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Kenya: Counties Need Help to Manage Healthcare

6 July 2015

The government hastily devolved healthcare to the counties and the recent budgetary allocation seems not to appreciate the challenges that continue to plague the sector.

The national government is still allocating itself more resources for health care without clear mechanisms on how to intervene where the county governments are failing.

The Budget increased the allocation to health care by Sh14 billion compared to last year. This is welcome and demonstrates the Treasury’s commitment to enhancing access to healthcare.

However, looking at how health has performed since it was devolved, the increased allocation ought to have been more elaborate on how it will address the challenges that county governments have demonstrated they are incompetent to tackle.

These challenges include dilapidated infrastructure in referral hospitals, lack of medicines, frequent strikes, and loss of personnel. This has compromised healthcare provision in many counties, pointing to the need to for special consideration of this sector in the national budget.

Statistics paint a sad picture of healthcare in this country. Among Kenyans who need medical attention and do not seek care, a whopping 44 per cent are hindered by cost. Another 18 per cent are hindered by the distance to the nearest health facility.

It has become necessary to spell out the roles of the national and the county governments in provision of healthcare and to allocate commensurate resources to each.

We must ask ourselves whether the resources we are allocating to healthcare are spent prudently and, more importantly, whether we are getting value for money.

For instance, the government allocated Sh4.5 billion for the controversial leasing of medical equipment. However, there is no matching allocation for technical experts to manage these facilities, leave alone the fact that they may not have been a priority in some of the counties.

It would be prudent for the national government to provide greater technical support to the devolved units based on their specific needs and priorities.

Access to health and medical care is unequally distributed across the country. Although some counties, especially in the marginalised areas, have fared well in increasing access to healthcare, this has not been the case in big hospitals.

Devolution has transformed lives in a fundamental way and strong collaboration between the two levels of government would give the health sector even better results.

Counties have built, upgraded, and equipped 74 health centres, increasing access to affordable medical services by 30 per cent. Devolved units have acquired 51 kidney dialysis machines and reduced the cost of the procedure. And in places such as Mandera county, the first caesarean delivery since independence was conducted after devolution.

Accountability is a cause for concern as some counties are spending a lot of money on recurrent expenditure. This calls for the intervention of the national government in some areas of health provision.

As counties agitate for more resources, they should create structures to enhance accountability and root out corruption.

Mr Obonyo is a Global Young Diplomat and Africa’s representative in the World Bank’s Global Coordination Board.

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