REASONS WHY HEALTH SECTOR SHOULD NOT BE DEVOLVED

 The promulgation of the new constitution in Kenya in August 2010 effectively ushered in devolution as the latest and highest form of decentralization in Kenya. The health sector was the largest service sector to be devolved under this new governance arrangement. The rationale for devolving the sector was to allow the county governments to design innovative models and interventions that suited the unique health needs in their contexts, encourage effective citizen participation and make autonomous and quick decisions on resource mobilization and management possible issues. 


However, the sector in nearly all counties is currently bedevilled with monumental challenges ranging from capacity gaps, human resource deficiency, lack of critical legal and institutional infrastructure, rampant corruption and a conflictual relationship with the national government. The net effect of these challenges is the stagnation of healthcare and even a reversal of some gains according to health indicators. No doubt what is needed to guarantee an all-inclusive rights-based approach to health service delivery is its proper institutionalization to ensure good governance and effective community participation. This must however be accompanied by wider governance reforms as envisaged in the new constitution for the sustainability of Healthcare reforms.

Under devolution, the national government retained policy and regulatory functions while the health service delivery function was transferred to county governments. They were mandated with drafting county-specific integrated development plans; annual planning and budgeting; service delivery for public health, disease surveillance, community health services, primary health services, ambulance, county hospital services; recruitment and human resource management and partner coordination.

 It can be seen how national politics and dysfunction in a national body, here the Senate, affects the functioning of the county governments. Even before COVID-19, delays in fiscal disbursements have been common, that counties see it as a political strategy by the national government to sabotage their health delivery so that citizens can push for the function to revert back to the national government . In a pandemic situation, these delays not only undermined the objectives and spirit of devolution, and healthcare delivery but also the effort to countermeasure and manage the Coronavirus.

The government should deal directly with the health sector instead of bridging on counties because health workers are suffering alot.
 

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