U.S. advisers chasing ‘health care for all’ in Kenya
A new round of advisers is being sent to Kenya on behalf of the Obama administration, which plans to deploy individual private contractors to assist in the simultaneous expansion of health-care services and the ongoing decentralization of the national government.
Indeed, one of Obama’s long-term goals “is to establish a social health insurance system to enable equitable provision of health care to all Kenyan citizens,” one of the adviser-recruitment documents explicitly declares.
Specific to the delivery of health care and related services such as family planning, the U.S. Agency for International Development, or USAID, is recruiting a senior health-systems strengthening adviser to help manage “a complex $260 million program, the largest in sub-Saharan Africa and seventh largest in the world,” according to a contractor solicitation.
Working out of USAID’s Office of Population and Health in Nairobi, the selected candidate will advise USAID/Kenya on all aspects of family planning, maternal and child health, nutrition, tuberculosis, malaria and HIV/AIDS.
USAID’s Kenya-wide integrated package of health services is “designed to strengthen local capacity” to eventually offer the services independently.
The agency noted that among government-administered sectors affected by government decentralization, “Health is one of the most devolved sectors and USAID is deeply involved in supporting the government of Kenya to implement the new structure.”
The adviser will be tasked with finding solutions to obstacles Kenyans face in receiving health care, particularly “public sector maternity and primary health care services,” which became free for Kenyans in June 2013.
Additional challenges to “maintaining quality services during this transition period” include “shortages and inequitable distribution of health workers,” the majority of whom are located in urban areas.
Similarly, despite USAID’s goal to strengthen Kenyan capacity to provide health care, the country faces major financial impediments to efficiently allocating health resources. Not only has the percentage of Kenyan-government health expenditures declined, but 34.5 percent of Kenya’s total health expenditures remain dependent on international donor support, USAID acknowledged.
“An estimated 30 percent of people now receiving care in public facilities could afford to use private services if they had insurance,” it continues. “Shifting them would allow the government to focus public sector resources on the poorest and most vulnerable citizens.”
To devise solutions to the challenges, the senior health systems strengthening adviser will work with various USAID/Africa and USAID/Kenya interagency health teams “with considerable interaction with USAID/Washington,” the agency says.
Another new USAID contractor position is a senior devolution adviser, or SDA, who will focus on implementing a $125 million portfolio of existing U.S.-funded programs. The SDA specifically will assist in the transfer of concentrated political power from Nairobi to the county governmental level, as ordered by Kenya’s relatively new constitution.
This five-year devolution effort is but one facet of the administration’s proposed FY 2015, $553 million foreign-assistance budget for Kenya, considered a key U.S. ally in combating terrorism and promoting stability in the region. While the funding level is consistent with previous fiscal years during Obama’s second term, dollar-wise it is significantly less than the nearly $800 million in annual aid to Kenya in his first term.
USAID earlier this year set a mid-February deadline in considering potential SDA candidates, who must have previous experience providing oversight of similar government-decentralization initiatives, preferably in Africa.
The selected candidate will seek to ensure the devolution programs are conceptually sound, regularly monitored and analyzed, and effectively managed, according to a Personal Services Contractor notice that WND discovered via routine database research.
Accomplishing these goals is a monumental task, considering that five distinct USAID offices are pursuing the endeavor “in collaboration with Department of State colleagues,” who in turn must align U.S. efforts “with the work of international donor partners,” the notice says.
Complicating matters is the administration’s acknowledgement of the risk in facilitating the devolution process. Although it may successfully decentralize national Kenyan power, it also could inadvertently create 47 equally corrupt county systems, as WND reported in 2013.
The agency at the time pointed out that that successful decentralization can create a “more responsive, open and pluralistic government,” while simultaneously running the risk of “systemic failure that further exacerbates the problems that it was intended to alleviate – often leading to a frustrated populace and a re-centralization of power.”
Contracting giants Development Alternatives Inc., or DAI, and Chemonics International currently are implementing Kenyan programs for the administration, which on multiple occasions has handed out no-bid contracts and contract extensions.
In some of those instances, USAID awarded contracts with the specific goal of alleviating the financial burden on Kenyan taxpayers when their government failed to assume control of programs, despite existing agreements between the two nations enabling the Kenyan people to assume greater control over such programs.
In one such instance, rather than returning $224 million in Kenyan program funds to U.S. taxpayers when the price of generic drugs plummeted, USAID awarded a 15-month contract extension to Chemonics to complete a project for which the Kenyans purportedly were ill-equipped to assume control.
The extension was valued at the equivalent of the program’s potential savings: $224 million.
USAID similarly awarded a no-bid contract to DAI – by changing contractual language – when it appeared that Kenyan county governments would be forced to foot the bill for an incomplete segment of a devolution-related program.
Indeed, the agency in that contract modification simply assigned new responsibilities to DAI that otherwise would have been transferred to Kenyan officials in the Financial Inclusion for Rural Microenterprises, or FIRM, project.
Rather than go through with the transfer, U.S. taxpayers shelled out an additional $3 million in technical assistance for which the individual counties “would be forced to incur without the extension,” the agency said.
The approach follows a pattern of heightened U.S. involvement in Kenyan affairs that WND began exposing in 2012, when USAID’s self-described exponential growth in its Kenyan aid portfolio was discovered.
Follow-up coverage likewise exposed a USAID scheme to methodically sway global media to report favorably on agency activities.
A WND investigation additionally discovered a cover-up of the activity. Days after the report, the government eliminated all trace of the propaganda-plan documents from a publicly accessible database.