Now that at last the HSC is in the BBI, what next?

Now that the Health Service Commission (HSC) is in the Building Bridges Intiative (BBI): what next? Last two weeks it was hooray!! – at last, the HSC is in the BBI!  it’s in clause 163 section: A and B. Whether there is anything else that will be good to write home about as far as the BBI is concerned is another matter altogether. The dye is cast for health workers and personal convictions aside most will be tempted to support it.

Health workers have been faced with a need to rise to demands of frequent policy changes and industrial unrest in the health sector in the last couple of years.  The generations to come will be kind to judge us well, in that we got something out of it. As the year when Kenyans came together to take united and concrete action to place the health workers and by extension their wellbeing to the front and centre.

But the most critical developments so far has been the devolution of health services from the national government to county governments. It will not be that easy to withdraw a function of the county government by the stroke of a pen…  Lawyers like saying the law, the constitution is very clear. I am not one so I see that the bearing for clarity will have to be borne by the lawyers hired by HRH.

The government nevertheless has seen to it that with the rolling out of universal health coverage (UHC), there will be some contradiction of saying devolve all pillars of health care and leave the HRH central. With counties going to be getting 50% of GDP, there will be a push-pull situation since HSC will take back some of that funding, or will mean counties get less of that.

That being a dilemma the proposal to have a health service commission for Kenya will need a constitutional referendum, which means it is still a tall order by any standard. From now on it will be about how to get past the riddle of getting a Health Service Commission (HSC).

We are in a constitution-making moment right now (though driven more by political interests), but it is a chance health workers cannot afford to waste.

Mark you the government will likely be looking at the Health Service Commission as an alternative way of dispute resolution in health care. More on this angle here. Also on efforts on how to safeguard against strikes.

Kenyans are no longer naïve. It seems a valid observation and the BBI clause 163 sec B has said as much that Kenyans might wish to ‘eat their cake and have it’ by leaving ‘their health’ devolved.  Whether health remains a devolved function or not need not be the question since it will most likely mix up issues.

There will be those who will want us in the mix, but that is a complicated situation we need to be worried about. Many are those who would like to enter into ‘non-issues’ like ‘when does life begin?, ‘abortion is illegal, except…’ like last time in Bomas.  However, I am saying this with a lot of caution.

We hope that at least Kenyans by now know that the idea of health workers under the county governments does not seem to work or was unlikely to work, though we cannot be too sure about that. This is something that can be rectified in our lifetime if we work together. Moreover, it’s is not as if HSC is a new idea – it is well articulated in the Vision 2030. The previous Bomas or perhaps Waki draft had HSC.  The HSC  got buried somewhere in between these and Naivasha Draft. Why was it dropped, any minutes to the same effect?  Concerning its mandates, structures, composition and possibilities what can we adapt. Can we convince Kenyans?

We failed to insert the Health Service Commission (HSC) into the constitution in 2010 to deal with human resources for health. Devolution was the in-thing, it was the tail that wagged the dog. We need to find out what is the new gist equivalent of the then devolution momentum of 2010. But certainly is not HSC.

As the political class fight it out for the largest cake, we need to worry if they can also convince Kenyans (or why would it be so hard to convince the Kenyans) that it was for their good if Kenya can get a Health Service Commission into the referendum question and subject it to a YES/NO vote. It is a chance we cannot afford to waste.

As health care workers we should perhaps not lobby that the health docket goes back to central government (much as we will be watching that space keenly). Let other quarters drive that part of the agenda (but not) on our behalf.

Our gem is the Health Service Commission. It is our thing and Kenyans would be less reluctant to let us have it.  It will be taking nothing away from them; instead, it will be taking away what counties were struggling with – HRH. HSC will be handling issues like: employment, deployment, promotion, redesignation, training, discipline and transfers uniformly.

Perhaps governors will find it a relief since HRH has given them enough trouble already; they at different points have admitted that they did not have the capacity to handle HRH.capacity to handle HRH. It had earlier been thought that the formation of HSC would undermine devolution.  That is a battle we must be ready to fight going forward. Even though there will be numerous occasions that health (HRH) will need to shed off every hard skin for this one thing – HSC.

There are numerous pillars in the health system and HRH is just one of them, so HSC would be the least likely panacea for all of them. Then there are the constitutional functions of SRC, Ministry of Labour, etc. The perennial cadre rivalries issues, disparities, cross-generational issues, etc.

Technicalities like -What will be the structure of HSC, whys and why not? Or maybe just anchor HSC through an act of parliament to start with. Why did we not consider this option? ‘We didn’t need #BBI to see, acknowledge the need for an HSC…’, a certain posting from social media.  Some quarters mainly from people at KMPDU even suggest it is very much possible. It’s possible they might be having something worked out, hopefully with everyone’s interest at heart. There is no problem with each cadre coming up with a draft then comparing notes.

I knew one thing during urologic surgery for men with strictures. If the boogie goes in too easily, then that is not the right one. We need as a health care fraternity to see to it that the proposed HSC is just about right – not perfect. Not too much not so less. We can work on a followup cosmetic later… If you apply a tourniquet too tight any a well trained professional will tell you that the stump distal to it will die off, so we need to allow some breather for the counties now and then. It will be a give and take all the way.

Even if we don’t get our HSC in the referendum question the katiba change will still happen this year, next year, sometimes, never. Never – is the least likely. HSC will then remain a dream, but a nice one all the same. Like I said before, at the end of it all, it will be what will be of most benefit to Kenyans with or without a Health Service Commission.

Now that BBI has been launched with pomp and colour, there goes campaigns of divisiveness, focus being the year 2022 elections. No one will remember the Big 4 agendas anymore. Not forgetting the holiday season.

There is a caption to it though; after the national debate which we hope will not tear the nation apart, it will be our aspiration that Kenyans in their wisdom will allow BBI to pass with very minor changes to it just the way 2010 constitution was done.  A post on social media said as much, ‘When we passed the new constitution in 2010, we were told how Kenya will be heaven on earth!!!’

This writer foresaw some of these scenarios and shared the same here.

By the way now that we are headed for the holidays, welcome to the medical profession where any day is workday nad holidays don’t matter… Soon and very soon the leadership both in health care or otherwise will be off for holidaying while Kenyans wait for health care. Shouldn’t such sporadic work with lots of secrets on the untold cost of caring be anchored somewhere in the constitution?

2020 is the WHO year of the nurse in commemoration with the bicentenary (200th) birthday of Florence Nightingale. Prepare for it, present something through NursingNow Kenya chapter. It is an opportunity to raise the visibility of the nursing profession in policy dialogue.


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