Kenya’s 2013/14 Health budget cuts threaten to cripple sector

By Paul Wafula

NAIROBI, KENYA: For every Sh100 President Uhuru’s Government will spend this year, only about Sh5 will go towards the ailing healthcare system.

This is less than last year and only a third of what Kenya and other African countries pledged to invest on healthcare two decades ago. It also makes 2013 the fourth year in a row that Kenya has cut health spending in a trend sector insiders say is grinding medical facilities to a halt.

In 2010, Kenya spent Sh7.20 for each Sh100 on healthcare. This fell to Sh6.10 in 2011 and last year, it was further cut to Sh5.9. This year, the national and county governments plan to spend Sh5.70 per Sh100 on the sector, translating to 5.7 per cent of the Sh1.6 trillion budget.

Doctors have termed the trend “a catastrophe”. They note the Government will spend Sh2.50 this year for every Sh100, and worry that counties are likely to follow the precedent set by the National Government.

The underfunding is happening at a time when most medical equipment in public health facilities are more than 20 years old, some double their lifespan, and may experience frequent breakdowns.

Lacked equipment

Last week, The Standard reported how a Kisumu clinical officer at Chula Imbo hospital recently watched a mother and her unborn child die because an ambulance did not have fuel to ferry her to the Kisumu General hospital for specialised treatment.

In a month long campaign that seeks to get to the bottom of Kenya’s medical negligence, we also reported how a health officer helplessly watched a 12 year-old child die of meningitis at Malava District hospital in Kakamega County because the facility the child was transferred from lacked the proper equipment to diagnose and treat the disease. It was too late to provide effective treatment to the child at Malava.

“All of us at the ministry know that this is not enough. But what do we do? We just have to do with what we are given,” a senior official familiar with budgeting at the Health Ministry, who requested not to be named for fear of retribution, told The Standard On Saturday. Health Cabinet Secretary, James Macharia, raised concern over the inadequate funds. Mr Macharia says his docket needs Sh160 billion, but only received Sh34.7billion.

But even worse, at least 40 per cent of the total budget allocation is lost through corruption, questionable procurement and misappropriation of funds. “We lose 20 to 40 per cent as has been documented in a World Health Organisation report,” said Dr Boniface Chitayi, the former secretary general of the doctors union.

It has also emerged that the Government has no intention of implementing the Musyimi task force report, that is critical in reforming the sector, given the competing interests on expenditure under a tight budgetary environment.

Devolved

“It is now apparent that the whole process of developing it was primarily to hoodwink doctors into ending their strike of 2011. The great document that came out of the process has been thrown onto the shelves of the archives to gather dust,” Dr Sultani Matendechero, the Kenya Medical Practitioners and Dentists Union (KMPDU) secretary general said via email sent to us.

The doctors union says most hospitals need weighing scales, thermometers, blood pressure machines, glucometers, stethoscopes, laryngoscopes, foetoscopes, patella hammers, pulse oximeters, ultrasound machines, incubators, delivery beds and so on. The needs in terms of infrastructure are colossal.

“We also need renal dialysis machines, MRI and CT-Scan machines in selected hospitals. The list is endless. Our hospitals are in a pathetic state,” Dr Matendechero added.

The Government however, says that devolution has added a new matrix to the implementation of the report given that the bulk of health functions are being devolved.

“Implementing it (the report) will be done over the years. What has not been clear is that some money has been allocated to the county governments, so the total expenditure will be more than the Sh34.7billion allocated for the National Government,” the Director of Public Health and Sanitation Dr Shahnaz Kassam Sharif said in a telephone interview.

The Standard On Saturday has established that the county governments have been allocated Sh60 billion for health in addition to the Sh34.7billion set aside for the National Government. This brings the total allocation to Sh95 billion, or 5.7 per cent of the budget.

But doctors argue that it is impossible for counties to spend over Sh60 billion on health. They say the county Governments will not spend 28 per cent of their money on health alone given that they have other priorities like infrastructure, salaries, and local developments funds. Even if the counties were to spend the entire Sh60 billion allocation on health, it would still mean there has been a reduction to the sector progressively over the last ten years.

Doctors have maintained that unless the Government implements the reforms, there is no end for the pain that patients are undergoing due to underfunding of the sector.

According to the Musyimi task force report made available to The Standard On Saturday, the National Treasury was to allocate a minimum of Sh217 billion to the Health Ministry to implement a three-year plan dubbed the health stimulus package. This was to begin last year. But the Government has apparently developed cold feet. Treasury was also to increase progressively, at 2 per cent per annum, the Ministry of Health budget until Kenya can achieve the Abuja Target of 15 per cent of the budget.

Data from the economic survey 2013, and budget estimates, reveal that Health Ministry allocation was reduced significantly in the last three years where spending decreased from 7.2 per cent in 2010 of the Sh998.8 billion budget, to 6.1 per cent in 2011 and 5.9per cent in the Sh1.5 trillion budget of 2012.

The sector is running on less than a third of its recommended budget. Though the real figures have been growing year on year, the increment has not matched the pace of the total budget. The health sector has not been prioritised at the same level as education and infrastructure.