County governments demand Global Fund billions – or else

By Gatonye Gathura

County governments in Kenya have termed as unacceptable a refusal by Global Fund to channel its money directly to the devolved units.

Last year the Council of Governors (CoG) had requested Global Fund to consider channeling some of its grants directly to the counties and not through the Ministry of Health (MOH).

For a start, the CoG had suggested the Global Fund channel part of its current Sh39.2 billion ($384 million) grant to Kenya for HIV, malaria, and tuberculosis to the counties.

But in a letter to the Principal Secretary for Health, Susan Mochache on 24th May 2019 the fund turned down the request.

“Kindly note that the Global Fund does not approve the proposed county proposal for the Global Fund engagement with counties through conditional grants,” said the fund in a letter copied to the CoG.

In response, on 4th June 2019 all members of the County Executive Committee in charge of health met in Nairobi and unanimously advised the CoG to reject the decision.

“The Global Fund was ill-advised ……… and made an erroneous interpretation of the Constitution, and counties do not agree with the decision,” they said in a communiqué to the CoG.

The communiqué signed by the CEO at the CoG secretariat Jacqueline Mogeni listed several resolutions which could further destabilize an already limping health sector.

Targeted are the Kenya Medical Supplies Agency (KEMSA) and the Universal Health Coverage (UHC) project.

The communiqué said the council will be heading to court to stop proposed legal amendments to make it mandatory for counties to procure all medical supplies from KEMSA.

This amendment is seen as largely driven by donors who have put huge investments in KEMSA to ensure it procures only from donor preferred sources.

“Nonsense,” says James Kamau of the Kenya Treatment Access Movement (KETAM) a local NGO. “Counties want to open channels of underhand drug procurement from unverified sources,” said Kamau.

Also in a move that could delay the national rollout of UHC, the counties now want the MOH to provide them with a UHC policy framework before the scheme is scaled up to the other 43 counties.

“The MOH should brief governors adequately about the financial implications of UHC and the sustainability and tenability mechanisms in place,” demands the health committee.

Justifying its decision, the Global Fund says counties lack the capacity to effectively implement its programmes as well as adequate accountability systems.

In any case, the fund says its grants in Kenya are performing well under the current arrangement with tremendous results.

This seems to contradict its own audit on local grants published in November last year which had threatened Kenya with possible loss of support due to poor accountability.

The audit covering 2016 and 2017 told of massive irregular payment to workers and project activities.

The audit report also said  up to a quarter of health workers were not following the required HIV testing procedures suggesting a significant number of Kenyans may be getting false HIV results.

The auditors found condoms worth ($6 million) Sh600 million procured by the KEMSA had not been tested for quality at the National Quality Control Laboratory as required.

They also report finding medicines worth ($3.8 million) Sh380 million stored by KEMSA in leaking warehouses along Commercial Street in Industrial Area.

Governors have consistently complained that Afya House was being allocated too much money while most health functions have been devolved.

A recent analysis of the national health budget, by the USAID funded Health Policy Plus project, showed allocations to Afya House to have increased significantly over the last three years.

The ministry was allocated a total of Sh90 billion in the 2018/19 budget compared to Sh60 billion allocated during each of the two preceding years.

Data shows loans and grants from donors to the MOH increased from 18 billion to 24 billion in the last two national budgets.

Comparatively the combined health allocation to the 47 counties in the ending financial year (2018/19) was Sh117 billion just about Sh27 billion more than provided to Afya House.

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