Governors missing as Kenyans struggle with SHA

On Saturday, Mercy Kibon* took her son to Kibra Kianda Level 4 Hospital with a fever and difficulty in breathing.

They found no healthcare workers since they were on strike. In despair, she sought help at a private clinic, where her son was diagnosed with pneumonia and immediately placed on treatment.

“This is not the first time I have missed services here. Sometimes, we are told to buy medicine. But this time, my son was not even examined because there was no one to attend to him,” says Mercy.

Her experience reflects the struggles of thousands of Kenyans who rely on Level 2, Level 3 and 4 health facilities for basic diagnosis and treatment.

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The county-run facilities remain ill-equipped unable to provide primary healthcare, regardless of receiving primary healthcare funds to serve patients in need of basic healthcare, reducing referrals that congest national referral hospitals.

Governors have been faulted for being mute despite growing need of healthcare, as the Ministry of Health and top officials work round the clock to actualise the Social Health Authority (SHA).

This is despite health being a devolved function. John Juma, a health economist, criticised governors saying they have remained an extension of the executive, instead of coming up with policies to improve health in respective counties.

“Governors have failed Kenyans. The spirit of devolution was to make county governments independent so that they can address issues of people within their respective counties independently away from influence of National government, and decisions made in Nairobi,” says Juma.

He said the Constitution states that primary healthcare should fully be provided by county governments because they are closer to the people, and that people's needs are different from county to county.

"Some counties need more maternal healthcare, primary some need more primary healthcare, others child immunisation than others. And having decisions made in Nairobi, then it happens like a full package for all counties, which should not be the case,” said Juma.

According to him, some counties are not ring-fencing money for primary healthcare as entailed in Facility Improvement Fund (FIF), as entailed under SHA.

With the ongoing uncertainty in actualisation of SHA, money collected under FIF laws could have been used to run facilities with delay of SHA disbursement.

"Money goes to county revenue fund, and the governors are using the money for their operations, and run other roles like construction of roads, yet SHA is not sending money. What do we expect. This is why mwananchi continues to suffer,” he said.

KMPDU Deputy Secretary General Dennis Miskellah took an issue with silence of governors saying it is disappointing, yet at least 90 per cent of health is devolved.

He acknowledged that though governors raised an issue with being sidelined during establishment of Social health Authority (SHA) Act 2023 that gave birth to SHA, but they need to take responsibility to guarantee quality care.

“Governors complained they were not included fully as stakeholders, and SHA regulations. This is challenge KMPDU raised but this does not mean governors should keep silent. Governors are applying the model of wait and see.

But it is unfair, because the national government is actualising SHA and making it function but where are governors?” posed Miskella.

Governors, he said, get a higher allocation from SHA, money that is from exchequer. The money he observed should be channelled to counties to help them run Level 2 and Level 3 facilities.

He added that indigents should also be paid for by a shared allocation from county, and national government, but counties have not been keen on the allocation according to the doctor. “Has counties set money under their budget allocations to pay indigents,” he posed.

The doctors representative further criticizes governors saying they run away when health seem to fail, but should take responsibility of the sector because health is fully devolved.

“Governors cannot be coming in when it comes to things like employing doctors, and human resource that entails employing their own people, they celebrate with a narrative of having health devolved. But when it comes to difficult times, like SHA is facing challenges, they cannot step in and help,” he added.

Primary healthcare that entails level 2, 3 and 4 hospital majorly run by counties according to the doctor are not working.

Failure to equip the facilities he observed results into unnecessary referrals that congest major facilities in the country more so Kenyatta national hospital (KHN), MTRH and Level 5 hospital across the country.

“Patients are congesting at Kenyatta because of poor state of healthcare in counties that are under Governors. There is no proper referrals from Level 2, 3 and 4 hospitals, and even with referrals, patients still have to buy drugs outside the hospitals. This is reasons why Kenyans are not willing to remit their pay to SHA,”

He adds, “It doesn’t make sense for you to pay SHA, but when you go to a hospital, you cannot access simple painkillers and simple tests.”

He added that counties have the role of providing services in county hospitals, and not renaming and categorising hospitals, yet no services are offered.

“Governors should improve state of facilities under their jurisdiction for Kenyans to enjoy benefits of paying SHA. Their silence has been very loud,” observed the union official.

Contacted for response on the role of County Governments amid wrangling in provision of health care, PS for Medical Services Harry Kimtai said governors are not seen in healthcare.

“Governors need to stock their facilities. Our responsibility is to procure services from hospitals in counties,” said Kimtai.

He added, “This is why we pay primary healthcare fund for Level 2 and 3 hospitals. We want them to equip and staff their facilities so that Kenyans are not turned away,”. 

But in a quick rejoinder, Muranga Governor Irungu Kang'ata said every governor is doing what they can do best in provision of healthcare.

He said there has been delay in reimbursement of money to counties, making it hard to run Level 2 and 3 hospitals where majority of Kenyans seek basic healthcare.

“SHA should reimburse money that we rarely get. There is likelihood that health at level 2, 3 is not good because of SHA. SHA need to help us restore Level 2 and 3 hospitals,” Kang’ata told The Standard.

SHA, including the defunct National Health Insurance Fund (NHIF) woes Murang’a about Sh200 million, accumulation for over years.

Claims from the new health scheme are also lower, as compared to NHIF according to the governor. For example, Murang’a Hospital used to receive reimbursement of Sh15 million monthly, an amount that has reduced to only Sh5 million under SHA.

“There has been no clear explanation of delayed pay to hospitals, and when we asked, we are taken over circles,” said the Governor.

Failure to get pay, he adds limits purchase of essential commodities from Kenya Medical supplies Authority (KEMSA).

Kisumu Governor Anyang' Nyong'o said delays in disbursement of funds to counties by the national government, delays and affect service delivery in counties.

He added that the government should address its functions in the new SHA that is causing a lot of unnecessary problems, but not undo NHIF.