Governors warn of looming crisis in health sector

Governors have raised the alarm over a looming paralysis in the healthcare sector following the government’s failure to renew contracts of thousands of staff.

Council of Governors (CoG) has written to President William Ruto, urging him to order the Ministry of Health to implement pending decisions in the sector to avert a looming crisis, especially at the county level.

Governors in particular cited the ministry’s delayed implementation of the critical February 12, 2023 Summit Resolutions despite being of “extreme national interest”.

“Summit enhances consultation and collaboration including consideration of matters of national interests between the two levels of government, among others. However, allow me to state that some of the critical decisions, made during meetings, despite being of extreme national interests in the health sector have not been implemented by the Ministry of Health,” said CoG, in a letter to the President, dated March 15.

Of particular concern to governors is that the Ministry of Health was directed to extend contracts of the Universal Health Coverage (UHC) staff for three years under the same terms and conditions.

But the Public Service Commission (PSC) extended the contracts for UHC staff for a period of one year, which will lapse as soon as next month, effectively paralysing operations in health facilities run by counties, especially the Level Four and Three hospitals.

“The Ministry of Health therefore has failed to implement this resolution as was agreed thereby posing a risk in disrupting health service delivery across counties,” governors said.

The county bosses noted that during a Summit held on December 18, 2023, the ministry was directed to undertake servicing and maintenance of the Medical Equipment Supplies (MES) for the period between January to March this year, while county governments were to undertake the same for the period between April to June this year.

But the period for which the ministry was to service these equipment is almost lapsing yet there has been no maintenance and servicing of these equipment, a situation that has disrupted critical services like renal, radiology and Intensive Care Units.

They insisted that the specialised medical equipment play a critical role in ensuring accurate diagnosis and treatment.

“Lack of implementation of the aforementioned Summit Resolutions significantly impedes health service delivery nationally. The purpose of this letter therefore, is to bring these matters to your attention and to kindly request that you issue a directive to the Ministry of Health to expedite implementation of Summit Resolutions,” said CoG which is chaired by Kirinyaga Governor Anne Waiguru.

Biggest gains

According to the governors, the biggest health gains in the country have been made during the devolution era, with counties’ progressive investment in the sector resulting in improved key health indicators.

To this end, many more Kenyans today are able to access high quality health services within their counties as compared to the pre-devolution era.

“The gains made under devolution have happened under very difficult circumstances. Health functions were devolved without requisite resources causing huge underfunding of county governments. Alongside the underfunding of counties, there have been constant threats from the national Ministry of Health to optimal health service delivery as espoused in the constitution,” the CoG stated.

Governors also stated that the perennial failure by the ministry to implement very critical resolutions of the Summit that both levels of Government resolved to address has dire consequences to health service delivery.

According to them, the Human Resource for Health (HRH) pillar of the health system is critical for provision of health services, a function that is fully devolved.

Additionally, the Ssummit meeting held in December resolved that a conditional grant on 50/50 payment of stipend would be implemented by the National and county governments to enhance preventive and promotive health services at level one.

But the county chiefs say the ministry has backtracked on this agreement and paid some Community Health Promoters (CHPs) directly, thus contravening the provisions of the recently enacted Primary Health Care Act.

They said this move not only compromises accountability but also undermines existing management coordination structures for this level of services.

Governors said the Summit is the apex intergovernmental body for consultation between the National and county governments and provides a platform for consultation, collaboration and consideration of matters of national interests between the two levels.

Devolved functions

“Lack of implementation of the Summit resolutions impacts on health service delivery and for the aforementioned Summit resolutions, this will further disrupt health service delivery nationally. Furthermore, these challenges are compounded by late disbursement of equitable funds by National Treasury and National Government holding on to implementation of devolved health functions,” they regretted.

At the same time, the county bosses are concerned with the Ministry of Health’s move, through policy, legislative and administrative measures, to continually create additional unfunded mandates for county governments without providing additional financial resources.

In addition to the cost of paying CHPs, the governors said the Primary Health Care Act has prescribed the establishment of primary care networks (PCN) at prohibitive costs for county governments.

They said that transferring operational management of PCNs, including funding to the Ministry is an unconstitutional re-centralization of a function that is clearly devolved to counties.