The new constitution promulgated in Kenya introduced a concept of devolution of resources and power from the national government to 47 units that were effected after the 2014 elections. Health services was one such function that was devolved. Devolution of health however presents unprecedented opportunities and challenges to the health sector, especially in surgical services, that determine the effectiveness of overall service delivery.
Devolution of healthcare services allows county governments:
- To design innovative models and interventions that suit the unique health sector needs in their contexts
- Sufficient scope to determine their health system and citizen priorities
- To make autonomous and quick decisions on resource mobilisation, subsector resource allocation and spending, and management of arising issues.
Devolving the health function also presents institutional and resource allocation and utilisation challenges that must be dealt with to assure effective and sustainable healthcare service delivery at the county level.
This panel will be discussing the impact of devolution on surgical services under the following guiding questions for panellists.
- Human resource
- i) The need: The lancet says 5 billion people do not have access to safe, affordable surgical and anaesthesia care when needed. Access is worst in low-income and lower-middle-income countries, where nine of ten people cannot access basic surgical care. What would you say is the real need of surgical services at the county level?
- ii) The number of staff required: Surgery requires nurses, anaesthetist and surgeons; supplies, instruments and equipment and space. If the need is that great, what is the policy of the national and county governments towards addressing the need in terms of staff, stuff and space? How has devolution impacted the training, attaining and retaining staff for this important work?
- One of the key issues where surgery is concerned is quality of care where it is given. How is the county monitoring that they are:
- i) Ready for quality of care by employing qualified staff?
- ii) How does the employment terms help in getting personnel whenever you need them
iii) Monitoring what their staff is doing in terms of number and quality of services
- iv) Kenyatta National Hospital and Moi Teaching and referral hospital has seen increased number of referrals since devolution, what brings about? For example-is it profitable for hospitals, falling under the counties’ responsibility, to treat as many patients as possible or will their budgets put pressure on them to refer patients to national referral hospitals in order to save costs and prevent losses?
- Way forward
- i) How do we ensure devolution in health improves surgical services? Could we have a technical committee composed of professionals that help counties think through these issues and bring together national assembly /senate in crafting policies towards staff, stuff and spec for surgery?