Devolving healthcare, or the process of transferring responsibility for healthcare services from federal or national governments to local governments or private institutions, has been a topic of debate for many years.
While some proponents of devolution argue that it can increase efficiency and decision-making, there are also many demerits associated with this practice. Our experience has taught us that healthcare cannot be run in 47 different ways and succeed.
Firstly, devolving healthcare has led to an unequal distribution of resources and services. Local governments do not have the funding or resources to provide adequate healthcare to all citizens, especially those in remote or economically disadvantaged areas. This has created disparities in healthcare access and outcomes, which has exacerbated existing social and economic inequalities.
Secondly, devolution has led to the fragmentation of healthcare services. As the responsibility for healthcare is shifted to multiple stakeholders, coordination and integration between services have been lost. This has resulted in less effective and efficient service delivery, as well as an increased likelihood of medical errors and miscommunications.
Thirdly, devolving healthcare has led to a decline in the quality of care. When healthcare is left to county governments, which do not have the necessary expertise or infrastructure to provide high-quality healthcare services, this has resulted in poorly trained healthcare workers, outdated facilities, and inadequate equipment or supplies, which has clearly compromised patient safety and health outcomes.
Fourthly, devolving healthcare has resulted in a lack of accountability and oversight. Without centralised leadership and governance, it has become difficult to monitor and regulate healthcare providers, ensuring that they are delivering safe, effective, and ethical care.
This has led to situations where providers have engaged in fraudulent or unethical practices or provide substandard care without fear of repercussions.
Finally, devolving healthcare has had implications for public health. As county governments manage their healthcare services independently, they may prioritise localised concerns over broader public health goals.
This has resulted in a lack of investment in disease prevention and control strategies, which can have negative consequences for both individual health and the wider community.
While some may argue that devolving healthcare has brought services closer to the people, this merit pales in comparison to the near-catastrophic impact that it has brought. In addition, this line of thinking does not scrutinise the quality of healthcare that is said to now be closer to the people.
In conclusion, while devolving healthcare may have some potential benefits, the negative impacts cannot be ignored. From inequalities in access to healthcare, to fragmentation of services and a decline in quality of care, the drawbacks of devolution should be carefully considered before implementing any changes in healthcare governance.
Any steps towards devolution should take into account the need for centralised leadership, oversight, and accountability to ensure the provision of high-quality, equitable, and effective healthcare services for all.
National chairman, Kenya Medical Practitioners, Pharmacists and Dentists' Union. [email protected]
