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
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