Tuesday, December 20, 2016

Saving face, come hell or high water

What does healthcare in Kenya entail? If you go by the rhetoric, two things: salaries and wages, and equipment and their billions of shilling worth of tenders. And it seems that the latter prevails over the former. Every time.

When the Government of Kenya, through the Presidency and the Ministry of Health, entered into a medical equipment supply agreement with who knows who, for thirty-eight billion shillings, the greatest whinge from devolved government wasn't that the equipment had been acquired without their input or consent (they hadn't) but that the terms of the tender had been negotiated exclusively by the national government, leaving the counties out of the party. They weren't unhappy that they were saddled with debts they couldn't service; they were unhappy that when contracts were being negotiated (and the backhanders that go with such "negotiations") senior county government bigshots never got the chance to ride the gravy train.

What remained unresolved, almost a decade since the process commenced, was the state of the health policy, its implementation, emerging challenges in the light of new constitutional imperatives, and the comprehensive bargaining agreement between public healthcare workers and their government. It isn't that difficult to understand why this is so.

If you have ever been to the National Treasury building, you will notice there are two banks of lifts. One is marked "VIP" and another is marked "Senior Staff". These two are set apart from the remaining four, and are reserved for the Cabinet Secretary and his Principal Secretaries (VIP) and the other, as you've surmised, the "senior staff", whoever they happen to be. The former have restricted access, access being controlled by keys. That isn't what makes them remarkable; what makes them remarkable is that they are gold-plated. The remaining lifts which seemed to have last been serviced when Mwai Kibaki was Minister for Finance, retain what looks like the original paintwork they had when they were installed.

The reason why healthcare workers receive short shrift from their employers despite CBAs and the like is that 99.99% of them are not fit, in the strange hierarchy of the Kenyan public service, to access gold-plated lifts like the ones at the National Treasury. For sure, almost all Kenyans who are not "VIPs" or "senior staff", never mind how much they pay in NHIF and NSSF contributions, do not deserve gold-plated anything, only the appearance of something.

"Face", as the Chinese have demonstrated through so many kung-fu films, is sometimes more important than anything else. To save "face", the Government pretended to offer Kenyans better healthcare by committing thirty-eight billion shillings to purchase medical equipment and a goodly sum to market the achievement in the media. It is why Machakos District Hospital has witnessed the "launching" of equipment that was delivered in 2014 at least three times in the last three years. It doesn't matter that the real equipment delivered to Machakos at great cost finds no technical or medical experts to operate them; all that matters is that the right people look good when the photojournalists come with their cameras.

Healthcare is a complex subject, made more complicated in an environment bereft of a coherent up-to-date policy or substantial public investment or resources. Kenya isn't Cuba where one of the last communist countries has managed to control the health of its citizens in ways that we would chafe at. It isn't the United Kingdom, whose cradle-to-the-grave taxpayer-financed National Health Service, warts and all, is a model that is the envy of the world. This is Kenya where the gold-plated-lift riders demonstrate their faith in Kenya's healthcare infrastructure, both public and private, by flying out to foreign medical facilities, even for minor injuries.

What we pay attention to, almost to the total exclusion of anything else, is face. And because the President cannot be seen to lose face, no matter how long the doctors stay on strike or how many Kenyans die in agony because of it, neither the President nor his government will bend an inch. At some point, something will have to give.

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