By Mohamed Haji
The national government has finally arm-twisted the few remaining governors into signing the shillings 38 billion contracts. Contracts characterized by more heat than light. These contracts or con treats depending on who you ask, is shrouded in mystery, governors appear not to understand the terms and conditions of the contracts they signed and the national government has used PR and propaganda to drive the sour deal down their throats. They appear to have selected to throw away huge sums of money as uninformed public opinion seems to support the national government position. Unfortunately it is the end user (the poor Kenyans) who will ultimately pay the price. These are contracts that hide more than the contractors are happy to reveal. The governors have called for a probe of the deal but surprisingly after they have signed the MOU aptly named as Memorandum of misunderstanding. Closing a gate when the horse has already bolted is probably leadership Kenyan-style. Health is a devolved function but the national government is hell-bent on contracting expensive equipment on behalf of the counties. This is likely to leave sour taste on the tongues of the health consumers of the 47 counties as the deal appears shadier by the day.
Value for money
Sketchy contract’s terms and the dearth of facts and figures make gauging its value for money trickier. The limited information regarding the contract is probably by design that will more than likely hurt our health challenges than heal. According to the former CoG chairman the contract will cost each county sh800 million at the end of its term. This will be a huge drain on the development budget of almost all counties that are already struggling with their capital and recurrent expenditures. Putting this expenditure into perspective, shillings 800 million prudently used will transform the economic and health status of millions of Kenyans beyond the imagination of those pushing for this costly contract.
The equipment said to have been contracted to the counties include dialysis machines and cancer diagnosis equipments. Cancer is increasingly becoming a challenge and its early detection may help cure the patient. Its early detection also makes managing the disease’s social and economical effects on both the afflicted and their relatives less of a burden. Cancer is estimated to account for 0.04% of Kenyans death annually. It is the third ranked killer in the country after infectious and cardiovascular diseases. The prevalence of kidney diseases in the country is about half that of cancers (0.02%) and the death that may arise from kidney failure in the country is negligible. Dialysis machines become necessary if both kidneys fail to function. The statistics make the necessity of these high-priced equipments available in every county questionable. We have a leadership that conflates emotions and practicalities and a people that judge policies and programmes by their intentions and not the results. This is a grave mistake that may lead to waste while not improving the health status of our people.
Obesity is the most important trigger for kidney diseases and most of cancer cases. It is the leading cause of hypertension and diabetes which are risk factors for kidney diseases and some cancers. Diabetes and obesity are lifestyle diseases that require early interventions different from hiring expensive equipment. Misplaced priorities and the failure to give serious thought to prudent use of resources is becoming a hallmark of this administration and indeed of our county governments.
The governors and the national government are not so strange bedfellows and share in equal measure the wastage that will result from this deal. In almost all counties, there are no employees trained in the use of the said equipment. Counties are struggling to recruit frontline staff such as nurses and finding difficult to keep medical health officers in the hospitals. For the national government to chest-thump it will provide high-tech equipments that require the presence of highly trained health staff such as oncologists and nephrologists is sheer incompetence or PR gone bad. Most of the equipment will atrophy from lack of use. Maintaining these expensive machines will consume budgets that would otherwise have been used for more important public health measures. This is unnecessarily huge drain on the meagre resources already available. The billions on this contract should instead have been used to fully equip and expand the specialist services available at Kenyatta National Hospital (KNH). The hospital has currently about 30-bed capacity for adult cancer sufferers. This could be increased. The dialysis machines available in the hospital could also be exponentially increased to enhance availability for all kidney patients including from the counties. The knowledge base of the specialists and indeed the number of specialists in the hospital should also be increased to boost the specialist-patient ratio. The counties will make funds available to anyone referred for specialist attention at KNH. The hospital will bill County governments for anyone referred from the county hospitals. This will keep costs on rare diseases such as kidney failure and cancers in perspective. According to the signed contract, County governments are obligated to pay the more than shillings 80 million annually with or without the use of the equipment or services of the specialists that are nonexistent in this juncture. This is unfair on the counties which may have almost zero patients suffering from these diseases. A grotesque waste of resources.
Change of Focus
The national and county governments’ hyped focus on medical services should change. Prevention is always better than cure. The misplaced focus on treatment of diseases and building of big hospitals may be politically attractive but may hinder progress to better the health of our populations. The County governments should focus more on public health services such as keeping lifestyle diseases at bay. Health education and provision of vital social services will much better address our ballooning health challenges.
Haji is a social commentator and a Nepjournal columnist