MoH, CoG clash over control of ambulance services

A fresh tussle has erupted between the national and county governments over control of ambulance services, raising fears of disruption in delivery of critical health care.

The latest dispute stems from a directive by the Kenya Medical Practitioners and Dentists Council (KMPDC) requiring all counties to register their ambulances, emergency care personnel and technicians with the Council by today.

KMPDC says the move is necessary to standardise emergency services, improve the quality of pre-hospital care, and support the Social Health Authority’s Emergency, Critical Care, and Chronic Illness Fund.

It warned that failure to comply would attract sanctions, including withdrawal of licenses to operate ambulances or provide emergency services.

The Council of Governors, however, has rejected the directive and advised counties to ignore it, sparking a standoff with the Ministry of Health.

“We therefore advise county governments to disregard the public notice and treat it with the contempt it deserves,” CoG chairman Ahmed Abdullahi said. 

He accused the regulator of violating resolutions reached during a meeting between Health CECs and the KMPDC on September 5 in Mombasa.

He said the CECs had rejected the proposed standards, citing duplication of roles and conflicts between national and county mandates, which he said would create operational and financial inefficiencies.

The Wajir governor said counties had already developed dispatch and referral protocols for ambulances, long before the Ministry of Health provided any policy direction on the matter.

“Counties have invested in ambulance services throughout the country over the last 12 years since devolution,” Abdullahi said.

He also cited Article 186 and Part 2 of the Fourth Schedule of the constitution, which expressly assigns ambulance services to county governments.

He also cited Article 189, which obliges the two levels of government to cooperate in the performance of their functions while respecting each other’s constitutional mandates.

“We further affirm that the KMPDC Act does not confer any functions to any level of government.”

“Accordingly, the threatened consequences of non-compliance with the notice are of no effect to counties performing their constitutional mandates,” he said.

The clash sets the stage for yet another intergovernmental dispute that could affect the coordination and efficiency of emergency medical services countrywide.

Currently, the two levels of government are locked in a fight over control of several functions valued at billions of shillings.

For instance, county bosses have proposed the dissolution of the Kenya Rural Roads Authority (Kerra) and the Kenya Urban Roads Authority (Kura), saying they are performing devolved functions.

“There is no need for all those road agencies when the roads are in the counties. We can save on those staff and utilise those in the counties,” former CoG boss Anne Waiguru told a parliamentary committee last year.

Kisumu Governor Anyang Nyong’o said, “I don’t know how effective Kurr/Kerra and KRB/Kura are anymore, but the county governments can save a lot of money. If those two institutions are disbanded, then a lot of money will be saved.”

ODM leader Raila Odinga has also called for abolition of the agencies to fully anchor devolution. Raila said Kerra and Kura are no longer useful under the devolved system of government.

"I am the one who introduced Kura, Kerra, and Kenha, but that was under a unified system of government. With a devolved system of government, you don’t need Kerra, you don't need Kura. All of them should be surrendered to the county government,'' Raila said.

 INSTANT ANALYSIS

 The Kenya Medical Practitioners and Dentists Council (KMPDC) issued a directive requiring all providers of ambulance services and emergency care personnel to register with the Council by September 15, Monday. But Instant analysis. 

The Kenya Medical Practitioners and Dentists Council (KMPDC) issued a directive requiring all providers of ambulance services and emergency care personnel to register with the Council by September 15, Monday. But the Council of Governors rejects directive, saying it violates a prior agreement and that KMPDC doesn’t confer government functions.