Taskforce denounces Bungoma Health Services Act, recommends drastic changes

In Summary:

• Taskforce membership
• Observations / Findings
• Recommendations
• Report (pdf)

BUNGOMA COUNTY HEALTH AND SANITATION REPORT – Feb 2024

Task Force members

1. 1. 1. Barasa Kundu Nyukuri – Chairperson
      2. Stephen Yambi – Member
      3. Amos Makokha – Member
      4. Ezekiel Odeo – Member
      5. Mukenya John – Member
      6. Albert Simiyu Wamalwa – Member
      7. Phelgona K. Odipo – Member
      8. Leonard Momos Juma – Member
      9. Erick Nakhurenya – Member
      10. Dr. Sylvester Simiyu Mutoro – Member
      11. Sella Mutsotso – Member
      12. Everlyne Namalwa Wambulwa – Member
      13. Purity Kafuna Masinde – Members
      14. Abisai N. Kiboi – Secretariat
      15. Everlyn Efumbi – Secretariat
      16. Lucila Wakoli – Secretariat

Observations and Findings

• The Taskforce established that the Bungoma County Health Services Act, 2019 was not compliant with the Constitution of Kenya, 2010, and other policy and legal instruments at global, regional, and national levels. It does not incorporate some of the devolved functions under Part 2 Clause 2 of the Fourth Schedule, particularly the aspects of Veterinary Services, Refuse Removal, Refuse Dumps, and Solid Waste Disposal.
• The force observed that the petitions by some unions at the High Court of Kenya and the County Assembly of Bungoma were driven by factors such as discrimination and non-representation of some key cadres in leadership and governance structure of the health and sanitation, especially the County Health Management Team (CHMT). The CHMT was bloated and characterized by leadership wrangles, discrimination, suspicion, and mistrust, which negatively impacted departmental management and service delivery.
• The current structure of the County Health Management Team and system were not effective in terms of public and stakeholders’ participation, involvement, and consultation in decision-making and implementation of program and project activities in the County Department of Health & Sanitation
• The force observed that emergency medical services were not adequately covered in the Bungoma County Health Services, despite it being one of the socio-economic rights in Article 43 of the Constitution of Kenya, 2010. Indeed, emergency medical treatment and healthcare were not guaranteed in most health facilities across the County due to financial constraints, inadequate specialized workforce, lack of appropriate infrastructure, equipment, and health and sanitation products.
• The Bungoma County Health Services Act, 2019 did not have significant provisions for modern health technology services except for Laboratory Tests. Indeed, such as E-Health and Sanitation Service Delivery and E-Health Governance, E- Monitoring and Evaluation were not addressed by the Act.

Download:

• 1. FINAL VERSION OF THE REPORT OF THE BUNGOMA COUNTY HEALTH AND SANITATION
  2. SUMMARY REPORT OF THE HEATH AND SANITATION TASKFORCE

• The task force identified and analyzed the constitutional, policy, legal, and administrative gaps in the Bungoma County Health Services Act, 2019 that hampered its effective operationalization and implementation.
• Whereas the Human Resources / Workforce in the Department has steadily increased courtesy of the current regime, the number of doctors, nurses, and specialized personnel was still below the minimum of its targets, threshold, and standards required by the World Health Organization (WHO). The workforce in all cadres across the County health facilities was not adequate for optimal performance and effective delivery of health and sanitation services to the ever growing population.
• The Health and Sanitation Taskforce observed that most of the health facilities are poorly equipped thus jeopardizing the delivery of quality health services.
• The Taskforce observed that the current County Referral System is inefficient and the ambulance services lack central command, which undermines effectiveness in achieving the intended health outcomes.
• The task force found that there was a large number of casual workers and some on fixed contracts providing services in various health facilities across the County. However, their recruitment process may not have been regular and/or sanctioned by the County Public Service Board as required under Sections 59 and 60 of the County Governments Act, 2012, and the Human Resource Manual of the County Public Service.

• The Task force established that the Department of Health and Sanitation did not have an approved Organizational Structure (Organogram) that clearly illustrates entry, progression, career growth, and development of staff across the cadres based on their respective schemes of service. That there was a draft functional organogram that was yet to be approved by the County Public Service Board. The County Public Service Board did not also have an Organogram for all the 10 departments approved by the County Assembly of Bungoma.
• The task force found that the Department of Health and Sanitation had a draft functional organogram as opposed to an approved staff establishment or organogram. The aforementioned draft organogram lacked clear indicators for career entry, progression, and growth in each cadre. The County Public Service Board (CBSB) of Bungoma does not have an approved integrated staff establishment/ organization structure (Organogram) for the entire county public service. The CPSB did not honor the invitation to meet the Taskforce despite receiving and acknowledging an official communication from the Taskforce.
• The CPSB does not have specific approved organization structures/staff establishments for each of the Ten (10) Departments in the county Government of Bungoma. The Taskforce recommends `that the CPSB should formulate urgently an integrated county public service organization structure for all county government departments. The Board
• should formulate a specific one for the Department of Health and Sanitation, guided by the scheme of services for different cadres in the health and sanitation sector, in line with its mandate and functions stipulated in Sections 59 and 60 of the County Governments Act, 2012.
• The task force established that the Department of Health and Sanitation had great potential as a revenue stream through appropriation in aid but there were no proper mechanisms and revenue infrastructure to tap it. Some of the specialized healthcare services such as City Scan, and Intensive Care Unit inadequate at level 5 and level 4 facilities in the County.
• The Taskforce established that the role, relationship, and effectiveness of the collaboration National government and the County Government of Bungoma in the promotion and provision of adequate and quality healthcare services, including the attainment of Universal Health Care is generally good. However, there was a lack of clarity on the role and responsibility of the County Government in the administration and management of some functions such as recruitment and payment of stipends for Community Health Promoters and the operation of the Social Health Insurance Fund (SHIF) and implementation of the Facility Improvement Financing and other recently enacted policies and legislations.
• The review found that the Bungoma County Health Services Act, 2019 did not have any provision for alternative medicine, including Herbal Medicine and indigenous Health Knowledge.
• The task force observed that despite the huge annual budgetary allocations for the Department of Health and Sanitation, compared to other departments, that amount was still inadequate to recruit adequate qualified personnel and commodities like medicine.

Recommendations

• The Taskforce strongly recommends that the Bungoma County Health and Sanitation Services Amendment Bill, 2024 should be compliant with various articles and provisions of the Constitution of Kenya, 2010. It should incorporate some of the devolved functions under Part 2 Clause 2 of the Fourth Schedule, particularly the aspects of Veterinary Services, Refuse Removal, Refuse Dumps, and Solid Waste Disposal. The Bill should also be formulated within the framework of Sustainable Development Goal (SDG3) Number Three, Vision 2030, Health Sector Policy 2014-2030, and Universal Health Coverage Policy 2020-2030, among other national, regional, and global policy and legislative instruments governing the health and sanitation sector.

• The task force recommends that the top leadership and management teams in the Department and health facilities should embrace dialogue, negotiation, and alternative dispute resolution mechanisms before petitioning the County Assembly and/or the courts of law.
• The Department of Health and Sanitation should establish an Internal Dispute Resolution and Grievance Handling Mechanism to manage disputes and foster collective responsibility and unity of purpose in diversity. The Department should review, adopt, and implement the orders resulting from the various petitions and recommendations of the departmental committee reports and findings of this task force.
• The appointment of the County Director of Health and Sanitation should be open for competition by the County Public Service Board to all qualified and competent health workers with at a masters degree and at least ten years of experience in management.
• The composition of the new County Health and Sanitation Management Team (CHSMT) and the Sub County Health and Sanitation Management Teams (SCHSMTs) should be competitive, gender-responsive, and representative of all cadres in the Sector. The recruitment of the hospital boards and management committees of all health facilities and levels should also be competitive, gender-responsive, and representative of community diverse interests.
• The Task force recommends the reduction of the number of members of the CHSMT from 22 to 15 while considering the issue contentious and delicate issue inclusion and representation of all essential service units/sections in the management. The re-constitution of CHSMT and SCHSMTs should be driven by the merit and significance of the services offered and not be based on programs and projects in the department, which are sometimes short-lived or temporal depending on interest and availability of funds from development partners. The term limit for the CHSMT and SCHSMT members should be 3 years renewable once based on satisfactory performance.
• The Taskforce recommends that the health management structure and systems should be reviewed and restructured to make them effective in terms of public and stakeholders’ participation, involvement, and consultation in the decision-making and implementation of program and project activities in the County Department of Health & Sanitation.
  
• The Taskforce recommends that the County Government of Bungoma should invest more human, material, and financial resources in emergency medical services in line with the new national legislation on Emergency Critical and Chronic Illness Act, 2023.
• The envisaged Bungoma County Health and Sanitation Amendment Bill, 2024 should provide for modern health technology services except for Laboratory Tests. Indeed, such as E-Health and Sanitation Service Delivery and E-Health Governance, E- Monitoring and Evaluation were not addressed by the Act.
• The Taskforce recommends the County Public Service in consultation with the Department of Health and Sanitation should recruit an adequate and competent workforce for effective delivery of service.
• The Taskforce recommends that there is a need for the County Public Service Board in consultation with the Department of Health and Sanitation to review the issue of casual workers and some on fixed contracted staff with a view of rationalizing and regularizing their continued employment across the health facilities across the County. The recruitment process should be guided by a county policy on casual workers formulated by the County Public Service Board and approved by the County Assembly of Bungoma.
• The Taskforce recommends that the Department of Health and Sanitation should in consultation with the County Public Service Board, formulate a comprehensive Organizational Structure (Organogram), with clear guidelines for entry, progression, career growth, and development of staff across the cadres based on their respective schemes of service. The County Public Service Board should also urgently finalize the Master Organogram for all 10 departments and submit it for approval by the County Assembly of Bungoma.
• The Task force established that the Department of Health and Sanitation had great potential as a revenue stream through appropriation in aid (AIA) but there were no proper mechanisms and revenue infrastructure to tap it. Some of the specialized healthcare services such as City Scan, and Intensive Care Unit inadequate at level 5 and level 4 level facilities in the County.
• The Taskforce established that the role, relationship, and effectiveness of the collaboration national government and the County Government of Bungoma in the promotion and provision of adequate and quality health care services, including the attainment of Universal Health Care as generally good. However, there was a lack of clarity on the role and responsibility of the County Government in the administration and management of some functions such as recruitment and payment of stipends for Community Health Promoters and the operation of the Social Health Insurance Fund (SHIF) and implementation of the Facility Improvement Financing and other recently enacted policies and legislations.
• The envisaged Bungoma County Health and Sanitation Services Amendment Bill 2024 should have provision for alternative medicine, including Herbal Medicine and indigenous Health Knowledge by domesticating what is provided for in Sections 75 to 78 of the National Health Services Act, 2017.
• The Taskforce observed that there is a need to provide adequate budgetary allocations for the recruitment of human resources and the purchase of health products and technologies for all the health facilities in the County.
• The Health and Sanitation Taskforce recommends that the envisaged Bungoma County Health and Sanitation Amendment Bill, 2024 should be structured around the Eight (8) Pillars of the World Health Organization (WHO) that have been domesticated in the Kenya Health Sector Policy 2014-2030 and Universal Health Coverage (UHC) 2020-2030.
• The Taskforce observed that most of the programs in the department were donor-funded and not sustainable at all in the long run. There is a need for a sustainable own-source revenue (OSR) framework for financing health and sanitation services to reduce over-dependency on the national exchequer and donor funding for most programs.
• There is a need for the Department to formulate Public Private Partnership (PPP) Policy Framework to enhance partnerships and linkages in the Sector through Memorandums of Understandings (MOUs) with strategic partners and development partners as a strategy for attaining Universal Health Coverage (UHC).
• The County Public Service Board should take charge and full responsibility for the recruitment of all cadres of staff in consultation with the CECM, Chief Officer and Director of the Department of Health and Sanitation. The contracted technical staff should be considered for absorption on permanent and pensionable terms whenever vacancies occur in the Department based on the budgetary allocation for the recruitment of more health and sanitation personnel in order to reach optimal levels of the workforce across the facilities.

Download:

• 1. FINAL VERSION OF THE REPORT OF THE BUNGOMA COUNTY HEALTH AND SANITATION
  2. SUMMARY REPORT OF THE HEATH AND SANITATION TASKFORCE

• The Health and Sanitation Department should review and amend the BCHSA, 2019 to incorporate adequate and appropriate support measures geared towards the provision of equitable, affordable, and high-quality healthcare and sanitation-related services. The amendment should be in line with the recently enacted national legislations, such as the Facility Improvement Financing (FIF) Act, 2023, the Social Health Insurance Act, 2023, Digital Health Act, 2023, and Primary Healthcare Act, 2023.

• The Task force found that some of the health and sanitation workers (frontline staff in the sector) were facing mental challenges, including severe mental illness, which required urgent intervention by relevant professionals and specialized mental health service providers. The Department of Health and Sanitation should invest in separate but equipped and staffed mental health care facilities, one specifically for the health & sanitation workers and another for clients /mental patients from the general public; There is need to establish the Bungoma County Health and Sanitation Research and Development Committee that will be charged with the responsibility of approving all research proposals, projects and granting consent for data collection and sharing of information and reports. The said Committee should report directly to the Chief Officer of Health and Sanitation who will in turn update the CECM in charge on the Research Findings.
• The Taskforce recommends the restructuring of the Health and Sanitation Services Bill, 2024 alongside the following Eight (8) Pillars: Health & Sanitation Leadership and Governance, Organization of Service Delivery, Health & Sanitation Workforce, Health & Sanitation Financing, Health & Sanitation Products and Technologies, Health & Sanitation Information, Health and Sanitation Infrastructure, Research and Development in Health and Sanitation.

~ Report ~