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Pumwani left Sonko with egg on his face

By Irungu Houghtonn | September 22nd 2018

The pendulum of public approval can be treacherous for populist leaders. Nairobi Governor Mike Sonko recently found this out in the calamity of Pumwani. What started as an action to expose staff negligence has left the entire management of our county health system exposed to public scrutiny.

The question is, what can the governor do next? Pregnancy, child-birth and after-care comes at great risk for most babies and their mothers. Twenty mothers still die giving life each day across Kenya. And 75 per cent of infants who don’t make it die in the first seven days. Maternal health-care is critical priority for all our 47 county governments.

At 9.27pm on Sunday September 16, Governor Sonko received a whistle-blowing call claiming the Pumwani’s life-support machines had been switched off. Eleven babies had died as a result. It needs to be acknowledged that he moved quickly to act personally and publicly.

Within hours of the visit, the Hospital Board and key staff had been interdicted and suspended. When the county secretary, health minister, chief officer and the county attorney contradicted his analysis, they too were suspended.

But now that the dust has cleared, it is clear Sonko misfired by acting on partial information as Pumwani has bigger problems.

Based on various accounts, it is now clear that babies were not killed by staff negligence and the deaths have now all been accounted for. The hospital is, however, poorly managed, under-funded and resources are poorly allocated.

Too many of the staff at Pumwani are not directly involved in patient care. Out of a workforce of 800, there are only 12 doctors and 116 nurses. There are only five obstetric gynecologists. Absenteeism, demoralisation, poor supervision and staff tensions are rife. While health is allocated 21.5 per cent of the county budget, huge budget cuts have directly affected Pumwani. The autoclaving machines broke down twice that week. The lack of a working incinerator, body-bags and a morgue is only part of the problem. New-borns often share the same beds and the neo-natal unit is run down. Medical recordkeeping is weak, a factor that might have led to the governor’s heightened suspicion during his televised raid.

But there is nothing more dangerous for the reputation of an elected leader than to get it so wrong in full view of the public. For other professions, it is the equivalent of a brain surgeon operating on the wrong person or a Fire-Marshall operating a fire engine with no water.

In moments like these, honesty and corrective action is the only way out. In his characteristic way, Sonko turned to personal philanthropy to address the real public health challenge that lies squarely at his door. His personal donation of cooler boxes may be an admission that he now understands how the 11 babies ended up in plastic bags.

Political populism has its strengths. Listening to the needs of the vulnerable is important in a world where too many of the powerful listen too little. It also has a disruptive capacity to shake up bureaucracies that are too self-interested to act in public interest.

Political populism has its weaknesses too. If decisions are guided by the personal priorities and styles of the leader, he or she will inevitably overreach and make mistakes. Over-reacting without facts never gets to the source of the problem. Failing systems can only be rescued by institutional approaches not personal populism and blame raids.

Now that the complexity of the problem is clear, there are some choices Sonko could make. Reinstating the county health and legal leadership would be an important one. Involving them, the doctors and nurses unions and other oversight bodies to address old problems would be another.

A reliable and open feedback and complaints management system that can verify rights denials would also go a long way to catalysing the county government to act.

-The writer is Amnesty International Executive Director. He writes in his personal capacity. Twitter: @irunguhoughton


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