Healthcare Devolution and Service Provision Debate – Where is the Voice of the End User?

July 6, 2015

Healthcare provision and management in Kenya has been dragged to the dogs! With long-standing feuds on salary delays and unequal pay, lack of facilities and drugs, as well as varying corruption scandals in the sector, mwananchi has been taken to the cleaners! Patients are fast dying from the numerous healthcare workers’ strikes as much as they are from inadequate resources to offer even the most effortless treatment they may require.

The government, in its bid to resolve these healthcare biases on those who cannot afford it in private facilities or abroad, as well as to ease pressure on the overstretched national referral hospital: Kenyatta; has decentralized health service provision to newly formed counties, managed by the 47 County Governors leading each.

I have been keenly following this debate on the Managed Equipment Services (MES) rolled out by the Kenyan government and placing them in 2 facilities in each of the 47 Counties. According to ASTERAL, a company that specializes in MES, the concept is described as “outsourcing of all aspects of medical equipment to a third party company that specializes in providing this type of service.”

One would think this is a great initiative for several reasons. First, the equipment is not only sophisticated but lifesaving and used to be found only at the national referral hospital, Kenyatta National Hospital. Second, 38 billion shillings spent on the capital funding of the equipment is way higher than what the counties can invest in. And third, such equipment run on technology that becomes obsolete quite fast, hence leasing makes more sense.

What do Governors have to say?

The Governors whose Counties are set to benefit from this project have come out strongly to question the implementation of the project saying they were not consulted when the decision was made. They say the procurement was shrouded in secrecy and had not seen the contract between the government and the supplier. The government insists that the governors are not buying the equipment and therefore have no business dealing with the procurement process

What do the healthcare worker’s think?

Healthcare workers have also suffered the brunt of these wrangles, and taken to voicing their opinion through the Kenya Medical Practitioners and Dentists Union (KMPDU). They raise concerns and queries pertinent to the use of the equipment. Foremost, many of these professionals are not trained in handling this cutting edge technology, and secondly, some facilities do not have space to accommodate the equipment and may not have the necessary installations to operationalize the equipment such as electricity. Moreover, issues of duplicating efforts on some of the equipment already purchased by a few counties, prioritizing of County needs, the need to purchase smaller (and possibly manageable gear such as scissors and scalpels), have all been tabled by both KMPDU and County government leaders as feasible concerns.

Doctors are seething with rage. They will no longer take the way the Counties have handled the health sector: with blatant ineptitude and little concern. They have cited cases of mistreatment through delayed salaries which has caused them unimaginable anguish; anguish that they could not even wish on their worst enemy – the central government. Their suggestion – the sector should be taken back by the central government. Whether that is the panacea to the problem, your guess is as good as mine.

What do the citizens say? Does their opinion really count?

Having the voice of the end user in this debate would be useful in focusing the debate. Though the ongoing debate is healthy and may in the long run mean effective healthcare service delivery, someone needs to talk to the people. Let the people’s voice be heard. This way, the decision whether or not to accept the MSE scheme will be made after considering input from the intended beneficiaries. In many cases, decisions are made without relevant evidence and hence the projects end up not really improving the wellbeing of the citizens.

Before the government can worry about sorting out the mess in the management of the health sector, before rolling out this ambitious MES scheme and even before lobbying the health care workers to support the implementation of the MES, let us hear from the people.

The Governors, healthcare workers and the government all have different opinions – but there are parts of their argument that have remained consistent over the last few weeks. However, the citizen’s voice has not been heard.

What should the debate really focus about?

The biggest debate should not be about whether the central government should determine the priorities in health care financing or the County Governments but should be focused on service delivery. Will these efforts lead to good healthcare for the citizenry?  Will this mean that they can get access to better healthcare equipment at a lower price? Will it save them from going long distances in search of treatment?

Perhaps pertinent questions to be asked are; Has MES scheme or capital funding for medical equipment worked elsewhere in similar environments? How has devolution impacted on this essential service sector? Does this amount to duplication of efforts in equipping County hospitals? Who determines the Counties’ priorities when it comes to financing health care? And is the deal a sustainable investment?

However, MOST important should be; what does the end user have to say about the whole idea?