How graft, greed tainted Uhuru Kenyatta's lofty plans for health

President Uhuru Kenyatta and Deputy President William Ruto inspect medical equipment procured through the Managed Equipment Services (MES) Project at State House, Nairobi. [PSCU, Standard]

Fifty years after independence, President Uhuru Kenyatta took over the leadership of the country his father had led immediately after independence. Within these five decades, Kenya had gone through three presidents, had its fare moments of optimism and pessimism too.

But as he got sworn into office, no one would have imagined that he would be fighting the same problems his father vowed to end. Top on the list was a collapsing healthcare system whose creaking foundations unintentionally supported the lives of millions of Kenyans.

Healthcare was a key and critical election promise by Kenyatta as he, for the second time, made a stab at the presidency in 2013.

“Our hospital services must be improved, with better pay and conditions for healthcare professionals and a higher standard of care and treatment for patients being central to our health sector reform agenda. Easily preventable illnesses such as malaria, tuberculosis and HIV/AIDS still claim too many lives each year,” Kenyatta’s 2013 manifesto said.

“Only 1 in 10 Kenyans has health insurance and our public health facilities are stifled by inadequate management, insufficient medical supplies and poor procurement procedures. A pitiful 12% of current Government spending on health goes to running services; the balance is eaten up by bureaucracy and corruption.”

The problems facing healthcare were clearly identified. The solutions too were provided in the document of his election pledge. The problem lay in executing the solutions and dealing with the ghosts of Afya House once and for all.

“The intention was there,” nurses union boss Seth Panyako says. “There were various declarations and announcements made that could genuinely have benefited the people but all these grand plans fell through.”

The 10 years of Kenyatta’s presidency were not short of the grand. For him and those around him, it was to either go big or go home. Unfortunately for them, this only opened up key areas of service delivery to bigger corruption.

One of the noble ideas suggested within the public healthcare system was the mobile clinics initiative meant to be spearheaded by the Office of the First Lady in 2014. The idea was simple. Not every part of the country was accessible.

To bridge this gap, the Office of the First Lady, in collaboration with the Ministry of Health, launched an ambitious project to reach the disadvantaged. The architecture of the project was anchored on mobile clinics – low loader lorries fitted with containers customised to offer health services.

The dream was grand. The units were to be fitted with a mini-emergency room complete with a maternity ward to help reduce the mortality rates at delivery. With time, it was argued, these units would also be fitted with enough equipment to handle most medical emergencies.

Every county was to receive at least one such clinic to help it keep up with the medical needs of the residents. Less than two years later though, this initiative became one of the most scandalised projects by the government.

In the years that followed, empty containers were supplied to government at exorbitant costs. Many of those supplied had little more than the odd stethoscope and a stool. It was estimated that the National Treasury lost Sh800 million paid out to faceless suppliers with close ties to the government.

The clinics though were just a tip of the corruption that characterised President Kenyatta’s first term in office. In totality, estimates say that Sh5 billion was lost during that same period through elaborate schemes within Afya House.

Among the schemes was the botched Managed Equipment Services Scheme (MES). The original idea of the scheme was for the national government to support devolution of equitable, accessible, affordable and quality healthcare by equipping two hospitals in every county and four national referral hospitals with outsourced specialised state-of-the-art medical equipment.

The aim of the project was to provide Kenyans with excellent, uninterrupted health services regardless of their location in the country. Under this arrangement, equipment manufacturers were outsourced to supply, install, train users, and provide maintenance, repair and replacement services for the specialised medical equipment for the duration of the MES contract.

But there was a catch. While the national government sourced and contracted the suppliers, counties, who were the main beneficiaries of such a scheme, were left in the dark.

Kenya signed contracts with five private firms in 2015 to lease specialised equipment like CT scanners to the 47 county governments, who manage most health services, in a deal praised by the World Bank at the time for its ability to be replicated elsewhere on the continent.

“Counties are not aware of the contractual agreements on the Managed Equipment Services (MES) between the National Ministry of Health and the suppliers of the equipment,” said then Council of Governors Chairman Wycliffe Oparanya during his submissions before a Senate ad-hoc committee formed to investigate the leasing of the MES in 2019.

The Senate was to later term the deal by the government a “Sh63 billion criminal enterprise that flooded hospitals with over-priced and unnecessary equipment”.

“The MES (Managed Equipment Services) project was a criminal enterprise shrouded in opaque procurement processes,” the Senate’s ad hoc committee on the deal said in its final report.

The sheer greed within the health sector underlined Uhuru’s first term. The deliverables were few and far apart. Even the most noble of ideas were somehow tainted by insatiable greed.

The end of his first term saw massive drug shortages across major public hospitals, some gains such as the fight against HIV/Aids, malaria and tuberculosis were constantly under the threat of erasure.

Funding for the health budget under Kenyatta increased marginally to 9.1 per cent from around 7.8 per cent when he took over in 2013. This, though, still fell short of the 15 per cent pledge.

“While government allocations to the health sector and the MOH have increased in absolute terms over the last three fiscal years, the overall share of the health ministry’s budget at the central level as a proportion of total government budget remains small, impeding the ministry’s ability to perform its constitutionally assigned functions, including advancing the piloting and scale-up of universal health coverage,” a 2021 policy brief on Kenya’s health sector by a consortium of aid organisations reads.

This inadequate funding hit the country where it hurts the most.

“Strategic programmes for HIV, tuberculosis, malaria, medical commodities/drugs, and vaccines suffered as funding declined from Sh20 billion in FY 2017/18 to Sh15.2 billion in FY 2019/20,” the brief reads.

The full extent of the years of underfunding and underdevelopment was to be experienced in 2020 as Covid-19 spread across the world, landing in Kenya and stumbling upon an ill prepared government with an even more unprepared health sector.

Critical infrastructure that can be termed as basic such as the availability of oxygen in public facilities led to hundreds of deaths from the virus. Healthcare workers responded to the pandemic with limited protective wear.

The one thing though that the country was eventually able to do – purchase of emergency medical supplies and protective kits for health workers – was again shrouded in graft.

In September 2020, investigators recommended the prosecution of at least 15 top government officials and businessmen over the misuse of billions of shillings meant for buying Covid-19 medical supplies.

As dozens died and thousands were hospitalised across the country, a cabal of politicians and well-connected business people profited from the non-supply of protective equipment for healthcare workers.

“Investigations have established criminal culpability on the part of public officials in the purchase and supply of Covid-19 emergency commodities at Kenya Medical Supplies Authority (Kemsa) that led to irregular expenditure of public funds,” reads a recommendation by the Ethics and Anti-Corruption Commission in September 2020.

The commission further recommended the prosecution of all officials at Kemsa over allegations of the scandal.

Past the cloud of graft, there have been some strides made within the health sector too. In February this year, Kenyatta launched the national scale-up of the Universal Health Coverage (UHC). Although still in its early days, the scheme promises to provide a lifeline to millions of Kenyans to whom healthcare is an unattainable luxury.

“My administration has developed the Universal Healthcare Coverage Policy, covering the period 2020–2030, to guide the acceleration of the progress in attaining Universal Health Coverage,” the President said during the national rollout.

Official numbers from the Office of the President also boast of an increase in health infrastructure.

“The investments the government has made since 2013 have seen an increase of 43 per cent in public health facilities from a stock of 4,429 facilities in 2013 to 6,342 currently. In the same period, our ICU capacity has increased by an impressive 502 per cent and our total hospital bed capacity has also increased significantly by 47 per cent,” President Kenyatta said.

As he leaves office, he has handed his successor most of the problems he inherited from his predecessor. In essence, the same problems facing healthcare that his father pledged to end 60 years ago will still be part of Cabinet discussions after the August 2022 polls.