New regime has a healthy dose of medical stuff to sort out

The incoming government will have a lot on its in-tray regarding state of healthcare given that health is among the Big 4 Agenda that President Uhuru Kenyatta's administration has been pushing for. Others are food security, manufacturing and affordable housing.

For starters, the Kenyatta administration over the last ten years, pumped billions of shillings into flagship projects in the health sector ranging from the Linda Mama, Managed Equipment Service (MES) project, Cuban doctors and Universal Health Coverage (UHC). More billions still, were lost in multiple scandals, including misappropriation of Covid-19 funds, NHIF, Afya House scandal and mobile clinics.

During the period the health docket was under four different Cabinet secretaries: James Macharia, Cleopa Mailu, Sicily Kariuki and now Mutahi Kagwe.

Of all the projects, Linda Mama, allocated more than Sh4 billion to kick off has sustained positive reception, reducing maternal and infant deaths.

Elizabeth Malel from Rongai, Nakuru County, is among hundreds of mothers who directly benefitted from free delivery under the Linda Mama Programme established in 2016. Since then, about 1.1 million mothers registered for the scheme annually.

Malel delivered her daughter via caesarean section at the Margaret Kenyatta Mother Baby Wing, at the Rift Valley Provincial General Hospital, without paying a penny.

"I was wheeled to theatre for an operation, having had an emergency. My National Hospital Insurance Fund (NHIF) card, covered the bills, plus follow-up care of my baby," said the mother, who delivered on December 3, 2019.

Linda Mama, under the NHIF, caters for deliveries, natural and CS, treatment and management of complications, arising from pregnancy, and at birth. The insurer caters for at least four post-natal visits, for monitoring the health of a baby.

According to NHIF CEO Peter Kamunyo, at least 65 to 75 per cent of deliveries are offered through Linda Mama.

"Though the number of CS deliveries is increasing, the programme, in general, has benefitted more women who would have otherwise not had access to hospital delivery services," Dr Kamunyo said.

Before the introduction of free hospital delivery, majority of women sought help from traditional birth attendants, contributing to high maternal and infant deaths.

For example, in 2008/9, Kenya's maternal deaths stood at 488 per 100,000 lives, according to Kenya Demographic and Health Survey, a number that reduced to 365 per every 100,000 lives in 2013.

Data by the ministry documents maternal deaths at 342 per 100,000 lives.

In this 2015 photo, President Uhuru Kenyatta and Deputy President William Ruto inspect medical equipment procured through the Managed Equipment Services (MES) Project at State House, Nairobi. Also present is CS for Health James Macharia, Director of Medical Services Dr. Nicholas Muraguri and Cheng Minghe of Mindray Megascope Health Care. Photo: PSCU

Though the Managed Equipment Service (MES) was launched with good intentions to boost healthcare in counties, President Kenyatta's Sh63 billion project has been marred by damning scandals.

The Senate ad hoc committee reported in September 2020 termed the project as 'a criminal enterprise shrouded in opaque procurement processes".

According to the report, the Ministry of Health relied on a 'faulty tool (public sector comparator) to justify a predetermined outcome in relation to the award of tenders that likely resulted in imprudent use of public finances'

Challenges encountered during the implementation of the project launched in 2015 included lack of a sustainability strategy beyond the seven-year contract, lack of specialised personnel and infrastructure to absorb the equipment in some counties.

Also, value for money could not be guaranteed given the inefficiencies of the procurement processes.

The Senate asked the Directorate of Criminal Investigations (DCI) and the Ethics and Anti-Corruption Commission (EACC) to investigate the scandals. No action has been taken, even as the MES programme moves to its second phase, with counties forced to remit Sh200 million as lease fees. In the financial year 2021/22, the National Treasury allocated Sh7.2 billion for MES project-whose equipment has been put to use in some counties, while others gather dust at hospital stores due to lack of trained health professionals.

For example, theatre equipment assigned to Ziwa County Referral Hospital in Uasin Gishu County was unilaterally reallocated to Moi Teaching and Referral Hospital (MTRH) despite there being a viable alternative health facility.

Meru County has also been paying Sh200 million annually for the past five years, yet theatre equipment is still in the Netherlands.

Former Bomet Governor Isaac Ruto maintained that the idea to lease equipment was misplaced, unnecessary, and a waste of taxpayers' money as the equipment should have been bought instead of leasing, thus giving taxpayers value for their money.

Ruto, the only governor who did not sign the MES project reckons that, "Most of the leased equipment were already purchased by the county governments and as such the ministry should have first consulted the counties to find out their needs to avoid duplication."

Former Governor Joyce Laboso, who succeeded Ruto, signed the MoU on behalf of Bomet County in 2018.

Kisumu Governor Anyang' Nyong'o and chair of the Health Committee at the Council of Governors (CoG) says though MES project has impacted on the healthcare system, there are still some grey areas. Prof Nyong'o cited the dispatch of equipment to counties without establishing the requirements that should be addressed in the second phase.

During the first phase, Nyong'o said the government ignored human resources, an issue that affected the smooth operation of the equipment.

"Payment of MES should be as per the use, and if not in use, they can be taken back to the manufacturers in certain terms," said Nyong'o.

"We should leave counties to decide whether they want to enter into lease, for certain equipment and make a choice, and be supplied."

The MES project was first provided as an item on 'Feasibility Study' in 2013/2014 budget estimates and captured as 'Lease of Equipment' in subsequent financial years before the project was officially launched in the 2015-and the lease of the equipment done during the tenure of Cleopa Mailu.

Uhuru's tenure has also been faced with a shortage of human resources, an issue that contributed to numerous strikes by health workers, with a historic one in 2016/17 where several doctors' union officials were arrested and taken to court.

Following the strike, Uhuru's government under Heath CS Sicily Kariuki, flew in 100 Cuban doctors, to bridge the human resource gap across the country.

In June last year, Health CS Mutahi Kagwe signed a new cooperation agreement with Cuban Minister of Public Health Jose Angel Portal Miranda to allow 101 specialised Cuban doctors work in the country, as part of an exchange programme between the two states.

"There are many opportunities in Cuba that remain untapped, especially in the area of pharmaceutical, biotechnology, and vaccines. We look forward to a more robust collaboration," said the CS, during the signing of the agreement in Havana, Cuba.

Kagwe said the Cuban exchange programme is aimed at improving the country's primary healthcare system as a catalyst to achieving universal healthcare.

"One of the bridges you can have is to bring in experts to work with our locals, and I believe that's partly why the Cuban doctors were brought in, but I have a feeling it was also to show Kenyan doctors that there are other alternatives," said Dr Timothy Olweny, the secretary general of private hospitals.