OPEN LETTER TO THE COUNCIL OF GOVERNORS

Dear Governors,

It has been an interesting past 45 months. The election 2013 came with a lot of intrigues. 47 new governments were born. Within weeks, majority had morphed into tribal kingdoms that would put the Saudi Arabian Monarchy to shame.

The energy put into putting governance structures in place was tremendous. Every Emperor in his backyard needed to appoint his chief of staff, personal aides, cabinet and political advisors. Each one needed helicopters, plush offices and residencies, resulting in a governor living in a luxury hotel for months on end awaiting construction of the Governor’s Manor. The ire at not being able to fly the county flag hit cosmic proportions.

Amidst all these very important goings-on, the Governors still found time to receive their devolved functions. Those that the National Government wasn’t willing to give readily, they marched to the Capital and demanded for them.

One of the most appealing functions was Health. As the Ministry of Health was still dithering, the health workers, through their unions, were up in arms against devolution of Health. Members of the county assemblies had started harassing health professionals at work, to a point of dictating to them how treat their patients.

Governors convinced the Transitional Authority that as counties, they inherently possessed capacity to take on the juicy apple called Health. Juicy because it formed the largest chunk of the county budgets. Even juicier considering contributions by ‘development partners’ and the ‘Facility Improvement Fund’. The cherry on the cake was the much touted ‘Free Maternity Care’ funded from treasury.

Governors gleefully signed on the dotted line and forgot to read the disclaimer section, the first of which would be the so called ‘Devolved Functions’. The Ministry essentially served the counties the head and the feet while it kept the chicken. It retained nearly 80% of the Health budget, catering for national programmes such as vaccination, TB, Malaria and HIV, whose coffers are heavily supported by donor funding; research, under KEMRI (and we all have heard rumors of what hasn’t been happening there); and the much touted policy, little of which has been implemented in counties.

The poor counties took package home without ascertaining the contents. First, Afya house spent almost a year to transfer personnel files to the counties. By then, nearly every county had undergone a health workers strike, demanding up to 14 years’ worth of overdue promotions. In their hurry, counties had no clue about the unique nature of human resource for health management; including deployment, retention, transfers and in-service training. Lack of structures addressing these issues led to turmoil. The governors had no peace and the few who attained some sort of reprieve resorted to mechanisms that were nothing short of bribery with unstructured promotions unsupported by the public service act.

The inequity across the country led to the birth of the doctors’ unrest. The CBA monster was awakened. The Ministry of health had successfully negotiated a collective bargaining agreement with the doctors’ union in 2012 and signed it in May 2013, eight months before counties took over the health function. Attempts by the union to engage the Council of Governors to implement the CBA collectively across the country hit a wall. The Ministry had cunningly off-loaded its biggest headache by attempting to devolve its liabilities. 18 months of court battle resulted in a ruling that  parties must agree on a way forward with registration of the CBA and its implementation. The parties here being the signatories of the CBA, of which, the counties/Council of Governors were not party to.

The war has gotten down and dirty, with dissatisfied doctors resorting to a strike to get the government to deal. The clueless governors are caught up in the melee. The electorate expects them to provide health services yet the interruption has nothing to do with governors. The Ministry has skillfully drawn them into the battle and parlayed them on the front line.

Through the Council of Governors, the governors have attempted to get a solution, hence the quick trip to the courts to sue the doctors’ union, declaring the strike illegal. This is despite the fact that the strike is not against the Council of Governors, which by the way, does not have a single doctor in its employ. The same council once told the union that it has no capacity to sign a recognition agreement with the union as the employer is the individual county public service board. Now, I am not a lawyer, but I figure if this case came before my courtroom as a judge, I would be compelled to toss it out on that basic technicality.

Meanwhile, the Ministry of Health is hard at work, trying to wiggle out of this one, without the pressure of dealing with sick county residents.

My unsolicited advice to the governors, you are in the wrong camp. The doctors are fighting your battles for you. Let them square it out nationally, get their CBA implemented and treasury budgets for it without you having to beg for the money to cover the financial implication. The end result will be a bunch of happy doctors serving your loyal subjects with motivation. The only demand governors should be making, is to the Ministry of health to hurry up, sort out this mess and allow their electorate to continue enjoying their right to health!