Nipate
Forum => Kenya Discussion => Topic started by: Omollo on February 23, 2015, 01:50:21 PM
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This is a statement from the Governors. However the Compliant National Media has conspired to fudge it. The Standard has even published it as a news report by one of its own journalists. The problem is he never read through it to edit away tell-talke signs of a statement by Governors. I was alerted to this statement and have taken time to make it clear for easy reading and understanding.
It looks like Uhuru appointed his tribesmen with a clear mission to help scam for money to fill up the campaign chest for 2017. Thus Macharia has figured out his own way of contributing to the kitty. His problem is that he is trying to rob thieves. Governors have seen it for what it is and are not playing ball. Not even Jubilee governors.
Nairobi, Kenya:
In fulfilment of Schedule IV of the Constitution, the 47 County Governments have over the last two years undertaken a phased but sustained strengthening of the six pillars (Leadership and Governance; Service Delivery; Human Resources for Health; Strategic Information; Commodity Security; and Financing) of the Health System to ensure improved access and utilization of quality health services by residents.
Service delivery in the health sector has improved tremendously due to more focused, need based investments and closer supervision by the County Governments. Indeed, the last two years has witnessed more investment in the health sector by the County Governments in real, annualized resource deployment than in the 50 years between Independence and Devolution.
Traditionally marginalized parts of Kenya have not only seen quality health services realized but made more accessible to the community in a more cost-effective manner thanks to the open, collaborative efforts by the two levels of Government . This consultative Framework has worked well in adherence to Article (6) of The Constitution.
Health services are both labour intensive and costly. Human resources, considering both headcount and skills, are a key input to the process. Health Infrastructure development is another key component in improving access to quality services.
Under Schedule FOUR of The Constitution, the Counties are responsible for health services at the Community (Level - 1) Level, and from Level - 2 (Dispensary) to Level - 5 (County Referral Hospitals). The Counties are investing heavily in this area by constructing and renovating health facilities and equipping them.
Due to the high cost of Health equipment and the rapid changes in technology, many Governments and Private Health Providers the world over are considering financing mechanisms to develop the necessary capacity to deliver quality health services and reduce equipment obsolescence. These include well-structured and implemented Public-Private Partnerships (PPPs). The Managed Equipment Services (MES) support to Counties by the National Government (MoH), and launched by H.E. the President, is a form of Public-Private Partnership (PPP).
A strong PPP allocates tasks, obligations, and risks among the public/state and private partners/ non-state actors in an optimal way. PPP is embraced only where the Public Sector Comparator proves that this service cannot be accessed through the normal Government Purchase system.
The Council of Governors understands and appreciates that the PPP arrangement can help strengthen the County Governments’ capacity to respond to the health needs of our citizens. In principle, we are not opposed to the PPP arrangement. However, there are several concerns on which we hope to get a favourable clarification from the National Government and specifically, the Cabinet Secretary for Health:
1. From the various PPP options below, which Models was chosen for the project?
- Resource Sharing ;
- Service Level Contracts;
- Regular Equipment Maintenance;
- Service delivery;
- Equipment Placement;
- Build, Operate and Transfer;
- Hire Purchase of Equipment/Infrastructure;
- Lease of Equipment/Infrastructure
2. Who has the residual ownership of the equipment after the contract period of seven years? Is the cost of Ksh.38 Billion inclusive of the residual value or will we have to pay a different sum to retain ownership?
3. Who provided The Transaction Advisory service for the project, since this is a requirement for all PPP arrangements? To whom do the Counties and the Leasing Companies go to for counsel and negotiation support if the Contractual obligations need to be varied?
4. International PPP Practice outlines five key phases of a potential PPP-Arrangement:
• Phase 1: PPP Project Identification, Screening & Selection
• Phase 2: Completing the PPP Feasibility Analysis & Risk-Allocation Structure
• Phase 3: Conducting the PPP Tendering & Procurement
• Phase 4: Final PPP Contract Signing & Financial Closure
• Phase 5: Monitoring & Ensuring Post-Award PPP Performance
Whereas the National Government could have undertaken Phase 3&4 with little involvement of the Counties, the others require a lot of consultation and collaboration for effective implementation and outcomes.
Identified County needs have to be the desired, realistic; and the solution selected the most impactful. Just to highlight why, see the attributes elaborated below that make up Phase 1&2:
5.- Who is the Custodian of the material reports from Stages 1 & 2 that informed the choice of items in the list provided to the Counties as part of the draft MoU?
- Where are the Actual PPP Contracts Signed by National Ministry of Health with the FIVE Companies?
- Is there any intent/promise built into the Contracts to achieve appreciable Technology Transfer to an Emerging African Economy?
- Who has the real responsibility for Base Payment for leased equipment or the National Treasury will deduct money from the County Allocations and pay this sovereign debt of Ksh. 38 Billion over seven years?
- The resource commitment to realize this MES initiative is staggering at Ksh. 38 Billion over seven years and clearly this is not a County, but National/Sovereign debt payable by ALL Kenyans.
6. - To what level has the National Assembly and the Treasury engaged the Public Sector Comparator to get a feel of the Value for Money justification and direction?
- It is not clear to the Counties if the equipment made available under this arrangement and stated in the list annexed to the MoU is all that is expected from the Ksh. 38 Billion.
- Further, it is not clear if the allocation will be equal in value, equitable or according to need.
- This is important information for the Counties because we have to, as appropriate, manage the perception and expectations of our own residents.
- An Equal Share Approach would, from a rough calculation, put at each County’s disposal for procurement of equipment (if converted into a conditional grant) a staggering Ksh.808 Million over the envisioned 7-year life of the MES arrangement.
- This works out to about Ksh. 115 Million annually
- That level of investment in direct equipment procurement and upgrade would transform some of the Counties into Singapore or Taiwan in terms of health services, especially if the revenue generated through cost-sharing at Level - 4 and - 5 is re-invested to build on that foundation.
- It is also not clear to us too, and we seek clarification from the National Government, if the location of the tagged equipment for the named two specific health facilities per County is immutable. That is, if there can be a shift based on the current reality (poor fit as a consequence of undertaking Stages 3 & 4 of the PPP Guidelines first… and parts of Stage 1 &2 are currently underway).
- Some of the listed equipment already exists and in service in these facilities, and no one expects us to pull out of service What We Own to take in leased replacements that will transfer back to the Leasing Agent in seven years.
7. - What prior infrastructural investment is required?
- Are these suppliers the ones to also put in place the infrastructure, such as the rooms and other requirements?
- Does the infrastructure require special architectural details?
- How much will it cost?
- Have the infrastructural costs been provided for?
- Is it part of the contracts that have been signed by the National Government and the foreign suppliers?
8. - Health being a devolved function, there is need for an intergovernmental agreement between the National Government and Devolved Government, to allow the National Government to do what it has done. Such an agreement is provided for in the Constitution at Article 187
- So far, there has been no dialogue between the two levels of Government about this “transfer of function.”
- The MoU circulated to the Counties for signing is too simplistic and unclear, and needs some sober and objective discussion; and
- especially on the many stated Obligations of the Counties and very few for the National MoH in this proposed arrangement.
- We are NOT saying NO to support…and any is welcome… We are only being prudent to ensure any agreements entered into protect the wealth and rights of the people of Kenya who voted for the new Constitution and who elected ALL of us into office.
Read more at: http://www.standardmedia.co.ke/article/2000152640/why-governors-are-opposed-to-sh38m-medical-equipment?articleID=2000152640&story_title=why-governors-are-opposed-to-sh38m-medical-equipment&pageNo=3
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That deal smell fishy..i think Macharia is upto no good with that kshs 38B. Why can't national gov concentrate on their job. Fund national hospitals. Or heck build them. KNH is a mess. Leave counties to do their own thing using their own ideas..Machakos delivered 70 Ambulance with meagre resources..give them 120M every year..and they'll know what to do.
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can't understand why so many projects worth billions which state house is having a visible hand are coming out stinking .... is it uhuru and co quest to accumulate money as fast as possible ..... except robin hood sonko who seems to be okay with his current sources looks like everyone else is hungry
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Health has been devolved to the counties. Why then come up with "equipment" for the county hospitals?
BTW what will Wajir and Mandera do with the cancer treatment centers? Surely these counties have other health priorities other than cancer.
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It will be hard if not impossible to respond to this objection by governors. In fact if they go ahead and sign the MoU they would be liable for serious legal consequences. The National Government cannot treat them as Moi would the defunct Provinces and Provincial Commissioners. The power of the governors and the counties is derived from the people through the constitution. The National government cannot purport to acquire equipment for County governments. This is just plain and clear corruption where some foreigners have struck a deal to grease Macharia's hand as they are allowed to fleece the counties.
Incidentally this would not be the first corrupt minister for health. Amukoa Anangwe was fired for corruption under the Moi regime! Just imagine"!. Then we had Ngilu getting off lightly. Beth Mugo stole openly as did Anyang Nyong'o. Clearly there is something (iko kitu) in Afya House that turns good people in to thieves.
Health has been devolved to the counties. Why then come up with "equipment" for the county hospitals?
BTW what will Wajir and Mandera do with the cancer treatment centers? Surely these counties have other health priorities other than cancer.
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Exactly.
Health has been devolved to the counties. Why then come up with "equipment" for the county hospitals?
BTW what will Wajir and Mandera do with the cancer treatment centers? Surely these counties have other health priorities other than cancer.
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They are "sourcing it" and demanding that the Counties pay for it! Yet the counties have not 1. Requested for the equipment 2. Participated in the procurement 3. Participated in the negotiations and the drawing of up of the contract
Exactly.
Health has been devolved to the counties. Why then come up with "equipment" for the county hospitals?
BTW what will Wajir and Mandera do with the cancer treatment centers? Surely these counties have other health priorities other than cancer.
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Dialysis centres for Wajir and Mandera. Surely, why should these counties pay for expensive medical equipment that will rot in the hospitals?
Also no infrastructure and let us not even mention personel to man these machines.
BTW GE is recruiting big time for the role out of this programme. Contracts have been signed and is now binding. Which ever way, Kenya has to pay.
They are "sourcing it" and demanding that the Counties pay for it! Yet the counties have not 1. Requested for the equipment 2. Participated in the procurement 3. Participated in the negotiations and the drawing of up of the contract
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http://mobile.nation.co.ke/news/Ruto-rejects-medical-equipment/-/1950946/2742928/-/format/xhtml/item/1/-/l08mhhz/-/index.html
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There is all that talk about the inflated cost to the counties. Does that matter? Afred Mutua is not one of those who is known to think before appending a signature to something he may feel would hurt certain interests.
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Veritas
Do you understand why many governors do not wish to sign the Uhuru and Macharia deal? I can understand if you believe in the good the machines would do - even with a "little" corruption by the side.
http://mobile.nation.co.ke/news/Ruto-rejects-medical-equipment/-/1950946/2742928/-/format/xhtml/item/1/-/l08mhhz/-/index.html
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Read this one to understand the whole saga even better.
http://www.standardmedia.co.ke/?articleID=2000164732&story_title=Kenya-is-the-executive-trying-to-kill-devolution-through-leasing-of-medical-equipment
Veritas
Do you understand why many governors do not wish to sign the Uhuru and Macharia deal? I can understand if you believe in the good the machines would do - even with a "little" corruption by the side.
http://mobile.nation.co.ke/news/Ruto-rejects-medical-equipment/-/1950946/2742928/-/format/xhtml/item/1/-/l08mhhz/-/index.html
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This is not an issue to be politicized.
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Why not? Why should the government force equipment on counties - some who don't even have hospitals to place it in? How would you like me to negotiate a car, set the price, arrange for monthly interest for ten years - all without your knowledge or contribution - and then ask you to "take" the car ... oh yes and sign the deal to pay for the next ten years?
This is not an issue to be politicized.
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Lame excuse. What is politics? Health services were devolved with the new constituition. If the national govt had meant well it should have first sat with county govts nd discussed the issue before signing contracts and thereafter seek the signatures from the counties.
This is not an issue to be politicized.
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Those machines were requested by hospitals based on consensus. Omollo, instead of a car think of an incubator for a new born. Who would deny that? No hospital or staff in the world. Same goes for dialysis machines. Those machines are a public right to basic healthcare. No amount of politricking changes that fact.
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I think you are not sufficiently informed about the issue to have a debate. I withdraw
Those machines were requested by hospitals based on consensus. Omollo, instead of a car think of an incubator for a new born. Who would deny that? No hospital or staff in the world. Same goes for dialysis machines. Those machines are a public right to basic healthcare. No amount of politricking changes that fact.
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bump
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I can understand the refusal to sign if the counties do not need the machines.
However if they do, I think they should source their own machines if they can find them cheaper than what GoK is offering.
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EACC and Auditor General should do their job and give it a clean bill of health or not.The national gov can always buy counties or kenyans anything. Counties should not be forced to sign if they do not want to. Ultimately the money belong to the public and therefore parliament, senate, EACC, Auditor General and everyone else...should do their job..to protect public interest.
If Macharia has eaten..let it be known.
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The counties are to pay for the leasing. If the machines had been donations from the national govt, there would had been no discussions. This is not the case as the counties are to pay each 95M Ksh. per year. Total in a year 4.5B Ksh. Total for the 7 years leasing period 32B ksh.
This amounts to national govt dictating the health budget of the counties.
EACC and Auditor General should do their job and give it a clean bill of health or not.The national gov can always buy counties or kenyans anything. Counties should not be forced to sign if they do not want to. Ultimately the money belong to the public and therefore parliament, senate, EACC, Auditor General and everyone else...should do their job..to protect public interest.
If Macharia has eaten..let it be known.
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I'm not sure about the maths in that staggering deal (more reason to be circumspect and demand audit) but Jaindi Kisero seem to think the national gov got a good deal from the best medical manufacturers. 95M per annum...is leasing arrangement. Definitely Macharia and Uhuruto did a poor job consulting the governors.
http://www.nation.co.ke/oped/Opinion/-hospital-equipment-leasing-deal/-/440808/2738002/-/966muxz/-/index.html
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Pundit and Kadudu
Yes, the National Government can extend grants to the Counties. I believe the High Court settled this matter in the CDF case. However the grant cannot cause the county to incur unnecessary expenses. This arrangement is not exactly a grant. It also has the potential of interfering with revenue sharing by allowing the National government to reduce the amount due to counties in order to pay for the equipment.
Governors are right to demand assurances. Yes I agree that the AG (Auditor) should look in to it. Sadly we lack a key office that I keep on mentioning: Inspector General (http://www.oig.doc.gov/Pages/default.aspx). We can make ours truly independent and expand his role to such things as compliance with the Diversity requirements.
The reason is simple: The AG and EACC are undertakers. The IG would be a doctor.
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Ok. first, thanks for the article. It is brief and to the point.
I agree with him that the PR and consultation was not done. Clearly Macharia must be new in Project or Program Management. He skipped an important stage and it is predictably derailing his project.
If you examine what Jaindi says and what the CoG (Ruto) says, you will find some strange linkage. Ruto is asking for the information which Jaindi seems to already have.
I'm not sure about the maths in that staggering deal (more reason to be circumspect and demand audit) but Jaindi Kisero seem to think the national gov got a good deal from the best medical manufacturers. 95M per annum...is leasing arrangement. Definitely Macharia and Uhuruto did a poor job consulting the governors.
http://www.nation.co.ke/oped/Opinion/-hospital-equipment-leasing-deal/-/440808/2738002/-/966muxz/-/index.html
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There is need for more information about this. I have to agree with Veritas that we shouldn't politicize some things. I'm still somewhat trusting Macharia.
Ok. first, thanks for the article. It is brief and to the point.
I agree with him that the PR and consultation was not done. Clearly Macharia must be new in Project or Program Management. He skipped an important stage and it is predictably derailing his project.
If you examine what Jaindi says and what the CoG (Ruto) says, you will find some strange linkage. Ruto is asking for the information which Jaindi seems to already have.
I'm not sure about the maths in that staggering deal (more reason to be circumspect and demand audit) but Jaindi Kisero seem to think the national gov got a good deal from the best medical manufacturers. 95M per annum...is leasing arrangement. Definitely Macharia and Uhuruto did a poor job consulting the governors.
http://www.nation.co.ke/oped/Opinion/-hospital-equipment-leasing-deal/-/440808/2738002/-/966muxz/-/index.html
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What is being referred to as "politicization" is the sober request for information as seen by the letter by the governors. The Uhuru GOK response blaming CORD started the politics.
The governors cannot be blamed for asking to get enough information before signing.
Jaindi says they will not be paying and that it is the National government that will pay. This is strange considering Health is devolved and there can only be a finite amount of the National Revenue spent on Health. Is Gok then increasing the amount spent on health? Because if it stays as before (including the regular annual increment) then the Counties would lose money.
Why didn't Macharia consult the counties before going ahead to sign the deal? That tender was floated twice. The first one was cancelled after it emerged that the bidding terms were tailor-made for certain companies. So Macharia had enough time to sensitize counties and obtain stakeholder views. He did not
There is need for more information about this. I have to agree with Veritas that we shouldn't politicize some things. I'm still somewhat trusting Macharia.
Ok. first, thanks for the article. It is brief and to the point.
I agree with him that the PR and consultation was not done. Clearly Macharia must be new in Project or Program Management. He skipped an important stage and it is predictably derailing his project.
If you examine what Jaindi says and what the CoG (Ruto) says, you will find some strange linkage. Ruto is asking for the information which Jaindi seems to already have.
I'm not sure about the maths in that staggering deal (more reason to be circumspect and demand audit) but Jaindi Kisero seem to think the national gov got a good deal from the best medical manufacturers. 95M per annum...is leasing arrangement. Definitely Macharia and Uhuruto did a poor job consulting the governors.
http://www.nation.co.ke/oped/Opinion/-hospital-equipment-leasing-deal/-/440808/2738002/-/966muxz/-/index.html
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Yes. Mutual us the man!!!
He delivered.
That deal smell fishy..i think Macharia is upto no good with that kshs 38B. Why can't national gov concentrate on their job. Fund national hospitals. Or heck build them. KNH is a mess. Leave counties to do their own thing using their own ideas..Machakos delivered 70 Ambulance with meagre resources..give them 120M every year..and they'll know what to do.