Tuesday, 23 April 2013


Mr. President got it awfully wrong. If health was a direction West, he looked East and walked on whistling.

I will start by painting the picture with a few allegories.

We have a rugby team that is doing excellent, and a football team that is drab, would Mr Friday- The rugby coach turn around the fortunes of Harambee stars? I don’t know, you tell me.

In most opinions, the country’s Justice system is broken, very few are able to get justice timely and consistently. Would you opine that Mr Titus Naikuni would be able to fix this docket? Isn’t he a manager? And shouldn’t managers have the capabilities of ‘fixing’. Superpowers.

Dear friends, it is true that there is such a thing as a ‘health system’. It is also irrefutable that systems, by their superficial definitions need ‘management’. Such extrapolation implies, for the system to be better managed, you should get the best manager- any manager. Try that in Healthcare and you will realize just how flat wrong you are. We have tried this before, haven’t we?

First, the basic health system is built between a doctor and a patient. It is about how the two interact to achieve a mutually acceptable end. Most of the times, this means good health for the patient and some motivation for the doctor, though not always.

What is critical to understand is that, delivery of Health veers greatly away from the mainstream systems. Its socialistic unlike most of our systems which are capitalistic. The very end motivation thus, is not revenue collection but an upside trend in mortality reversal. I would be damned to employ someone I have to define the basics of what the various mortalities are and what they mean. Put them down and expalin it like I would to a 6 year old how the mortalities have trended over the years, yet again EXPECT him to come up with innovations on how to reverse these trends.

Why are we experimenting yet again? Why not try this in the Justice department? Or maybe get a career bishop/theologian to head it? Wouldn’t he be of ‘more justice and unmatchable morality?’

As we continue with the most disappointing trends in how our mothers die, will we cling to the argument that we need just any manager? Apparently to increase revenue you might argue, ha!

Ask the KNH Lesiyampe how he has managed to collect more revenue from the National Hospital yet our mortalities still rise with each penny collected, yet the number of basic essential machines remain static. Argue on as we die, win the argument, and close the cover to your coffin, softly, do not band it.

I would forgive my boss if he did not understand the contents of the ‘Maputo call for action’ or the OECD criteris for funding AIA, but I should nto forgive him if he has to learn the intricates of ‘ The Abuja Declaration’ ‘The Alma Ata’  and the good concepts of achieving universal healthcare from day one of office. I must not forgive him.

Even if we are looking for ‘the manager’ shouldn’t the knowledge of Health Systems be an added advantage?
I suspect, yet again our sun has been killed. It cannot be this dark and its daytime. LET US PRAY.

#In medicine we use the pen to sign death notifications, it signifies the lowest limit of our endevours.


  1. Even after what Richard Lesiyampe has done for KNH?

  2. our denominator has always been patients... how are the mortalities? ask me...

  3. ...one with a technical backround relevant to the docket they hold office for.Is it yet another lame move to allow redundancy in the healthcare management?

  4. Abi you have only taken a microeconomic perspective in this article- fare enough. But you need to look at the bigger picture too, which happens to be more important.
    The biggest problems with health care in Kenya are financial – that is cost and access. For a majority of Kenyans, the high cost of health care has remained a critical barrier to accessing quality and timely health care services. It is estimated that roughly four in ten Kenyans who fall sick do not seek medical care due to the high cost of health care. Other huge problem is access to health care - we have few health facilities.
    The biggest issues the government is concerned about in health care are related to efficiency, effectiveness, value and behavior in the production and consumption of health and health care. The demand for health care is a derived demand from the demand for health. Health care is demanded as a means for consumers to achieve a larger stock of "health capital." The demand for health is unlike most other goods because individuals allocate resources in order to both consume and produce health. That is why he employed a banker so that he can deal with costs,charges,expenditures, and universal access to healthcare in Kenya .

  5. peter, you I and did not know who the nominee was up until yesterday, How do you now purport to authoritatively know the reason for his appointment, is your take speculative?

  6. Not speculative - I'm just saying I would do the same.For every Kenyan to get quality and affordable healthcare we have first to reform the underlying economic dynamics at work in the system – cost, expenditure, access, insurance etc - and that’s why prez chose a banker who has experience in cost and expenditure management at a macroeconomic level . It’s my opinion that this guy’s job will mostly be resource allocation. But as you say, when it comes to creating policies around health care administration he MUST work closely with the healthcare industry. Nyongo failed mostly because he tried to micro-manage the health sector (politicians do this all the time) instead of working with them. The health sector should look at the health secretary not as a manager or supervisor of the health industry, but as the “bank” of the industry – basically you tell him what you need and he finances it. But time will tell if he is the man for the job.

  7. Abidan, the Cabinet Secretary for Health need not be a medical doctor to run the ministry. It only needs a serious manager, a strategic leader, a good administrator, not an MBChB holder or a physician for that matter. The performance of the former Medical Services Prof. Nyong'os should not be used to advance the debate that the Health Ministry must be led by a doctor. KNH CEO Richard Leserian is a not a doctor but an administrator. We had seen CEOs who were doctors who nearly ran down the referral hospital; Prof Meme, et al. The World Bank President, Dr. Jim Yong Kim, who recently took over the reign the institution is not a banker, or economist or a financial expert but a medical doctor & anthropologist. We need someone who will ensure health resources and personnel work effectively by prudently managing the finances and resources at his disposal. I am not against a medical doctor with management skills being at the helm of this very important mininstry. Let's give him chance. Kenya Medical Practitioners, Pharmacists and Dentists Union, Kenya Medical Association and other bodies in the health sector must supportMr. James Macharia.

  8. Alex Ndalila, i read your post upto Lesiyampe and stopped to ask you what you would tell me about his performance at KNH... overall