Devolving Health means investing in Doctors
By Internews Data Dreger
By Geoffrey Kamadi
The national budget of KSH 1,459 trillion for the financial year 2012/ 2013 has been described variously as the country’s most ambitious yet.
And it was designed to deepen our economic and social prosperity within a system of devolved government, according to this year’s theme.
But revelations in mid May by the health cabinet secretary Professor James Macharia, show that The Treasury had allocated less than a quarter of funds his ministry was seeking.
The ministry had been allocated only KSH 34.7 billion, against KSH 160 billion it was asking.
This could only mean that “deepening our economic and social prosperity” will remain an elusive objective if not something of a pipe dream in itself.
After all, for a country to thrive economically and prosper socially, her people’s physical and mental wellbeing has to be guaranteed.
And there is no better way to achieve this than by expanding and improving the quality of healthcare services and infrastructure through increased financial support for the Ministry of Health.
It will be remembered that provision of affordable healthcare to all, was one of the outstanding issues raised in the presidential debates prior to the elections.
Political parties went to great lengths to articulate how provision of healthcare to all will be achieved under their administrations, should the electorate give them the mandate.
Dr Boniface Chitayi, Secretary of Health Affairs for The National Alliance (TNA) told journalists just before the elections that the Jubilee government will guarantee fully equipped health centres within a 5km radius of every family.
He was explaining the party’s manifesto at a roundtable discussion appropriately themed: The Politics of Health at Internews offices.
Dr Chitayi told journalists that the Jubilee government increase financial allocation to health to get to 12 per cent in the first five years.
This will gradually be increased to the targeted 15 per cent, in accordance with the Abuja Declaration of 2001.
Under the current budget, the health sector received KSH 85 billion, translating to 5.8 per cent of the national budget. This is not even half of what the Abuja Declaration requires.
As much as it is difficult to see how the country will attain this goal if the Ministry of Health is not getting the financial support it needs, it will be virtually impossible for the Jubilee government to fulfil promises it made to Kenyans.
According to Dr Chitayi, the Jubilee government planned to add an impressive 55 referral hospitals on top of the existing eight all over the country. It therefore begs the question: where is the money going to come from?
Kenya is not only suffering from a severe lack of doctors, but its training capacity to acceptable World Health Organisation (WHO) standards and therefore somewhat keep up with the ever rising demand, is grossly wanting.
Only about 200-360 doctors are trained by the Kenyan universities every year. Experts in the sector say that it would cost approximately KSH 4.2 million to train a single doctor.
Kenya has 1 doctor for a population of 8,000, way below the minimum WHO figure of 1 doctor/ 1,000.
In other words, the doctor-population ratio is up to eight times less ideal than the minimum standards set by the WHO.
The total number of doctors in the country is 5,000. It means that we need 35,000 more doctors to get to the 40,000 mark commensurate with the minimum WHO requirements.
Ultimately, the country will have to cough up a whopping KSH 147 billion for training doctors alone! This amount surpasses the entire budget allocated for health by a cool KSH 62 billion, a difference nearly equalling the amount given to the Ministry of Internal Security of KSH 65.9 billion.
Unless the manifesto presented by the Jubilee coalition was nothing more than high sounding pronouncements, it will be a herculean task to find monies required to train doctors, leave a lone building a single health facility.(This article was first published on the Daily Nation on June 5, 2013)
Geoffrey Kamadi is a consultant with Media 101 Communications, specializing in science and development reporting:
Connect with the writer on Twitter: @gkamadi
By Peter Orengo – The Standard
I have read with interest, Aghan Daniel’s blog on devolution and health financing in Kenya. Whereas I totally agree with his assertions and arguments, I would like to state that during the presentation of the 2013/14 national budget, President Uhuru allocated the national budget for health at Sh98 billion but Sh64 billion of this is to be devolved to the County governments. There is fear that most of this money may be redirected to other areas like putting up county offices and buying cars for county bosses.
The health budget should also be looked at the bigger picture premised on the Abuja Declaration of April 2001 when African Union countries meeting in Abuja, Nigeria, pledged to increase government funding for health to at least 15%, and urged donor countries to scale up support. Only one African country has reached that target. Overall, 26 have increased the proportion of government expenditures allocated to health and 11 have reduced it since 2001. In the other 9, there is no obvious trend up or down. Current donor spending varies dramatically, from US$ 115 per person in one country, to less than US$ 5 per person in 12 others.
What is more profound is that the allocation for health this year is less than last year and only a third of what Kenya and other African countries pledged to invest on healthcare two decades ago. It also makes 2013 the fourth year in a row that Kenya has cut health spending in a trend sector insiders say is grinding medical facilities to a halt.
In 2010, Kenya spent Sh7.20 for each Sh100 on healthcare. This fell to Sh6.10 in 2011 and last year, it was further cut to Sh5.9. This year, the national and county governments plan to spend Sh5.70 per Sh100 on the sector, translating to 5.7 per cent of the Sh1.6 trillion budget.
If you analyze the budget allocated to health this year, it is the same as saying that the national Government will spend Sh2.50 this year for every Sh100. Yet counties are likely to follow the precedent set by the National Government.
The underfunding is happening at a time when most medical equipment in public health facilities are more than 20 years old, some double their lifespan, and may experience frequent breakdowns.
The issue of funding health is a big one because even the Health Cabinet Secretary, James Macharia, has raised concern over the inadequate funds. Mr Macharia says his docket needs Sh160 billion, but only received Sh34.7billion.
By Aghan Daniel
This year, the Ministry of Health was allocated Sh 34.7 billion.
This is the money that will be shared with the county governments. My first point here is, as things stand currently are County governments prepared to provide effective health services? Which branch of government will pay salaries for doctors, nurses, and other health workers? Are our county governments really ready to take charge of health financing in their areas of jurisdiction? To me, I feel that for the next one year, let the central government continue to pay these workers as systems are put in place to embrace devolved health financing.
I was listening to a radio station this morning and the expert being interviewed said that there is a lot of apathy by Nyanza residents on taking up medicine as a practice. How do we expect to have people who can understand some cultural orientations among this group of people to effectively do their work if their sons and daughters give medical school a wide berth? In any case, in most of the appointments that I have seen at the county level, even professionals are appointed from the same region, how much will this impact on health sector?
As we think about the mess that is likely to be experienced in the public health sector, journalists should look at both sides of the coin – to also query the role of the private sector such as the church – will the church continue to milk county residents dry in pursuit of huge profits? I talk about this because I come from Kendu Bay a predominantly Seventh Day Adventist (SDA) area where costs at a hospital like Kendu Mission Hospital are way above what the locals can afford. The residents therefore resort to the government institutions in the area whose hallmark is sharing of beds (not due to lack but due to mismanagement and theft by the health officials at the local level).
Finally as journalists take up the watchdog role of ensuring the county governments perform, the governments should be reminded that Schedule 4 of the Kenya Constitution 2010 assigns to the County Governments the function of delivering essential health services, and to the National Government, the functions of stewardship for health policy and oversight of national referral health facilities. The health sector, therefore has a fundamental duty to take legislative, policy and other measures, including the setting of standards, to achieve progressive realization of the right to the highest attainable standard of health for every Kenyan as enshrined in the Constitution.
By Isaiah Esipisu
Source: TrustMedia Alumni Blog –
After years of dependence of food aid in the semi-arid Eastern Kenya, Stephen Mwangangi from Kinyatta village in Yatta district has discovered how to keep his family food secure by using just one acre piece of land despite the droughts.
The entire region also known as Ukambani is dry. But through a church-led self help group known Christian Impact Mission, farmers have discovered means of survival – combining indigenous knowledge with emerging technologies to grow high value horticultural crops for domestic and the export market.
“On my plot, I grow maize purely for domestic consumption, and horticultural crops such as soy beans, French beans, bullet pepper, cucumbers, carrots, tomatoes among many others for both domestic and the export market,” said Mwangangi.
The father of three learnt the technique of high value farming in extreme conditions two years ago, when he joined a group that has since then vowed to drive hunger and food-aid out of the entire Ukambani region.
“There is a special reason why smallholder horticultural farmers like me have to work within a group, especially if the target is the export market,” he said.
“The produce from my farm alone for example is too little that it cannot support the quantity required by the export agents. But with groups, we usually grow similar crops at the same time, then harvest and combine produce from several plots in order to achieve the required quantity,” he explained.
Further more, Mwangangi reckons that working in groups encourages experience sharing, innovation and it is an encouragement especially for smallholder farmers who might have experienced losses due to given particular reasons.
Through small groupings of up to 15 farmers, which form the larger Christian Impact Mission group, Mwangangi among other farmers have learned of different methods of adaptation to climate change, through selection of appropriate crops, rain water storage, value addition and many other methods that have helped him transform his life from dependency (on food-aid) to independence.
“Many studies have shown that most of the foodstuffs eaten worldwide is produced by smallholder farmers. Yet in our group, we have realised that such smallholder farmers cannot benefit from the high value export market if they have to work as individuals,” said Dr Bishop Titus Masika, the founder of the Christian Impact Mission which brings together 3000 households from Yatta district within Ukambani region.
Instead of working on community projects, the 3000 households have discovered that they can preserve rain water for irrigation at a household level, grow maize in nurseries for easy watering before transplanting the same into zai-pits once it rains, use method of moisture preservation in zai-pits, and grow high value horticultural crops for income generation.
Such are reasons that formed the basis for the Agricultural Green Revolution in Africa (AGRA) to implement a project aimed at strengthening the development of farmer-based organization – as a way of promoting the green revolution agenda in Africa.
The organisation is an international non-governmental organisation dedicated to improving of farm productivity for small-scale farmers across the continent.
Launched in on May 3, 2012, AGRA’s new project dubbed Farmer Organisation Support Centre in Africa (FOSCA) aims at strengthening managerial, organisational and technical capacity of farmers organisations with an aim of transforming them to provide demand-driven and income enhancing services to their members.
“Using FOSCA, we are targeting 220,000 smallholder farmers through not less than 70 farmer organizations across Africa,” said Dr David Ameyaw, AGRA’s Director for Monitoring and Evaluation.
Through the Christian Impact Mission, Mwangangi is able to earn at least Sh40,000 ($500) per week from the export market. “We have no particular season because we do not depend on rainfall. We use irrigation instead,” said Mwangangi.
Anita Onumah is another smallholder who hails from Kitase village, Ekropong district in Eastern Ghana.
In her early 20s, Onumah is able to pay her own college fees at the University of Ghana in Accra, thanks to her small chili pepper faming project for the export market.
“I specialise mainly in chilli farming because it doesn’t need much attention. And as a student, I can always manage it from a distance,” said the agriculture student, majoring in Post Harvest Handling at the university of Ghana.
She attributes her success to the Vegetable Producers and Exporters Association of Ghana (VPEAG), which was her link to the export market.
From a two acre piece of land, Onumah harvests 500 boxes of chili, each weighing 5.5kilograms in an average season. “Each box fetches me up to five US dollars, which earns me up to $2500 every three months,” she said.
Her produce ends up in the United Kingdom, France and Italy.
The FOSCA project will therefore target existing former groups such as the VPEAG, Christian Impact Mission among others according to Dr Ameyaw.
Despite the fact that the Kenyan government harmonized environmental laws under Environmental Management and Coordination Act (EMCA) 1999 nearly ten years ago, few Kenyans seem to be aware of the goodies of this piece of legislation.
This move was taken by the government for the purposes of coordinating environmental management in the country. The National Environmental Management Authority (NEMA) is the custodian of environmental issues in Kenya.
And by the way what is an EIA?
An EIA is an assessment of the possible positive or negative impact that a proposed project may have on the environment, together consisting of the natural, social and economic aspects. It is the process of identifying, predicting, evaluating and mitigating the biophysical, social, and other relevant effects of development proposals prior to major decisions being taken and commitments made.
Where then does environmental impact assessment (EIA) fall within the law? One only needs to look at the National Environment Action Plan, NEAP (GoK, 1994) and the National Policy on Environment which emphasize the need for environmental Impact Assessment (EIA) on development projects.
The Act that I have referred to above makes EIA mandatory for all projects specified in the Second Schedule of the Act.
The purpose of any EIA is to ensure that decision makers consider the ensuing environmental impacts when deciding whether to proceed with a project. EIAs are unique in that they do not require adherence to a predetermined environmental outcome, but rather they require decision makers to account for environmental values in their decisions and to justify those decisions in light of detailed environmental studies and public comments on the potential environmental impacts of the proposal.
As I write this article, there are many sticky issues on EIA in the country. Experts have always been baffled by the insistence by NEMA officers that EIA reports be accompanied by approved drawings and project costs.
EIA is supposed to help the developer come up with a clear decision on whether to commit finances on the project depending on its environmental sustainability and social acceptability. If the developer is made to commit financial resources to engage architects, engineers and quantity surveyors to develop architectural drawings and project costs, then of what use is the assessment to him/her? If this situation were to obtain, the developer shall have not benefited from the EIA process if a project in which s/he has spent millions of shillings in fee to consultants is rejected by NEMA.
What is even more worrying is situations where critical environmental issues are raised by stakeholders on projects for which EIAs have been carried out and licences issued. Does this mean that proper public consultations are not carried out, and if not, on what basis are the licences given?
How willing are members of the public in providing critical input in EIA process in order to inform correct decisions? Is there some form of apathy within the ranks of the general public concerning the whole philosophy behind EIA and what informs this apathy?
These are some of the many questions that we need to provide answers to if we are to achieve benefits associated with EIA process as is internationally practiced. NEMA should be more focused than their counterparts in local authorities who are currently bogged down with poor workmanship in the building industry due to weak enforcement of development control regulations.
The author is a Lead EIA/Audit Expert based at Mazingira Limited, Nairobi
Sometime early this year, a contingent of senior officers from the Ministry of Medical Services, led by the minister, Prof Anyang’ Nyong’o, visited the KEMRI/CDC campus in Kisian, Kisumu. Theirs was a fact finding mission as well as a learning experience following the successful and excellent laboratory operations at the premier medical research facility. Prof Nyongó’s entourage included his Permanent Secretary and other senior staff and members of the Kenya Medical Laboratory Technologists Board. Also in the team was one Dr. Moses Njue, the Chief Government Pathologist.
While giving his remarks during an address to the KEMRI/CDC staff gathered to listen to the visitors, Dr. Njue talked about how shoddy autopsies lead to police losing key court cases and thereby ending up abetting crime. He attributed this to the fact that several Labs in Kenya either lack the personnel or equipment or standards equal to the task of conducting serious autopsies, whose results can sustain and indeed be the basis of winning a court case.
A few months later, renowned athlete Samuel Kamau Wanjiru (God rest his soul in peace) died under mysterious circumstances. Kenyans were treated to all kinds of drama ranging from conflicting police theories to family feuds over the cause of his death and other matters I would refer to as private family affairs that should not have reached non family members.
Too much has been said and written about the death of Wanjiru. He is not the subject of this article, but the events after his death are, certainly. I want to review the conflicting theories around the cause of his death and try to stir our minds into thinking. First it was the suicide story, then that he was pushed over the balcony, then yet another that he was hit on the head before falling over and others not documented. Pathologists present including Dr. Njue during the autopsy were perplexed and seemed not to agree with each other on what exactly caused the star’s death.
Without casting aspersions on the work of the pathologists at the centre of the Wanjiru case and certainly without appearing to demean the profession, I asked myself if, going by Njue’s own admission, certain court cases lost could have been won with proper and accurate autopsies done to determine the cause of death.
A few questions could help us understand this predicament even better. Could there be murderers enjoying freedom out there while their victims are rotting in graves and families and friends left behind agonizing? On the converse, could there be people languishing in prisons convicted of crimes they never committed because a pathologist failed to do his job properly? Still could there be court cases dragging for years on end because autopsies are done back and forth? How many families struggling to come to terms with the death of a relative have to be taken through an exhumation exercise because somebody failed to perform his or her job correctly? The issues are myriad.
I said earlier that I would not want to appear to accuse practitioners of this noble profession; I believe without them this country would be doomed. Anyhow, matters surrounding bungled autopsies and the questions I have raised above need some answers. I believe something can be done. This may be in form of investing in up to date and ultra modern forensic and pathology equipment in government laboratories, proper training of personnel and any other measures that could guarantee right and desired results.
The writer is a public relations practitioner and journalist.