Mutahi Kagwe's take on Covid-19 vaccines

You recently said your ministry would not be in a hurry to place orders for Covid-19 vaccines. What is the difference between your ‘vaccine denial’ and those who say Covid-19 is a hoax? Njeri Aseneka, Thika

From the onset, I have made it very clear that the government is committed to providing its people access to safe and effective Covid-19 vaccines as soon as they are available.

Our scientists at Kemri are collaborating on local vaccine trials, to ensure that we have sufficient data on the safety and efficacy of the most promising vaccine candidates, and Kenya is a part of an ongoing bilateral agreement with the Global Umbrella facility for the Covid Vaccine (Covax) that will facilitate our access to the successful vaccines at a lower cost and possibly even enable us to create national emergency strategic reserves.

I understand the urge that many have to secure vaccines as soon as possible and I share it. However, as the CS for Health, my responsibility is not just to enable access to a vaccine or vaccines, but to ensure that we make the best possible choices on them and that our decisions are irrefutably supported by science. We are being methodical but are moving with speed.

For instance, we have already established and engaged a coordination structure comprised of all key stakeholders to properly plan for key aspects of the Covid-19 vaccine introduction.

As we speak, they are discussing service delivery, vaccine, cold chain and logistics, demand generation and communication, prioritisation, targeting and Covid-19 surveillance, monitoring and evaluation and safety monitoring.

We have also engaged the Kenya National Immunisation Technical Advisory Group (Kenitag) to ensure that we get an independent scientific analysis of the disease burden and the feasibility of the vaccine within the context of our existing systems.

As this is happening, we have engaged the regulatory authorities (Pharmacy and Poisons Board) and the National Vaccines Safety Advisory Committee on expediting regulatory approvals and mechanisms of safety monitoring.

As you can see, there is quite a bit that needs to be done before we can say we are now ready, hence my caution. We need to be careful that Kenyans and people resident in Kenya get value for their investment but even more importantly, that any vaccine is safe for use.

Many Kenyans have been watching the activities surrounding Universal Health Coverage (UHC) scheme, but nothing has been clear apart from the counties where it was piloted. What is the true position on this agenda? Komen Moris, Eldoret

UHC visibility is a key factor in the success of the health aspect of the Big Four Agenda. After the pilot which ended in January 2020, there was a scale up of what was done in the pilot counties in terms of more health workers across the country.  So far, 8,774 have been hired by the counties. Counties had drawing rights to access free essential medicines and commodities which they drew down from Kemsa. This was to ensure their availability at dispensaries and health centres so that there was no need to go to the higher level hospitals for ailments that could be handled at that level.

Also, community health workers were trained on UHC and how to manage various sicknesses so that these services could be accessed at the household level. About 90,000 were trained and they are the same that are being used to treat Covid-19 patients.

In the next phase of UHC, we will still continue with the provision of what was described above to ensure that the primary health care levels (community, dispensary and health centre) are able to meet the needs of Kenyans. We will now add the financial protection of those who are the most vulnerable households through an UHC insurance scheme which will be managed by NHIF.

You admitted that cartels were entrenched in Afya House. Kemsa did the unthinkable during Covid-19 procurements yet nothing has happened. Do you still believe that you are the right person to lead this important ministry? Carey Yiembe, Mombasa

It must be remembered that I invited investigating agencies to come and investigate goings on at both the ministry and Kemsa. We are clear that we must deliver on the promise of right to health for all residents in Kenya.

Fortunately, we have statutory institutions that are charged with the fight against corruption and I am glad to report that they are busy at work.

 While they do their work, some officers are already on suspension to pave the way for these investigations. We are working on restructuring not just Kemsa but the entire health sector and its institutions to ensure we deliver health services as we should. The fight against corruption is one we must engage in without fear and this is something Kenyans can hold me to.

The Kemsa procurement story is sad and it is obvious they procured what they did not need or more than they needed just to defraud the public. What happens to the supplies they procured that are still in their stores? Githuku Mungai, Nairobi

First, the situation at Kemsa is under investigation and we are waiting for the report to decide on the most appropriate course of action. But even as investigations are ongoing, the President gave some directives on the need for transparency in the procurement and management of affairs at Kemsa.

These directives are being operationalised. On what is in the warehouse, counties are at liberty to draw down the stocks depending on their demands at the prevailing market prices for those commodities.

The Kenyan health sector is seriously being stretched by the Covid-19 pandemic now that the rate of deaths, including those of doctors, clinical officers and other front line care givers, is going up every day. As the Cabinet Secretary, what personal sacrifices are you willing to take to save the situation? Dan Murugu, Nakuru

 Serving the people of Kenya as the Cabinet Secretary for Health is a privilege and a duty that I take seriously. Since assuming office I have committed myself to ensuring that I deliver on my duties and I will continue doing so.

It is said numbers don’t lie. Do you think the possibility of a second round of lockdown is far-fetched, given the notable spike in the number of infections? Francis Njuguna, Kibichoi

The answer to this question remains out there depending on how Kenyans and people resident in the country continue behaving. Escalation or de-escalation of the measures is done based on epidemiologic modelling, prevailing disease burden — mortality rates, hospital bed occupancy and the number of critical cases in hospital.

How does the government intend to finance the UHC programme? Is the government again thinking of compulsory subscriptions from those who are employed to provide healthcare to those who are not employed? David Kamoi Gacago, Maragwa

Kenya has a blended financing approach to UHC. There is direct (input/tax-based) financing from the National Treasury through the Ministry of Health to support certain health system pillars (human resources for health/healthcare workers, medicines and medical supplies, capacity building of community health volunteers).

There is also output-based financing through the UHC insurance scheme that is managed through NHIF. Kenya mandates salaried employees to pay for NHIF which is deducted in their payslips. For an equitable and sustainable approach to social health insurance, Kenyans who can pay for health insurance will be required to pay while those who can’t will be paid for by the State.

As the Covid-19 cases rise in the second wave, we are seeing a situation where our healthcare infrastructure and equipment is again being called into question despite recent initiative to have counties set up 300-bed isolation units. Getting an ICU space currently is a herculean task and many patients have died in ambulances while being moved from one health institution to another in search of an ICU place. What is your take on this? Donald Bowen, Naivasha

We have been working very closely with the county governments to build enough capacity in public facilities to contain the virus and I wish to confirm that this is the case. We are aware that many Kenyans prefer seeking health service from private facilities. It is very likely that these facilities get easily overwhelmed hence the thinking that the healthcare system is generally overwhelmed. We have enough capacity in our public facilities and I encourage people to use these facilities more.

Politicians are the greatest culprits when it comes to flouting Covid guidelines by holding public meetings without masks or social distancing. How long are we going to handle these political leaders with kid’s gloves yet ordinary Kenyans are arrested every day for not following the protocols? Byram Musyoka, Kitengela

As we have said many times before, responsibility for the fight against Covid-19 is personal because the mitigation actions depend on the individual. This disease does not discriminate against anyone. We must move beyond our focus on government actions and focus more on individual efforts.

In any case, the ultimate punishment for dalliance with the disease could very well be the loss of life for an individual, and this includes those in the political class. People must take responsibility for their own actions.

In your travels across the country, I am sure you have witnessed laxity from the public on adhering to the Covid-19 containment protocols. What steps has the ministry taken to strengthen public trust on the information passed by the ministry? Nyaga Albert, Embu

I do not believe that there is a ministry that communicates with the public as much as we do. In addition to the daily updates which we provide, there are numerous activities we undertake that aren’t necessarily seen.

For example, we carry out health promotion and community engagement countrywide on a continuous basis and we enforce the presidential directives through the County Emergency Response Committees and use of national government administrative officers, Nyumba Kumi system and members of the national police service.

You may have seen our risk communication through advertisements on TV, radio and SMS platforms in accordance with International Health Regulations of 2005. These channels are key to our dissemination of information because they are captivating. Finally, we are also using community health volunteers to pass key messages to people at community level, including the vulnerable groups.

When you assumed office, NHIF was spending 54 per cent of all the subscriptions it collects from members on administration and 46 per cent on paying medicals bills for subscribers. What structural changes have you undertaken at NHIF during your eight months at the helm of the Health ministry? Samuel Waweru, Kikuyu

Thank you for the question. However let me first point out that the numbers you have provided are not accurate. NHIF expenses pay-out ratio as at 2016/2017 financial year was 22.2 per cent and it reduced to 11 per cent in the concluded 2019/2020 financial year.

 I am sure that you know this is significantly lower than the recommended maximum administrative expenditure ratio of 15 per cent which is why we are still working to reducing it through improved efficiencies. I am currently working with a team of consultants on the reforms at NHIF and they have recommended a maximum of five per cent which, with the implementation of UHC, is achievable.

When it comes to the overall reforms at NHIF, its first important to appreciate that changes started before I joined the Ministry and to state, therefore, that what I am doing is accelerating the implementation of key reforms in order to deliver value for contributors to the fund, the biggest of which is government.

The reforms that I am pushing for are many and far-reaching because they include every angle from structural and administrative to operational. Some of them, as you may have heard me say several times, require changes to the Act establishing the fund and these too are being undertaken.

 I am very pleased with the progress we have been making and excited about their anticipated impact on the UHC agenda to deliver affordable, quality healthcare to all Kenyans.