Last year, the Cabinet Secretary for Health, Henry Rotich, said that Sh29.090 billion would go to recurrent expenditure, while Sh31.179 billion would be spent on development. This is a curious arrangement. While the Afya House budget lines have remained the same and the amount swollen each year, the functions are no longer with them. Both the recurrent and development functions reside with the county governments.

The retention of health funds at Afya House could explain why the National Government entered into a hasty agreement. There was a chubby budget to control.

The ministry has since controversially leased medical equipment and imposed it upon the counties. It has also bought mobile clinics that are still idling near the port of Mombasa.

It also turns out that the leased equipment was handled through a company with links to powerful offices in the National Government. Issued under the government’s affirmative action policy for women and youth, this procurement was not open to competitive bidding.

The chickens of a precipitate CBA are now coming home to roost on a defective agreement that should never have been. Even a cursory perusal reveals shocking details. Mr Mark K Bor signed the CBA on June 27, 2013 in his capacity as Permanent Secretary in the Ministry of Public Health and Sanitation. It is instructive that there was no such ministry at the time. Nor was Bor a PS on the substantive date.

Under the Kibaki/Odinga Nusu Mkate Government, the public health and sanitation portfolio was one of the two health ministries.

The other one was the Ministry of Medical Services. An agreement of this kind would have fallen more squarely under the Medical Services Ministry. How it ever ended up being signed by a non-existent Public Health and Sanitation Ministry is a mystery.

But even more confounding is that the two ministries had ceased to exist by June 27, 2013 when Bor signed as the PS in charge of one.

READ: Uhuru declines to meet demands of striking medics

At that time there was an effective brand new principal secretary – under the new constitutional dispensation and nomenclature – in the person of Mr Fred Sigor. And the ministry was simply the Ministry of Health and not the Ministry of Public Health and Sanitation as is reflected in the CBA. How did Sigor fit in?

Other anomalies assume that the Ministry of Health is the doctors’ de facto employer, which is misleading.They include things like deduction of union dues that the ministry is expected to pass on to the union. There is also training, promotion and leave, all of which assume that the ministry and not the individual county governments will be in charge. Indeed, the section on remuneration gives a list of allowances that will be paid to "doctors employed by the ministry.

These grey areas ought to have been streamlined by the defunct Transitional Authority, the Ministry of Health and the CoG.

At the crucial time, however, both the doctors’ union and the national government behaved in a manner suggestive of joint hostility against devolved government. If the doctors were asking to be restored to the national government, the national government seemed to be deliberately stoking the fires of discord between the doctors and the county governments. Doctors’ salaries seemed to be deliberately delayed while the rest of their welfare was thrown into confusion. Their CBA did not even recognise that devolution was a reality and that the new authority in town was the county government.

Would the culpable myopia that informed the CBA in 2013 seem to be still at work, four years later? If the current phase of agitation began in 2012 before devolved government, devolution is now a reality. Yet most of the time the Ministry of Health has sat with the doctors while ignoring the CoG.

Even if they were to reach an agreement tomorrow, the two would constitutionally still need the CoG to implement it. It is not clear, for example, whether the ministry planned to provide conditional grants to the counties to cater for the proposed 40 per cent pay rise, or from which fund they purposed to draw whatever amount they might agree on.

Pulsating need for sobriety remains. Primarily, the national government may need to let go of health as a devolved function, complete with the funds that go with it.

Informed feelings

There are informed feelings that if the devolved funds that the ministry has cringingly clutched on were allowed to go, it would be a lot easier for the CoG to reach a lasting understanding with the medics. The same authorities also suggest that it would be important for the medics to come out of denial and accept that devolved government is here to stay.

Rather than pursue a hopelessly flawed CBA with the national government, it might help their course a great deal for them to push for the health funds to follow the health functions in the counties. That way, they are likely to negotiate for better perquisites for themselves, as well as for a robust working environment.

Source-The Standard (press release)