Titus Gitonga

AccountabilityActivitiesHealth

Learning Circle on Transparency and Accountability in Health Financing

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Transparency International Kenya with the support of the Health Action Fund convened a Learning Circle on Health Financing on 9th November 2018 at Heron Portico Hotel in Nairobi. The Learning Circle sought to initiate discussions on Transparency and Accountability in Kenya’s Health Financing Models with the specific topics of discussion being:

  • Experience Sharing Working on Accountability in the Health Sector
  • Familiarisation of participants with Kenya’s Health Financing Models
  • Transparency and Accountability considerations in realising the Right to Health
  • Designing Working Strategies for Health Accountability

The meeting was attended by:

Experience Sharing Working on Accountability in the Health Sector

Titus Gitonga a Programme Officer from TI-Kenya presented on the various interventions by the organisation noting that TI-Kenya has over the years developed innovative approaches aimed at empowering citizens with information in order to effectively participate and demand accountability within the Health Sector. Among the innovative approaches adopted include:

  • The Mobile Drug Tracking System (MDTS) . MDTS is a web and mobile based platform used to track the availability and movement of drugs and pharmaceuticals at facility level. MDTS also incorporates citizen modules where information regarding availability of drugs can be accessed via location and facility and provides for a short code which allows for registration by users to get various updates regarding the drug groups.
  • Another innovative approach is the Action for Transparency (A4T) A4T is a Nairobi based project aimed at empowering citizens to monitor the allocation and utilisation of funds to public primary schools and health centres. The project incorporates the use of social accountability tools such as Public Expenditure Tracking surveys and social audits to track the flow of resources at health centres and disseminate the information through web and mobile based platforms including the A4T mobile App available for android and IOS phones.

  • The Health Sector has also been identified as being among the sectors highly affected by corruption. The 2017 East Africa Bribery Index (EABI) signifies that corruption in the form of bribery continues to be rife in provision of Medical and Health Services, identified as among the top ten most prevalent sectors in regard to bribery. Reporting bribery incidences also remains very low with an overwhelming majority (94%) of Kenyans who were surveyed indicating that they encountered bribery but did not report to any authority or person.
  • Following a report done by TI-Kenya, KELIN and the Society for International Development, the Ethics and Anti-Corruption Commission went on to carry out a systems and procedures review of the Health Sector and also released a report titled, ‘Review of Systems, Polices, Procedures and Practices in the Pricing of Pharmaceutical and Non-Pharmaceutical Supplies in the Kenya Public Health Sector’. The EACC report among other findings highlights the systemic weaknesses and opportunities existing in the procurement and dispensing stages of pharmaceutical and non- pharmaceutical supplies in the public sector and recommends compliance with national specifications for medical and medical suppliers, disclosure of evaluation criteria in bid documents and capacity building in market survey to address noncompliance issues with national standard specifications for medical and medical suppliers in the acquisition stage.

Ms. Linda Wanjiru, a Programme Officer at KELIN familiarised participants on the work that KELIN has been doing in the Health Sector specifically in relation to governance,  pushing for transparency and accountability in accessing information and demanding for compliance with existing legal provisions on access to information, public participation  and prudent use of public resources. She indicated that in partnership with other organisations including TI-Kenya, Katiba Institute and ICJ-Kenya, they had submitted request for information letters to the Kenyatta National Hospital  (KNH) in relation to construction of a private hospital at KNH and another to the Council of Governors seeking information on the Agreement between Kenya and the Cuban Doctors with no response as at the time of the forum.

Ms. Wanjiru also indicated that through an initiative by OSEA, KELIN is leading the Health and Governance Convening – Kenyan Chapter. The Convening aims at enhancing collaborative work between different organisations working in the Health Sector and has since formed two working committees to assist in driving the accountability agenda including: Research and Evidence Gathering Committee; and the Litigation Committee. She invited participants to join in on the Convening and be part of the work being undertaken by the various organisations already in the committee.

Mr. Aggrey Aluso, the Health Rights Program Manager at OSEA also familiarised the participants with the organisation’s work supporting the Health Convening in Kenya and other participating countries including Uganda and also indicated that they were keen on supporting governance work on open contracting and good governance in the health sector.

Mr. George Githinji working on public budgets at TISA also gave a highlight on TISA’s experience in advancing public participation in the budget process. TISA also had a learning session on Private-Public-Partnerships for which the health sector also has had some huge investments around and would thus be interested in advancing these discussions.

EACHRights and ICJ-Kenya were in the initial stages of working in the Health Sector having participated in marketisation and privatisation of the health sector discussions initiated by OSEA.

Dr. Wala Elizabeth, the programme director for health systems strengthening at Amref Health Africa also indicated that the organisation was engaged in capacity building in Nairobi, Kwale, Kisumu and Vihiga of health practitioners on a health model that ensures continuous quality improvement in the delivery of health services in county and sub-county health facilities. The Kenya Quality Model for Health (KQMH) is a systems approach to strengthening quality health care in Kenya towards universal health coverage through training and mentorship using the national health information database (DHIS2).

Kenya’s Health Financing Models

This session was moderated by Dr. Matiko Riro. Dr. Matiko is a Doctoral Fellow in Health Economics at the University of Bergen in Norway. He is a medical doctor and a Commonwealth Scholar with an MSc in Public health (Health Economics) from the London School of Hygiene & Tropical Medicine (LSHTM).

It was noted that Kenya has made a commitment of accelerating its progress to achieving Universal Health Coverage (UHC) and has taken a number of steps to reform its healthcare system, to put it on the path to realising this goal.

Currently only 17 % of Kenyan households are covered by health insurance of any type, while the rest of the population relies either on donor aid, government spending or out of pocket spending for accessing health care. This makes the ambition to provide universal quality health care to all those in need, regardless of their ability to pay, a major undertaking that will require a major shift in the mechanisms and systems through which health is governed, financed and delivered.

Participants discussed the diagrammatic representation on flow of funds for the health sector below:

Participants described the flow of resources in the health sector as, “Confusing”, “Complicated”, “Inconsistent”, “Unrealistic”, “Incomprehensible”, among other adjectives describing just how complicated public financial flows in the health sector has become over the years. Some of the concerns raised on transparency and accountability in health financing include:

  • Lack of effective collaboration between the National and County Governments in designing effective laws, policies and guidelines for enhanced accountability on health finances;
  • Appropriation of County health functions by the National Government thereby also taking up budget allocations;
  • Lack of research to inform effective resource allocation and utilisation;
  • Corruption through inflated procurement costs for pharmaceutical and non-pharmaceutical products, equipment’s and services;
  • Unequal and inadequate distribution of health practitioners/professionals;
  • Unclear reporting structures for health outcomes in relation to the resources utilised;
  • Lack of adequate and effective avenues and structures for complaints handling and citizen engagement at the facilities and oversight structures;
  • Unclear insurance schemes for the public including the Kshs. 4 Billion Students insurance plan and other insurance schemes being implemented by different county governments.

Designing Working Strategies for Health Accountability

In view of the need for informed and effective development of working strategies to enhance transparency and accountability in Kenya’s Health Financing models, TI-Kenya would initiate a first round of research on the following areas of interest:

  1. Enabling Environment: any laws, policies, rules, or regulations, at both a national and county-level, that might impede the effectiveness of the various health financing models.
  2. Access to Information: the extent to which the identified health financing models are structured towards ensuring attainment of the highest attainable health standards including ensuring equitable, affordable and quality health care to all citizens.
  3. Public participation: the extent to which public health financing models allow for effective public participation in their formation and implementation including transparency, accountability and feedback mechanisms.
  4. Value for money: how the various health financing models respond to the need to ensure value for money in provision of services and health resources.

Participants also identified other opportunities and strategies to support realisation of the right to health including:

  • Collaborative research, evidence gathering and information sharing;
  • Collective action, advocacy and awareness creation;
  • Elaborate stakeholder engagements aimed at building consensus and influencing policy;
  • Policy reforms informed by the Constitutional provisions on the realisation of the Right to Quality Health Services, Access to Information, Public Participation and Prudent use of Public Resources;

A follow up engagement on this discussion would be called to validate the research results from an initial assessment on the highlighted areas on transparency and accountability in Kenya’s Health Financing Models.

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AccountabilityEducationHealthSocial Audit

Become an A4T Social Auditor for your Community

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By making it possible for all citizens to monitor government expenditure in the Health and Education Sectors in Nairobi, Action for Transparency, A4T, helps uncover suspected corruption and mismanagement of public funds. The Social Audits under the A4T project are aimed at determining the extent to which Government Services on Education and Health have managed to meet the requirements on Transparency Accountability and Participation of citizens.

If you would like to make an impact in your community as a social auditor please fill in this form and join the A4T Social Auditors Network

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AccountabilityMedia

A4T at the 2018 Annual Media Summit and Journalism Excellence Awards (AJEA)

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The Action for Transparency (A4T) team was represented at the 2018 Annual Media Summit and Annual Journalism Excellence Awards (AJEA) held from 1st to 3rd August 2018 in Nairobi. The Annual Media Summit is a meeting of media practitioners and other stakeholders designed to deliberate on pertinent issues affecting the sector, organised by the Media Council of Kenya. This year’s theme: Media & the Big Four Agenda anchors the role of the media in not only promoting robust public debate on the Agenda, but also encouraging the sharing of ideas and holding its implementers to account.

The Media Council of Kenya also runs the Annual Journalism Excellence Awards (AJEA) in May each year. The awards recognise excellence in journalism, encourage professionalism in the practices of journalism as provided for by the Code of Conduct for the Practice of Journalism in Kenya and inspire Development Journalism in Kenya in respect to Vision 2030. The journalism awards encourage journalists to excel and adopt a professional style that is acutely conscious of its role as an agent of change and development in the country.

Transparency International Kenya through the A4T project supported the Good Governance Reporting Award during the 2018 Annual Journalism Excellence Awards (AJEA) held on 3rd August 2018 in Nairobi. John Kamau of the Daily Nation won the Print Category while Wellingtone Nyongesa of Radio Maisha bagged the Radio category. The TV Category went to NTV’s Andrew Ochieng.

The Good Governance Reporting Award is geared towards upholding the fight against graft, promotion of the rule of law, ethical practices and national cohesion in matters of governance. The articles/stories entered in this category exhibit professionalism and inclination to promote national values as provided for by the Constitution on Leadership and Integrity.

TI-Kenya’s Executive Director Samuel Kimeu noted that the media is one important player in the fight against corruption whose role should not be underestimated.

Mr. Samuel Kimeu – TI-Kenya Executive Director speaking at the 2018 Annual Media Summit

“As a watchdog, the media plays an important role in ensuring that the country’s resources are well managed and utilized. We therefore urge the media to keep the anti-corruption campaign alive by highlighting the loopholes used by the corrupt and the damage caused to our society,” said Kimeu.

According to Media Council’s Deputy CEO and Programs Manager Victor Bwire, the Good Governance Reporting is key because it fosters transparency and accountability in the use and management of public resources.

Good governance is cornerstone of the watchdog role of the media,” said Bwire.

National Assembly Speaker Justin Muturi, who was the Chief Guest at the awards, celebrated the two reporters who uncovered bribery in the House describing them as brave. It had earlier been reported that the journalists were summoned to appear before parliament over the expose but the Speaker confirmed otherwise.

Hon. Muturi cautioned Members of Parliament against their obsession with “summoning” individuals noting that such powers should be used sparingly and only when necessary. He noted that corruption has led to loss of credibility in both MPs and journalists and called for the need to deal with the vice.

The A4T project continues to empower Journalists primarily in Nairobi County to actively counteract corruption and mismanagement of public funds. Engagement with journalists under the A4T project has been achieved through: Media Forums where journalists are provided with a platform to discuss and share ideas on issues affecting effective reporting especially on corruption in the Education and Health sectors; and, capacity building for journalists mainly on investigative and data journalism. It is hoped that these interventions will result in an increase in the level of interest and quality of stories on accountability issues affecting the Education and Health sectors.

 

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AccountabilityActivities

July 11, 2018: African Anti-Corruption Day

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Theme: ‘Winning the Fight against Corruption: A Sustainable Path to Africa’s Transformation

The African Union (AU) Assembly declared 2018 the ‘African Year of Anti-Corruption’ and 11 July of every year as the “African Anti-Corruption Day”. The inaugural African Anti-Corruption Day is dedicated to giving prominence to the anti-Corruption fight on the Continent and to commemorate the adoption of the African Union Convention on Preventing and Combating Corruption (AUCPCC).
This Day offers governments, leaders, anti-corruption agencies, civil society organisations, the private sector and citizens an opportunity raise the profile on anti-corruption issues and to advocate for transparency, accountability, integrity and better service delivery from public institutions nationally and regionally.
Governments and non-state actors have been instrumental in raising awareness about the devastating effects of corruption on governance, service delivery, human rights and socio-economic development. Additionally, numerous campaigns have been organized to influence national, regional and global agendas that seek to demand for systemic change. Despite efforts made towards combating the culture of corruption, the vice continues to erode people’s sense of equity, dignity and patriotism. This is reflected by citizen’s general sense of despair, given the failure of governments to effectively address corruption.

Kenyan Context

The 2017 Corruption Perceptions Index (CPI), published by Transparency International, highlights that majority of countries are making little or no progress in ending corruption, while further analysis shows journalists and activists in corrupt countries risk their lives every day in an effort to speak out. The findings very much reflect the Kenyan situation, particularly the attempts by government to curtail the governance sector NGOs and media space, culminating in the media shutdown early in 2018.
Over the last couple of months, the Auditor General’s reports and investigations by the Ethics and Anti-corruption Commission as well as the Directorate of Criminal Investigations have highlighted the unrelenting prominence of corruption and wanton wastage of public resources. Among the recent corruption scandals include the Kshs. 1.9 Billion irregular procurement payments under the National Youth Service (NYS), the fraudulent payments for maize supplied to the National Cereals and Produce Board, the Ruaraka Land probe and controversial sugar imports.

Activities to mark the African Anti-Corruption Day

The A4T team participated in planning and carrying out activities to mark the African Anti-Corruption Day marked on 11th July 2018. The activities marking the day offered a great opportunity to create awareness on the effects of corruption in the Education and Health sectors as the focus areas of the A4T project.

The activities were organised in partnership with other organisations including; Kenya Human Rights Commission (KHRC) and the Kenyan Section of the International Commission of Jurists (ICJ).  Among the activities carried out included:

  • Online Campaign on 10th July 2018 – The two hashtags for the tweet chat #AfricansAgainstCorruption and #STOPTheseTHIEVES generated great discussions online around corruption in Kenya and regionally. The two hashtags were the top trends in the Country on the day. The A4T team also participated in developing an online Citizen Against Corruption mapping tool which was also publicised on the A4T App where citizens mapped out their individual and collective actions against corruption on the Citizens Against Corruption Mapping Tool. The tool highlighted information on:
    • the actions people have initiated in the fight against corruption;
    • the actions people are willing to engage in towards supporting the anti-corruption agenda; and
    • the support people need to effectively engage in the fight against corruption.

A Public Dialogue Forum at Ufungamano House in Nairobi was held on 11th July 2018. The forum was organised into two panel discussions consisting of community activists and civil society organisations.The discussions centred on citizens experiences and their role in the anti-corruption agenda as presented by the citizens panel and plenary; and the regional anti-corruption agenda, the cost of corruption and an analysis of the anti-corruption legal and institutional frameworks in existence and how they have contributed to the anti-corruption agenda. The media also extensively covered and reported on the event. Kenyans Mark the African Anti-Corruption Day

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AccountabilityMedia

2017 Corruption Perceptions Index (CPI)

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The 2017 Corruption Perceptions Index (CPI), published by Transparency International, highlights that the majority of countries are making little or no progress in ending corruption, while further analysis shows journalists and activists in corrupt countries risk their lives every day in an effort to speak out. Kenya scored 28 points out of the possible 100, a slight improvement from 26 points in 2016 and 25 in 2015. However, the score is still lower than the combined average score for Africa, which is 32.
The survey indicates that countries with the least protection for press and non- governmental organisations (NGOs) also tend to have the worst rates of corruption. The findings are very much a reflection of the situation in Kenya particularly in view of  events after the 2017 General Elections by Government targeting NGOs in the governance sector and curtailing of media freedoms during a shutdown of major broadcasters on 30th January 2018 resulting from covering of the opposition’s ‘Swearing In’ ceremony.

The index, which ranks 180 countries and territories by their perceived levels of public sector corruption according to experts and business people, uses a scale of 0 to 100, where 0 is highly corrupt and 100 is very clean. This year, the index found that more than two-thirds of countries score below 50, with an average score of 43. Unfortunately, compared to recent years, this poor performance is nothing new.

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