CS Susan Nakhumicha: I will ensure universal health coverage dream is realised in my tenure

Inside Health Cabinet Secretary Susan Nakhumicha Wafula’s office overlooking a picturesque view of Nairobi City is a corner she likes the most. You will certainly notice it when you get in.

When she has no blazer hanging on the coat rack, a large rosary takes up that space. Behind it, there is a table with a statue of Mary, a rosary, a Bible and a crucifix. This a sign that most decisions she makes, be it in her family or in the ministry, are driven by her Christian background.

“This is where I start my day. I pray for protection, guidance and wisdom in all that I do throughout the day. When I get into the office, I ask God to protect me, and before I leave the office, I also thank God for the day. It is my favourite place in my office,” she says.

Ms Nakhumicha had a sat down with Saturday Nation’s Angela Oketch and spoke about Kenya Kwanza government’s universal health coverage plan, changes at the National Health Insurance Fund and cartels at Afya House, often called the ‘Mafya.’

Who is Susan Nakhumicha?

I am a mother and a professional in the health sector. I did a degree in pharmacy and a Master’s in supply chain management. I have been in the health space for the longest.

I began at the very bottom which was dispensing drugs at the chemist, I then moved to the hospital setting still behind the window dispensing. My last position as a pharmacist was at AAR Kisumu where I was in charge.

I then joined Mission for Essential Drugs and Supplies (MEDS) where I worked in operations and moved to the supply chain. I have worked in a number of hospitals dealing with sourcing health suppliers and commodities, and then I transited and joined global programmes as the health of supply chain. I was then plucked and brought to the ministry.

You head one of the most sensitive ministries in the country, what should Kenyans expect from you?

I am cognizant of the sensitivity of this ministry; it is a matter of life and death. Matters of health touches on every Kenyan.

I am clear on what I need to deliver and that I should give Kenyans all we promised including Universal Health Coverage (UHC), which is one of my top priorities.

Many are expecting UHC to be an event. It is a process, and measures and strategies are being put in place to be able to achieve this agenda.

To start us off the journey, we have two key pillars. The Kenya Medical Supplies Authority (Kemsa) will ensure the security of commodities to drive health care while the National Health Insurance Fund (NHIF) will deal with the financing bit, ensuring that money to take care of Kenyans' health is available.

We are doing a lot of reforms in the two institutions to realign our goals.

At the NHIF, we are shifting the thinking from just registration and taking care of individuals to households. Instead of covering an individual where a spouse contributes and they are taken care of individually by NHIF, they will instead be taken care of as a household.

The national insurer has concentrated on schemes; we have forgotten about the basics. We are now structuring NHIF to be able to cover people at the bottom of the pyramid.

It has not been an easy task pushing Kenyans at the informal set-up to pay up their monthly contribution. We are coming up with an essential package for all Kenyans regardless of their class; this will not dictate the kind of service you get and doing away with the schemes.

We are reorganising finances at NHIF to focus on primary health care — preventive, promotive and rehabilitative. What we are saying is that we want a scheme that covers everyone.

There have been so many complaints from Kenyans about NHIF; not getting services, and hospitals complaining of reimbursement delays. How best can the issues be handled?

NHIF is not meant to be competing for private insurance, which is what is happening now because of the many enhanced schemes. We are refocusing this and concentrating on the hustlers and the poor.

We are introducing a national social security scheme which takes care of everybody and for Kenyans who can afford private insurance to pay for it.

Read: State mulls lowering NHIF charges to widen health coverage

With the introduction of the basic package, anyone can get services in all facilities in the country. We are moving away from competing with private insurance and refocusing NHIF to meet the needs of every common Kenyan.

Why then are government employees (police and teachers) shifting their cover from NHIF?

Why would NHIF take care of a police force while a mama mboga is not able to access health care? Is this equity? It is not.

If the police want the enhanced scheme, let them have it at a private provider while we create room and finances for a common Kenyan who cannot be able to get the services in a private hospital.

You came in at a time when Kemsa was marred by numerous scandals. What are your plans to clean it up?

A major shift in how we conduct our operations as Kenyans is on the way.

The agency has been on reforms for a very long time, and I am not getting into this ship of reforms. We have to move. Kenyans need services.

If Kemsa is unable to do procurement, then we will have to give the sector to experts — there are so many of them in this country — to procure, then Kemsa can warehouse and distribute.

It has the capacity for warehousing and distribution, so we will leverage what it is good at the moment and whatever it is not good at, we will see how best we can achieve that.

In Kenya Kwanza plan, we promised affordability of commodities and health care and this is purely the responsibility of Kemsa. We are rethinking what strategies to use in terms of procurement to meet the basic needs of Kenyans.

We have developed an essential package to have all the institutions, including private, public and faith-based, working together in terms of procuring the commodities to achieve economies of scale and distribution through Kemsa.

In procurement, once you consolidate and the quantities are big, you buy less frequently and this will reduce the cost of health care. We are analysing the national requirements of all the commodities and procuring them at once at the lowest price possible.

Health ministers who have come before you have talked of Afya House cartels. What’s your plan to tackle them? 

These are people known to us. I know them by their names and faces. Should they make my work difficult, I am going to announce them in public so that they stop interfering with my work if that is what it takes.

Why do we make it look like they are people without faces and names? They are companies owned by people we know.

It is going to be difficult for them to penetrate. The inside cartels should just be ready to move to other ministries.

I have made it very clear that any meeting should be done in my office and not in the bars where they meet to strike deals. I know they will hate it but this has to be done.

Watch: How I will deal with Kemsa cartels - Health CS nominee Susan Wafula

One of the things that I am very keen on is the process that we are following; we are going to do away with emergencies, where one is rushed to sign documents. If we do our things right, there will be no room for cartels.

Procurement is going to be very open and everyone, including private, public and faith-based hospitals, is going to participate.

We are going to leverage technology and everyone can log into the portal and see what’s going on. I have given the CEO at Kemsa instructions.

I have come from a space where we did not use a single paper and operated efficiently. That is how I plan to open up Afya House and it is going to be so easy to use technology to deal with the cartels.

Anybody transacting business with Afya House must use an official email. Why would someone use my personal email to transact business?

Government corruption index reports rate the ministry among the most corrupt. Your take?

I don’t know about the rating, but I am not scared at all. With the current government, we have no room for corruption and President William Ruto has said this on many occasions.

And to add on that, there will be no private institutions; some of us when given offices run them like private entities.

I am going to do the policing part and ensure that we change the face of Afya House.

How do you plan to resolve issues around the Medical Equipment Service (MES) scheme?

Leasing medical equipment is the way to go. It is my view that as a government we are in the business of providing service and not owning machines and equipment.

What we have done with the existing contracts, we are reviewing them — we asked for three months to review them. We are moving into the maintenance and service phase where we will be paying less.

Still, on counties, they have complained that the ministry still retains most of the devolved functions.

There is clarity on what the national government is supposed to be doing, same for counties, but we are going to complement and work together because our focus is patients.

Read: Governors seek lower prices in new medical equipment lease deal

If we start telling them about devolved functions, they will not understand, all they want is to ensure that they are able to get drugs and services in hospitals.

We have met with the Health committee and we have agreed that we just have to work together. In the next two weeks, we are meeting again to unpack and ensure that we drive towards a common goal.

From your analysis, what ails the health sector and how do you plan to fix that?

As we were planning to work on our manifesto as Kenya Kwanza, we did research to find out the issues in the health sector to come up with plans. 

First, is that most Kenyans are paying for their health care from their pockets, and many WhatsApp groups are being formed to fundraise for medical support.

My plan is to reduce this and how we do this is by working with many entities and sourcing collectively for commodities used in the health sector. This is by focusing on NHIF for health care financing to take care of the health of all Kenyans.

Secondly, lack of proper health commodity security. We have a plan of transforming Kemsa to function optimally to fill the gap.

Once we start procuring well through other mechanisms, then we will be able to take care of health commodities.

Thirdly, the health workforce, where a big number of health workers belong to the counties but we have a role to play at the national level.

We want to centrally manage health workers in such a way that counties are sharing experts.

The fourth was the cost of health products and technologies. The solution here is local manufacturing. How do we improve and build the capacity of the manufacturers to produce for local consumption and export the excess?

In Kenya, 70 per cent of drugs in the market are imported. We have started a conversation with the National Treasury to ensure that the tax regime is friendly enough for the local manufacturers to manufacture and meet Kenya’s requirements.

Local manufacturing will also earn revenue for the country; if we are able to produce more than we need, we can sell the excess.

Moderna is groundbreaking in March to start local manufacturing of vaccines.

The fifth issue identified was corruption and the solution was to use technology; with the help of the ICT ministry, we must have a system that every Kenyan can own their health records on their phones.

What keeps you awake at night?

I might answer this question and find myself in trouble but the truth is, I did not anticipate the magnitude of the position.

On my appointment, it was overwhelming and exciting and the moment I started working, I realised it is not what I thought.

I am having to work extremely hard but I want to believe that we are just taking off. So far, it is been very busy, and my sleep pattern is not consistent.

It is a shift, of course, and I can no longer do the things I used to take for granted like just walking to Moi Avenue and having my fries.

There is a lot to be done and I no longer have time for my friends. I am very cognizant of the work balance. I really try to give my son his time.

I am awakened by the fact that all Kenyans are focusing on me to give my best. My boss, President William Ruto who is a performer, wants nothing but the best for Kenyans.

Has this position affected how you relate with your family?

Very much. In my previous job, I was working from home; it was paperless so we could work from anywhere.

I was always home with my family but now, I have to be in the office. I am not available all the time but once I get the balance, I am going to be available to them, and they understand.

What do you want to be remembered for?

I want to be known as Mama Afya Mashinani so that anyone walking to any facility in this country can get services. That I brought down this heavy monster that people call UHC to the people.

We have a huge population of youth who are always on their phones. I want them to know that I brought healthcare to their phones and they can access their data and medical records on their phones.

What is your parting shot?

Kenyans support me in this journey. It is difficult. I am committed to ensuring that I deliver my best.