Kenya’s public health system is in a crisis with corruption as the biggest challenge. The latest suspension of $21 million (Sh2.1 billion) direct funding to the Ministry of Health by USAid adds to a series of issues pointing to a system in need of urgent governance and leadership changes.
The impact of the doctors’ strike that dragged on for more than 100 days is still fresh, but the government has not fully honoured the back-to-work plan signed with the doctors. Earlier revelations by government auditors that Sh5 billion could have been misappropriated is the most heartbreaking because proper use of these resources could have helped thousands of poor people to access lifesaving services.
As a doctor who previously managed a district hospital, I know the realities of financial mismanagement too well. Every day, doctors are forced to send patients to private facilities for medicines and laboratory testing. And, too often, doctors watch helplessly as Kenyans die of conditions that could easily be treated with the right resources. For every dollar misappropriated, a child is likely to die because they cannot access lifesaving medicine such as antibiotics.
Assertions by Health Cabinet Secretary Cleopa Mailu that the suspension of funding by USAid will not affect service delivery is unfortunate and appears to ignore major challenges in the health sector that need to be addressed urgently. Even though the suspended amount of $21 million is a small fraction of the estimated $650 million (Sh65 billion) total support by USAid to the health sector, it is a signal of the level of abuse of public funds.
Many public facilities are going without essential supplies and medicines, leaving the poor without healthcare. Recent conversations with several colleagues still working in the public health system point to a very frustrated workforce – doctors and other health workers are trained to heal and often get frustrated when they lack tools to do so.
The suspension of USAid funding on grounds of corruption should, therefore, act as a wakeup call to face a major challenge that cuts across the whole health system – from the Ministry of Health headquarters to the counties that are constitutionally responsible for health delivery. Every day we see incidents of fraud, waste and abuse of public resources by those charged with the responsibility of healthcare delivery. The action by USAid should be a warning to other development organisations that support the much needed maternal and child health services. With fewer resources coming to support provision of essential services, many women, children and adolescents will die.
There are, however, a few actions that can be taken to improve the situation. First the President needs to step in to ensure the law enforcement agencies act against high ranking public officials recently named in the health sector corruption scandals. This will send a strong signal to our partners that we are keen on making good use of their taxpayers’ money.
Second, there is an urgent need to reform the priority setting and procurement systems. We can do this by working with governance experts to check wastage and fraud in counties, appropriately named “devolved corruption”. Devolution was envisaged in the 2010 constitution to improve healthcare. However, because of a poorly developed roll-out plan devoid of checks and balances, we now see overt fraud, wastage and abuse at the county level. This leads to too many lives cut tragically short and lost productivity due to avoidable illnesses among the poor.
Finally, we need to increase registration with the National Hospital Insurance Fund. Every year many Kenyan families fall into poverty when forced to pay high out-of-pocket expenditures for a sick family member. Expanding participation in the NHIF will help prevent this because it will put the purchasing power in the hands of the patients to choose between public and private providers based on quality. It will also shift the role of government away from service provider to that of a strategic purchaser, thereby reducing avenues for corruption. All health facilities should be contracted by NHIF to deliver high quality services to citizens at pre-negotiated prices.
Ultimately, the Kenyan public using NHIF cards would be able to access treatment and medication for cancer, heart disease and other diseases without any payment. If Kenya implements these reforms, more people will have access to improved quality services using the resources currently available.
Dr Bernard Olayo is a public health specialist and founder of the Centre for Public Health and Development. He is an Aspen Institute New Voices Fellow.