BBI REPORT

Health service commission invalidates objects of devolution

Inequities and inequalities perpetuated by state organs before devolution.

In Summary
  • For the 50 years before devolution, the national government established a paltry 20 health facilities in the entire Wajir county, served by about 80 employees.
  • Under the national government there were pervasive adverse human resource practices.
LISTEN TO US: Striking health workers during a demonstration at Afya House in Nairobi
LISTEN TO US: Striking health workers during a demonstration at Afya House in Nairobi
Image: FILE

Kenyans, through the Building Bridges Initiative, seem to have found common purpose and unity to marshal resources to build an economically vibrant nation.

There are considerable proposals in the BBI report that will transform the lives of Kenyans and put the nation on the path of economic growth and social prosperity. Key amongst these includes the proposal to increase revenue allocation to counties, reform of electoral processes and renewed focus on economic and social inclusion.

However there is a need to revisit the recommendation to form a Health Service Commission to recruit and manage human resources in the health sector.

The first Schedule of the Constitution defines devolved functions as per the aspirations of Kenyans. One of the key objects of devolution, as stated in Article 174(h), is to facilitate the decentralisation of state organs, their functions and services from the capital and enhance checks and balances and separation of powers.

This object is cognisant of the inequities and inequalities perpetuated by state organs in the years before the birth of devolution. Centralisation of resources and functions was the main reason Kenyans demanded devolution. It was clear that resources and services were being hoarded and diverted to favoured areas at the expense of certain regions.

For the 50 years before devolution, the national government established a paltry 20 health facilities in the entire Wajir county, served by about 80 employees. Under the national government there were pervasive adverse human resource practices. It was common for health staff to moonlight with NGOs while in the government payroll. There was chronic absenteeism and most health facilities would only be functional for a few hours a day.

After seven years of devolution in Wajir, nearly every village has a health facility and every subcounty has a fully equipped hospital able to handle surgeries. They are close to 900 staff, with more than 30 medical officers. The formation of HSC is likely to reverse this tremendous progress.

After seven years of devolution in Wajir, nearly every village has a health facility and every subcounty has a fully equipped hospital able to handle surgeries. They are close to 900 staff, with more than 30 medical officers. The formation of HSC is likely to reverse this tremendous progress.

Besides, the health sector is already facing enormous problems that are a bottleneck to the full realisation of devolution of health services. There is inordinate amount of resources left at the national level, even though health is a fully devolved function. There are also arbitrary decisions, such as the leasing of equipment by the national government that has burdened the counties with unnecessary costs.

The constitution establishes the County Public Service Boards, which are responsible for the provision of systems and mechanisms for human resource mobilisation and development in a manner that best enhances services by county institutions. The boards closely consult with the governors and are accountable to the county Assemblies through periodic reports.

Should a HSC be established, it will mean two parallel institutions will manage the county human resources, a recipe for rivalry and conflict. It will also not be practical for the county assemblies to oversee and hold to account a constitutional commission.

 

In addition, the governor will not be able to consult regularly with HSC to solve day-to-day emergencies in the health sector. The decision will likely open a Pandora’s box—the demand for commissions to be set up to oversee every devolved function.

Whereas it’s possible the sector may be facing real challenges, the ideal way to deal with them will be through the strengthening the CPSBs. The BBI report has also shed some light on this matter. The CPSBs require operational and financial independence to effectively execute their mandate.

The National Consultative Forum of the CPSBs has already drafted a comprehensive CPSB bill and forwarded it to the Senate Committee on Labour and Social Welfare. The richly draws from the challenges and experiences of the first CPSBs.

It would be prudent for the Senate, Council of Governors and the CPSB National Forum to build on the BBI momentum to strengthen CPSBs and ward off any attempt to revert devolved functions to the national government through covert, cavalier and duplicitous mechanisms such as the establishment of HSC.

In any case, such a matter should be subject to a referendum as it dilutes the powers and services of a devolved function.

Former County Public Service Board member, Wajir, and CPSB National Forum Executive Committee member