As the country started
to implement the devolution process, I could not help but wonder if the health
system would carry with it the loop holes of yester years, such as poor
governance, time wasting, weak institutional capacity and an inability to
deliver basic services to the citizens. Some health facilities were pretty much
nominal facilities with no basic services available.
For the devolved health
services to succeed, we need to view good governance as a public good:
Good
planning: Planning will help County governments to match and
prioritize health needs; demanded health services, finances and the available time. This should be done through strategic plans, annual
plans, and monthly plans and even the daily plans. It is necessary to identify the health tasks
to be carried out and anticipate any possible deviations that may occur. To reduce these
deviations it is important to distribute tasks into set
milestones. The Phases will allow all health care team members
to visualize the actual status of health indicators at any time and assess the
possible need for replanning and adjustment.
Implementation:
Planning cannot be significant if the said plans will not be operationalized.
Once the county health system commits to planning, they need to create logical
step by step approach to accomplish the county health objectives. The county
health managers should maintain the momentum for change by providing resources,
developing competencies and skills and building a support system for the health
workforce.
Resources mobilization: Resources should be readily available to ensure availability
and accessibility of health services by citizens in a timely way. The counties
should not expect the allocated money to be adequate for all the health needs. Competing
needs will always be there and hence the need to mobilize resources through
inviting the needed investors. The county health managers should create a worthy
public private partnership (PPP) environment to attract Non-governmental
organizations (NGOs), Community based organization (CBOs) among other partners.
It does not hurt, to come up with
creative ideas like the first ladies half marathon to raise funds for various
health activities.
Team
work:
Health systems are made up of people
of different cadres working together to achieve a common goal. The people are
frequently required to work as a group, hence the need to focus on team work.
The county health sectors will need to improve the effectiveness of health workforce
with particular attention to performance, collaboration and knowledge of
individual roles in relation to the county health sector.
Use
the generated data for decision making: The greatest
expectation of the county health sectors is guiding the health system in maintaining
an environment of accountability. Effective county health leaders will use data
extensively to guide them in decision making. The generated data will help
clarify issues, identify alternative solutions to problems and target resources
more effectively leading to evidence based decisions. In fact the real question
in the county health sectors should not be whether to integrate the use of data in decision making,
but how?
Monitoring
and Evaluating: Tracking down the health inputs,
activities and outcome will enhance transparency and accountability. The county’s
health sector should frequently take stock of their progress. Monitoring and evaluation
should not only apply to money but also to performance and the satisfaction to
service delivery in the eyes of users. The county health sectors should set indicators
and put measures in assessing them and reviewing the actual results compared to
the goals established.
Invest in the health work force: A motivated worker is a productive
worker. And a productive worker is a more profitable one. Now more than ever,
the counties need motivated health workforce. Given the limits of the various
theories of human motivation, counties health managers should focus their
attention to the real world and what has worked. A strong work culture with no
bossy bosses, stable work environment and good benefits like the pension plan,
health financing for family members and other little incentives is the ideal
work culture.
The county health managers
should provide dialogue opportunities for expressing self. Everyone likes to believe
their opinion matters and that they
too matter. Giving frequent feedback to the health personnel will make
them embrace and feel that they are part of the devolving system. A few
counties view capacity building as a liability and a waste of time, hence no
budget allocation, however investing in capacity building of the health care
workers is one of the most motivating factors. Let's face it; it makes more
sense to retain employees than hiring new ones all the time. One of the best
ways I know to retain the health workforce is to make them feel appreciated.
Never underestimate the value of simply acknowledging the workforce for the
good work. Formal recognition may acknowledge performance but the informal one
has a greater impact.
Embrace change: While change cannot
happen overnight, there are a few things that county health sectors can do to
better the health sector and deliver better services to citizens. Allow the
entry of new technology to the counties; ‘digitalize’ some department or the
health facilities to start with, this will boost overall performance by
increasing productivity and health services
