And, because money hardly reaches the people it is allocated to, its absence (even when stolen) does not really make a significant impact. This seems to be the scenario behind the suspension of Sh2.1 billion funding to the Ministry of Health by the American government.
According to the US embassy in Nairobi, the drastic action by the US Agency for International Development (USAid) is as a result of alleged endemic corruption in the ministry, which according to audit was abetted by high-ranking officials, through weak accounting procedures and outright fraud.
A look at the main activities affected by the aid freeze shows the channels through which billions of shillings were siphoned. These include non-core activities such as salaries and wages, domestic and international travel, procurement of supplies and equipment, fleet maintenance and fuel assistance, and information and communication technology-related services in both grants and financial management.
While corruption continues to be entrenched in public institutions, we still need to be hopeful and look at what needs to be done going forward. Like the rest of Africa, our health sector is in a stagnating crisis whose resolution needs restructuring the current systems to achieve universal health access as stated in the UN’s social development goals.
Statistics from the World Health Organisation (WHO) shows that while Africa carries 25 per cent of the world’s disease burden, its share of global chance to remodel health expenditure is less than one per cent. To worsen matters, Africa manufactures less than two per cent of the medicines it consumes. Consequently, quality health, usually only found in expensive private hospitals, tends to be the preserve of people in the upper economic brackets, while the poor rely solely on under-funded public health facilities.
Secondly, while malaria and HIV/Aids still carry much of Africa’s disease burden, they are largely being contained through better prevention and treatment measures, including use of treated mosquito bed nets, increased availability of anti-malarial medicines and distribution of anti-retroviral drugs. Of major concern today is the spiralling of non-communicable diseases (NCDs) such as cancer, heart and respiratory diseases, pneumonia, diabetes type 2 and high blood pressure as the leading cause of deaths in Africa.
Indeed, WHO says in 2012, NCDs killed 38 million people worldwide, of whom 80 per cent were from the developing world, including Africa. Managing the diseases has become a monumen tal challenge because of the need for advanced diagnostics and drugs, intensive disability management and prolonged care. This leads to what has been called the “multiple disease burden” in already overstretched health care systems.
Meanwhile, African doctors are seeking better employment overseas as thousands of African patients troop to India in search of affordable advanced medical attention. It is a situation that, if not addressed urgently, will lead to the crumbling of our hospitals. Luckily, however, there are some significant gains made in recent years, especially in drastically reducing maternal mortality.
According to the UN’s Africa Renewal quarterly (December 2016-March 2017), it is time to rethink the continent’s health care systems. At the core of this new outlook is the appeal to African governments to concentrate on providing basic healthcare and affordable drugs. The new approach would entail a lot of ingenuity. For example, Rwanda has established a national health insurance scheme which now covers 91 per cent of the country’s population.
USAid should restructure its current model of assistance and seek ways to make a bigger impact directly on the health of poor Kenyans. I think we have had enough workshops already and it is time to roll up our sleeves and get down to work.
The American agency can seek new areas of engagement, and invest in areas that will create the biggest impact for the majority.
The writer is the executive director, Centre for Climate Change Awareness—[email protected] centreforcca.org