I am writing this letter addressed to you Hon. Mutahi Kagwe, the Cabinet Secretary for Health acknowledging the commitment, focus and determination you have exhibited since taking over the docket. Its tough being a Health CS in a sick country with over-dozed cartels fueled by corruption injected tenderpreneurs working with some public agencies that have dirty hands, cannot isolate from bad behavior or keep social distance from stealing public funds in face of such pandemic as COVID19. But as ever, you are a tough Kenyan and might try the establishment of the health Commission to oversee the provision of health services to Kenyans. By the way, the Teachers Service Commission, the Public Service Commission, the National Police Service Commission, among other commissions in other sectors have not been a very bad experiment. While you have emerged as a very good media consumer and follower, I am not sure you will get time to read this.
It’s unfortunate that you took over the health docket in the midst of the COVID-19 pandemic, which then has seen the implementation of mitigation measures including military, public health, and legal interventions, Kenyans are unwilling to realize that the virus exists, problematic government communication architecture, an endemic cartel system at the ministry of health (former Ministers; Fred Angatia, Dr Amukowa Anangwe, Charity Ngilu dealt with similar lethal ones), devolved health ministry with centralized services, governors with mixed priorities, overstretched and demoralized health professionals. I am sure while the drugs, testing kits and other small stories have surprised you, try the payroll, touching on ghost health workers and you will see the mother of all battles with the cartels.
Other commitments by the government including providing 15 percent of the national budget to health as committed through the Abuja Declaration have failed, regulation of medical health, implementation of a fully functional universal access to health as per the President’s big agenda and halting the migration of health professionals from the country because of poor or leaking financing are still struggling. The leasing of medical equipment and the centralization of the medical and drug supplies and the attendant massive failure and accountability is a lesson that has gone into the country’s history as the worst approach for the national government in supporting devolved functions.
Of the several attempts that have been fronted as a way of dealing with challenges in the health sector, the establishment and actualization of the Health Commission as provided for under the right to adequate health is still the untested intervention. Some of the problems the health sector is experiencing and is stuck in would have been dealt with firmly by a professional, accountable, and functioning health commission, as the constitution had provided for, and what experts have raised several times. Let the ministry concentrate on policy implementation and guidance, as you leave matters including pay, welfare, research, insurance, promotion, and related to the health commission. It would be the commission doing, for example, insuring the health professionals just like the other commissions have done for their staff, data on current payroll and state of financing of the sector, recruitment and human resources issues, promotions and overseeing the remaining phases of devolving health- with structures including sub-county and county health services that will enable dealing with grassroots issues. Medical supplies to the counties is a major challenge in the value chain, and for the health, ministry to depend on the counties to give the exact data of health situations in the country, where they have no presence, it’s hard. Just look at the results.
The government, through Vision 2030, commits to improve the overall livelihoods of Kenyans; provide an efficient and high-quality healthcare system through devolution of funds and management of healthcare. The President’s Big Four agenda once more prioritizes the provision of health care especially access to universal health and this merits serious attention.
To achieve this milestone, the government promised to delink the Health ministry from service delivery and concentrate on policy guidance in order to improve management of health institutions primarily by devolution of health management to communities and healthcare experts to counties and national hospitals. However, the operationalization of the body to harmonize these functions is missing- we have still maintained the old way of running health, while expecting different results.
Try a well funded, professional and structured health commission and you will have scored big, not just for yourself, but for the health professionals, health services and the country.
Victor Bwire is the Deputy CEO and Head of Programs at the Media Council of Kenya.