Strikes, staff shortage among factors that ail health sector

Hillary Mageka @hillarymageka

A report on the status of health facilities has cited industrial strikes, staff shortage and lack of expertise as some of the challenges inhibiting quality of healthcare services in counties.

The research released yesterday by Institute of Certified Public Accountants of Kenya (ICPAK) and Uraia Trust, states that, 10 years since the advent of devolved governance, health facilities in counties are dilapidated and cannot address critical health needs, especially complicated cases that require specialised attention like cancer.

According to the report, only Kenyatta National Hospital (KNH) and Moi Teaching and Referral Hospital (MTRH) for instance, have radiology hubs in their facilities.

“Most counties have invested in new health infrastructure such as new dispensaries and clinics. However, they lack personnel, namely nurses, clinical officers and laboratory technicians,” the report.

It adds: “Some doctors employed by counties use most of their time in private facilities as opposed to their workplaces (government hospitals).”

Report proposes that medics working in public health entities be restricted from running private facilities.

As much as the budgetary allocations have been increasing over the years, ICPAK noted that the country has a long way to go when it comes to human capital in the health sector.  

The institute calls for the extension of the Abuja Declaration, which stipulates that the health budget should account for at least 15 per cent of the State’s annual budget to the counties because health is a devolved function.

However, a majority of counties visited recorded minimal budget allocations to health, making it difficult to effectively provide health services.

 The study showed that currently, there is a total of 7,333 registered doctors to cater for a population of about 46.6 million Kenyans.

According to the World Health Organisation (WHO), the doctor-patient ratio in Kenya is 1:16000 against the recommended ratio is 1:300.

Core function

The study sought to assess the progress made in implementation of health as a core county government function by evaluating funding and budgetary allocation and assessing corresponding systematic growth in the specific programmes.

Healthcare is one of the devolved functions under the Fourth Schedule of the Constitution of Kenya.

The national government, however, retains health policy functions and national referral health facilities such as KNH and Moi Teaching and Referral Hospital.

While devolving health facilities and pharmacies, ambulance services, promotion of primary health care, licensing and control of undertakings that sell food to the public.

Others are veterinary services (excluding regulation of the profession), cemeteries, funeral parlours and crematoria and refuse removal, refuse dumps and solid waste disposal.

The report, whose launch at a Nairobi hotel was boycotted by the Council of Governors, noted that poor pay and delayed salaries and remunerations were solely to blame for frequent  industrial strikes by health care workers. 

According to  World Bank Health Sector Report 2018, the doctors’ 100‐day strike in 2016 and nurses’ industrial action of 2017 that lasted over five months severely disrupted delivery of health services.

“The nurses’ strike gravely impacted the provision of health and nutrition services countrywide with over 50 per cent of primary health facilities being shut down in six drought affected counties,” the report.

Corrupt department

Besides, health department is one of the most corrupt departments in counties.  

Data from the Ethics and Corruption Survey by the Ethics and Anti-Corruption Commission report indicates that health services, including ambulance, health facilities and cemeteries was ranked second in corruption perception at 15.2 per cent, just after Finance and Planning Department at 17.8 per cent.

According to the World Bank Health Sector Report 2018, the advent of devolution adversely affected the transfer of grants to health facilities.

The report established that counties did not submit financial returns despite repeated follow up by the Ministry of Health.