COVID-19 :KENYATTA'S FAMILY IN 63 BILLION ILLEGAL HEALTH DEAL

When Jubilee government launched the multibillion shilling medical equipment leasing plan in 2013, it was billed as an answer to the country’s health challenges.

The move was expected to bring specialised healthcare services closer to the people

Seven years later, county governments are complaining that they are paying more than double the agreed cost of leasing the equipment from the national government.

State House was aware of multi-billion price variations in the controversy-ridden Sh63 billion medical equipment leasing deals for counties.

Council of Governors (CoG) chairman, Wycliffe Oparanya (Kakamega) told the Senate committee probing the Managed Equipment Service (MES) that the county bosses protested to President Uhuru Kenyatta about the price variations. 

Governor Oparanya told the Senate team that during a meeting between governors and the president, they questioned why each county had been asked to pay Sh200 million annually up from Sh95 million for the leased equipment.

In some counties, the high-tech equipment is still not operational for a number of reasons, including lack of trained staff to operate the machines.

In West Pokot County, only the theatre and imaging equipment are operational. Others such as dialysis machines and intensive care unit equipment are lying idle in stores due to lack of foundational infrastructure and specialised staff to run them.

TRANSPARENCY

Oparanya told the committee that the procurement of the equipment on behalf of the counties was not done according to the law.

“Governors made it clear in different council meetings that counties never requested for the MES project,” he said.

Revealing the contents of the Memorandum of Understanding (MoU) on the leasing scheme for the first time, Oparanya said some governors signed the document under duress.

“We signed it under duress because the pressure was too much. When I signed it, I didn’t even want to read it because the equipment were already there, they were delivered on a Saturday at night,” he said.

“What is before us is a general feeling supported by fact that somebody or some people sitting at the Ministry of Health headquarters connived to do business using counties as the conduit,” said Wetangula.

Oparanya told the committee that procurement in the project was not done according to county needs citing an example of Turkana County that received a CT scan machine even though it already had one. Other counties that Oparanya said already had some equipment but took in more under the MESwere Laikipia County (x-ray and theatre equipment) and Embu County (dialysis machines and a water treatment plant).

Senator Moses Wetangula (Bungoma) sought to know why the governors went ahead to sign the MoU before studying it. He expressed fear that the entire deal may have been fraudulent.

Healthcare workers in the county said even the new theatre equipment has not been a game changer because they only replaced the old machines with new ones.

“It’s not that we are doing more surgeries since the new equipment came nothing has changed,” one health worker who sought anonymity told the Nation.

The staffer said the imaging equipment work fine but the films are sourced from suppliers at rates far above the market price.

Although some governors and county health executives have hailed the leasing programme, others are complaining about the dent it has created on county coffers.

The project — officially known as Managed Equipment Service (MES) — has been controversial since the national government announced that it would invest Sh38 billion to equip 94 public health facilities with state-of-the-art equipment for theatre, sterilisation, dialysis, intensive care and radiology, under a public-private partnership model.

The bickering went to court when the Council of Governors and a lobby group, International Legal consultancy group filed a suit to stop the leasing deal.

The details on the monies involved in the contract have been scanty, and the figure has been changing.

In May 2017, former Health Cabinet Secretary Cleopa Mailu quoted US$450 million (Sh45 billion) as the amount the government had invested for the programme for “a long-term partnership with private providers for the period 2015 to 2022 to supply, instal and maintain medical equipment in health facilities in Kenya”.

The governors and doctors union, the Kenya Medical Practitioners Union (KMPDU), are not only questioning the pace of the implementation of the programme but also the manner in which it is being done since most of the 94 county and two national hospitals that were earmarked for the programme lack the requisite infrastructure and personnel to operate the machines.

COST

Mr Mailu said the programme would have “a training component for healthcare workers and to date a total of 98 health facilities in Kenya have benefited from the specialised medical equipment”.

Stakeholders said the training component has largely been ignored.

Speaking during county executives Mandera Senator , who was also the Senator Finance committee chairman, told KIE that the leasing fees had increased from the initial Sh95 million to Sh200 million.

Mr Mohamud said they were recently informed that the number of hospitals increased by 21. “We do not know where those 21 hospitals are located,” he said.

“The initial agreement indicated that the deal was for installation and maintaining the equipment. However, I have been to counties where the staff do not even know what the machines were to be used for,” the senator said.

“There is a lot of confusion. Even when we ask the minister, it seems she does not have the information as well. Something is clearly amiss,” he said.

CONSULTATION

While appreciating that his county had a weak healthcare system and may have benefited from the machines, he faulted the government’s assumption that all hospitals and all counties would have the same health needs.

Isiolo Governor speaking to us said he spent a “considerable amount to get the dialysis equipment up and running”.

In Turkana, health executive Jane Ajele said the county needs two additional renal nurses, saying the two they have are inadequate. The Health ministry has not responded to our request for comment.

In a previous interview, Dr Benjamin Tsofa, an expert in health policy and systems at Kemri Welcome Trust, said a health investment that takes a huge chunk of taxpayer’s money should involve some preliminary studies.

“The country does the maths to answer questions like, ‘is this cheaper and value for money over long term?’ ‘Is this the range of medical expertise that we need?’”

It is not clear whether such a study was done before the rollout of the MES programme.

STRATEGY

In April 2017, the Health ministry refused to hand over the contracts for scrutiny by the Health committee when the National Assembly Budget and Appropriations Committee raised questions about the extra monies allocated to the health docket.

Health economists say the benefits of MES include unburdening governments of technology obsolescence and provides access to customised financial solutions that can allow long term purchasing of equipment.

While referring to general public-private partnerships, Dr Gitahi Githinji, the group chief executive of Amref Health Africa, said: “PPPs are not bad as long as it is the government setting the agenda, and not the external partner.”

"The government should ideally look at its health strategy and needs and whether it would be cost-efficient to get another entity to provide services to its people and pay.”

He said the government should not focus on curative services alone and ignore primary healthcare that is cost-effective.