Why more billions are at risk at Afya House, Kenya

By Gatonye Gathura

More billions are at risk at the Ministry of Health as an expert audit says ministry lacks capacity to run the IFMIS accounting system.

The ministry is in the process of running a Sh1.7 trillion HIV endgame project and a Sh227 billion World Bank loan initiative for reproductive health.

In June an extensive study on the ministry’s capacity to implement the electronic accounting system had warned it was vulnerable to manipulation.

The study by the Ministry of Health, Kenya Medical Research Institute, the London School of Hygiene and Tropical Medicine, UK, and the University of Oxford, UK, said the ministry lacked sufficiently trained personnel.

For example, it says the ministry has employed only 844 health records officers and six economists against a staff establishment of 4,071 and 53, respectively.

“These concerns were also echoed by health NGOs who felt that the system is very ‘vulnerable’ due to shortage of human resources,” say the study funded by the ministry and the Bill Gates Foundation.

Administrators responsible for the electronic financial systems which involved the maternity and NHIF refund schemes, the study says were not conversant with accounting language.

The study covered among others Nairobi and in all accounted for 17 per cent of the total population and 11 per cent of all health facilities.

“We believe that a nationwide implementation would be premature at the moment,” advised the study published on 28th June 2016 in the Global Health Action journal.

Despite this advice the government has since brought on board two of its most expensive health projects in recent history.

 

In 2014 the former Cabinet Secretary for Health Mr James Macharia launched a Sh1.7 trillion HIV Revolutionary Roadmap.

The programme promised to avert about 800,000 deaths, 1.2 million transmissions and eliminate new infections by 2030

But it is the Global Strategy on Women’s, Children’s and Adolescent Health programme launched by President Kenyatta last year that is of some interest.

The five-year programme estimated to cost Sh 227 billion between last year and 2020 is funded thorough a controversial loan by the World Bank ‘s Global Financing Facility.

The programme is being piloted in Kenya, the Democratic Republic of the Congo, Ethiopia, and Tanzania.

According to the terms of this loan Kenya and the other participating countries are each supposed to raise one dollar to qualify for four dollars as loan from the World Bank.

This has however met stiff opposition from a section of Western donors describing it as a sure way of further improvising already poor countries.

In a report appearing in the scientific journal The Lancet, soon after the launch of the programme, Sweden had indicated its opposition to the scheme.

Consequently Sweden declined to provide funds towards the plan. The Lancet report also mentioned Simon Wright, head of child survival at Save the Children expressing their concerns over the Bank’s arrangement.

“We remain concerned that the plan should not lead poor countries into more indebtedness,” he says.

But even as the debate on allegations of fraud at the Ministry of Health continues in the media and among politicians the voices of donors and civil society are conspicuously missing

“I can’t comment, remember the officers being mentioned have a lot of say on who gets funding even after this dust settles,” said an outspoken HIV NGO head on the promise of anonymity.

Hence this time around Kenyans are unlikely to hear donor protests such as the famous echoes of ‘vomiting on our shoes’ by former UK High Commissioner to Kenya, Edward Clay during the Kibaki era.

But things have changed since 2012 when Kenya’s main donor, the US altered her HIV funding policy from what it calls non core to core activities.

In the shift which rendered hundreds of Kenyans in HIV NGOs jobless, the US had dropped behaviour change initiatives in favour for biomedical products consuming programmes.

Consequently the US Embassy in Nairobi has highly invested in the Kenya Medical Supplies Agency as the sole vehicle to deliver these biomedicals, a position supported by Afya House bureaucrats but opposed by the Senate and the Council of Governors.

This is one of the thorny issues holding the crucial Health Bill 2016 which is set to go for arbitration between the National Assembly and the Senate.

But also the donors have established less acrimonious channels of handling corruption without attracting public attention.

In the latest incidence, reported last week in this newspaper where it had been confirmed that ministry officials had stolen Sh160 million meant for vaccines the Government and the donor have entered into a MoU where Kenyans will repay the lost money.

The MoU between the Ministry of Health and GAVI Vaccine Alliance confirms money and vaccines were stolen, how and by whom but both entered an agreement that the public return the money.

The ‘Memorandum on Kenya Programme Audit report’ appears here on the internet. www.gavi.org/about/governance/audit-and-investigations/   Audit report Kenya – May 2016

The first such MoU was effected in 2012 when Global Fund lost Sh 270 million for malaria and HIV to thieves at the Ministry of Heath.

The other scandal which was quickly diffused during CS Macharia’s watch was the loss of unspecified millions from a World Bank project for strengthening laboratory capacity in East Africa.

Rocket Science

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