DE­VOLVE THE HEALTH BUD­GET

In Nairobi, for in­stance, we are fir­ing on all cylin­ders, and against great odds, to de­liver qual­ity pri­mary health. We have al­lo­cated 27 per cent of our to­tal bud­get to run health func­tions

The Star (Kenya) - - Voices - EVANS KIDERO Nairobi city county gover­nor

Acom­mon pre­cept of physics at­trib­uted to the Greek philoso­pher Aris­to­tle vouches for na­ture’s nec­es­sary and un­equiv­o­cal dis­taste for a vac­uum. The phrase “na­ture ab­hors a vac­uum” is re­flected in a phe­nom­e­non we un­fold­ing in our coun­try as we grap­ple to un­der­stand the con­text in which the min­istry of Health is caught up in claims and counter-claims of al­leged cor­rup­tion. Aris­to­tle held that na­ture en­ter­tains no vac­u­ums since at ev­ery point in time, the denser sur­round­ing ma­te­rial con­tin­uum would im­me­di­ately fill the rar­ity of a bud­ding void. The con­fu­sion at the min­istry of Health as to whether money was lost or not per­fectly fits the cir­cum­stance of na­ture ab­hor­ring a vac­uum.

The ad­vent of devo­lu­tion in 2010 was a revo­lu­tion for a coun­try such as ours, reel­ing af­ter decades of in­equity and other man-made con­tra­dic­tions of a repub­lic. The devo­lu­tion of the health func­tion un­der the Fourth Sched­ule of the Con­sti­tu­tion was par­tic­u­larly a mas­ter­stroke and nec­es­sar­ily so. For much too long, a de­tached, of­ten over­whelmed and Leviathan-like cen­tral govern­ment ei­ther over­looked or un­der­ap­pre­ci­ated the pri­mary health needs of its peo­ple.

Un­der the sched­ule, and through a pop­u­lar vote, Kenyans yanked off the func­tion of pri­mary health­care from the na­tional govern­ment and handed it over to the county gov­ern­ments, closer to the peo­ple.The only health func­tion left with the na­tional govern­ment, ac­cord­ing to part 1 ( 28 ) of the sched­ule, is pol­icy for­mu­la­tion.

To fur­ther firm it up and pro­tect the will of the peo­ple, the drafters of the Con­sti­tu­tion stated in Ar­ti­cle 186 and 187 that the pow­ers and func­tions of both lev­els of gov­ern­ments would re­main as set out in the Fourth Sched­ule un­less the two gov­ern­ments agreed to trans­fer func­tions be­tween each other.

To this date, there has not been any trans­fer of the pri­mary health func­tion from the county govern­ment to the na­tional govern­ment. Not one that we are aware of! Yet for the last four years, the min­istry of Health, up to 2010 the ex­ecu­tor of the pri­mary health func­tion, has been re­ceiv­ing huge al­lo­ca­tions re­flec­tive of its for­mer func­tions which have since been trans­ferred to the coun­ties.

The con­fu­sion and dif­fi­cul­ties ex­pe­ri­enced by the coun­ties in the ex­e­cu­tion of their health func­tion are largely due to this seem­ingly re­cal­ci­trant ap­proach by the na­tional govern­ment to fully and gen­uinely de­volve the func­tion along­side its bud­get.

In Nairobi for in­stance, we are fir­ing on all cylin­ders, and against great odds, to de­liver qual­ity pri­mary health to our peo­ple. We have al­lo­cated a whop­ping 27 per cent of our to­tal bud­get to run the var­i­ous health func­tions.Still, it re­mains a drop in the ocean of our needs as a county. We both de­serve and re­quire more money to run the health func­tion in a man­ner that can sat­isfy our peo­ple.

Yet at the na­tional level, a sit­u­a­tion where a largely amor­phous min­istry finds it­self float­ing in bil­lions of shillings un­awares where to chan­nel them ob­tains.

A func­tional vac­uum sets in and one of the at­ten­dant pos­si­ble con­se­quences as na­ture tries to fill it in the ab­sence of re­cal­i­bra­tion of the min­istry to con­sti­tu­tional re­quire­ments is greed! It is log­i­cal to ex­pect the state man­darins at the min­istry to pull out all stops to ex­haust this fund­ing — in­clud­ing what now ap­pears to be prodi­gious pro­cure­ment. The stub­born fact of the mat­ter, how­ever, is that the min­istry does not — strictly speak­ing — em­ploy a sin­gle doc­tor or nurse. And so, the stark choice fac­ing the coun­try is clear: Ei­ther fully de­volve func­tions along­side their fund­ing or con­tinue the spin­ning of our own wheels of con­fu­sion and pos­si­ble loss of funds.

The con­fu­sion at Afya House is a nec­es­sary con­se­quence of fail­ure to re­spect the law. It has ev­ery hall­mark of fail­ure to ap­pre­ci­ate the ob­jects and pur­pose of devo­lu­tion.

Which­ever way one wants to look at it, it is an un­nec­es­sary cri­sis cre­ated by the fail­ure to ap­pre­ci­ate a vac­uum ex­ists at Afya House and that the only way to cure this is to re­ori­ent the min­istry to the con­sti­tu­tional re­al­ity.

Again, and if this can drive sense into those hold­ing their ground against the Con­sti­tu­tion, na­ture ab­hors vac­uum. The train of devo­lu­tion left the sta­tion five years ago and un­til we re­ori­ent our­selves to fill the vac­u­ums cre­ated at the cen­tre, malev­o­lence will take over.

THERE HAS NOT BEEN ANY TRANS­FER OF THE PRI­MARY HEALTH FUNC­TION FROM THE COUN­TIES TO THE GOVERN­MENT

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