Scandals threatening President Ruto's bid for better healthcare

A worker at Kenya Medical Supplies Agency warehouse at its headquarters in Embakasi, Nairobi, on November 25, 2022. [Elvis Ogina, Standard] Over the last 12 months, the health sector has been dotted with damning scandals even as it struggles to implement the much-hyped Universal Health Coverage (UHC). The Kenya Kwanza government, under President William Ruto, has been struggling with scandals reported in various agencies within the Ministry of Health. The agencies which have been rocked by scandals include the National Health Insurance Fund (NHIF) and Kenya Medical Supplies Authority (Kemsa). President Ruto went head-on to sack Health PS Josephine Mburu, and suspended Kemsa CEO Terry Ramadhani after they were implicated in the Sh3.7 billion mosquito nets scandal. Ruto, who appeared agitated in an interview with a local media station after the scandal came to light, assured Kenyans that he planned to restore order at Kemsa. "Watch this space, what you have said is correct. I am doing something about it, and I do not want to speak it now, you will see results," said Ruto. For emphasis, he added: "I want to give you my commitment that I will clean Kemsa, whatever it takes, whatever it costs, I will clean up Kemsa." Mburu became the first high-ranking government official to be sacked, just a few months after taking office. Irregularities witnessed in the procurement of long-lasting mosquito nets at Kemsa saw the donor withdraw the tender, which was handed over to Wambo.Org. In the scam, Kemsa's technical evaluation committee had identified Partecea East Africa as the winning bidder. However, in its review, the Global Fund found that none of the bids were responsive. In the tender, the authority was to earn 2, 3, and 5 per cent of tender value for the various transactions, which translates to Sh74 million, Sh111 million and Sh185 million, respectively. The 2 per cent is money earned for the procurement process, three per cent is for warehouse services and five per cent for distribution. There were 17 bidders for the mosquito nets tender. A total of 10 million mosquito nets were to be distributed. Health Cabinet Secretary Susan Nakumicha with Kenya Medical Supplies Authority board Chairman Irungu Nyakera when they appeared before the National Assembly Health Committee at Panari Hotel in Nairobi on June 20, 2023. [Boniface Okendo, Standard] Officers suspended alongside Ramadhani were Martin Wamwea, Lenson Kariuki, Dr Pauline Duya, Livingstone Njuguna, Dr Charles Kariuki, Justus Kinoti, Cosmas Rotich and Anthony Chege. Investigation into the matter is ongoing by parliamentary and senate health committees and the EACC. Ruto appointed Dr Andrew Mulwa as the acting Kemsa CEO, and Irungu Nyakera as the chairperson. The two were appointed alongside Hezbon Omollo, Bernard Bett, Dr Jane Masiga and Ms Jane Mbatia, who are all board members. Health CS Susan Nakhumicha has maintained she is determined to fight corruption at the authority. "I will not stop at anything, even if it means sending home an entire department, I am ready to do it," she said. "This institution must be clean. We are going to uproot all the roots, all the evil spirits that have been planted in this institution- nitazing'oa (I will uproot them)," said Nakhumicha during the inauguration of the new CEO and board at the authority. But to stop corruption at the authority, Prof XN Iraki, an economist and a professor at the University of Nairobi, said monopoly should be done away with. Lack of competition, he said, has continued to affect the smooth flow of work at Kemsa, resulting in substandard work. "Kemsa should not be a monopoly. Anyone willing to buy medical commodities should buy from an open market so that Kemsa is just a supplier, just like any other," said Iraki. He added: "Anytime there is competition, people will improve on quality, efficiency, delivery. But without competition, it is naturally we shall have substandard work" According to Iraki, once the monopoly status is done away, there will be transparency and efficiency in service flow at the authority. James Kamau, a health economist, and the CEO of Kenya Treatment Access Movement said Kemsa should be an independent authority. Mr Kamau said though it is an authority, it operates under the Ministry of Health, an issue affecting its independence. "Kemsa is influenced by individuals at the ministry, a move that has led the authority into trouble as it has to play to tunes of individuals with interest," said Kamau. Also, to avoid misappropriation of funds and irregularities in distribution, Kamau observed that Global Fund and other donors should procure commodities directly, and hand them to the Kenyan government, instead of providing the country with tenders for supplies. "We get allocated Global Fund money, to buy medical commodities, but we 'steal' it. Why can't we then receive commodities instead?" posed Kamau. Wrangling at NHIF has also seen managers at NHIF in Nairobi and Meru Counties suspended, over alleged minting of millions of shillings through rough hospitals in their areas. The action was taken after it emerged that a section of Kenyans have lost millions of money through dubious payment after being coaxed by individuals claiming to be employees at NHIF. Hospitals under probe in the scandal include Among hospitals which had been scheduled for grilling include Jekim Medical Center in Meru, St Peter's Orthopedica and Surgical Hospital in Kiambu and Afya Bora Hospital in Mwea, Meru. Others are Joy Nursing and Maternity Hospital in Kamkunji Nairobi, Jekim Hospital in Imenti South, Beirut Pharmacy and Medical Center. It is alleged that the hospitals were paid at least Sh1.54 billion for 30,11 claims made between July 2022 and June 2023. President William Ruto during the groundbreaking ceremony for Kakamega Aggregation and Industrial Park in Likuyani Constituency, Kakamega County, on August 31, 2023. [Hiram Omondi/PCS] Facility owners in the two counties are alleged to ferry patients across the country to hospitals within the two counties. Unfortunately, some of the patients are left unattended, subjecting some to premature death. Nevertheless, NHIF which the patients are subscribed does not cater for the treatment of the patients, leaving cumulated unpaid bills. Nakhumicha admitted that corruption at NHIF was deep-rooted. "We have a big problem. How is it over 60 per cent of the payment goes to private facilities," she said while appearing before the National Assembly Health Committee led by Robert Pukose. The CS pleaded with the committee to support her in the fight, for the smooth operation of the health system. "I am seeking your support to be with me on this one. If you are really intentional about us cleaning health in this country, we must work together, there is no way out of this," said Nakhumicha. Even with anatomy of sagas at the ministry, the CS has maintained she will handle them head-on, and ensure Kenyans receive quality healthcare. Makhumicha has maintained that NHIF is a primary cog in the implementation of Universal Health Coverage (UHC) which a key agenda for the Kenya Kwanza government. The insurer, she said, will ensure all Kenyans enrol for health scheme, and access quality health services. "NHIF is critical in achieving Afya mashinani, aimed at delivering primary healthcare at the grass-root," said the CS.CS. In December 2017, President Uhuru Kenyatta announced improved healthcare through UHC, which was aimed at ensuring equitable access to healthcare, without risk of financial hardship.

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