Health Ministry shake-ups raise hard questions on UHC rollout

Health PS Harry Kimtai before the National Assembly's Departmental Committee on Health to deliberate on the KNH Oxygen plant,at the Bunge Towers, Nairobi. April 24th,2024 [Elvis Ogina , Standard] The Kenya Kwanza administration has carried out sweeping changes in the Ministry of Health leadership over the past two years in a bid to actualise Universal Health Coverage (UHC) which is a cornerstone of the government's economic transformation agenda. These changes have included the hiring and dismissal of Cabinet and Principal Secretaries and structural reorganisation of the ministry as Kenya Kwanza attempts to overcome UHC's persistent teething problems. But views remain divided on whether these frequent changes are accelerating progress or creating obstacles to affordable healthcare. As part of the UHC agenda, President William Ruto established two arms - the State Department of Medical Services and Public Health -to streamline healthcare governance and spearhead sector reforms. Peter Tum was appointed as Principal Secretary (PS) for Medical Services, while Josephine Mburu was assigned the Public Health docket However, a procurement scandal at the Kenya Medical Supplies Authority (Kemsa) involving donor-funded mosquito nets led to their removal-Mburu was dismissed, while Tum was reassigned. In came Harry Kimtai who replaced replaced Tum as Medical Services PS, while Mary Muthoni took charge of Public Health and Professional Standards. In last week's reshuffle, Kimtai was moved to the Ministry of Mining, with former Kenya Medical Practitioners and Dentists Union (KMPDU) Secretary-General Fredrick Ouma Oluga appointed as PS for Medical Services. Muthoni, who retained her position, continues to champion the preventive and promotive health agenda under the primary healthcare pillar, where community health promoters play a crucial role. Before Ruto's administration assumed office in 2022, the Health ministry operated under a single state department, overseen by PS Susan Mochache. However, KMPDU Deputy Secretary-General Dennis Miskellah said splitting the ministry into two departments created confusion, particularly regarding budgeting and resource allocation. Dr Miskellah noted that overlapping functions led to critical oversights, including the failure to budget for medical interns last year. "The State Department of Medical Services initially budgeted for interns, but they were later transferred to the Professional Standards Department, which was unaware of the financial requirements," he told The Standard. "This led to the current internship crisis." A similar issue arose regarding training funds for registrars. Previously, the Medical Services Department covered tuition payments, but unclear responsibilities resulted in unpaid fees. "We hope that, with time, the ministry has resolved these issues and that each department now fully understands its specific roles," Miskellah added. In an interview with The Standard, Kimtai insisted that the established structures will actualise UHC, alongside newly enacted laws such as the Primary Health Care Act, Facility Improvement Financing Act, Digital Health Act, and the Social Health Insurance Act, 2023. "SHA (Social Health Authority) is the financier of UHC. I leave the ministry at a stable state. The systems started from zero - there were no laws. But with experts and officials, we ensured Parliament passed the necessary legislation, which President Ruto then assented to," said Kimtai. SHA was rolled out on October 1 last year, replacing the National Health Insurance Fund (NHIF), which had been in operation since 1967. Under the reforms, contributions to the Social Health Insurance Fund (SHIF) cover treatment at Level 4, 5, and 6 hospitals. Patients with chronic illnesses or emergencies benefit from the Emergency, Chronic, and Critical Illness Fund. Despite the government's push for SHA, concerns have emerged, including delays in claim approvals and limited tariff benefits. For example, overseas treatment are capped at Sh500,000. Kimtai, however, assured that tariff benefits are under review due to public concerns. "Kenyans' complaints are valid-for instance, SHA services at Levels 2, 3, and 4 hospitals have been limited due to delayed disbursement of funds from the exchequer. This is being addressed, alongside tariff adjustments," he said. The transition of staff at SHA is ongoing under the supervision of the Public Service Commission. SHA currently has 815 staff, compared to 1,732 under the defunct NHIF. Digitisation of health facilities nationwide, through the Digital Health Authority Act, is expected to speed up treatment and hospital payments under SHA. The Medical Services Department aims to digitise all hospitals, creating a paperless healthcare system - a key pillar of Taifa Care. This technology is already being piloted in Mombasa and Embu counties. "New systems and restructuring at SHA and the Digital Health Authority will shape UHC implementation," Kimtai stated. With healthcare being a devolved function, Kimtai emphasised that strong collaboration with the Council of Governors will be essential for delivering quality healthcare. As donor support declines, he stressed the need for domestic financing. Kimtai defended the ministry's increased budget allocation from Sh118 billion to Sh204 billion for the 2025/26 financial year, as outlined in the Budget Policy Statement that is awaiting National Assembly approval. Oluga, a former Chief Officer of Health at Nairobi Metropolitan Services (NMS) , is expected to build on Kimtai's efforts to implement UHC. KMPDU welcomed Oluga's appointment, citing his experience and public health track record. At NMS he spearheaded the construction of more than 70 healthcare facilities and recruited 200 doctors and nurses. The UHC agenda was initially spearheaded by Susan Nakhumicha, Kenya Kwanza's first Health Cabinet Secretary, before she was dismissed in July last year. Nakhumicha, who served as Health Cabinet Secretary from 2022, was replaced by Deborah Barasa last year following mounting pressure from Gen Z protesters. In an earlier interview with The Standard, Nakhumicha asserted that previous regimes had failed to implement UHC due to the absence of legal frameworks. Through the Kericho Declaration, signed in the presence of Head of Public Service Felix Koskei on October 18, 2023, health workers' unions, the council, and the ministry pledged to collaborate. Following the Sh3.7 billion mosquito net scandal, Andrew Mulwa was appointed as Kemsa's acting CEO before being succeeded by Dulacha Ejersa Waqo. Dr Mulwa was later reassigned to head the National AIDS and STI Control Programme earlier this year.

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