Why more billions are at risk at Afya House

The ministry is in the process of running a Sh1.7 trillion HIV endgame project and a Sh227 billion World Bank loan initiative for reproductive health.PHOTO: COURTESY

More billions are at risk at the Ministry of Health, an audit has shown.

This, says the audit, is because the ministry lacks capacity to run the Integrated Financial Management Information System (IFMIS), an accounting system.

The ministry is in the process of running a Sh1.7 trillion HIV endgame project and a Sh227 billion World Bank loan initiative for reproductive health.

In June, an extensive study on the ministry's capacity to implement such big projects through the electronic accounting system was questioned and found to be vulnerable to manipulation.

The study by the Health ministry, Kenya Medical Research Institute, the London School of Hygiene and Tropical Medicine (UK), and the University of Oxford (UK) said the ministry lacked sufficiently trained personnel.

For example, it says the ministry has employed only 844 health records officers and six economists against a staff establishment of 4,071 and 53, respectively.

"These concerns were also echoed by health NGOs who felt the system is very 'vulnerable' due to shortage of human resources," say the study funded by the ministry and the Bill and Melinda Gates Foundation.

Administrators responsible for the electronic financial systems which involved the maternity and National Hospital Insurance Fund refund schemes, the study says, were not conversant with accounting language.

The study covered among others Nairobi and in all accounted for 17 per cent of the total population and 11 per cent of all health facilities.

"We believe that a nationwide implementation would be premature at the moment," advised the study published on June 28, this year in the Global Health Action journal.

Despite this advice, the Government has since brought on board two of its most expensive health projects in recent history.

In 2014, former Health Cabinet Secretary James Macharia launched a Sh1.7 trillion HIV Revolutionary Roadmap.

The programme promised to avert about 800,000 deaths, 1.2 million transmissions and eliminate new infections by 2030.

But it is the Global Strategy on Women's, Children's and Adolescent Health programme launched by President Uhuru Kenyatta last year that is of some interest.

The five-year programme estimated to cost Sh 227 billion between last year and 2020 is funded through a controversial loan by the World Bank’s Global Financing Facility.

The programme is being piloted in Kenya, the Democratic Republic of the Congo, Ethiopia and Tanzania.

According to the terms of this loan, Kenya and the other participating countries are each supposed to raise one dollar (Sh100) to qualify for four dollars (Sh400) as loan from the World Bank.

This has, however, met stiff resistance from a section of Western donors, describing it as a sure way of further impoverishing already poor countries.

In a report appearing in the scientific journal dubbed The Lancet, soon after the launch of the programme, Sweden had indicated its opposition to the scheme.

Consequently, Sweden declined to provide funds towards the plan. The Lancet report also mentioned Simon Wright, head of child survival at Save the Children, expressing his concerns over the Bank's arrangement.

"We remain concerned that the plan should not lead poor countries into more indebtedness," he said.

But even as the debate on allegations of fraud at the Health ministry continues in the media and among politicians, the voices of donors and civil society are conspicuously missing.

"I can't comment, remember the officers being mentioned have a lot of say on who gets funding even after this dust settles," said an outspoken HIV non-governmental organisation head on the promise of anonymity.

Hence this time round, Kenyans are unlikely to hear donor protests such as the famous echoes of 'vomiting on our shoes' by former UK High Commissioner to Kenya Edward Clay during the Mwai Kibaki era.

But things have changed since 2012 when Kenya's main donor, the US, altered its HIV funding policy from what it calls non-core to core activities.

In the shift that rendered hundreds of Kenyans in HIV NGOs jobless, the US had dropped behaviour change initiatives in favour of biomedical products consuming programmes.

Consequently, the US Embassy in Nairobi has invested highly in the Kenya Medical Supplies Agency as the sole vehicle to deliver these biomedicals.