Category Archives: Devolution

Makueni County Healthcare

The Makueni County government is this week conducting new registration for a universal healthcare program in the 60 sub-wards in the county.  The Makueni University Healthcare program will provide essential health services to county residents at eight sub-county hospitals, and the county referral hospital.

It is being lauded and Makueni Governor Kivutha Kibwana who previously battled with the county assembly (parliament) that he was elected alongside in 2013, now appears to be enjoying a resurgence after his re-election on August 8 which he easily won, while 29 of the 30 county assembly legislators (MCA’s) were voted out.

The MCA’s had tried to impeach the Governor and he subsequently moved to dissolve the entire county government. A commission on inquiry looked into the disputes at Makueni and made some recommendations to the President, but as he never forwarded the report to the Senate for debate and approval, the situation was never fully resolved, until the 2017 election.

In promoting the Makueni health care program, the county government states the high level of poverty (60%) in the region as a reason why they set out to provide free health care to senior citizens (above 65 years of age) in the county through a pilot program in 2016. They deemed it a success and decided to expand it to universal health care and they have already enrolled another 33,344 households, excluding the senior citizens. The ongoing registration aims to net 180,000 new households and the benefits of the program will be improved health care with no out-of-pocket expenses for households which have previously resorted to selling livestock or land to meet family medical expenses. During the test phases, Kshs 138 million was expensed, with the bulk of that going to pharmacy expenses (33%), then inpatient (24%) and laboratory (15%) expenses.

The Makueni program will pay for emergency healthcare, laboratory, radiology, theater, cancer screening, drugs, and ambulance evacuation, among other expenses. The cost is Kshs 500 per year for a household and that will cover a nuclear family – beneficiary, spouse(s) and dependents of school going age. It is separate from the government’s national hospital insurance fund (NHIF), and Makueni will not cover services outside the county, such as scans, MRI’s, post-mortems, ICU, dialysis, and other specialized services not available within the county.

The ambitious and novel Makueni program is similar to one in Muranga county that sought to mobilize savings for county investments, but which was scuttled by regulators and wary investors.

The latest Auditor General (OAG) reports on Makueni noted that the county government received (2015) revenue of Kshs 6.3 billion (that included Kshs 5.9 billion from the national government) and that Kshs 5.4 billion was spent, leaving a Kshs 0.9 billion surplus. The OAG noted the disruption of the government activities but gave an adverse opinion on the Makueni county assembly (legislators) accounts while those of the county government (executive) were qualified. The executive was flagged for operating bank accounts at banks other than the Central Bank, and also for issues with the procurement of assets and construction of dams. The report on the assembly noted issues with lack of supporting documentation, hiring of professionals, including lawyers in the case against the governor, and trips that Makueni MCA’s had made to Mauritius, Boston, London, Malaysia Dubai and Singapore.

Muranga’s Shillingi kwa Shillingi

Kenyan counties are expected to raise funds for some of their activities to and this is crucial as many counties will not able to fund their operations and programs with the funds allocated to them by the national government. 
 
Muranga County Government has an interesting vehicle called Shillingi kwa Shillingi (translated as shilling by shilling) through which they intend to mobilize resources from Murang’a residents (and the Murang’a diaspora)  by targeting a total of 100,000 people who will save an average amount of Kshs 3,000 ($35) per month towards a goal of raising Ksh3.6 billion ($42 million) a year 
 
The invitation states that the ultimate objective is to match every shilling received from (the) national government with an equal shilling contributed by the people of Murang’a through savings, hence the “Shillingi kwa Shillingi” concept ... (and the) savings will be used in development projects such as real estate, property development, commercial power generation, agro-processing, trading and any other social and economically viable projects in Muranga and beyond.

There have been newspaper and TV ads for the Shillingi program which have been careful to sidestep a caution by the Capital Markets Authority (CMA) on unlicensed investment solicitations to the public, by stating that the Shillingi contributors are members who are saving (the more they save, the more shares they get), but they are not investors who expect a dividend.

This is a novel undertaking spearheaded by the Murang’a Governor, and one which more counties should emulate once they see how it works.  The investments will be overseen by a respected audit firm, Deloitte, who have been appointed as project managers and Safaricom Business are the ICT partner who will handle SMS registration and M-Pesa collections, but savings payments can also be made through Equity, Cooperative and Jamii Bora banks.