By Nuru Ahmed and Michelle Amayayi
In spite of the constitutionally guaranteed Freedom of Access to Information granted to every person by Article 35 of the Kenyan constitution, a study by Institute of Economic Affairs (IEA) has shown that the leasing of medical equipment project is faced with lack of disclosure and publicity of any information regarding the project by the national government since its inception. This has raised a lot of issues and suspicion.
In a move to investigate the cost effectiveness of the leased medical equipment, IEA in partnership with Open Society Institute of East Africa (OSIEA) carried out a study on the managed equipment services (MES) project dubbed Value for Money Assessment.
The aim of the study was to evaluate the value for money for the MES project in Kenya as an emerging health sector financing option by presenting facts and clarity of the project, analyzing its status of implementation, performance and drawing recommendations for policy engagement on its corrective measures.
The MES project is a 7-year project worth 38 Billion that was initiated in 2015 as an alternative health care financing option to scale up health infrastructure for provision of specialized medical care. The budget has however shot to 63 Billion to cater for the 21 additional hospitals. An average share of 25% was the budget allocation for provision of health care services where 5% of the MES Project is a share of total county health budget per year.
Six private firms were contracted by the national government to equip two hospitals per county and four national referral hospitals with different sets of medical equipment, from theatre and intensive care units (ICU) to machines for offering renal dialysis and imaging services. They would also train users and offer maintenance and repairs for the equipment provided.
Kwame Owino, the Chief Executive Officer of the Institute of Economic Affairs (IEA) speaking during the launch of the study in Nairobi on 13th February, 2020, emphasized the need for transparency in matters regarding the project to the public.
This will make Kenyan citizens know about the MES Project and how the equipment was delivered to different hospitals country wide, he said.
“The lawfulness and accuracy of expenditure of 4.57 billion shillings on the MES Project spent in each year for a period 2015, 2016, 2017 and 2018 was not verifiable due to lack of supporting documents,” said John Mutua , Programme coordinator, IEA.
Edwin Kamaru, the representative of the Office of the Auditor General, applauded the efforts of IEA and encouraged the importance of citizen accountability audit in matters of health saying that “citizens should be able to hold the people we have delegated responsibility to accountable.”
He also outlined that health is a very sensitive and important issue in the country saying, “a healthy nation equates to a strong economy.”
The study reveals that a number of factors negatively impacted overall implementation of the MES project, leading to poor service delivery results. The design of the MES Project, for instance, was not informed by a comprehensive disease burden and health infrastructure needs assessment, given that counties are not homogeneous in terms of their medical priorities and needs.
In addition, lack of transparency on the entire project with regard to the terms and conditions of the contract and poor regulation of this typical Public Private Partnership project increases financial and corruption risks. This has made the project a burden to taxpayers.
The MES Project took place in only 7 counties of Nandi, Nakuru, Nyamira, Siaya, Vihiga, Uasin Gishu and West Pokot in 2017. The equipment was not used in West Pokot and there is no report for the four years since the MES Project started in all the counties.
All the 47 counties in Kenya were to take part in the MES Project but only 7 counties responded to show some details about the project. At these counties, there was a failure to meet the constitutional utilization of money and under-utilization of delivered medical equipment.
In 2015, these seven counties signed a memorandum of understanding (MoU) but a county like Nyamira the MoU was not provided for audit and information on whether the MoU exists in other counties that had audit queries on the MES was not explicitly mentioned.
With medical staff at the hospitals still to undergo training on how to use the equipment, many machines remain packed in some county stores for lack of utilization. There is also poor infrastructure for MES to be kept or maintained in some counties.
Since the MES Project started, there is lack of access to data of the equipment presented to the 47 counties. There are no facts on the equipment presented to the hospitals, lack of supporting documents on procurement process at counties, lack of specific details on medical equipment delivered, unsupported medical equipment leasing, lack of explanation on leasing rentals and there is no report for the four years since it started.
There is need for further evaluation and reconfiguration of the project before it lapses to ensure that citizens actually receive value for investment in the sense that there are better health outcomes. There is also need for better clarity on the outcomes of the activities of the MES Project. The medical equipment should be redistributed informed by evaluation and audit of the MES Project
There is need for an inter-governmental frame work for the evaluation and re-configuration of the MES Project, use evaluation and audits to inform re-distribution of medical machines. Also to strengthen public finance management and audit systems for transparency and accountability of the MES Project. Adherence to transparency of the MES Project in conformity with the Public Private Partnership Act, 2013.