Afya House scandal should cause highest level of public outrage

I am grateful to be back on this column after taking a break to mourn my mother, Peris Nyaboke, who passed away recently.

In the short period that my mother has been gone, and despite the incredible kindness of the people around me, I am experiencing the full meaning of the words by Cardinal Mermillod who wrote “a mother is she who can take the place of all others but whose place no one else can take”.

My mother’s death, coinciding with the revelation of a major financial scandal affecting the Ministry of Health, has given me new insights into the value of life and, therefore, also a sense as to how unacceptable it is that corruption in the management of healthcare continues to blight the lives of the poorest people in the country.

At the heart of the Afya House scandal is a silent contest between the national and county governments regarding their respective mandates in the management of healthcare in the country. To be sure, the Constitution is not to blame, as it unambiguously vests all healthcare responsibilities on county governments, making this a devolved mandate. Why, then, should there still be a contest?

Two reasons explain the on-going problem. The first is a habit on the part of the national government not to let go of anything that it is capable of retaining control over, an impulse that was responsible for killing regionalism under the 1963 Constitution.

With a unitary government under the previous Constitution, the centre was the sole actor in the management of healthcare in the country, a situation that was brought to an end under the new Constitution.

PROVED DIFFICULT

The ability to let go of this function has proved difficult for the national government. This same problem afflicts the management of functions that were previously under the national government, and which the Constitution vested in independent commissions. The management of policing is a good example.

Second, because county governments are still only young things, they face undeniable capacity challenges in the management of their mandates, including healthcare. These circumstances provide an easy excuse, if not a reason, for the national government to continue holding onto its control over the management of the health functions in the country.

The politics of the management of healthcare is that the national government is pursuing a policy of deliberately undermining the constitutional arrangements on healthcare, ultimately to create a justification that health services should revert to the national government.

Thus there is a mismatch between the legal and the political over the management of healthcare. While the legal mandate is vested in county governments, in practice, the national government remains the driver of healthcare issues.

It is these circumstances that led to the problems at Afya House when the national government put in place arrangements that have now become a scandal.

A clear difficulty in the relationship between the two levels of government regarding healthcare is the lack of a focal entity that represents or negotiates with the national government on behalf of the county governments. In law, and in fact, each county government is a separate and independent entity in any negotiations with the national government.

SEPARATE NEGOTIATIONS

However, since it may not be practicable for each of the 47 county governments to maintain separate negotiations with the national government, it would be appropriate to have a focal entity, outside the Council of Governors, to address the relations between the two levels of government. Such an arrangement would foster responsibility, increase efficiency and also provide the leverage that county governments currently lack when engaging on healthcare issues.

A second problem has been a lack of publicly-available information on the substance of healthcare arrangements. Up to now, the contents of the alleged agreement by the national government for the leasing of health equipment by county governments is not publicly available and is only talked about in conjecture. It should be possible for the public to scrutinise the contents of such an important agreement. Further, the various agreements that are the subject of the Afya House scandal are only referred to in the audit documents but are not otherwise publicly available.

A framework law on the management of the relationship between the two levels of government regarding the provision of healthcare would provide for the parameters under which negotiations can be carried out and should also oblige the highest levels of transparency in the management of that relationship.

Thirdly, there is currently no organised demand at the grassroots level for county governments to improve their performance. This means that they lack any pressure to improve.

DENYING LOSS

The government has reacted to the Afya House scandal by denying that money was lost, promising to investigate and bring accountability and, thirdly, levelling its own accusations that malevolent people bent on tarnishing the good name of the government have, yet again, created an imaginary scandal. None of these reactions is new and is what the government does every time a corruption scandal emerges. The government has also shown great keenness in suppressing dissent on the Afya House scandal, coming down heavily on street protests that were planned against the scandal.

None of these actions are consistent with the rhetoric within Jubilee that the government is committed to fighting corruption.

Since many of us love the people who are closest to us, and feel deep pain when they become ill or suffer death, especially under avoidable situations, the Afya House scandal, a crime against the most vulnerable, should motivate the highest levels of public outrage, and popular action against corruption.

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