HERAF, between 30th July, 2014 and 1st August, 2014 held a training targeting health workers from Runyenjes and Manyatta sub – counties in Embu County. The training, held in partnership with the Embu County Health Management Team, was meant at increasing awareness among health care workers on the right to health, including its realisation in line with the Constitution of Kenya 2010, imparting knowledge among health care workers on the human rights- based approaches in health services provision and providing a forum for the health care workers to interact with the County Health Management Team, including the County Executive for Health, County Director for Health services, and the Chief Officer, Health.
From the prevailing discussions, it was clear to see that devolution of the health sector is facing several challenges. These challenges include but are not limited to the lack of clarity in the due process for the transfer of health care workers in between counties, the gazettement of Health facility management Committees as were elected towards the end of the year 2013, and the financing of Level 5 health facilities. In addition, there is minimal understanding among stakeholders in the health sector on the devolution process.
Need for Sensitization
In order to address the aforementioned, it was noted, it would be of utmost importance to increase the understanding amongst stakeholders on how devolution in the health sector is supposed to be realised.
To do this effectively, there was consensus among the participants including representatives’ from the civil society, the county health management team and the health care workers on the need to sensitize stakeholders such as health care workers and communities on the legal policy frameworks that are informing devolution in the health sector. These include County health strategic investment plans, the County Government Act, the Health policy, the Intergovernmental relations act, and the public finance management act etc.
In recognition of the pivotal role of information in ensuring that rights and responsibilities in line with the rights based approach are realized in the devolved government structure thus, it would be paramount for civil society organisations to implement project activities aiming at sensitizing health care workers and community at all levels on the policies, acts and other frameworks, related to devolution in the health sector. In so doing, the health care workers and communities will be in a position to better deliver on their roles and responsibilities effectively, including services delivery
Forums for engaging with policy makers and technocrats
Further to the underscored need for sensitization activities on the legal policy frameworks, discussions and questions as arising in the forum were a clear indication that more often than not, policy makers and technocrats, such as the county health management team (CHMT), and their respective constituents such as county health care workers have limited forums, for engaging in discussions about issues affecting the operations in the health sector or the changes in the government structure and operating environment that have an impact on the effective delivery of health services. In this regard, thus, it was recommended, civil society organisations should purpose to partner with specific county government health management teams to facilitate periodic meetings and engagement forums. In so doing, stakeholders, the CHMT and the HCWs included, will have a good understanding of the systemic challenges in the health sector, including their root causes, parties and offices responsible, and possible solutions for further action.
Foster partnerships between communities and Health care workers
The human rights- based approach to health services provision, stipulates that services providers (health care workers) and services users (citizens) alike have rights and responsibilities that complement each other. However, in the past, due to the increased focus on client rights and clients (communities) through sensitization, health care workers have often perceived communities as having a better understanding of their own rights and very little understanding of their responsibilities with regards to the realisation of right to health. In the words of health care workers, “there is so much that communities to improve their access to better health such as reporting the violation of their right to health and its causes to the relevant authorities, imploring their political office representatives to advocate for increased health financing and participating in the planning and sourcing for resources at given health facilities”. In light of such issues, HERAF would like to urge civil society organizations to implement projects aiming at fostering partnerships between health workers, health facility management committees and communities at large, by supporting stakeholders meetings, facility specific dialogue forums, and accountability and planning meetings. Such activities should be complemented by dissemination of information on the same, in a friendly manner such as using local radio, printing posters and through engagement of ‘bodaboda’ operators.
Through such activities, HERAF envisages that there will be increased community ownership and support for health facilities in various localities, as demonstrated through collaborations with HCWs and political office holders in addressing and solving problems that affect effective services delivery.