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.