• Health is a shared and devolved function under the Constitution.
• The national government is in charge of the country’s overall health policy and managing national referral hospitals whilst the counties are tasked with running county health facilities and public health services.
The joint approach by the national and county governments to fighting the Covid-19 pandemic in Kenya symbolizes the political goodwill needed to address the country’s health challenges. This political goodwill was evident at the Third Extraordinary Session of the National and County Government Coordinating Summit chaired by President Uhuru Kenyatta on June 10.
Among the key resolutions of the meeting is strengthening the collaboration between the national administration and the counties in containing the pandemic and gradually re-opening the economy. This spirit of partnership is critical not only in tackling the pandemic, but also re-imagining the country’s healthcare system, notably the quest for universal health coverage.
Health is a shared and devolved function under the Constitution. The national government is in charge of the country’s overall health policy and managing national referral hospitals whilst the counties are tasked with running county health facilities and public health services.
Effective delivery of quality and affordable healthcare however requires consultation, collaboration and cooperation between the two levels of government. Article 189 of the Constitution is clear on the need for close cooperation between national government and the counties in the exercise and performance of their respective functions.
Article 43 declares that every person has a constitutional right to the highest attainable standard of health which includes the right to health care services. Quality, accessible health care is therefore a fundamental human right. Health is also a key pillar of the Vision 2030 and the Big Four Agenda.
Covid-19 is a serious threat to our health system - the primary mechanism for attaining the constitutional right to quality and accessible health – and undermines the national universal health agenda.
The national response to Covid-19 must therefore be accompanied by a total revamp of the health system especially at the county level. With 38 out the 47 counties having so far recorded Covid infections, the disease is clearly devolving to communities at the grassroots.
Counties must therefore urgently upscale their Covid-19 response capacity. This includes increasing the number of inpatient beds, recruiting more health workers, and availing protective equipment.
According to the Ministry of Health, the inpatient bed density in Kenya remains low at 14 beds per 10,000 people, compared to a global average of 27, and 39 for upper-middle income countries.
The State has directed the 47 counties to set aside a minimum 300 beds each to Covid-19 isolation facilities, which is part of the national target of 30,500 isolation beds.
Implementing this directive will substantially close the gap in bed capacity thus boosting the health system’s ability to cope with the rising Covid-19 caseload. This will also help free existing bed capacity to continue handling the growing number of patients with non-communicable diseases (NCDs) like diabetes, hypertension and cancer.
As Health CS Mutahi Kagwe noted on Sunday, NCDs remain a major challenge to the health system even as it deals with the coronavirus outbreak. We also need to close the human resource gaps in the health sector. The total health workforce at county and national levels is estimated at around 40,000 against the 138,000 target by the ministry of health.
In April, the government allocated Ksh 1 billion from the Universal Health Coverage fund to cater for the recruitment of an additional 6,000 health workers. Of these, 5000 health workers will be based in the counties, thus improving their ability to respond to Covid-19 and other health challenges.
Providing Personal Protective Equipment (PPEs) is vital to protecting frontline health workers. It also creates business and job opportunities through local manufacture of masks and other protective gear.
All these measures will go a long way in enabling our health system to effectively respond to Covid -19 and equally important, support core universal health interventions like maternal and child health, immunization coverage, prevention of non-communicable diseases, and combating malaria, TB and HIV/Aids.
This will however require significant funding at national and county levels. The government has provided Ksh 5 billion in conditional grants to the counties through the Ministry of Health for the Covid-19 response. This should be utilized in improving county health infrastructure since the national government is supporting the hiring of additional personnel.
In the 2020/21 Budget, the government has allocated Ksh 111 billion to the health sector, of which Ksh 50 billion will be used to fund universal health coverage and provide quality and accessible health care to all Kenyans. Part of this kitty should be directed to prevention and control of the coronavirus. Ksh 500 million has been allocated to procurement of 20,000 locally made beds, a move that will support local manufacturing.
The intergovernmental summit also resolved that counties review their 2020/2021 fiscal strategic plans to include Covid-19 prevention and control measures. This is expected to unlock more funds for improving health care in the devolved units. However, there is need to ensure accountability and transparency to safeguard these resources from wastage and corruption cartels.
All said, investing in our health system as we fight Covid 19 will bring us closer to achieving universal health coverage. We must also harness and sustain the political goodwill manifested in the strong partnership at intergovernmental level to drive this agenda forward.
Peter Murumba is the Managing Director of Impulso Kenya Limited ([email protected])