The National Government’s continued holding onto nearly 90 per cent of health services yet health is devolved will stand in the way of the realisation of access to Universal Health Care services under the big four agenda.
Treasury has only been releasing 10 percent of health funds directly to the counties, with the remaining being disbursed through the Ministry of Health, yet for the realisation of the access to universal health as being pushed by President Uhuru Kenyatta under the big four agenda, County Governments are very critical and must play a big role.
The Government is also yet to establish the National Health Commission as required by the law. Governors are indicating their frustrations that while they have elaborate plans to improve health services in their counties, which is a constitutional requirement and a priority, the treasury’s continues to disburse funds through the Ministry of Health.
This means that the purchase of key health requirement and related essentials is a big challenge that must urgently be solved. Challenges that precipitated the Constitution to devolve the Health services included inadequate infrastructure (lack of primary health care facilities), poor medical supplies and inadequate qualified health professionals, which are still teething. Mandera Governor Ali Roba, who chairs the Frontier Counties Development Council, that brings together 10 counties that suffered historical injustices, says the Government must let go the funds meant for health as it’s a devolved function as a way of allowing counties contribute to the President’s big four agenda including improving provision of health services under the access to universal health care.
The Governor noted that frustrations is worse in the 10 counties that make up the Frontier Counties Development Council as the Government is also denying them funds under the Equalisation Fund as provided for under the Constitution, which would have enabled them catch up with the rest of the counties “Despite these challenges, we are committed and are doing everything we can to improve the quality and access of health services to the population. It’s our hope that the Government will see the importance of fully releasing funds directly to the County Governments so that we serve the people.
Its urgent and important laws are respected”, Governor Roba says. Amidst these challenges, Counties have strategically continued investing in the sector with positive feedback. For example, the Mandera County Government allocates 21 per cent of its budget to the health sector and has made tremendous progress in the area despite these challenges. According to the Abuja Declaration to which Kenya is a signatory, Governments in Africa are required to allocate 15 per cent of their national budgets to health.
Kenya is currently dong 7 per cent. The number of referral hospitals now stand at three from one, has upgraded three hospitals from level three to level four, primary health care facilities have increased from 18 to 68 centers, and construction of 25 new dispensaries completed, establishment of 4 modern maternity hospitals, 2 operating theaters, procured modern equipment and more importantly increased the number of health personnel to 833 including 265 nurses, 39 doctors, 108 clinical officers, 25 pharm tech and 47 laboratory technicians. They have already received the two Cuban doctors, which the CEC for Health Mohammed Sheikh, says will compliment efforts to improve specialised medical services. He says the County has sponsored a number of health professionals outside Kenyan for specialised trainings as a way of attracting professionals, which has been a huge challenge made worse by negative publicity.
Under the devolved system, the Government will aim to provide a health services through a robust infrastructure network as well as expand medical insurance coverage to increase access to health services. Flagship project to singled out include; revitalise community health centres to promote preventive health care (as opposed to curative intervention), de-link the Ministry of Health from service delivery in order to improve management of the country’s health institutions primarily by devolution of health management to communities and healthcare experts at district, provincial and national hospitals.
In the Social pillar of the Vision 2030, the Government commits to improve the overall livelihoods of Kenyans; the country aims to provide an efficient and high quality health care system with the best standards. This will be done through a twopronged approach: (i) devolution of funds and management of health care to the communities and district medical officers. The Government says it will continue to shift focus from curative to preventive care, help to expand immunisation coverage, improve reproductive health needs and allocate additional resources to facilitatean effective multi-sectoral response to epidemics.
“Our regions had suffered Mandera County Governor Ali Roba marginalisation including unequal health services, and we continue to see the same even currently, when treasury insists on giving money for health services through the Ministry, while at the same time saying health is a devolved function thus Counties should manage the health sector. This is putting us at cross roads with the people, and continues to undermine our efforts to improve health provision to the people, and play a role in the realization of the President’s big four”, Roba notes.
The Constitution 2010 requires that the Treasury sets aside 1.5 per cent of the total funds Parliament establishes the equalization Fund- into which shall be paid 0 .5 per cent of all the revenues collected by the national government each year calculated on the basis of the most recent audited accounts, received as approved by the national assembly. This is supposed to accelerate the level of services including water, roads, electricity, and health services. The Counties include Mandera, Wajir, Marsabit, Samburu, West Pokot, Tana River, Narok, Kwale, Garissa, Kilifi, TaitaTaveta, Isiolo and Turkana
