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Counties still in sickbay despite equipment scheme



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When the government launched the multibillion shilling medical equipment leasing plan in 2013, it was billed as an answer to the country’s health challenges.

The move was expected to bring specialised healthcare services closer to the people.

Five years later, county governments are complaining that they are paying more than double the agreed cost of leasing the equipment from the national government.

In some counties, the high-tech equipment is still not operational for a number of reasons, including lack of trained staff to operate the machines.

In West Pokot County, only the theatre and imaging equipment are operational. Others such as dialysis machines and intensive care unit equipment are lying idle in stores due to lack of foundational infrastructure and specialised staff to run them.

Healthcare workers in the county said even the new theatre equipment has not been a game changer because they only replaced the old machines with new ones.

“It’s not that we are doing more surgeries since the new equipment came … nothing has changed,” one health worker who sought anonymity told the Nation.

The staffer said the imaging equipment work fine but the films are sourced from suppliers at rates far above the market price.

Although some governors and county health executives have hailed the leasing programme, others are complaining about the dent it has created on county coffers.

The project — officially known as Managed Equipment Service (MES) — has been controversial since the national government announced that it would invest Sh38 billion to equip 94 public health facilities with state-of-the-art equipment for theatre, sterilisation, dialysis, intensive care and radiology, under a public-private partnership model.

The details on the monies involved in the contract have been scanty, and the figure has been changing.

In May 2017, former Health Cabinet Secretary Cleopa Mailu quoted US$450 million (Sh45 billion) as the amount the government had invested for the programme for “a long-term partnership with private providers for the period 2015 to 2022 to supply, instal and maintain medical equipment in health facilities in Kenya”.

Mr Mailu said the programme would have “a training component for healthcare workers and to date a total of 98 health facilities in Kenya have benefited from the specialised medical equipment”.

Stakeholders said the training component has largely been ignored.

Speaking during the three-day county executives conference held in Nairobi last week, Mandera Senator Mohamed Mohamud, who is also the Senator Finance committee chairman, told the Nation that the leasing fees have increased from the initial Sh95 million to Sh200 million.

Mr Mohamud said they were recently informed that the number of hospitals increased by 21. “We do not know where those 21 hospitals are located,” he said.

“The initial agreement indicated that the deal was for installation and maintaining the equipment. However, I have been to counties where the staff do not even know what the machines were to be used for,” the senator said.

“There is a lot of confusion. Even when we ask the minister, it seems she does not have the information as well. Something is clearly amiss,” he said.

While appreciating that his county had a weak healthcare system and may have benefited from the machines, he faulted the government’s assumption that all hospitals and all counties would have the same health needs.

Isiolo Governor Mohamed Kuti told the Nation he spent a “considerable amount to get the dialysis equipment up and running”.

In Turkana, health executive Jane Ajele said the county needs two additional renal nurses, saying the two they have are inadequate. The Health ministry has not responded to our request for comment.

In a previous interview, Dr Benjamin Tsofa, an expert in health policy and systems at Kemri Wellcome Trust, said a health investment that takes a huge chunk of taxpayers money should involve some preliminary studies.

“The country does the math to answer questions like, ‘Is this cheaper and value for money over long term?’ ‘Is this the range of medical expertise that we need?’”

It is not clear whether such a study was done before the rollout of the MES programme.

In April 2017, the Health ministry refused to hand over the contracts for scrutiny by the Health committee when the National Assembly Budget and Appropriations Committee raised questions about the extra monies allocated to the health docket.

Health economists say the benefits of MES include unburdening governments of technology obsolescence and provides access to customised financial solutions that can allow long term purchasing of equipment.

While referring to general public-private partnerships, Dr Gitahi Githinji, the group chief executive of Amref Health Africa, said: “PPPs are not bad as long as it is the government setting the agenda, and not the external partner.”

“The government should ideally look at its health strategy and needs and whether it would be cost efficient to get another entity to provide services to its people and pay.”

He said the government should not focus on curative services alone and ignore primary healthcare that is cost-effective.