Key Points
- Leadership & Health Workforce are the core pillars of Health Service Delivery
- Permanent & Pensionable terms of service beat Contractual terms
- A Health Service Commission will optimize HRH performance
DEVOLUTION NARRATIVES
As the national and county governments sit in Kirinyaga from today onwards they will generate a narrative of stories for the press to run with for the next one year on how devolution is working. The only problem with such an approach is that they forget to look at what is not working and what corrective measures have been proposed for the same.
DEVOLUTION AND HEALTHCARE HUMAN RESOURCE
The narratives that will be running in the devolution conference will have everything to do with machines and IT and anything visual to the mwananchi. Mwananchi will be told how many hospitals have been built, how many machines have been procured for dialysis etc. The treatment of human resource will be mentioned in passing e.g. we have employed 500 workers where 400 of these are support staff.
6 building blocks of health systems
Health experts aver that of the 6 building blocks of health systems the most important of them are the people. The people have two measures – LEADERSHIP/GOVERNANCE and HEALTH WORKFORCE. Human resource is considered an expenditure item in the balance sheet of the government. Yet without the health workforce nothing else can move. Health workforce must be paid their dues, failure of which leads industrial action. Good treatment of health workforce is thus key to health service delivery.
CONTRACTS
The national and county governments have now ganged up against the health workers and are giving health workers ridiculous contractual agreements. The push for contractual employment of health workers is part of a larger scheme to make the Kenyan health worker cheap and insecure.
Unfortunately it is our very own government perpetrating this. The proponents for so-called CONTRACT EMPLOYMENT are pushing a false premise that when a person is on PERMANENT & PENSIONABLE (P&P) as has been the case with government employment over the years they are complicit. This is far from the truth as is evident in healthcare that over the last 55 years of independence health workers who are P&P have had the greatest impact on development of the health sector in this country.
GOVERNORS AND MPS AS EXAMPLES OF CONTRACTUAL WORKERS
A good example of a contractual agreement has been that of Governors and Members of Parliament (MP). Whereas there have been good governors and MPs there are those who see that short term contract as a way to enrich themselves quickly before being voted out. They may be tempted to use their short-term contract term to accumulate enough wealth to win the next election. We have seen governors and MPs abandoning projects of their predecessors and thus wasting public resources. This is the effect of a contract. For the ministry of health and Council of Governors to purport to support contractual engagement of health workers is to kill the practice of medicine in the country. They are the ones with contracts. People on contracts are generally insecure, looking for other options and not concentrating on their work. Contracts to do not encourage ownership of a job. Studies have showed people on contract to be more productive than P&P.
CONTRACTS AND UNIONS
The last remaining voice of the people is the unions and associations that represent various groups based on interests. The government is pushing for contracts so as to limit the number of unionizable workers. The governors for instance instead of solving the nursing issues have decided the solution is to employ nurses on contract. Recently our top referral hospital, Kenyatta National Hospital tried pushing ridiculous contracts down the throats of desperate doctors by giving a six-month contract without any benefits.
GOVERNMENT ABDICATING ITS DUTY
We are continuously having a government that is abdicating its duty in providing the highest attainable standards of living for its citizens. It is giving wrong prescriptions to our problems. Our problems are not new and the solutions are there. Goodwill is lacking. We must follow medical principles of diagnosis, investigations and giving the correct treatment pathways to our problems.
The government must stop pushing us to private solutions for public problems examples of which are rife in government. When for instance a whole County Government of Kericho declares that an achievement of theirs is OUTSOURCING CLEANING SERVICES we must be outraged. A hospital is not any other hotel where you get a cleaning company to come and clean. There are biological hazardous materials that must be disposed in a certain way. There must be people within the hospital who must continuously be trained on how to handle such waste. Hospitals are places where confidentiality is key. You cannot just bring another cleaner from outside just because a company that has struck a deal with the governor on tender sharing employs them. This is ludicrous as an achievement of devolution.
HEALTH SERVICE COMMISION
Finally because counties do not consider Human Resources for Health an achievement and they are out to literally ‘finish’ the health worker then it is time we reverted to a central management of the scarce human resources for health. The commission will continue with the laid out terms of Permanent and Pensionable. This way the health worker will have access to credit and thus able to better their lives. There will be mobility of the limited expertise that we have of health workers. A HSC will promote growth and development of the worker and in effect of healthcare delivery in the country. The governors seem to want to ‘own’ the health workers for control purposes. I once advised a governor from the North to push for a health service commission. He was more interested in control than in reducing wage bill or increasing efficiency. He said ‘If you do not pay them you do not control them’.
Our hope is that the Health Service Commission Bill will receive 2/3 majority backing in parliament to help restore sanity in the management of Human Resources for Health in Kenya.
EAC AND HEALTH SERVICE COMMISSION
In the East African context where Kenya purports to be a giant it is Uganda that leads the way in having a HEALTH SERVICE COMMISSION. My Ugandan compatriot was in shock the other day when I informed him that Kenya does not have a Health Service Commission.
UGANDA HEALTH SERVICE COMMISSION
The HSC derives its mandate and functions from Article 169 of the 1995 Constitution of the Republic of Uganda; section 56(3) of the Local Government Act, CAP 243 and, the HSC Act, 2001 section 25(2). In the perspective of laws, the HSC was established in 1998 to address unique Human Resources for Health issues in the health service. Specifically, the Commission is mandated to appoint, confirm, promote and review the terms and conditions of service, training and qualifications of health workers. The Commission is also mandated to foster professional and work ethics, and exercise disciplinary control over the health workers under its jurisdiction.
The Jurisdiction of the HSC covers Central Government Health Institutions which include: – Ministry of Health and specialized institutions under it such as the Uganda Blood Transfusion Services, Uganda Cancer Institute and Medical Professional Councils. Other Central Government Health Institutions include: – National Referral Hospitals, Regional Referral Hospitals and the Directorate of Public Health and Environment under KCCA. In addition, the Commission provides technical support and support supervision to District Service Commission (DSCs) and Local Governments on matters relating to HRH management such as recruitment of health workers.
Institutional Guiding Principles
Expeditiousness: in handling of recruitment, appointment, confirmation, promotion, approval of study leave and disciplining of health professionals.
Responsiveness: timely response to the needs of clients and stakeholders in a way that meets their expectations.
Maximum attention: to unique and peculiar problems affecting health professions as they emerge.
Innovativeness: in strengthening the institutional capacity to effectively fulfill her mandate, organizationally and professionally.
Teamwork: in the course of executing her mandate, the Commission effectiveness from all its Members and staff acting as a body in a synergetic manner
GOVERNORS MUST LET GO OFF HEALTH WORKERS
So as the governors enjoy the view of Mt Kenya from Kirinyaga County they must remember that HEALTH is WEALTH and without healthy, well-motivated health workers those machines they have put up will not work on their own. Like a father who has to let go off his daughter at marriage, governors must push for a health service commission for more efficient utilization of the scarce human resource.