The governance crisis that the Nairobi Hospital Board has been grappling with peaked early last week with the dismissal of new chief executive Allan Pamba.
The action has created divisions, with some members saying they were not consulted by board chairman Irungu Ndirangu.
The removal of the CEO, barely seven months after he was appointed, has opened a lid on the split between some board members and the management, which accuses the faction led by the chairman of being overbearing.
What appears to be a recurring conflict among high revenue hospitals points to a deep-rooted problem of weak internal structures. The first is the lack of capacity in management of conflict of interest in the board. The second is failure to maintain transparent ways and systems of managing and dealing with related party transactions.
The board chairman and his deputy Chris Bichage are on the same side even as it emerges that at least five members out of 11 have disowned the decision to send Dr Pamba packing. The five are said to be planning a full board sitting to review the dismissal.
Dr Pamba took over as a substantive CEO in March following the controversial dismissal of Dr Gordon Odundo, which triggered wrangles at the premier hospital. The dismissals appear to be as a result of the same reasons – disagreement with board members on tenders.
Dr Odundo was sent on a 90-day compulsory leave on December 15, 2018 after the board said in an unsigned and undated statement that the decision was to “allow completion of the forensic audit”
Dr Pamba opened up to the Sunday Nation about lucrative tenders at the institution that “influential individuals want to control”. He, however, did not go into the details of the case he has filed in court.
Describing one powerful person on the board as “a helicopter which flies too close to the ground, and all the time”, Dr Pamba said his reluctance to look the other way on attempts to tamper with good governance practices created bad blood between him “and one or two board members”.
One of the issues involves mega tenders such as the ongoing construction of a Sh1 billion 150-bed-capacity wing funded by the United Nations. Dr Pamba said he has, however, not forgotten a warning from his professional colleagues who discouraged him from taking up the position.
“I took this job with my eyes open. Many told me that it was a risk and that it would ruin my reputation. The dismissal does not entirely surprise me,” he said.
Dr Pamba added that he advertised the tender, followed the right channel and it was awarded – only for a board committee to give it to a different company.
“At the Nairobi Hospital, we have the Kenya Hospital Articles of Association which spell out the functions of the board and management, what they can and cannot do,” he said.
Contacted last evening, however, board chairman Ndirangu said the matter is in court and he would not comment. “It is illegal to discuss the case outside court,” Dr Ndirangu said.
When Dr Pamba joined the hospital, the board that hired him had just been appointed. The previous team had been accused of bad governance. His struggle has been defining the roles of the board and those of the hospital management.
“I found myself being told what to do on operational rather than strategic matters. Committees were making operational decisions, which should not happen under normal circumstances with a non-executive board,” he said.
He gave the example of the board hiring senior managers – Human Resource and Finance director – going against the charter, which states that the CEO has the final say.
“It leaves one feeling just like a rubber stamping officer. They deliberate, make decisions and then I am told to authorise using my signature,” he said.
“Under ordinary practice, the board approves a full year budget once. The management is then charged to deliver targets against that budget, including the day-to-day operations of advertising and awarding tenders as per the hospital tender manual.”
Hospital sources said every tender has to go through the board finance committee for approval, even though it is the management that takes responsibility.
Dr Pamba, a holder of a Masters of Science degree in public health in developing countries from the London School of Hygiene and Tropical Medicine, said he has been asked to single source and identify institutions on several occasions, practices he declined.
“Those who were interested in the board operating as an executive board and especially in influencing tenders were not happy with me. This is the plight of many young chief executives. You are asked to do things and when they go wrong, people fall back to you,” he said.
Through a letter from the hospital board chairman last week, Dr Pamba was dismissed on claims that he failed to craft a performance enhancement plan.
“Please note that the September 10 letter extending your probation to December 12 gave you up to September 30 to acknowledge and execute the plan,” the letter signed by Dr Ndirangu read.
“Unfortunately, you responded on September 2 and requested that the board of directors review your performance in line with the board charter, contrary to your letter of appointment, which clearly states that the chairman of the board will review your performance.”
“Your failure to execute the performance enhancement plan and the probation extension letter implied your lack of interest to continue working for Nairobi Hospital.”
Dr Pamba said after his six-month probation ended on September 8, the board remained silent, only for it to respond on September 15. His probation was extended by three months without a review, he said.
