Many counties yet to receive medical equipment, says Munya

A team of doctors led by Navin Raina (second right) prepares to carry out diagnostic procedures at Mediheal Hospital in Nakuru on February 24, 2015 using a High-definition endoscopy machine. The multi-billion shilling medical equipment leasing plan was launched to answer the country’s need for accessible and affordable specialised health care. PHOTO | SULEIMAN MBATIAH | NATION MEDIA GROUP  

In Summary

• The multi-billion shilling medical equipment leasing plan was launched to answer the country’s need for accessible and affordable specialised health care.
• But its take-off was not without controversy with governors upset with the national government for assuming a devolved function without consultations.
• The bickering went to court when the Council of Governors and a lobby group, International Legal Consultancy Group, filed a suit to stop the leasing deal.
• Under the programme, two hospitals in each county were to receive to receive the facilities.

By WALTER MENYA
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The multi-billion shilling medical equipment leasing plan was launched to answer the country’s need for accessible and affordable specialised health care.

It came with a promise of bringing specialised healthcare services closer to the people.

“Soon, a hospital near your home will be well-equipped. You will not have to travel to Nairobi or overseas for specialised treatment,” President Uhuru Kenyatta said during the launch in May in Machakos.

But its take-off was not without controversy with governors upset with the national government for assuming a devolved function without consultations.

The launch was delayed by three months after contracts for the project between the Ministry of Health and equipment manufacturers were signed in February 2015 as the two levels of government bickered.
In fact, some governors had refused to sign the memorandum of understanding for the leasing of theatre facilities, dialysis kits, intensive care unit equipment and X-ray machines which cost Sh38 billion.

The bickering went to court when the Council of Governors (CoG) and a lobby group, International Legal Consultancy Group, filed a suit to stop the leasing deal.

Former CoG chairman Isaac Ruto then stated in court papers that procuring health equipment is a preserve of counties and allowing the national government to continue with the deal would rob off the devolved units of their mandate.

“Counties will lose a key part of their fully devolved mandate over the health sector if this court does not stop implementation of the MoU. The ministry has not disclosed to the county governments the contracts executed with medical equipment providers,” he said.

Seven months down the line, the implementation of the Sh38 billion programme is still enmeshed in controversies, including the status of implementation.

In his New Year address to the nation, President Uhuru Kenyatta lauded the programme and reiterated that the government would be done with it by June.

DELIVER PROMISE

“In 2015, we began to deliver the promise of effective, modern, hi-tech healthcare to all Kenyans.  In addition to the national, referral hospitals, we shall have two hospitals in every county equipped with facilities to screen and treat conditions that have caused patients, in the past, to travel abroad at great cost.  Already we have equipped 15 hospitals and our target is to complete the remainder by June 2016 to bolster access to health services.  Additionally the Government has in place a programme for 100 fully fitted containerised clinics with particular focus being improved services to informal settlements,” the President said.

Under the programme, two hospitals in each county were to receive to receive the facilities.
The suppliers of the equipment are General Electric (GE) from the USA, Philips from the Netherlands, Bellco SRL from Italy, Esteem from India and Mindray Biomedical of China.

“We have successfully engaged county governors to develop necessary conditions to attract appropriate professionals and to provide the resources required to make healthcare provision robust and sustainable,” he added.

But the governors and doctors union, the Kenya Medical Practitioners Union (KMPDU), are not only questioning the pace of the implementation of the programme but also the manner in which it is being done since most of the 94 county and two national hospitals earmarked for the programme lack the requisite infrastructure and personnel to operate the machines.

DELAYS IN DELIVERY

“There are only a few counties that have received the equipment,” Council of Governors (CoG) chairman Peter Munya said.
A tracking report by the CoG shows that only 15 counties have received the equipment.

The CoG report shows that only Kisumu and Kiambu have received equipment for two hospitals each while Kakamega, Bomet, Elgeyo Marakwet, Homa Bay, Kisii, Kirinyaga, Laikipia, Machakos, Murang’a, Nakuru, Nandi, Taita Taveta, and Uasin Gishu have deliveries for a hospital each.

But Health Principal Secretary Dr Nicholas Muraguri says there have been no delays in delivering the equipment.

“We are not behind schedule. We are on track to completing the programme by June,” the PS said.

Kakamega and Bomet got the deliveries despite officials in those counties saying they had not signed the MoU.

Dr Muraguri, however, told the Sunday Nation that he is only aware of Bomet which has not signed the MoU but one of its hospitals, Longisa Level Five hospital, received the equipment.

GOOD TO THE PUBLIC
“We talked to the Governor (Ruto) and agreed that we go ahead with the deliveries. He does not have a problem with that because these equipment are for the good of the public,” the PS said.

In addition, CoG said that the programme has plunged them into an unanticipated financial burden because each county will have to pay about Sh90 million annually as leasing fees for non-functional equipment. The leasing fees will be paid over a period of seven years, with the government paying about Sh4 billion in the current financial year.

Questions have also been raised on why the government was leasing some equipment that are readily available like instrument trolley, linen trolley and patient stretchers.

(READ: Leasing fees for county medical equipment inflated, leaders say)

While they are necessary, there is no reason for leasing them. I think they should have gone for major equipment. Why would the government lease a Sh15,000 equipment which even an individual can purchase?” KMPDU Secretary General Dr Ouma Oluga posed.

But the PS said the agreement with the suppliers was that the deliveries would come as a package. “If we were to buy all the equipment over the counter we would require about Sh70 billion. But with this model, the government is only going to spend Sh38 billion,” he said.

According to the PS, the government was satisfied with the progress being made in delivering the equipment to the counties.
For KMPDU, though the idea was good but the its implementation is wanting.

“The idea originated from our union during the negotiations with the government to end the doctors’ strike because some of the grievances we had were that there were no equipment for us to work with. But the implementation was not consultative. In fact I can say the whole thing was implemented under a lot of secrecy,” Dr Ouma said.

HUMAN RESOURCE SHORTAGE
“From our perspective, and we have stated this before, you don’t buy equipment without the doctors and other specialists to operate the machines. Otherwise, you will not serve the public,” Dr Oluga added.

The Ministry of Health, while acknowledging the human resource shortage, however, said that should not be a concern.

“I am not so worried about the human resource gap. Initially, that could be the case but progressively, we will get there,” he said, adding that the government has expanded training programmes for doctors, biomedical engineers and nurses in the country and abroad.

Auditor General Edward Ouko also told Sunday Nation that his office was looking into the programme.

“I am not in office. But the audit is in progress,” Mr Ouko told the Sunday Nation without getting into the details.

But Dr Muraguri said he was not aware of any audit queries about the programme.

“What is going on is routine audit. All government projects are routinely audited. But there are no specific audit queries. And even if there are, we shall provide the Auditor General with all the information he needs,” he said.

“It is going to be a game changer. It is going to transform health care in Kenya completely. And because of the model we have adopted, several countries are coming in to learn from us. Namibia is on the way,” the PS said.