THE HEALTH WORKERS PERSPECTIVE

(A functional, devolved healthcare service delivery for all Kenyans)

Presented to

THE PRESIDENT, Republic of Kenya His Excellency Hon. Uhuru Muigai Kenyatta

Prepared by

Kenya Health Professionals Union-KHPU Kenya Medical Practioners Pharmacists and Dentists Union - KMPDU Kenya National Union of Nurses- KNUN

A functional devolved healthcare service delivery for all Kenyans

Kenya Health Professionals Union KHPU Kenya Medical Practitioners! Phar"acists! and #entists! Union KMP#U Kenya $ational Union of $urses K$U$

NOVEMBER 2013

PREAMBLE

%&e the health 'or(ers of Kenya support de)olution. Health care 'or(ers )oted for this constitution *ust li(e any other Kenyan. &e ac(no'ledge that Health is one of the functions that ha)e been de)ol)ed to the counties under the constitution. Ho'e)er, the constitution gi)es a broad guideline. +he specifics and i"ple"entation 'ere to be 'or(ed out in a structured and secure "anner that ensures the continuity of health ser)ices. &hereas the constitutional pro)isions are fa)orable to all Kenyans, the interpretation and i"ple"entation ha)e been exclusi)e and inaccurate leading to conflict 'ith the health 'or(ers and disruptions in health care ser)ice deli)ery.,

Kenya Health Professionals Union-KHPU Kenya Medical Practioners Pharmacists and Dentists Union - KMPDU Kenya National Union of Nurses- KNUN

A functional devolved healthcare service delivery for all Kenyans

STATEMENT OF POSITIONS &e the health 'or(ers share the follo'ing )ie's 'ith regard to de)olution of hu"an resources for health.. Health 'or(ers in the public sector should be considered a $ational resource that should be e/uitably distributed a"ong all the counties. 0. +he responsibility of hiring, retaining and deploying health 'or(ers ought to be "o)ed fro" the central go)ern"ent to an independent statutory body. +he county go)ern"ents should ha)e an authoritati)e say in this independent body charged 'ith the responsibility of e/uitably distributing health 'or(ers throughout the country. 1. 2nce deployed to the counties, the health 'or(ers ought to be under the authority of the county go)ern"ents 'ho 'ould be in charge of deploy"ent 'ithin the county according to ser)ice need and can initiate disciplinary procedures against the errant officers.
Kenya Health Professionals Union-KHPU Kenya Medical Practioners Pharmacists and Dentists Union - KMPDU Kenya National Union of Nurses- KNUN

A functional devolved healthcare service delivery for all Kenyans

CONCERNS 2ur concerns 'ith the alternati)e "ethod of de)olution currently being i"ple"ented is that it has been exclusi)e rather than inclusi)e (lea)ing out )aluable input fro" health 'or(ers3, has not follo'ed the la', and has put "any li)es at ris( by disregarding the pri"ary goal of ensuring continuity of health ser)ices. &e note 'ith concern, that.. +he process follo'ed so far in de)ol)ing health has been inconsistent 'ith the constitution and the rele)ant acts of parlia"ent. 4or exa"ple, Article 055 (.3 of the constitution says %parlia"ent shall enact legislation pro)iding all "atters necessary or con)enient to gi)e effect to this chapter., Part (03 says, %in particular,, (b3 %+ransfer of po'ers fro" one le)el of go)ern"ent to another.,

Kenya Health Professionals Union-KHPU Kenya Medical Practioners Pharmacists and Dentists Union - KMPDU Kenya National Union of Nurses- KNUN

A functional devolved healthcare service delivery for all Kenyans

6ection 07 (.3 of the transition to de)ol)ed go)ern"ents act says, %the criteria for the transfer of functions applied for shall include8 (a3 the existence of legislation relating to the function applied for., Up to this day, no legislation has been enacted to guide de)olution of health. $o existing health la' as "uch as "entions the 'ord %de)olution., 0. A non collaborati)e, e)ery county for itself approach to the deploy"ent of the fe' health 'or(ers a)ailable puts se)eral counties, especially the "arginali9ed, at an inherent disad)antage "any of these counties 'ill be hard pressed to attract health 'or(ers. :nter county transfer of personnel has e"erged as a real challenge in such an approach. 1. +he sustainability of e)en standards of practice and /uality of care across the counties is not guaranteed due to the absence of appropriate regulation. 7. :nade/uately structured de)olution of health is leading to the loss of $ational )alues and principles in the deploy"ent of health 'or(ers. As 'e spea(, health 'or(ers 'ho do not originate fro" particular counties ha)e been re*ected and sent bac( to the Ministry of Health for redeploy"ent to their nati)e counties. +ribal, clan, and county of origin considerations are no' "a*or factors in the e"ploy"ent of staff.
Kenya Health Professionals Union-KHPU Kenya Medical Practioners Pharmacists and Dentists Union - KMPDU Kenya National Union of Nurses- KNUN

A functional devolved healthcare service delivery for all Kenyans

;. As a result of the e"erging challenges, 'e are 'itnessing the re e"ergence of health 'or(er brain drain that had significantly slo'ed do'n o)er the last t'o years. 4or exa"ple, bet'een <une and 2ctober 05.1, ;= doctors resigned fro" go)ern"ent ser)ice 'hile the $ational Asse"bly 'as copied to .> resignations in the last one 'ee( alone. +he sa"e trend is obser)ed across the other cadres of health 'or(ers. ?. A non consultati)e reclassification of hospitals, 'ithout the bac(ing of policy instru"ents or consonant legislation has created "a*or challenges especially 'ith respect to the regional hospitals including the for"er Pro)incial hospitals. #egradation of these hospitals to the nati)e county bears the follo'ing conse/uencesa. +he other counties in the region that used to share o'nership of the hospital find the"sel)es suddenly dispossessed of the rights to the only "eaningful health institution in the region. b. +he nati)e county is faced 'ith the burden of catering for patients fro" all counties as patients 'ill continue to cross the county borders in pursuit of health ser)ices. c. As a country, 'e 'ill 'itness the )iolation of consu"er rights for patients 'ho need to be referred to higher facilities existing only in other counties.
Kenya Health Professionals Union-KHPU Kenya Medical Practioners Pharmacists and Dentists Union - KMPDU Kenya National Union of Nurses- KNUN

A functional devolved healthcare service delivery for all Kenyans

@. +he need to ensure the continuity of health ser)ices has not been prioriti9ed in current i"ple"entation of de)olution in the health sector and the patient "ay ha)e been o)erloo(ed.

RECOMMENDATIONS 2ur hu"ble re/uests are8 .. +hat 'e 'ithhold the ongoing de)olution of Hu"an Resource for health until instru"ents and "odalities for the de)olution of health care are in place. 0. +hat an independent statutory body, 'ith authoritati)e representation fro" the county go)ern"ents and charged 'ith the responsibility of hiring and e/uitably deploying health 'or(ers to all the counties be established.

Kenya Health Professionals Union-KHPU Kenya Medical Practioners Pharmacists and Dentists Union - KMPDU Kenya National Union of Nurses- KNUN

A functional devolved healthcare service delivery for all Kenyans

1. +hat a Presidential "ultidisciplinary tas(force, dra'ing "e"bership fro" all sta(eholders, be set up to address the "odalities of de)ol)ing health 'ithin a specific ti"e fra"e.

CONCLUSION As 'e do all this, the one person 'ho re"ains at ris('hose life is at sta(e is the ordinary Kenyan citi9en A our patient and your electorate. &ith the current discussions on de)olution, it is easy to loo( at e)ery senti"ent as being either pro or anti de)olution. :n the process, the botto" line A in this case the pro)ision and i"pro)e"ent of health care in tande" 'ith the <ubilee Manifesto A "ay be forgotten. Bou as the country!s top leadership should not forget this botto" line. &e are offering suggestions
Kenya Health Professionals Union-KHPU Kenya Medical Practioners Pharmacists and Dentists Union - KMPDU Kenya National Union of Nurses- KNUN

A functional devolved healthcare service delivery for all Kenyans

for practical de)olution A de)olution that ser)es the purpose for 'hich it 'as intended. 2ur prayer is that you 'ould listen to us as sector players and e"brace our input to together build a better sector and reali9e the pro"ise of better healthcare to Kenyans in a de)ol)ed syste" that 'or(s.
6igned
CCCCCCC #ateCCCCC. Mr. Moses D2RRE, Genera Se!re"ar#, Kenya Health Professionals Union (KHPU3

CCCC.CCCC #ateCCCC #r. 6ultani MA+E$#EEHER2 Genera Se!re"ar#, Kenya Medical Practitioners Phar"acists! and #entists Union (KMP#U3.

CC.CCC#ate CC..CC. Mr. 6eth PA$BAK2, Genera Se!re"ar#, Kenya $ational Union of $urses (K$U$3

Kenya Health Professionals Union-KHPU Kenya Medical Practioners Pharmacists and Dentists Union - KMPDU Kenya National Union of Nurses- KNUN

A functional devolved healthcare service delivery for all Kenyans