Cartels hell-hole: Who's in charge of powerful cartels at Health Ministry?

The Health Ministry has witnessed many changes across various State Departments. [File, Standard] The scramble for billions at the Ministry of Health, deep rooted vested interests and radical policy shifts, have emerged as key factors behind the mess in the ministry, leading to frequent leadership changes. In less than three years since Kenya Kwanza administration assumed office, the ministry has had three Cabinet Secretaries, and five Principal Secretaries, raising questions about whether the interests of Kenyans are truly at the heart of these changes. The ministry has also witnessed many changes across various State Departments, including the Kenya Medical Supplies Authority (KEMSA), National AIDS & STI Control Program (NASCOP), National Health Insurance Fund (NHIF), and, currently the Social Health Authority (SHA). On Wednesday, President William Ruto transferred Aden Duale from the Ministry of Environment, Climate Change and Forestry to the Health ministry. He succeeds Dr Deborah Barasa, who had served for barely six months. Barasa took over from Susan Nakhumicha, who was appointed in 2022 under President Ruto's government. The high turn over and frequent changes have raised many concerns, with experts and unions questioning whether Duale will be able to address the issues in the sector and stabilise the ministry for effective service delivery. The Kenya Medical Association (KMA) Secretary General Dr Diana Marion said that instability in leadership, governance gaps, and inconsistent decision-making continue to undermine sustainable progress in the sector. "When political interference overrides structured planning, the consequences are felt in our hospitals, clinics, and communities. A mother in a rural dispensary struggling to get essential medication, a child unable to access emergency care, or a family burdened with high medical costs are all real reminders that health sector instability is not just about boardroom discussions, it is about real lives," said Marion. Leadership changes Marion faulted multiple leadership changes in recent years, each transition resetting priorities, delaying policy implementation, and disrupting long-term reforms. "Shakeup in the Ministry of Health creates uncertainty, disrupts critical reforms, and affects the morale of healthcare workers who are already stretched thin. Every time leadership changes abruptly, we lose valuable institutional memory, weaken existing structures, and push back the gains we have made," said Marion. John Juma, a health economist criticised the changes saying they reveal deeper problems in the country's top leadership, particularly in the office of President Ruto as the appointing authority. The current problem, according to the economist, is corruption, lack of accountability, and excessive control from State House. "The shake-ups will not solve the problems at the ministry because the problems originate from State House. Duale won't achieve anything unless the presidential advisors and the suppliers let the Ministry of Health free," Juma told The Standard in an interview. Kenya Medical Practitioners and Dentists Union (KMPDU) objected the appointment saying changes at the ministry is bringing unnecessary shake up. KMPDU Deputy Secretary General Dr Dennis Miskellah said the Ministry of Health is technical, and needs a technocrat to deliver the health agenda, qualities Duale does not possess. "We are not happy. You cannot keep destabilising the sector and expect smooth operations. Duale could not work with military. Shall he work smoothly in health that require technical understanding," questioned Miskellah noting that the health docket does not need a politician. "The sector needs someone who embraces policies for example if we say SHA is not working, he should get solutions to fix it, if there is an issue with interns, he should fix it. No politics, this is in black and white," said Miskellah. "What value is Duale coming to add in healthcare, honestly?" Balance interests Duale, he said will be required to learn how many cadres the health care has, laws that govern the sector, and also balance with Governors. Apart from shake up in CS positions, the sector has also had changes at the two state departments within the ministry-Medical Services and Public Health. President Ruto established two departments in the ministry to streamline healthcare governance and spearhead sector reforms. Peter Tum was appointed as Principal Secretary 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 valued at Sh3.7 billion led to their removal-Mburu was dismissed, while Tum was reassigned. In came Harry Kimtai who 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 KMPDU Secretary-General Fredrick Ouma Oluga appointed as PS for Medical Services. Miskellah said with appointment of Oluga to take over Medical Services, with Muthoni running preventive and promotive health, the sector was stable. Before Ruto's administration assumed office in 2022, the Health ministry operated under a single state department, overseen by PS Susan Mochache. "What value is Barasa going to add in environment? Do we really need healthcare to work? Do we really want SHA to work?" posed the unionist. "I am still waiting to see the value Duale will add. But as a union, we are saying if he comes ready to listen to us and make changes, we shall agree to that, but if he comes and bully us around, we shall just go on strike," said Miskellah. Implementation of CBA Miskellah maintained that doctors will be looking for implementation of their 2017 CBA and actualisation of the entire healthcare system like SHA. He added, "Until someone explains to me what Duale is coming to do at the Ministry, I am sorry. I am not saying he is incompetent, I am just saying he is unfit for the job. A hammer can drive a nail but it cannot drive a screw. Put the right person at the right job. As a union, we wanted this thing to work, but the actions makes us to doubt," said Miskellah. A senior official at the Ministry told The Standard that leadership at SHA is directly tied to the disbursement of SHA payments. The official, who requested to remain anonymous because of the sensitivity of the matter said the SHA individual has been manipulating payments to private payments. In the SHA payments list published on the authority's website three weeks ago, at least Sh1.4 billion was paid to SHA contracted hospitals. Top 10 counties which received the highest payments are Nairobi, Uasin Gishu, Kisii, Kiambu, Kisumu, Homa Bay, Wajir, Meru, Nakuru, Mandera and Migori. In the payments, Kenyatta National Hospital (KNH) got the highest amount of over Sh379.8m, followed by Kenya University Teaching Referral and Research Hospital (KUTRRH) at over Sh358m. Moi Teaching and Referral Hospital (MTRH) received Sh345.1 million, according to a 20-page document detailing payments made to various hospitals in the last three months. Other facilities with the highest payments included Rift Valley Provincial General Hospital, Nakuru (Sh179,543,911); Jaramogi Oginga Odinga Teaching and Referral Hospital (Sh132,343,775); AIC Kijabe (Sh122,767,559); Nairobi West Hospital (Sh129,273,579); North Kinangop Catholic Hospital (Sh103,455,944); Tenwek Hospital (Sh80,342,471); and Meru Doctors Plaza Limited (Sh73,585,962). Shockingly, the payment details were deleted from the SHA website, and flagged fake, after Kenyans and unions demanded audit into payment as smaller facilities were reported to receive more pay, despite their optimal operations. But Kenya Union of Clinical Officers (KUCO) Secretary General George Gibore applauded appointment of Duale, saying policy changes witnessed in the ministry could be behind the changes. Leadership at the ministry, according to the unionist, have not been able to spearhead health agenda the Kenya Kwanza administration is desiring to achieve. "The ministry needs someone who can be influential enough and be able to hold the ministry together including the county to fast track reforms and changes being reported," said Gibore. He added, "We feel there has been a lot of fragmentation, and things not falling in place. There is lack of clarity coming from the leaders in terms of what the ministry wants." Unifying leader The President Ruto's administration health agenda focuses on primary and preventive health unlike Jubilee Government under Uhuru Kenyatta that focused on curative health that was unattainable. The administration established laws to actualise UHC, namely Social Health Insurance Act 2023, Primary Health Insurance Act 2023, Facility Health Insurance Act 2023 and Digital Health Act 2023 that govern Social Health Authority (SHA) Nakhumicha was key in passing the laws. But amid plans to oversee their actualisation, she was sacked by President Ruto as a result of mounting pressure by Gen Z protesters. Duale, according to Gibore has leadership traits to push the health agenda, observing that ministry needs a manager, and not necessarily a trained doctor. "It is a better change. We want leadership, not just a name of a medic. Someone who can understand policy and how it should be implemented. I want to believe Duale can do better than Dr Barasa," he said. Actualisation of UHC has been major policy under Kenya Kwanza administration aimed at ensuring all Kenyans access quality care regardless of their financial status. SHA, is the main financier of UHC. However, despite SHA regulations requiring all Kenyans to register with the scheme, there has been laxity. Data shows 20 million people are registered with the scheme, but only four million are remitting deduction, an issue that might result into failure to actualise UHC. Kenyans have also complained of slow turn around time while seeking for care, while hospitals raise an issue with delayed claims. But according to Miskellah changes at the ministry are as a result of vested interests especially from private profiteers, and political interference. Miskellah said the ministry has cartels who do not work within the ministry. "They keep on saying Afya House has cartels but the cartels exists within the sector," Miskellah told The Standard in an interview. According to the doctor, private sector demand to have a say on how the running of the ministry, for example, how much health workers are paid, because they want public profits- "so that they pay their hospitals because they have profits." The ministry, he added, is influenced by individuals who want to bring foreigners to work without licenses for cheap labour, whereas others want to benefit from insurance cover. "We have people who want to get insurance deals for teachers and the police. Teachers are saying this thing is not working, the police are dying but nobody seems bothered," said Miskellah. Miskellah added that lack of proper leadership is also ailing the ministry. For example, he said the is a class between two state departments- Public Health and Medical Services, including the office of Director General of Health. Miskellah said the union and Kenyans had trust in attainment of UHC and smooth operations at the ministry when several professionals appointed, among them Seme MP Dr James Nyikal was appointed to chair the National Assembly Departmental Health committee.Dr Oluga according to the unionist is a technocrat with health knowledge being a trained doctor. "With technocrats at the helm of health we could have a proper structure to work on the issues. But what is this. Are we really keen on improving healthcare or we are just playing games," he said. He added, "With the recent appointments, I am afraid to tell Kenyans, that you better eat healthy and stay fit because there is no hope, not with the current governance structures both county and national." Governors who are expected to spearhead health, being a devolved function are however, doing little according to the unionist. "On matters health, Kenyans are on their own. They better know that. I feel sorry for Kenyans, and we have governors who are doing crazy things in counties at expense of health," said Miskellah. To actualise UHC and Taifa Care, according to Miskella, requires a stronger leadership structure, and good political will. "Sometimes I have wondered as a person, are failures of public healthcare intentionally structured to fail, so than somebody can benefit? Even when it comes to devolution, they said education is too expensive to devolve, they only devolved nursery schools. I sometimes wonder if actually we are serious with healthcare. Is it intentionally structured to fail?" he posed. Juma and Miskellah share same sentiments that despite drumming quality healthcare to all Kenyans, "there is too much talk and ideas on improving health care. However, when it comes to policy formulation and implementation, they have gotten it all wrong".

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