Mobile clinics: Same concept, different executors as Rachel Ruto launches bid similar to Margaret Kenyatta’s

Another round of medical kits and mobile clinics has been launched in seven counties in a drive to improve healthcare and ease accessibility this time by Kenya's First Lady Rachel Ruto.

In 2014, then-First Lady Margaret Kenyatta unveiled a similar initiative dubbed Beyond Zero campaign. She raised millions of shillings to purchase mobile clinics for all devolved units with some regions bagging two clinics.

Mrs Kenyatta prioritised reducing maternal and infant mortality rates and promoting child health. Taita Taveta was the first county to receive a mobile clinic, and later, the drive expanded to provide 52 clinics to all 47 counties.

The main question remains whether the latest round of medical health drive will make a major difference given that there has been insignificant change in the reduction of maternal deaths, which remain a leading cause of pain and socioeconomic disability.

And despite the promise that came with the initiative to free Kenyan mothers from the insecurities of maternity care, regrettably, maternal deaths in the country are still high.

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According to the data from the Ministry of Health, one in 38 Kenyan women is at risk of dying from childbirth complications such as excessive bleeding or obstructed labour.

At least 6,000 women die from pregnancy-related complications in the country every year, way above the global average.

While safe motherhood is easily achievable with the right policies and investments, Kenya’s investment in the sector has yielded dismal results.

While flagging off the mobile clinics, Mrs Ruto said inaccessibility to health services is one of the biggest obstacles to building a healthy nation. She distributed the equipment to Baringo, Marsabit, Samburu, Turkana, West Pokot, Mandera, and Isiolo counties.

The donation included three fully equipped mobile immunisation clinics, four medical refrigerators, cold rooms, and transport freezers worth Sh63 million.

These resources, she said, will guarantee that vaccines and medicines remain effective, particularly in harsh climates.

Mrs Ruto thanked the German Development Bank and Aga Khan University Hospital for contributing.

Universal health coverage

"This contribution aligns with the government's dedication to universal health coverage, which is a crucial aspect of the Bottom-Up Economic Transformation Agenda. She further added that through the collaborative effort of these organisations, they will work together to build a healthier and stronger population.

The Aga Khan University Hospital Chief Executive Officer Rashid Khalani, while handing over the equipment, said they would ensure that Kenyans' medical care is provided to them in a timely manner and as close as possible.

“I assure you of our commitment to support this agenda both in aligning the delivery of our services and by extending a helping hand to the public healthcare system. The mobile clinics will significantly increase the reach and accessibility of healthcare services, bringing them closer to the doorstep of Kenyans.”

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He adds: “The clinics will facilitate regular health screening through which we can identify diseases early, for early intervention which improves the quality of life for Kenyans. The government will also have the capacity to extend the reach of immunisation to the underserved far-flung areas," said Dr Khalani.

The Nation has also learnt that the same institution, the Aga Khan University Hospital, donated the 40th fully kitted mobile clinic to Margaret Kenyatta at State House, Nairobi, in 2016.

Presenting the donation to Mrs Kenyatta then was the Aga Khan University Hospital Chief Executive Officer Shawn Bolouki, who said the institution was proud to be associated with the Beyond Zero initiative in its journey to reduce maternal and child deaths across the country.

Beyond Zero, launched in January 2014, was registered as a private company which saw 52 well-equipped clinics given to all 47 counties end of 2016. Each of the clinics would cost Sh10 million.

Mrs Rachel Ruto, in her brief during the handing-over ceremony at State House, indicated that a team of eight nurses and drivers will receive training as part of knowledge-sharing and the continuous improvement of the health sector in the clinics.

It needs to be made clear whether it is the sponsors, the national government or the county government responsible for conducting the training and, therefore, who is responsible for the servicing and daily running of the clinics.

The same problems led to the grounding of the initial mobile clinics.

Investigations by the Nation revealed that in many counties, the clinics are choking in dust, with many regions citing inadequate health personnel, allowances, drugs and lack of insurance, fuelling the trucks and management costs.

Employ medics

Some counties struggled to employ medics, pay their allowances and at the same time fuel the trucks. They have since requested the national government's help to run the clinics.

The clinics needed drivers, nurses, clinical officers, clerks and lab technicians who worked in shifts.

In Siaya, Kisumu, Homa Bay, Vihiga, Kitui, Marsabit, Kericho, Bomet, Nakuru, Lamu, Mandera, Turkana, Narok, Bungoma, Nyamira, Kitui, Nyandarua, Nyeri, Murang’a, Kisii and Meru counties services have halted due to lack of fuel, drugs and allowances for nurses. The trucks are also grounded.

According to sources in Kitui County, which received two mobile clinics under Beyond Zero, staff used to go for weeks without allowances until they gave up and stopped working.

The mobile clinics, fitted with three consultation rooms, a laboratory and a pharmacy, are mainly used in the counties for emergency services, distribution of drugs and nets, and primary health services.

Initially, this was to be a charity initiative that attracted high-profile sponsors who organised fundraising events.

The initiatives also benefited from taxpayers' money with the former Ministry of Health and the Presidency has since allocated some money to the initiative.

Counties allocated money from Sh1 million to Sh10 million to run the clinics a year, but there was no sign of improvement in maternal care services in some counties.

Dr Edward Kariithi, the senior service delivery technical adviser at PATH, who spoke to the Nation earlier, said that most maternal deaths can be prevented if women received antenatal care to monitor the progress of the pregnancy and deliver in a health facility with qualified personnel and the right equipment.

“This is critical to take care of emergencies in good time. Safe motherhood is easily achievable with the right policies and investments. So far, Kenya has had quite several investments in the sector with little results,” says Dr Kariithi.

His sentiments were echoed by Dr Davji Atellah, Secretary General, of Kenya Medical Practitioners and Dentists Union who noted the many projects launched by the government are not aimed at improving Kenyans' lives but filling people's pockets. 

“With all the money that was spent on that project, it just went like that; I did not expect we would still be recording high maternal deaths as a country. Look at where we are; the same people involved in the other project are coming with the same initiative, not remembering that they failed Kenyans,” said Dr Davji.

He said the cost of public-private partnership projects in the health sector can be reduced by avoiding duplication of services between philanthropists and the State.

“We are spending millions on projects already or at least financed. The duplication is because of political boundaries and about control, yet in many occasions, several duplicated projects have similar requirements,” he said

He said the country has a serious problem in health finance, and the least they could offer Kenyans was to ensure that the hospitals are well equipped and stocked with drugs rather than launching projects to benefit few individuals.

Funding

“We need to start recognising that starting a similar project and just changing the name of the implementer is a waste of resources even if the projects are not funded by taxpayer’s money. The well-wishers involved in the funding would have picked a different project or a continuation for citizens to benefit from the project,” the authority said.

Dr Davji adds: “Many of the projects are to make money and not survive to the people. Unfortunately, we are joking with the lives of Kenyans. Mobile clinics are grounded, and we are launching the same in the counties. This is a shame,” he said.

In 2019, through the National Treasury, the government established a Public Investment Management unit to curb duplication of projects that served as conduits of corruption while increasing efficiency, effectiveness, transparency, and accountability in public spending.

The unit was to enable efficient identification and implementation of priority social and investment projects aimed at improving the quality of life for Kenyans.

“In particular, the implementation of PIM regulations under the Public Finance Act will streamline the initiation, execution and delivery of public investment projects and also reduce runaway project costs, a phenomenon that has characterised many development projects across the country,” said the National Treasury, in its 2019 draft Budget Policy Statement.

The statement notes that shedding duplication of projects and cutting misspending within the government will save resources required to support the fiscal consolidation programme.

Regrettably, Isiolo Governor Guyo Abdi Ibrahim, who was at the State House and a beneficiary of the mobile clinics, indicated that Isiolo County, like many other counties, faces its unique healthcare challenges.

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“We recognise these challenges, and we are committed to addressing them with determination, compassion, and a clear vision for a healthier county,” he said

Mr Muthomi Njuki, the Governor of Tharaka-Nithi County and Chair of the Health Committee at the Council of Governors, said, “The Geneva Convention puts the idea of the distance to access health facilities at a maximum of five kilometres.”

“The mobile clinics will take the services closer to the people and help scale up universal health coverage.”

Why they did not implement the initial idea and take the services closer to the people needs to be clarified.

Most of the governors then indicated that there was no budget to cater for the employees and fuelling of the clinics.

Many Kenyans struggle with how different Mrs Rachel Ruto’s initiative is from Mrs Margret Kenyatta's: same donors’ different years, same project.