At 7:15am on July 24, 2019, the current Health PS, Ms Susan Mochache, sent out a congratulatory message.
It was to Dr Fridah Govedi, a paediatric specialist who had just been appointment the director of the troubled Kenya National Blood Transfusion Services (KNBTS).
Per the WhatsApp message, Dr Govedi was tasked with one duty: “To reinvigorate and transform” the department that had just lost donor funding from the US Centers for Disease Control and Prevention (CDC).
The CDC had set up the KNBTS in 2000, immediately after and as a result of the bombing of the US Embassy in Nairobi, during which Kenya’s acute shortage of safe, quality blood and blood products became apparent. The CDC supported the KNBTS to the tune of Sh1.6 billion until their phased, planned exit in 2019, which left a lean, Kenya-funded budget of Sh275 million.
Dr Govedi was in for a stormy ride.
That message was the first of many communications between Dr Govedi and Ms Mochache. These memos and messages would reveal just how the fight for power, and the wrangles between Dr Govedi and her staff, would ultimately lead to the near downfall of this very critical institution.
On Dr Govedi’s priority list was the injection of additional funds from the government to keep the Service going – Sh4.6 billion to start with, she said, even more would be required later. She also wanted staff who had worked for the service for over 15 years removed or transferred.
Top on her list was Mr Charles Rombo, a lab technician and the service’s technical head, who had worked at the department since its inception and had served under its various directors. Dr Govedi saw Mr Rombo as a threat to her job, and the two fought viciously over who would control this unit with both running to PS Mochache over every issue that was going on at the department.
Perhaps what is telling about their squabble is that both took their issues to the PS and not anyone else in the ministry. The PS controls the running of funds and is held responsible for the usage of monies within the ministry. Their fight indicated that all issues would be solved by only the holder of this office.
There was no way of beating Mr Rombo, he knew the KNBTS in and out and, having worked closely with the other directors, he had the upper hand.
He had also survived losing his job in May 2004 after a vehicle the institution had purchased was reported missing while in his possession. The loss of the GKZ 191 Isuzu Trooper led to his arrest, and he was arraigned in court on May 12 that year for the alleged theft of the said vehicle. Mr Rombo denied the allegations and in a letter to the then PS, stated that the loss of the car was no cause for termination.
Asked about his chequered past at the institution, Mr Rombo said he was cleared by the courts. “The case went to court and was finalised,” he said. “If someone wants to smear me with all things (sic) I may not be able to exchange (words) with them.”
He refused to engage further on other matters relating to the KNBTS, saying all issues should be raised with the current Cabinet secretary Mutahi Kagwe, or Ms Mochache.
The Nation, reached out to the CDC to find out about the loss of the vehicle and a separate event where over 20 laptops they procured were also reported stolen at the KNBTS. A CDC official clarified that while the US government implements an accountability and tracking system to make sure “all funding recipients (like the KNBTS) comply with US federal guidelines,” neither the car nor the laptops were purchased using funds they had disbursed, and so they did not play any oversight role in the matter.
Meanwhile, the department entered a particularly strained phase of its existence. On January 10, Dr Govedi called her first staff meeting since her installation and issued instructions that no partners should be engaged until they had been referred to her for vetting and formalisation of their relationship with KNBTS. The partners had been forwarded and vetted by the CDC, and their relationships and nature of engagement with the KNBTS had been defined in earlier agreements with prior directors. Dr Govedi toppled all those agreements.
In addition, she wrote to the ministry once more to ask for money. “For the future, to enable KNBTS to undertake infrastructural improvement, expansion to more sites and procurement of commodities, equipment of the requisite staff, Sh14 billion will be required annually," she wrote.
The messages between the two would go on until Dr Govedi was unceremoniously transferred to Kenyatta National Hospital’s paediatrics unit in February. Whenever the PS would ask for a status report, Dr Govedi would use the opportunity to not only brief the PS but also inquire about the transfer of staff from the service.
While the fight for power between Mr Rombo and Dr Govedi went on, Kenyans suffered the consequences of an acute blood shortage.
There were only two blood drives conducted between August last year and March in Nairobi, while social media was awash with requests for blood for relatives and friends.
In August last year, an expectant 18-year-old woman from Dol Dol, Laikipia County, who went to a nearby hospital to deliver would end up losing her child because there was no blood at the facility.
She suffered 14 hours of labour. When she started losing blood, the maternity wing doctor-on-call could not admit her for an emergency caesarean section because of lack of blood.
The lack of blood was not only limited to pregnant women, but accident victims, who needed blood also went without. Surgery patients would rely on well-wishers to rush to donate blood in various facilities.
KNBTS only collected 164,468 units of blood during this time, a drop from the 172,041 units that were collected between July 2018 and June 2019. This is against the World Health Organization guidelines for the proportion of donors relative to the total population. Kenya should be collecting a million units of blood a year.
Documents obtained by the Saturday Nation, however, show that despite the service’s historical inability to reach its collection targets, it had drawn up a procurement list for Sh500 million it had been assigned under the Universal Health Cover programme in March. The list shows the intention to buy 470,080 blood bags at a total cost of over Sh200 million.
Meanwhile, the blood shortage did not stop the bickering between Dr Govedi and Mr Rombo both who sought the approval of the PS. However, a Bill currently before Parliament, in which stakeholders sought to establish KNBTS as a State entity with the sole responsibility to regulate and co-ordinate blood transfusion services in Kenya, would make it a critical time to be at the helm of the unit.
The Bill proposes a semi-autonomous, centrally co-ordinated blood service with a specific mandate, structure, and governance mechanisms to carry out blood transfusion services in the country. This means the director of the KNBTS would run a fully functional parastatal with its own funds, and the CDC would not be there to keep an eye on the expenses. It would also mean that the director would have access to the Sh500 million from the UHC programme as well as Sh1 billion from the World Bank intended to strengthen capacity at the KNBTS.
The proposed law that is also targeting a cartel said to be profiting from the trade, also states that health facility owners face Sh1 million in fines or a three-year imprisonment for sale of blood without the Cabinet secretary’s clearance.
The Kenya National Blood Transfusion Service (KNBTS) Bill, 2020 which is currently before Parliament, also prohibits the import or export of blood without the express permission of the CS.
This bill comes at a time when the Health CS has called on investigations to be carried out at the KNBTS over reports of the blood being sold outside Kenya’s borders.
Those accused of selling blood include the former director Dr Josephine Githaiga, who has recorded a statement at the Directorate of Criminal Investigations (DCI).
While she may have left office a year ago, Dr Githaiga has been dragged into the wrangles going on between Dr Govedi, Mr Rombo, and other staff at the KNBTS.
Partnerships she entered in 2018 and 2019 were raised by Dr Govedi who has on several occasions stated that blood cartels exist within the KNBTS. The DCI is investigating if two memoranda of understanding signed by Dr Githaiga to supply blood from the Embu Regional Blood Transfusion Services (RBTS) to Dadaab and Kakuma may have led to shady under dealings that saw the blood sold to Somalia.
Dr Githaiga signed the first MoU with the National Council of Churches of Kenya (NCCK) to supply blood and blood components from the Embu RBTS to Dadaab and Kakuma refugee camps.
KNBTS would supply blood from October to December of 2018, which was airlifted from the Wilson Airport, to health partners in the camps which included Kenya Red Cross, International Rescue Committee, and Medecins Sans Frontieres (MSF) – Switzerland Kenya Mission.
To supply the blood, the team led by Dr Githaiga drew up a budget of Sh369,000 for refreshments and fuel for KNBTS vehicles during the three months of their partnership.
Upon the expiry of the contract, Dr Githaiga entered into another MoU with MSF Switzerland Kenya Mission in 2019 to provide 60 units of blood and blood components supplied in two phases bi-monthly to MSF Dagahaley Hospital in Dadaab.
As per the agreement, the blood would be transported by the MSF Dagahaley and would be supplied from Embu RBTS yet again.
“Unless otherwise specified MSF will undertake the payment of Sh150,000 per quarter in local currency in support on the Embu RBTC blood camp drives as the supplier of blood component to MSF Dagahaley Hospital,” the MOU reads in part.
In March 2019, however, Dr Githaiga wrote to MSF to make amendments to the MoU requesting the money be channeled to the accountant at KNBTS whose name is Terry Boore. Details of the account given are Cooperative Bank, Ukulima Branch, account number 01116025720000 bank code 0011.
When reached for comment, Dr Githaiga said she could not comment on a matter that was under investigation. The rest of the employees referred the Nation to Mr Rombo for comment over the matter.
Things came to a head in March, as Dr Govedi was ushered out of her job via a 30-word-long text message that PS Mochache sent, asking her to hand over the office.
Dr Govedi had just been removed as the director of the KNBTS, and appointed in her place: none other than Mr Rombo.
The final message from the PS came at 6:21am on March 11. It read: “Please ensure you hand over fully at KNBTS, fuel cards and all, I don’t understand why this has not been done. And vacate the office back to MoH as earlier instructed.”
Dr Govedi immediately wrote to the PS asking for her name to be removed from the Integrated Financial Management Information System (Ifmis).
As the head of the department, her name was in the government procuring list and she was liable for any transactions done by the department.
Her move was calculated but she had made a blunder in September when she ordered 23,000 blood bags from MD Harleys Limited, stating that full payment would be made once Ifmis was opened.
This was a rookie mistake on Dr Govedi’s part because she had single-sourced for the items. Single sourcing must be done through a defined process in procurement law. The impact could be seen as a corrupt practice allowing an officer to choose a favoured supplier, hence the fraudulent use of public funds. She may be charged with abuse of office hence the request to be removed from Ifmis.
While Dr Govedi went on to start her new job at the KNH, Mr Rombo went on to occupy his new office. The CS Health also constituted a national advisory committee to oversee the supply and utilisation of blood and blood products in the country ,which Mr Rombo was also a part of.
However, Dr Govedi was not out of the race; she returned on May 4 to scatter all plans the ministry may have had in moving forward, with a court order reinstating her as KNBTS director. Mr Rombo was no longer the head of the unit.
With Dr Govedi’s return, CS Kagwe also dissolved the advisory committee. This was too much for Mr Rombo who would no longer operate at the head office and is said to have moved his work station to Afya House waiting for resolution of the matter. On May 16, Dr Govedi staged a spectacular come-back, arriving with workmen who broke into the KNBTS director’s office and changed the locks.
Meanwhile, at the head office, the employees are on a go-slow with some changing the locks to Dr Govedi’s office despite the court order reinstating her. The fight for who will take over this office remains unknown especially with PS Mochache roped into the drama. Kenyans will, however, continue to suffer as they wait for the KNBTS to finally resolve their issues.