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Why Counties should take back health services to the National Government

Why Counties should take back health services to the National Government
April 23, 2020 Eastern Newspaper
In Uncategorized

By Eastern Newspaper team

For a while now debate has been raging on whether county governments can handle the crucial health docket.

In the national budget, the national treasury allocates a small percentage of money to the county governments.

The national government is left with huge share but left to handle lesser duties like training and research.

Other institutions under the national government include; Kenyatta National Hospital, Moi Teaching and Referral Hospital, Mathare Mental Hospital, Spinal Injury National Hospital, among other few duties.

Experts and analysts have termed this as an indirect way of telling the counties to release the health docket to the National Government.

The Kenya Health Facility Assessment report under World Health Organization (WHO) essential medicines report released last year revealed shocking details where more than 90% of health facilities in the county do not meet the WHO recommended standards.

Some even lack basic equipment like thermometers and weighing machines without mentioning the human resource challenges that recommend two well-staffed and stocked facilities per 10,000 people.

Governors have been accused of corruption and nepotism when it comes to matters of recruiting health workers where political factors override qualifications and skills in most cases.

With Nairobi County being the first one to succumb to the pressure of service delivery, Governor Mike Sonko released the docket to the national government as a measure to save the millions of Nairobi residents who have been complaining of poor service delivery in the department.

Residents in Meru, Tharaka Nithi, Isiolo, Marsabit, Samburu, and Embu counties have been suffering due to a lack of adequate medical personnel, medicines, and diagnostic and treatment equipment.

Through respective assemblies and other channels, many residents have been crying for better services as they grapple with myriad diseases, including terminal ones.

An abstract from one of the Kenyan scholars, Leah Kimathi reads; ‘The health sector was the largest service sector to be devolved under this new governance arrangement. The rationale for devolving the sector was to allow the county governments to design innovative models and interventions that suited the unique health needs in their contexts, encourage effective citizen participation, and make autonomous and quick decisions on resource mobilization and management possible issues. However, the sector in nearly all counties is currently bedeviled with monumental challenges ranging from capacity gaps, human resource deficiency, lack of critical legal and institutional infrastructure, rampant corruption, and a conflictual relationship with the national government. The net effect of these challenges is the stagnation of healthcare and even a reversal of some gains according to health indicators’.

At the Meru Teaching and Referral Hospital (MTRH) and others across the nine sub-counties, the picture emerging is facilities lacking relevant personnel and equipment, thus compromising the lives of residents.

MTRH which has a monthly average of 27,000 patients is hard hit by a deficit of nurses in various sections, the report tabled by Kangeta MCA Romano Mwito, revealed recently.

The number of nurses at MTRH currently stands at 179, with 13 stationed at the crucial casualty section which is grappling with a deficit of 30.

The labor ward has 12 nurses, with the CECM in charge of health Misheck Mutuma revealing the deficit there is 48.

The post-surgical ward is having a shortfall of 22 nurses while the male surgical and female surgical have deficits of 39 and 15 nurses, respectively.

Mr. Mutuma said two nurses had resigned between January and March 10. Another 21 nurses are due to retire this year.

When Kangeta MCA Romano Mwito brought the issue of shortage of nurses in the county assembly, reps Purity Mugambi, Victor Kariithi, and Elias Murega said the health centers across Meru urgently needed the deficit addressed as it was compromising quality services.

Mutuma added that the national government is recruiting 13 registered nurses and 13 enrolled nurse interns for the Meru government.

It is a situation which has in the past angered MCAs who said the Meru government cannot handle health services.

Lack of an Intensive Care Unit is another factor that has angered MCAs and residents, who are forced to seek the services elsewhere.

Nesbitt Mugendi and Bakari Mugambi, from the Kenya National Union of Nurses (Meru), said over 90 percent of dispensaries and health centers in Meru are under-staffed.

MTRH CEO Dr. James Kirimi said though there were challenges, the facility had greatly enhanced its capacity since the advent of devolution.

Dr. Kirimi said: “In the early 2010s patients could not get dialysis, CT scans and specialized treatments anywhere else other than in Nairobi. Today here in Meru, for example, there are 5 C T scan machines and 2 MRI machines within Meru County. There are numerous dialysis units and several ICU beds.” Kirimi said these were none existent 10 years ago.

In Isiolo, a section of leaders there, including Senator Fatuma Dullo, has been decrying the poor level of healthcare at public facilities.

She said some of the leased equipment that the national government procured for counties and for which the latter was paying up to Sh200 million annually, was not operational, thus compromising service delivery.

“At Garbatulla and Isiolo General Hospitals most of the equipment are not operational. For Garbatulla theatre was not working. There are some of the equipment at Isiolo General that are not operational, which is not right,” Senator Dullo said.

Isiolo Governor Mohamed Kuti who is the health committee chairman in the Council of governors has severally admitted that the docket is facing challenges at the county but keeps on appealing to the national government to come out to save the counties.

In Tharaka Nithi some of the equipment was not operational as public hospitals lacked the three-phase power supply to run the machines.

In a report tabled recently by the Tharaka Nithi, the county assembly committee on health revealed that the county government cannot prioritize the issues of health of the residents.

The three main hospitals in the county, that Chuka general hospital, Marimanti Hospital, and Magumoni hospital are neither well-staffed nor equipped to handle the health issues in their respective areas effectively.

Under-staffing and lack of personnel to operate some of the modern equipment were some of the challenges faced by the county department of health.

In a recent statement, the county Minister for health Dr. Riara Nthuraku assured the residents that the department is committed to addressing all the issues that are currently affecting his department to ensure that the mandate is well executed.

Marsabit Governor Ali Mohamed recently admitted that the resources that his county received from the national treasury are not enough meaning they can only struggle with what they have to handle critical illnesses like cancer. He revealed the findings of a research carried out by KEMRI, where 30 percent of the county residents suffer from cancer of the esophagus.

Speaking while receiving medical equipment to be used in health facilities in the county; Governor Ali directed the Health CECM to assess the department’s capacity to assist the increasing cases of cancer where KEMRI reported 30% of cancer patients are the county.

In Embu, lack of adequate supply of drugs and staff was cited by a section of MCAs as a setback in the provision of services.

Recently Muminji Ward member of County Assembly Newton Kariuki recommended that failure by the county government to staff the many facilities that are scattered in the county is a clear indication that county governments cannot handle this important and sensitive docket.

He said counties are allocating a lot of resources in the construction of facilities without staffing them a situation that does not make sense at all.

The MCA lamented that; most of the ambulances that were bought by the county government are not in good working condition.

The MCA revealed that the only hospital that serves his constituents at Siakago is often closed at 4 PM leaving the patients at the mercy of private facilities in the area.

Kariuki revealed that he will be campaigning for the docket to be taken back to the national government in all forums including the ongoing building bridges initiative.

Also addressing the health issue at the Embu assembly chambers; Runyenjes MCA observed that the health docket eats more than a third of the entire county budget, with more than Sh1.6 billion going to salaries for healthcare personnel and another Sh.1 billion being allocated for operations and maintenance of motor vehicles and buildings.

Many residents from Mbeere and other parts of Embu County have been complaining of deteriorating health services in the county accusing the county government of misplacing its priorities.

Embu Deputy Speaker, Steve Simba accused the County Assembly Health Committee of sleeping on their job by not availing regular reports on the state of affairs in the crucial health department.

However, Embu governor martin Nyaga Wambora is giving his people hope by assuring them of better days to come as his government executes plans in the health docket.

Although Samburu County was ranked as one of the top counties in matters of equipping health facilities in the country by the World Health Organization, the residents of the county still travel for many kilometers in search of health services.

The problem of understaffing is still very evident in Samburu county; with a majority of the residents of the county living in semi-permanent structures, diseases like malaria and diarrhea contributes to the huge burden of management of health by the county government of Samburu.

With this fact, it is clear that more resources must be allocated to the counties to handle health, or else the docket should be taken back to the national government to save Kenyans.

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