If we fail to crack the nut of how to incentivise public doctors, devolution may fail altogether. This, at least, is Luis Franceschi's argument (Unhealthy Devolution: Underpaying doctors will take us from health to hell, Daily Nation, 22/11/13). This blogger will not quibble with that analysis for it is cogent and reasonable. However, when Mr Franceschi suggests that the solution lies in county authorities being more imaginative, because their lack of imagination has prevented them from offering solutions, he fails to appreciate that it is not a lack of imagination that will bring this crisis to a head, but what has become a troubling pattern with county governments nationwide: greed.
The reasons for the clamour for devolution are now well-known. The people were used to the central government, and the President, being the centre of the developmental universe. What the President decided, and what his government did, were one and the same thing. For almost forty years, the central government was an expression of the will of the President. It mattered not what the people wanted; the President knew best and doled out public funds without being troubled by things such as unequal distribution of natural or public resources and such like. With the election of Mwai Kibaki n 2002, and his re-election in 2007, things took a turn.
We may disagree vehemently on the political impact of Mwai Kibaki's presidency, but only the truly determined will find reason ti argue that Mwai Kibaki went to great lengths to spread around public resources. the death-dealing, but shiny, new highways are merely the most visible expression. His government experimented with various economic tools, including Kazi Kwa Vijana and the Economic Stimulus Programme to elevate the level of development in different parts of the country. Chapter 12 of the Constitution is the logical culmination of the past decade's changes. It fails or succeeds on whether county governments are capabe of tempering their avarice for the good of the people. Their records, thus far, have been disappointing, bar one or two truly inspired political; leaders at the county level.
Mr Franceschi is right; if county governments design a public finance system that will retain the services of public doctors (and if such a system is sustainable), in the long run, this will guarantee that families at the county level reduce the amount of family finances they spend on primary healthcare and the long term health costs of the county government will go down, with the savings going towards the county development budget. As we have observed over the past nine months, bar perhaps Dr Alfred Mutua in Machakos and Dr Evans Kidero in Nairobi, county governors lack the spark that will ignite the lamp of innovation in their governments. William Kabogo of Kiambu, for example, has been at war with his assembly since he took office; he is yet to unveil a strategy for the county that could have benefitted most from its close proximity to the Capital. Dr Julius Malombe of Kitui has failed to knit together an effective working relationship between his executive committee, the county assembly, his senator or his representatives in the National Assembly. Because of this, he is yet to unveil the strategy for exploiting the known, and large, reserves of coal, iron ore and limestone in his county. Similar stories are replicated in the remaining 43 counties.
It is therefore, optimistic to anticipate the moment when county governments will set aside petty political triumphs or losses in order to focus on the fundamentals of governance: healthcare, private investment and employment, market growth and stability, food and water security, infrastructure development and constant improvement in educational standards and facilities. They may be fundamental but they are the hardest nuts to crack. They require significant investment by both the public and private sectors. Some do not show instant results and may take a generation or two for their impacts to be felt. It is the impatience, and the glory-hounding of governors, that almost makes one despair. It is why this blogger believes that the fate of devolution is tied to the crop of governors and county representatives elected at the next general election. If the likes of Bungoma's Kenneth Lusaka are re-elected, we are doomed. If more who are in the mould of Dr Alfred Mutua are, devolution may yet restore Kenya to glory.