Author: Omboki Monayo

  • Opinion: Can Kenya’s New Health Fund Overcome Its Challenges?

    Kenya’s healthcare system is at a crossroads.

    The recent launch of the much hyped Social Health Insurance Fund (SHIF), managed by the Social Health Authority (SHA), promised to usher in a new era of universal healthcare. However, this ambitious initiative has encountered formidable challenges, with many Kenyans now questioning whether SHIF can live up to its lofty goals.

    As of October 2024, over 12.7 million Kenyans had registered with SHA, and contributions are set at a minimum of Ksh 300 per month for self-employed individuals, with salaried employees contributing 2.75% of their gross salary.

    The government anticipates that SHIF will collect around Ksh 133 billion in its first year, with projections rising to Ksh 148 billion annually as it scales up.

    This revenue, more than double what was collected by the previous National Health Insurance Fund (NHIF), is essential for achieving the fund’s aim: comprehensive healthcare for all Kenyans.

    Yet, despite this optimistic forecast, the transition from NHIF to SHIF has exposed a wide funding gap that has thrown healthcare facilities into a financial crisis.

    Reports indicate that healthcare providers are already owed billions in reimbursements, a debt carried over from the NHIF. This funding gap has left health facilities cash-strapped, jeopardizing service delivery and heightening the sense of instability surrounding SHIF.

    A key challenge lies in the informal sector, where many Kenyans struggle to maintain a consistent income, let alone afford health insurance premiums. Without a stable revenue stream from this population, the financial sustainability of SHIF remains uncertain. The government’s reliance on these contributions might make the fund’s projections unrealistic, given that financial constraints often prevent low-income earners from prioritizing health insurance.

    Moreover, the lack of infrastructure in rural areas continues to worsen these financial pressures. While urban centers have relatively better-equipped facilities, rural areas often lack basic medical infrastructure. Consequently, the country’s quality of healthcare remains unevenly distributed, depriving rural populations of essential services. If the government aims to make SHIF a truly national solution, it must address this infrastructure gap by investing in rural facilities and upgrading resources. The need for well-equipped clinics, medical supplies, and trained personnel in these underserved areas is urgent, as these facilities form the backbone of the public health system.

  • Kenya Unveils New Policy to Slash Billions in Government Vehicle Spending

    Kenya Unveils New Policy to Slash Billions in Government Vehicle Spending

    The Kenyan government is implementing a sweeping new policy aimed at drastically reducing the cost of its vast vehicle fleet, a move projected to save billions of shillings annually.  The Government Fleet Management Department (GFMD) policy, unveiled by the National Treasury, introduces stricter regulations on vehicle allocation and usage across all levels of government, from national ministries to county administrations.

    For years, Kenya has grappled with inefficient and costly management of its government vehicles.  The lack of a centralized system, coupled with inconsistent regulations scattered across various circulars, has resulted in significant financial losses. 

    In his introduction to the draft, Treasury Cabinet Secretary John Mbadi outlined some of the obstacles facing the government vehicle sub-sector, stating, “Additionally, there is no centralized data repository for government transport assets, resulting in inefficient asset sharing among ministries.” He further highlighted the lack of tracking for vehicle purchases, maintenance, and fuel consumption.

    “The consistent allocation of over Kshs. 10 billion annually since 2018/2019 highlights the ongoing need for effective reform,” Mbadi stated, noting that despite high expenditure – peaking at Kshs. 17.7 billion in 2016/2017 – service delivery hasn’t improved commensurately.  Challenges include fuel misuse, high maintenance costs, and vehicle obsolescence.

    The GFMD policy directly addresses these inefficiencies.  It significantly reduces the number of vehicles allocated to top government officials.  Cabinet Secretaries will now receive two vehicles each. Principal Secretaries, heads of parastatals, and Chief Executives will receive one vehicle each.  Senior officers will utilize vehicles from a centralized pool, promoting shared resources and reducing overall fleet size.  Commissioners and board members will use their private vehicles and claim reimbursement for official travel.  A similar structure is implemented at the county level.

    The new policy builds upon previous reform attempts, which were hampered by inconsistencies and implementation difficulties.  A 2013 initiative, while aiming to address rising costs, procurement flaws, misuse, theft, and inefficient utilization, faced operational hurdles.  The GFMD policy aims to rectify these shortcomings by creating a robust framework for government transport management.  Beyond cost reduction, it also aims to enhance local vehicle assembly and stimulate economic growth.

    The policy details procedures for acquiring, providing, maintaining, and disposing of government assets, including the use of private vehicles for official travel. It establishes a clear implementation plan, identifies key stakeholders, and incorporates a robust monitoring and evaluation framework. 

    In a departure from past reform efforts, the policy proposes the creation of a dedicated Fleet Management Department to oversee and coordinate all government fleet activities.  As CS Mbadi writes in the draft document, “GMFD outlines detailed procedures for the acquisition, provision, maintenance, and disposal of government moveable assets, including the use of private vehicles for official travel.  It also details an implementation plan, identifies key stakeholders, and establishes a monitoring and evaluation framework.  Crucially, it proposes the creation of a Fleet Management Department to coordinate government fleet activities.”

    GFMD’s vision is “World Class Fleet Management for Efficient Public Service Delivery.”  Its scope extends to all government transportation, including vehicles from development partner programs and projects, and even livestock used for transport in some areas. 

    The policy acknowledges that high costs are driven by factors including ineffective procurement resulting in unsuitable vehicles, weak regulations leading to vehicle misuse, poor management of vehicles acquired through development partnerships, and the absence of a central coordinating body for fleet operations.  Further contributing factors include fuel and spare parts mismanagement and theft, unequal asset distribution, and extremely low vehicle utilization (averaging just 48.8%).

    The policy draws on best practices from countries like Malaysia, Australia, and Rwanda, adapting effective fleet management standards to the Kenyan context.  It emphasizes modernization, safety, and evidence-based decision-making, anticipating the integration of technology-based solutions, such as geo-fencing, to improve tracking and streamline operations. 

    GFMD aims to create greater certainty and predictability in future amendments by addressing inconsistencies in existing regulations. 

    According to Principal Secretary Dr. Chris Kiptoo, “This policy which was subjected to rigorous public participation, will improve government transport service delivery, free up financial resources, streamline procurement, and optimize economies of scale through improved inter-agency coordination.  It will also institutionalize a clear separation of roles within the transport function. Furthermore, the policy will curb escalating maintenance and overall transport costs, enhance fleet utilization, improve the safety of government officials, and ensure a responsible process for acquiring and disposing of transport assets.” 

    The overall goal, he says, is to achieve better value for money and cost-effectiveness through optimal vehicle allocation and utilization. The expectation is that the implementation of the GFMD policy will result in substantial cost savings and improved efficiency within the Kenyan government’s transport system.

    The success of the GFMD policy hinges on rigorous implementation and consistent oversight.

    While the projected cost savings are substantial, challenges remain. Addressing entrenched bureaucratic inertia, ensuring widespread buy-in from government officials accustomed to existing practices, and effectively utilizing technological solutions will be crucial for realizing the policy’s full potential.

    Ultimately, the long-term impact of the GFMD policy will be judged not only by its financial achievements but also by its contribution to more efficient and transparent governance in Kenya.

  • Staying Safe Between the Sheets – Spotlight on Sexual Health

    Staying Safe Between the Sheets – Spotlight on Sexual Health

    By OMBOKI MONAYO

    Have you had your HIV test this year yet? If not, take time this week to get tested. Regular testing for STIs is also crucial. Consider discussing STI testing with your partner(s) before engaging in sexual activity to ensure transparency and safety.

    Open and honest communication with your partner(s) about sexual health, STI status, and birth control options is vital for fostering a healthy sexual relationship. Additionally, getting vaccinated against STIs, such as HPV, hepatitis B, and herpes, is recommended by healthcare providers and can provide important protection.

    Sexual health encompasses not only physical well-being but also emotional, mental, and social wellness concerning sexuality. It is far more than just the absence of disease or dysfunction. Many people suffer when they lack bodily autonomy, control over their reproductive choices, or the freedom to experience safe and consensual sexual relationships. Access to contraception and the necessary information to make informed decisions about sexual health is an essential aspect of achieving overall sexual well-being.

    In Kenya, the percentage of married women using modern contraceptives has steadily increased over time, from 32% in 2003 to 57% in 2022. Over the same period, the unmet need for family planning declined from 27% to 14% (KDHS 2022).

    Contraceptive uptake is measured using the Modern Contraceptive Prevalence Rate (mCPR), which is the percentage of WRA who are using, or whose partners are using modern contraceptives. The country aims to achieve 64% mCPR by 2030.

    While remarkable strides have been made in providing access to safe contraception methods, there remains a significant gap in empowering the population with the necessary information to enable individuals to make informed decisions about sexual activity.

    In a September 4 press release marking World Sexual Health Day, Marie Stopes Kenya (MSK) identified the lack of Comprehensive Sexuality Education (CSE) as a critical issue that continues to leave many young people vulnerable. MSK emphasized the pressing challenges faced in Kenya, particularly the absence of comprehensive sexuality education for adolescents and young people.

    “This education gap has resulted in high rates of unintended pregnancies, unsafe abortions, and sexually transmitted infections (STIs) among adolescents,” read the statement.
    In light of these challenges, MSK has called on the Kenyan government to prioritize the funding of reproductive health, particularly family planning, stressing that this is not only a health concern but also a matter of human rights and social justice.

    “Investing in sexual and reproductive health is essential for empowering individuals to make informed choices about their health and their futures,” MSK. The organization highlighted the societal benefits of ensuring access to family planning services, explaining that it can contribute significantly to the well-being of the broader community.

    Furthermore, MSK is urging for the adoption of an inclusive approach to advancing Sexual and Reproductive Health and Rights (SRHR). This approach is captured in the Family Reproductive Healthcare Bill of 2023 and seeks to address all aspects of sexual and reproductive health to ensure that everyone has the opportunity to achieve the highest possible standard of sexual well-being. Sexual health, the organization added, is fundamental to achieving overall health, gender equality, and social and economic development.

    MSK stressed the importance of recognizing, respecting, and protecting sexual health for all. By working together, it believes that a society can be built where every individual can reach the best possible standard of sexual and reproductive health and well-being.

    In line with safeguarding sexual health which includes reducing the risk of sexually transmitted infections (STIs) and unintended pregnancies, here is some practical advice on maintaining your sexual well-being.

    You can adopt several key practices that prioritize your sexual health and well-being while also protecting your partner. First and foremost, it is essential to use condoms consistently and correctly every time you engage in sexual activity, whether it be oral, anal, or vaginal sex.

    Using water-based lubricants during sex can help reduce the risk of condom breakage and enhance pleasure. It is also advisable to avoid sharing sex toys. If sharing is unavoidable, use condoms on the toys and ensure they are cleaned thoroughly before and after use. Limiting the number of sexual partners and being aware of their sexual history and practices can further minimize risk.

    Moreover, it is important to avoid alcohol and drug use before and during sexual activity, as these substances can impair judgment and lead to risky behaviors. Practicing self-care by getting enough sleep, maintaining a healthy diet, and managing stress can also contribute positively to sexual health and overall well-being. Finally, it is crucial to seek medical attention promptly if you experience any STI symptoms or have had unprotected sex with a partner whose STI status is unknown.

    By adhering to these practices, you can maintain and protect your sexual health, contribute to your overall well-being, and ensure a safer, healthier society for all.