Mr President, what next for Health ministry after Cabinet dismissal?

Last week, the President bowed down to the pressure by the ongoing Genz protests to disband his Cabinet. The Ministry of Health is probably one of those where the dissolution was most welcomed. Medical interns, who have remained in limbo for months, are looking forward to a fresh start. 

However, what really matters is the way forward after the dramatic presidential declaration at a press conference. If there is a time when this key ministry has been at a crossroads, this is truly it! One of the Presidential campaign platforms was universal health coverage (UHC) for all Kenyans. It therefore means that the ministry has been under immense pressure to deliver on such a heavy promise. 

Unfortunately, things haven’t been as rosy despite key Acts being passed in Parliament regarding the same: the Primary Health Act, the Social Health Insurance Act, the Facility Improvement Fund Act and the Digital Health Act. To the true stakeholders of these Acts, Wanjiku and the healthcare providers who are involved in the implementation, there is an unacceptable disconnect between the two. This had been demonstrated in the rejection of the rules to the Act at the Senate level thus far. 

So, how did we go so wrong? These Acts were intended to improve care, both at community and at facility level, for all Kenyans, without the need to incur any additional out-of-pocket expenditure for the service. But the more they are interrogated, the further away they seem to move from the intended outcome. What is even more disturbing is the fact that the Ministry of Health has not been providing leadership through open communication and meaningful stakeholder engagement. 

There seems to be a lack of understanding by the decision-makers on the magnitude of the work that needs to be done, priority-setting to ensure smooth transition of the same and actual and true engagement of the stakeholder in how they want UHC delivered. The focus has been put on the ceremonial activities that seem to promise big, yet don’t have much impact on the ground. 

For instance, the pomp and dance that accompanied the launch of community health promoters (CHPs) has not trickled down to actual service improvement.  CHPs were intended to actually create demand from the community, for early and timely care-seeking. However, nothing seems to have been done at facility level to prepare for the influx of these patients to the facilities when they seek these services. 

We are relieving the planless launch of free maternity services all over again. We saw a massive influx of mothers to antenatal clinic and delivery rooms, which was great in itself, but we did not guarantee quality maternity services due to lack of the needed strengthening of health systems, to achieve this goal. Despite a decade of the service, we have not achieved the desired impact in reduction of maternal and neonatal mortalities and morbidities. 

The whole UHC rollout stinks to the high heavens of the same. We have enacted laws to be implemented on the same health systems without first empowering them. We have dwindling health service provider to population ratios in a system that will heavily rely on adequate human resource for health (HRH) staffing; and no, the CHPs don’t count towards these numbers. 

The doctor, nurse, clinical officer, pharmacist and other allied health worker interns, who have perennially breached the HRH gap, are at home instead of being in health facilities doing what they are trained to do and improve service delivery. Yet the one person tasked to ensure the system does not stop is failing to advise on the way forward, paving way for the circus we have been subjected to in the past two years. 

Scandal after scandal continues to hit each of the health systems building blocks in Kenya, without recourse. The health commodities pillar is under siege by repeat scandals of corruption at the Kenya Medical Supplies Agency. Let’s not even get started on the huge embarrassment we were subjected to regarding vaccine procurement this year, leaving our children vulnerable. 

Health financing isn’t faring any better as the National Health Insurance Fund groans under daylight theft of monies meant for the health of Kenyans, with no repercussions whatsoever. At county level, where service delivery is expected to happen, county departments of health are groaning under misuse of funds for health. In fact, the thieves are heavily sanitised and business goes on as usual. 

The health information systems pillar remains a mystery to the public. The Digital Health Act is to be implemented in a country where not a single devolved public unit can brag of a proper digital health records platform. How, pray tell, are we intending to implement the Act without acknowledging the heavy investment required to go into making it work?

As stakeholders in health, we are tired of the tokenism. We want real leadership in the Ministry of Health. It is the most important pillar in health systems. We want top leadership that actually understands healthcare, is able to see the full picture and appreciate how all these systems pillars must work for Wanjiku to actually enjoy a healthy life. We want a leadership that truly gets the fact that primary health care does not mean poor medicine for poor people, but rather actual quality healthcare brought down to the people where they are. 

We expect this leadership to embrace good health governance in the execution of their mandate. It cannot be business as usual if we are to achieve UHC, providing equitable health care across the country. The wastefulness and corruption needs to come to an end. Real servant leadership must emerge in order for the people of Kenya to enjoy their constitutional right to health. 

The perennial silos existing in the ministries, resulting in lack of coordination and cohesion in decision-making, needs to come to a stop. Cabinet exists for a reason, to lay down priorities for our country. Health, education and food security remain basic needs that must first be fulfilled in order for the rest to stand a chance at the other priorities seeing the light of day. 

Mr President, you have wiped the slate clean. We are ready for a fresh start. Please give us real leadership from the top, all the way down. 

Dr Bosire is an obstetrician/ gynaecologist