted with health personnel.

Adolescent sexual and health reproductive health in Kenya

On 28th of July 2015 we were represented at a dissemination meeting of the fact sheet on Adolescents Secxual and Reproductive Health in Kenya organized by Center for the Study of Adolence (CSA). Adolescent sexual and reproductive health (ASRH) is a crucial component of lifelong health and well-being of individuals, which contributes to the health of future generations. Among the key areas of concern were; the ASRH policy directions for instance, how to ensure young people get information so that they can make informed decision, programming and how to make good use of celebrities in conveying positive messages since they are role models, how to contextualize certain issues in terms of reference since the approaches may vary due to geographical locations in Kenya, service provision and  HIV testing, communication strategies, youth friendly services and how to factor in financial barriers that hinder quite a good number of adolescents from accessing various services.

It was concluded that there is need to advocate for ASRH policy at the county level through the elected leaders, and have a clear access to information, meaningful involvement of adolescents. On programming, issue of coordination should be enhanced through multi-sectoral e.g. Ministry of Health, Ministry of Education and Ministry of Agriculture. More emphasis should be placed on resource mobilization and allocation as well as the interpretation of the policy statements by both the media and the general public.

A new Dawn

We are pleased to share that Mr. Edward Miano Munene, HERAF’s former Executive Director has been appointed as the Coordinator of the Beyond Zero Campaign. We take this opportunity to congratulate him on the appointment. We also take pride on this achievement and representation as he was absorbed as one of HERAF’s board member. In regard to this development, HERAF’s board has appointed Mr. George Gathenya to take over leadership of the organization as the Executive Director with effect from 1st April 2015. Mr. Gathenya brings to HERAF a vast experience in policy advocacy, governance and health systems strengthening. Join us to welcome Mr. Gathenya to the HERAF family in our pursuit to empowering Kenyans to enjoy the right to health.

Community’s Participation in Health Sector Governance

In a bid to strengthen community’s participation in health sector governance in Narok, Isiolo, Kiambu, and Siaya Counties, we have been conducting a baseline survey to provide in depth understanding of citizen’s engagement in governance of their health sector. The communities have been very receptive and supportive to the whole process. Their level of awareness is low thus putting the need for capacity building as a major priority. It is our hope that once the survey is done, it will be used as a tool to offer capacity building to the Counties mentioned to enable them be fully equipped and confident enough to be involved in the governance of their health sectors.