Health service that left more questions than answers

As the clock ticks towards the end of a deal the county governments signed for health equipment, it remains unclear what happens next.

While the national government maintains a straight face that the deal was above board, counties and senators continue asking unanswered questions on what is contained in the fine print.

The latest comes after the Auditor General raised queries over the same during an ad hoc committee meeting of the Senate chaired by Bungoma Senator Moses Wetangula on Tuesday this week, stating that procurement laws were flouted, contracts varied and counties forced into the arrangement.

On February 5, 2015, after much haggling, the Ministry of Health, counties and Managed Equipment Service (MES) providers signed a deal that would see counties receive medical equipment and pay every month for them. Now the senators want to know who the directors of the service providers are.

The tender sum was Sh43 billion to be shouldered by the counties. So far, Sh18 billion has been paid with counties paying Sh95 million annually, a sum which has risen to Sh200 million. The contract was to run for seven years with the possibility of an extension for three years.

Four months later, the Council of Governors (CoG) claimed that governors were forced into the deal. The then CoG chair Peter Munya, who was governor of Meru County fired a protest letter to the national government.

“The purpose of this letter is to request your esteemed office to follow up on this issue and confirm all governance systems have been followed as provided by public financial management act and that the contractual agreements meet economic and ethics rules and other laws as laid out in the constitution. This will ensure the Governors are not held responsible for any misdeeds related to this project,” stated the council’s letter.

Dr Wekesa Masasabi, the director general of health says that the contention is over the nature of equipment and the amount counties should pay.

"Counties have complained that while they got different equipment, they have been forced to pay a flat rate from the equitable share revenue, and this is why some of them have raised concerns and asked the government to review this," says Dr Masasabi.

He, however, states that the tendering process was overboard and states that the missing link could have that counties were not consulted as to whether they were ready for the equipment they received.

Recently, in a heated session, the senators termed it a major scandal.

“Mr Speaker, we are staring at a huge scandal in the Ministry of Health,” said Makueni Senator Mutula Kilonzo Junior.

But this is not the first time the Senate is raising issue with the deal. On April 30, 2019, senators debated the medical equipment project and asked for it to be scrapped.

Mandera Senator Eng Mohammed Mahamud called for funds proposed not to be included in the budget. He pointed out that the project has been a bone of contention between various stakeholders.

“This Senate, because of the confusion in the medical equipment leasing – there are no answers coming in terms of the cost of the project; when the project will end and what is being delivered – in the BPS, as I said, we recommend the suspension of that project pending further information. 

The senator castigated the project as having many grey areas that are yet to be resolved as counties have never been aware what they are signing for as “The equipment is delivered in in counties and in crates and containers and they are told to keep them.”

Mahamud said, “I urge Senators that even if the leasing of equipment was noble and was going to be beneficial, it cannot be a gravy train where we shroud it in mystery and nobody wants to answer questions. We have seen even how our own distinguished colleagues in the Committee on Health have looked helpless bystanders as these things happen in the country.”

At the county level there is mixed feedback.

In Wajir County, two hospitals benefited from the arrangement; Wajir County Referral Hospital received theatre equipment, a renal unit and imaging equipment. County director of health Dr Dahir Somow says that when the equipment came, people were looking at hardware and not software – that could have been the first pitfall.

“To have proper dialysis services, you need a nephrologist or a physician without which the machine will be of no use,” states Somow.

The county had to take its health officers for training on how to operate the equipment. The coming of Cuban doctors in an exchange programme was another boon since the one posted to the hospital was a radiologist who operated the radiology machine; but that was for a while.

Somow explains, “When the two Cuban doctors were abducted in our neighboring county, Mandera, in April their fellow doctor with us here was taken away for security reasons.”

But he adds that generally, it has helped alleviate some of the challenges that the residents faced like having to seek dialysis services out of Nairobi. He argues that despite claims of the equipment being overpriced, the quality was good.

In Siaya, the county director of health Dr Ken Oruenjo said that some of the equipment supplied are still not in use. The county received a CT scan, radiology machine, ICU machines and a dialysis unit.

Oruenjo says that the ICU equipment is not yet in use because there were parts that were not supplied thus rendering the entire unit unusable. The CT scan is also not in use because the radiation protection unit is not yet complete.

“We have already trained the professionals to handle these equipment but they are still not in use because of missing parts or because where they are to be operated are not complete,” says Oruenjo.