Thousands of Kenyans could soon have their access to life saving HIV drugs cut because of turf wars in the two ministries of health.
Competition over who should control donor monies between the ministries of Medical Services and Public Health has already caused shortages of essential drugs in most public hospitals.
It is also the main reason why Kenya has been denied $270 million (Sh21 billion) by the Global Fund. The funds would have been used in the war against Aids.
Jostling for a piece of the cake, the ministries, which are headed by Prof Anyang’ Nyong’o (Medical Services) and Mrs Beth Mugo (Public Health), presented overlapping roles and budget lines in the rejected proposal to the Global Fund.
Kenya has appealed the decision, but chances of success are considered low, again as a result of competing agencies within the two ministries.
One component of the appeal proposed the strengthening of the national health systems. However, according to the appeals panel, it fell short of explaining how this will be managed and coordinated amid the rivalry.
“The majority of the proposed interventions fall within the responsibilities of the two ministries, but their roles have not been described,” says a report of the fund’s appeals committee while rejecting Kenya’s proposal a fortnight ago.
The National Aids and STDs Control Programme (Nascop), for example, has two heads each falling under the two ministries. This means there is duplication of efforts and an unsustainably high number of workers.
“No justification is presented for the high share of the human resource component or its sustainability,” says the report.
Apart from the two health ministries, other duplicative roles are allocated to the National Aids Control Council (NACC) under the Ministry of Special Programmes in the Office of the President.
Of particular concern to the Global Fund is the overlap of tasks between the NACC and Nascop.
The two run preventive programmes, some of which are similar, but each presents its own budget for approval.
NACC, for instance, has an information, education and communication component, that is similar to Nascop’s.
The two also have programmes around testing and advocacy. NACC argues that they have been doing all these things before the split of the Ministry of Health, and the tasks should not be taken away from them.
Under the current arrangement, the principal recipient of the Global Fund money is The Treasury. In 2008, with the formation of the coalition government and the split of the Health ministry, the Ministry of Public Health was chosen as the sub-recipient of the funds.
There are feelings in some quarters that this decision was influenced by coalition politics with Mrs Mugo, who is affiliated to the Party of National Unity, seen to have carried the day to the chagrin of Prof Nyong’o.
There is one school of thought which argues that ordinarily, money for procurement of ARVs should go to the Ministry of Medical Services which is in-charge of treatment and care, while Public Health handles prevention programmes.
Another school of thought argues that since the Ministry Public Health and Sanitation is in-charge of many of the health facilities at the lower level, then it has the right to control the way the funds are used.
Whereas the Global Fund does not dictate to governments on who should receive the money, sources within the NGO sector say they would have wished to deal with a single ministry.
As things stand now, the Ministry of Medical Services prepares a plan and budget of the drugs they require and then hands it over to the Ministry of Public Health and Sanitation to finalise the lucrative procurement process.
This situation is unpopular with the Medical Services ministry and some of its senior officials openly expressed their dissatisfaction with the way the treatment programme is being handled.
“When things go wrong with the procurement, it is the Ministry of Medical Services that is blamed,” complained one senior official at the ministry who did not want to be identified because of the sensitivity of the matter.
“Now everybody is coming to us asking about the fate of patients and the procurement — matters we have no idea how they were handled. If we are the ones doing treatment and care, let us also do the procurement,” added the officer.
With information trickling in that Kenya has been denied Round 9 funding, the two ministers have reacted differently.
Mrs Mugo is optimistic that the country will win the next round of funding from Global Fund, which it plans to apply for as a single ministry.
While officers in this ministry expressed optimism about future funding, those within the Ministry of Medical Services are speaking a different language.
They say they are not enthusiastic about applying for the next funding — Round 10 — since their morale is low after the appeal fell through.
The war over who controls HIV/Aids money is not new. It dates back to 2003, when the Ministry of Special Programmes, in the Office of the President, was assigned the HIV/Aids docket.
Then, some medics argued, HIV/Aids could have been tackled better by the Ministry of Health and was, therefore, misplaced under the Office of the President.
The Global Fund would have wished that these functions be tackled by one agency for uniformity, reduction in duplication of tasks and minimisation of wastage.
In fact, the Fund is said to have expressed serious reservations with how the roles of NACC, the Ministry of Medical Services and that of the Public Health and Sanitation are defined.
In some cases, the roles are either overlapping or misplaced.
The other issue the Fund might have based its decision to reject Kenya’s application for Round 9 funding is the failure to synchronise proposed activities of the various agencies with the budgeted figures.
Unless alternative sources of funds are found soon, Kenyans who depend on this cash for their very life are in for a rough ride.
An AWC Feature