For some time now, a tug of war has been ongoing between governors and national government on the latter’s decision to lease medical equipment on behalf of the counties, with the county chiefs citing covert graft in the scheme.
And though the majority of the county bosses are not satisfied with the pact as currently drawn, some have gone ahead to sign the deal out of the fear that the alternative – declining to be party to it – would have serious political ramifications.
When the plan was first introduced, the Council of Governors made a decision to reject the plan wholesale over “a lot of grey areas”, especially because the national government was not forthcoming on matters of concern raised by governors, such as the idea that the cost of the equipment was grossly inflated – the CoG contended that what will be spent on the equipment in the leasing period is higher than the cost of actually purchasing the equipment. However, a section of governors have since changed tack and agreed to the plan, even joining the government’s bandwagon to call on their dissenting colleagues to get on board.
Under the scheme, each county is expected to pay Sh98 million a year for seven years, which will see them receive, among others, dialysis and cancer equipment, and intensive care units. Counties are expected to pay for the cost of the equipment even when they have not received the equipment already, which is what is likely to happen for the next two years, at least, begging the question where this money will go in the meanwhile.
Bomet governor and former CoG chair Isaac Ruto (inset), in an exclusive interview with the Nairobi Law Monthly, says that he is yet to be convinced to sign for the equipment, particularly because he is still setting up the requisite structures, and what he terms as a mischievous ploy by government to bully governors into agreeing to a “very expensive option”.
“Even though governors met and agreed to get on board, I haven’t bought into the fidelity of the project. The whole point of leasing is, first because of ease of accessibility and two, because of the friendlier cost of leasing,” says Ruto. “What is, however, happening is that governors are being asked to give a silver-lined approval to a very costly project.”
The governor offers that because CoG operates on the principal of consensus, the county chiefs agreed to sign on a voluntary basis.“A number of us had very strong reservations about the nature of the project we were being asked to endorse, but we opted to express our reservations individually. Personally, I wonder why I am being compelled to sign for a machine for which I have are neither structures nor personnel. Besides, we already have purchased a dialysis machine, and I absolutely do not see why I need to get another this quickly.”
The main problems that governors have with the project are the cost involved, and the choice of machines given in relation to the health priorities identified by various county governments. Most importantly, the governor says, they were never consulted before the government began executing the plan.
“National Government did not involve governors when the project was initiated. Its drafters do not understand the health challenges and priorities of different the people on whose behalf they are purporting to act. What is it that they intend to treat? What is the problem, so that we agree on how best to deal with it?
Governor Ruto sees a powerful, unseen hand in the rush to have the scheme rolled out, and calls on his colleagues to be careful about entering into a deal they not fully understand.
“They keep telling us that it is state-of-the-art technology – which they say is not as expensive as the manual machines. Why then is the cost so high? Why were we not involved in drawing the plan/agreement? We don’t know what informed the discussion.”
A question of priorities
But while the governor is critical of the deal, he is not entirely dismissive of the scheme, and asserts that what he wants to do is get the assurance that it is a transparent, accountable affair, and the chance to set up structures to accommodate the equipment. He cannot, he says, just give out money for which more pressing needs have been identified.
“In Bomet, for example, I lose more children and mothers to maternity-related complications than to anything else; that is where my priority lies now. Of course, I need to improve these other areas, but that is a question of when, not if. To take care of patients with kidney problems, for example, Bomet already has a dialysis machine and people to run it. Before I can come back to that, I need to focus on where the problem really is.”
“The money we have been asked to pay – we will pay this year yet we won’t receive the equipment – why don’t we use it to set up the required structures? One of the hospitals chosen as a beneficiary in my county is still under construction; there is nowhere to put the equipment. Besides that, I will need a minimum of two years to get the right personnel – those who are already qualified medical officers – and train them. If I were to send high school leavers to college, it would take about 11 years for them to be ready (from training and internship to postgraduate studies) for them to be ready. Establishing a cancer centre, for example, takes about 11 oncologists. That is not something you just wake up and do.”
The relationship between the national and county governments is at a bad place, and this tussle points to continuity of that strain. For a regime known to tolerate corruption to its highest echelons, the medical equipment leasing scheme sounds like many of the failed projects the State has initiated, but which continue to gobble up billions every financial year. This, Governor Ruto says, informs part of his reasons for not embracing the scheme.
“Because of the secrecy surrounding the scheme, there is good reason to believe that the cost of the equipment has been deliberately inflated. This is not impossible for a government as mischievous as Jubilee.”
Does he think government will win the war on graft?
“Eliminating corruption shouldn’t be just about investigating and punishing culprits after the fact; rather, it is the whole question of ethical conduct and integrity. What we have is noise being made about missing figures and files. But what we ought to focus more on is ethical conduct, and focus on extolling integrity.
“Good math will not lead to good people. We must ensure public participation so that everyone is a watchman. Let’s be serious about implementing Chapter Six of the Constitution… facilitate public participation and governance will become more transparent. ^