Why President’s pet project is on its deathbed

Wednesday, October 28th, 2020 00:00 |
Then Health CS Sicily Kariuki (now in Water docket) and Narok Governor Samuel Tunai sign an agreement on Universal Health Coverage last year. Photo/PD/File

Mutuku Mwangangi and Noven Owiti

The government is racing against time to salvage one of President Uhuru Kenyatta’s pet projects, the Universal Health Coverage (UHC) from imminent collapse.

Dogged by problems ranging from misuse of funds, corruption and inadequate infrastructure to diversion of funds to the Covid-19 pandemic, the multi-billion-shilling project appears to be on its deathbed.

Medical practitioners maintain that though the project was noble, the government may have tried to “bite more than it could chew” when it moved to implemented it at once.

Now technocrats at the Ministry of Health are pondering how to revive a project once billed as the panacea to the challenges bedevilling the health sector.

To salvage UHC from collapse, the ministry has organised a four-day forum in Mombasa, beginning tomorrow, to initiate a complete audit of the pilot scheme with a view to formulating “fresh implementation strategies”.

The meeting, which is expected to be graced by President Uhuru Kenyatta, will bring together stakeholders in the health sector including governors, medics, insurance experts, economists and sociologists to re-evaluate the scheme.

On Saturday, the President is expected to hold a roundtable meeting with governors to decide the fate of the project.

Yesterday, Health Cabinet Secretary Mutahi Kagwe told People Daily the Mombasa meeting will take stock of the successes and challenges facing the project before deciding on the way forward.

“During the meeting, we shall receive the score card from the four counties where the pilot was done and evaluate where we have come from, where we are and where we are going,” Kagwe said.

But other sources intimated that the meeting will mainly focus on the financial challenges facing the programme. 

Unveiling the project on December 12, 2018, the President said UHC  programme would go a long way in addressing challenges facing the country’s health sector and termed it part of his Big Four Agenda for sustainable national development.

“Universal health coverage is essential in addressing our national challenges and will go a long way in achieving the core principle of the Vision 2030 Agenda, the realisation of a society where no one is left behind,” the President remarked the following day when he launched the programme and signed the UHC Charter with four governors in Kisumu.

Harsh verdict

The programme was to be implemented in four phases starting with the pilot one in Kisumu, Nyeri, Isiolo and Machakos before rolling it out to the remaining 43 counties.

But almost two years after its launch, stakeholders are questioning the viability of the project amid high expectations from the public and various players in government.

Already, the Council of Governors (CoG) has passed a harsh verdict on the project, describing it as “a total failure” that needs to be re-evaluated afresh.

In their meeting with Kagwe last week, governors attributed failure of the scheme to a number of factors, among them failure to clearly define the UHC policy through consultations between the two levels of government to form a basis for joint allocation of funds and the overdue demand to restructure the National Hospital Insurance Fund (NHIF) and Kenya Medical Supplies Authority (Kemsa).

Others are failure to recruit additional medical staff and lack of clarity in the Ministry of Health’s liaison with the Red Cross over the training of community health volunteers.

Yesterday, CoG chairman Wycliffe Oparanya told  People Daily that the project was implemented without adequate consultations between the various stakeholders, leading to its failure.

“We hope that the meeting in Mombasa will come up with a better mechanism, particularly financing, to put it back on track. But so far, there is nothing to celebrate about the scheme,” Oparanya said.

The governor disclosed that after its failure, residents of the four pilot counties were asked to revert to NHIF to access medical services.

Machakos Governor Alfred Mutua, whose county was among the four, believes his was a successful venture due to the political will. “The success of UHC would be determined by political will and not financial support. In any case, the implementation of free secondary and primary education is more expensive than UHC,” Dr Mutua said.

“If every county can be allocated about Sh2 billion within a year, translating to Sh100 billion for all the counties, we shall be able to purchase equipment and drugs as well as pay doctors,” Mutua says.

But Mutua is opposed to the ministry’s proposal to bring on board NHIF, arguing that not every Kenyan can afford to pay the state health insurer’s monthly minimum fee of Sh500.

While rolling out the project, the President disclosed that the four pilot counties had received Sh3.17 billion conditional grant, with each getting Sh800 million.

According to a Memorandum of Understanding with the Ministry of Health, the counties were to match the amount with their own investments, one of the reasons that led to the failure of the project.

About 80 per cent of the money was to be used to buy drugs and basic medical equipment for the pilot phase that was to end on December 13, 2019, but was later extended to March 13, 2020.

Basic medicines

Health sector stakeholders have decried lack of inclusion in policy making and funding challenges as some of the shortcomings that grounded the programme.

According to the Kenya National Union of Nurses chairman Joseph Ngwasi, the project’s roll out was rocked by insufficient personnel, lack of capacity building and motivation to the medical staff who are the executors of the programme.

There were also insufficient medical supplies and pharmaceuticals that made it lose meaning since patients were forced to buy prescribed basic medicines in private health facilities. 

“The supply of commodities surprisingly went down such that facilities were straining to get basic medicine. How does the Government expect this programme to succeed when there are no basic drugs such as painkillers and antibiotics?” Ngwasi asked.

There have also been concerns from different quarters that corruption claims dogged the programme ranging from employment of medical professionals to supplies of commodities by Kemsa.

Oparanya said the project’s failure was largely contributed by Kemsa’s monopoly, turnaround time of orders and poor products. Health stakeholders have also cited lack of clear implementation policy ahead of the anticipated rollout, especially on the issue of community health workers who provide services at the primary level.

There has also been a lack of adequate healthcare professionals, especially in Radiology departments.

A good example is Makueni county that has not been able to offer Radiology services due to lack of a radiologist. Multi-million-shilling CT-scan machines procured under the leased programme lie idle in Makueni Level Four Hospital as patients seek services from private health facilities.

In Kitui, the health sector has reportedly been grounded even as the county rolled out a universal medical cover. Patients seeking medical services in public hospitals were forced to buy prescribed drugs from private clinics.

The project was also bogged down by frequent strikes and go-slows by health personnel due to unpaid and or delayed salaries. In Embu county, the situation is the same as patients fully finance their treatment. 

According to the chairman of all County Executive Health Committee Members (CECM) in the country and Makueni Health CECM Andrew Mulwa, the project failed due to unpredictable funding. Makueni County was the first to implement universal healthcare at the onset of devolution. “

Input financing does not guarantee a better healthcare because it is not sustainable at all and that is why we are pushing for an output reimbursement through either NHIF or any other mechanism,” said Dr Mulwa.

 Makueni County was the first to implement universal healthcare at the onset of devolution, making it a benchmark for the national UHC roll out.

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