Is there your own experience? Let me at this juncture, do we have any of the... Maybe before we go to the next, just for clarity, Shikoku has said we need to do more to make sure that equipment are available in more of our facilities. I know we have a program with our county governments. Yesterday the faith-based hospitals also said if it is possible for us to consider them in the supply of equipment under our next program, it would be a good thing. And I think that is what was said, that we need more facilities with the correct equipment for purposes of treatment. Waziri, do you have some ideas on how we can make equipment much more available in more hospitals? What is the strategy? Because I thought we have a plan.
Your Excellency, let me talk for the public health facilities, those which are under the county government and under the national government. It is very easy to place equipments and we have done that in over 239 facilities across the country in major equipment. We are only having an MRI in two facilities which we now intend in the next one month to upscale to about 20. So we get requests from our counties because we have signed an entire partnership agreement between us, the national government, the county, and the vendors. And we're going to now reach out to the faith-based. But just on two things, and I'm very happy the lady was speaking on behalf of the cancer patients, the reduction in the cost of care in Kenya is a problem we must all discuss: government, the private sector, pharmaceutical companies. And what she says, from 135,000 that particular drug to 40,000, is as a result of an MOU the Ministry of Health have signed with Roche, one of the biggest pharmaceutical companies. And we are going forward to do the same with Pfizer. Pfizer, as a pharmaceutical company, supplies most of the essential medicines in our country. So the president of Pfizer is coming to see you next week, but I have done a rider that before he comes to see you, the condition is that of the essential products that his company sells to Kenya, there must be a price reduction. For equipment, Your Excellency, I agree, we're going to upscale. Finally, Shikoku said about systems, and I agree with him, there are facilities that tell our citizens that the system is down. And I want to give this to Anthony and Mary, you know our systems being down is very fast. And facilities level five and six and up to PhD, we can tell. But there are facilities in our country, I really want to speak to our citizens: do not fall into the trap when we are told the system is down so that you pay out of pocket. This is a message we must pass to our citizens today. Every out of the 44 counties, 39 counties in at least have one CT scan in their sub-county referral hospital. Some have two, and I'll give the example of Bungoma. In Bungoma County, Referral Hospital, and in Uasin Gishu, Nairobi, I'm sure Governor Sakaja is here. And this morning we had a testimonial from citizens that there are more equipment in the Nairobi county hospitals and facilities before 2022. So I really can only say that this is very good.
Thank you. Thank you. We will go to the matter of cancer because this is a listening session. Chair of Council, when we signed the intergovernmental partnership agreement, we informed counties and we actually worked with them on the list of equipment available under that program. And it was our expectation that every county will request the equipment which they think will assist them in delivery of service. Is there anything we can do more, Chair, to persuade counties to get on board the equipment? Because I think we had only one county who had not signed the IPA agreement. That was Kiambu County. I'm told last week they have now signed. So there is no reason why every facility in Kenya should not get at least the minimum equipment so long as they have the number of patients that will justify the installation of those equipment. Do you want to say something?
Your Excellency, with respect to the NESP, the National Equipment Support Program, we have intergovernmental agreements between individual counties and the ministry. This can also be amended with respect to what is ordered. If a county that had signed up for five pieces of equipment realizes that they need more, nothing stops them from signing an addendum to request more. And I know in my county, the more we have upgraded facilities, we have actually increased that request. And for a place like Nairobi, I'm sure the governor is going to speak, where traffic of patients is not a problem, there's no reason why, for instance, Nairobi cannot have more facilities with more equipment. The cancer centers have been more regional, save for places like Nairobi. In the rest of the country, they have been at what we used to call the general hospitals at the provincial level. But now there is a lot more counties, by the last count at least 28 counties now have a level five. Initially, level fives were only at the provincial headquarters. I would now expect, Your Excellency, each of these level fives to set up cancer centers and to ask for equipment through NESP so that we can further decentralize cancer treatment. Your Excellency, thank you.
Thank you. Thank you very much. Governor of Nairobi, something has been said about Bungoma, but I know for a fact that Nairobi County is among the counties that we have supplied quite a bit of equipment. Governor?
Thank you. Thank you very much, Your Excellency. And thank you, Chris. All our facilities have equipment, but what we want to raise, Your Excellency, and I'm very happy about this very candid discussion, where you provided medicine, we provided medicine as counties. Nairobi Hospital, before the next program, it's a big hospital. We need to sort out what we call the weakest link, and it's a problem across the country, Your Excellency. Let me start with an example. That time I went to Tassia one day, level four, and I knew that we had just supplied medicine the day before. When I was leaving, a young man, you know, normally they come and says, 'Governor, there's no medicine.' So I said, 'No, I know there's medicine. Give me that list.' When you look at what has been asked for, and I forced the opening of the store, it was there. But somebody told him 'hakuna dawa' and sent him to a chemist across the road because either they own that chemist or they're getting a cut from that chemist. Madam Mingi, like today, there's no hospital that should say it has no medicine, for sure. But many times that weak link is the human link of some unscrupulous people. And we've taken many for disciplinary action, and I know my colleagues have gone through the same, who will tell you that the machine is not working. I know for a fact Mathare has functioning X-ray and all that equipment, including from NESP. All our, you know, I think 45 or so facilities, all level five and fours, are stocked. But how we sort out the place where you're told the machine is not working because the person telling you that is getting a cut from that private facility for referring people to that facility. Now, there are options we have, Excellency. One, we can have a helpline where if you can, DHA, for that, then we can isolate the individuals. Because, you know, Excellency, you can set systems, you've set equipment, we have put machines, but that weakest last link, which is in major part, and many of our health professionals are very good, but there are few who, because of corruption, which is what we must deal with, if someone comes and pays 5,000, Excellency, that is the problem. But in terms of equipment, we have them in all our facilities. Excellency.
Thank you very much. Governor, and I think it is a point of feedback from what Shikoku has said, that we have a challenge that we need to sort out, and that challenge we are going to sort out if citizens also help us. So I think what Governor Sakaja is saying is, if you go to a facility, and like for example what Shikoku was saying, Badi is a public facility. He was referred to a private facility to undertake a certain procedure because whoever referred him, because I know Badi, you know Badi cannot be among the hospitals without an ICT machine or X-ray machine for that matter. But because that reference benefits somebody in some way, we should therefore, with the assistance of DHA, be able to work with citizens. If they go to a facility and they are told either this equipment is not there, go to the next, or this medicine is not here, go to the next, they should be able to verify. You know, this is homework for us. This is feedback for Mercy and for Anthony and the PS and Minister for us to go and figure it out and work with the counties to make sure we get rid of that mischief. So, thank you very much for that. Now, the second one is Wangu. Wiro has very emotionally talked about cancer and the support we are giving them. I remember very well the MOU that Duale has referred to when we were negotiating with the manufacturers to bring the price of that particular cancer medicine from 135,000 to 40,000 because our argument was as government we have a pool of patients, we need to benefit from economies of scale, and they agreed to bring the price down substantially, actually to a third. There is a catalog of more equipment because of where we are today, and this is important for Wiro and all of us to know that there is power in us negotiating as a government. It is the reason why we agreed with counties that instead of every county going to negotiate with suppliers on their own, let us pull together. We will provide leadership so that we negotiate as a block. That way we have greater power of negotiation. So to the point of Wiro, we've managed to do with one company, Pfizer. I met the president of Pfizer once. I am yet, I'm doing another appointment with him because quite a substantial part of the medicine that we are using comes from Pfizer. And our engagement with Pfizer now is that they will not be supplying our facilities individually. They will be supplying us collectively, and that is the point why Duale is saying we are going to engage them this time around so that we can negotiate the prices the same way we negotiated the prices for Roche and all the others. So to your point, Wiro, we have understood your feedback. We're doing something about it to make sure that we bring those other prices down. But there is one more thing that Wiro has said which we have to answer. Wiro has said that there is another 1,000 that has become 1,500, and I think she is saying that it is not covered by our SHA. What do we have to say to that? Somebody help me. Whether PS or who?
Your Excellency, I think the CEO and Dr. Massey can... Okay. The CEO of Kenyatta National Hospital and also SHA. Okay. So, Massey, you... Thank you. Thank you, Your Excellency. As I hand over to Dr. Massey, it is correct, Wiro, that you do have to pay 1,500 for your outpatient visit. Your Excellency, what we are doing about this is, like we mentioned, at the end of October we are reviewing a benefit package, and we are reviewing the outpatient benefit package. Many Kenyans, Your Excellency, have come to us and told us that SHA is doing well, but we need to do something at level five and six hospitals outpatients. So, so far we have our numbers. We'll be presenting them and defining a plan in how Wiro and those costs can be diminished or at least reduced at the end of October, 30th October.
Now, just to the point, this is a challenge that faces not level two, not level three, not level four, but level five and six. So level five and six, because my understanding was that for level two, level three, and some level five for outpatient facility is covered fully by SHA.
Yes. So, Your Excellency, just to clarify, level two's dispensaries, health centers, and level fours, specific level fours, it is covered by SHA on a walk-in walk-out. But for certain level four facility entitlements, level fives and six, it's not covered. So we've had that complaint from many Kenyans, the simple procedures where you need a specialist in a level five who might not be in a dispensary or health center or a level four that is available in KNH. So we are working it out so that we get a package and so that we are able to reimburse for that.
Very good. So again on Wiro, this is very good feedback. We are working on a benefits package for SHA. We had an initial one because we also wanted to be sure that we don't say we are going to pay for so much and yet we had not had an experience of whether we would be able to pay or not. With the benefit of a year and a half of working with the benefit package that was there, we are now ready for a review on areas that citizens like you have come back to us and say there is this pain point on my visit for cancer treatment. I do not know whether there is any added value the CEO of Kenyatta can... I think it has been answered effectively by Mercy because that's the truth, right? Do you want to say something? Continue.
CEO Kenyatta National Hospital
20:46 ↗
Thank you very much, Your Excellency. I don't think I need to add anything. We are going to see how by the end of October that this package can be reviewed so that we can assist some of these patients. These cancer patients go through very, very difficult times, and indeed that's why we have gone ahead at Kenyatta National Hospital to introduce a golf cart. In fact, we have two golf carts at Kenyatta National Hospital which receives these patients at the bus stages and indeed take them to the cancer center. Those who go through chemotherapy, some of them after that procedure are usually very weak. You know, they are fragile, and then we take them back to the bus stage. In fact, including the KMTC bus stages, you also use the same golf carts, which actually does not use fuel, is actually electrical, does not cost us anything, and we navigate them through all the different areas of the hospital. So, Your Excellency, we take this very seriously and therefore we're going to see how best we can review to make these people comfortable. Thank you. Thank you, sir.
Thank you very much. I think we've gotten some useful feedback from those two great Kenyans. Please proceed.
Thank you. Excellency, because of what was said of the referrals, if the facility, the public facility, is working and a patient is referred out, chances are it's a healthcare worker that is doing the referral. So I think we bring in the healthcare workers now to give their comments also on that particular issue and any other that they may have. Any healthcare worker in the room? There's a hand up.
Thank you very much, Your Excellency, and the government officials here. So first of all, to respond to my brother and my boss, Honorable Sakaja, it's true. I'm Dr. Dennis Miskella, the deputy secretary general of KMPDU. It's true that we come from Kenya, even these healthcare workers are Kenyans, so we know we come with our weaknesses. That in this sack of healthcare workers, there are rotten apples. And as KMPDU, we never shy or defend when healthcare workers make mistakes. We also fall sick, so we know that sometimes that motivation to get that extra money through all those bad ways are there. But then again, as healthcare workers, we will also not sometimes allow ourselves to be the punching bag that when there's no drug, when the machine is broken down, sometimes genuinely those equipment break down, sometimes genuinely those drugs run out. So let us not punch the healthcare worker. They really go through so much to help. But what I can say is that please, can we have a proper feedback mechanism where the citizens themselves can report? Because even this debate, Your Excellency, about SHA not working is not because SHA is not working. It's because somebody has paid for SHA, but when they go, apart from the consultation fee, they have to buy drugs outside, they get frustrated. So what do we do instead? Why can't you have a setup where the governors can promise this summit that drugs will always be available? Not every time you see a lad bringing curtains, they bring the drugs that we asked for. If you could ensure that when a patient walks in through the hospital, and I'm glad that DHA has put a system that when you walk in to when you walk out, you don't pay for anything or buy anything outside. But to expect citizens to come and pay for SHA, then everything else they buy from outside is a problem. But as I move to something else, that right now the healthcare worker is the most demotivated cog in UHC. Why do I say so? Because on the pillars of UHC, there are certain things. Financing is one of them, and SHA is doing a pretty decent job on that, I won't lie. We have negotiated the US government deal funding around the HIV and TB. Perfect funding. We are doing a good job on the issues of CHV reforms. 80%, 90% fill rate. Perfect. We are doing a good job on that. Infrastructure, right now in this country, within 5 kilometers, there's a hospital, and we just saw a deal of 13 hospitals, 300 bed, being done in almost 13 counties. A decent job. ICT and record keeping, good job, digitization. The biggest challenge that we must face is the human resources of healthcare. As we sit here, 33 counties have not paid salaries. That's a fact. And they have to pay rent still and go to work with fuel. As we speak here, we have healthcare workers who on the 9th of every month can't access care because governors have sent money to shock them out. So you offer services that you can't offer yourself. As we sit here, people are on strike because certain counties, after the Ministry of Health gave 8.6 billion to absorb UHC workers, the counties refuse to take them. So we must discuss. Yes, we must discuss the country. And I really face to back to back. You say that you have felt the pain of the healthcare worker and you promise to be a neutral arbiter without compromising the evolution. And this beyond 2030 discussion, we must let Kenyans decide: are they happy with how health is being run in this devolved system or not? We are not fighting devolution. We are not fighting devolution, but why can't we let primary healthcare, level 1, 2, 3, be run by the counties, then the complex, expensive 4, 5, 6 be run by the Ministry of Health so that if the counties fail, then the 4, 5, 6 is working. If the 4, 5, 6 fail, then the 1, 2, 3 is working to give Kenyans a reprieve. That's all that we are asking for. Make care for us, the healthcare workers, so that we can care for the patients too. Thank you.
Thank you. Thank you very much, Dr. Miskella. Allow me to have a nurse. A nurse. Okay. Maybe we can listen to a nurse and then we can respond to Dennis because he has raised a very fundamental issue by way of feedback.
Your Excellency, protocol observed. I want to begin by saying that, Your Excellency, if there is something you did in this country that we will always remember you for, is to bring that man in the Ministry of Health, that Aden, to the Ministry of Health. And he has brought up a team that is actually working, plus his peers. The most smiling and the doors always, very welcoming and work. And even Director General Dr. Amoth and the entire team at the Ministry of Health, Your Excellency, these people are working today. Your Excellency, we can say we have... First, I want to admit, because I must speak with a clean heart, I was one of the serious critics of SHA when it came up. And you know, you used to ask me, it is you who brought SHA because it is us that formed this. Our issue was not about the services to be provided. Our issue, I was being pushed by the people I was leading. They were saying 2.7% was high. But I can admit to you, Your Excellency, that SHA works. Every month I spend about 100,000 shillings supporting my people in my constituents. I pay between 6,000 and 12,000 every month. Everyone telling me I'm sick, I say, 'Have you registered, sir?' 'No.' 'I cannot pay your hospital bill. Go get assessed, send me the assessment, then I pay, you go get treated.' It is working, only that we have a few people who are very poor, they can't afford. You assess somebody, tells you, 'I have... the husband built a house and he died.' So they give you, pay 8,000, yet you cannot afford that. Maybe that's the area that may want to be revised. Your Excellency, I want to thank the Ministry of Health. We have had problems, as my colleague said here yesterday. Every year we have been having problems at Ministry of Health internship. We call, we fight, we destroy things. The Ministry of Health, there is one particular year where we broke things. The Minister of Health and the interns was such. Today, as we are talking, under the leadership of your PS, Honorable Aden, there is no breakage. There is no mandamano on internship. That disease has been cured. Secondly, Your Excellency, the issue of universal health coverage, which you and your brother, former President, employed during COVID-19 through his guiding and support and working with parliament and all people responsible for revenue allocation, 8.6 billion was allocated for absorption of UHC staff into permanent and pensionable. But as we speak today, nurses in this country are on strike because the county governments have refused to absorb these UHC staff. It is our prayer, Your Excellency, that national referral health facilities have acute shortage of nurses and other healthcare workers. Since you have the money, why can the Ministry of Health just take these nurses and other health workers to the national health facilities? Your Excellency, we can talk about medical products and technology, health information system. Of course, the health information system actually has worked very well. You know that is why yesterday you said that have been removed from the system. I would want to say under that health technology, health management system, they should be linked to the medicines and even equipment. So that if Governor Sakaja has supplied medicine to hospital A, there is somebody somewhere who is in charge of looking at the system and knowing that this medicine is in stock. So that if a client calls and is told this medicine is not there, and he calls that number you want to establish, a person who is not in that hospital will be able to call that hospital and say, 'Our system shows this medicine is in stock. Why are you not giving out to the public, the patients?' For us as nurses, we are happy because, Your Excellency, our services, we don't refer nursing services. We cannot tell you go and get it outside. We will give it because you always have it. So we may not be actually affected by that. Your Excellency, a motivated workforce, a workforce that has not been paid, cannot deliver services. As we talk today, yesterday you actually said all the county governments received their share of revenue for the last financial year 100%. County governments today, Your Excellency, have not paid statutory deductions and third-party deductions. They have not paid loans. They have not paid pensions. Some have not paid loans in the last financial year. As we speak today, August is coming to an end. Health workers have not been paid salary for July. They have not been paid salary for August, will end next week. How do you expect these health workers to go to work, to feed their children, to pay rent? You are embarrassing health workers in this country. If you are a health worker and or a public servant and you have been paid salary and you don't pay for your rent and your landlord throws you out, Your Excellency, human resource policy requires that you are disciplined because you are embarrassing the employer who is government. Now, since we are the ones being embarrassed, what do we do? Can we impeach the employer? The only weapon given to us by the Constitution of Kenya under Article 41 is to go on strike. So we are asking, we open a conversation. Are we ready as Kenyans to continue having a healthcare system that is very critical in the hands of a devolved system where only nine counties in this country have had their budget passed up to now? 14 have never submitted their budgets. 24 have had their budget rejected. Are Kenyans ready to have the health human resource with these administrators who can't even have their budget passed? Who can't even afford their budgets? This is a conversation that we need to open.
Thank you. Thank you very much.
Your Excellency, the last one, I cannot sit before saying this. I'd be lynched by members. I'll be lynched. Your Excellency, in 2017, you and President Kenyatta gave us a return-to-work formula where you improved our terms and conditions of service. From that time up to now, that return-to-work formula of 2017, Excellency, has never been implemented. It has been a cause for four strikes, including the one that is going on right now. I know you have goodwill and you mean goodwill for this country. Through your goodwill, I'm requesting you to ask the Chair of the Council of Governors to sit down with us on Friday, have a solution, and SRC should be on board because in 2017 we had that CBA, it was taken to SRC, SRC rejected. And today, even if we sit with Council of Governors and agree and SRC rejects, the strike will still continue. So I'm requesting you, I know you mean goodwill for people, talk to the Council of Governors, SRC, so that we sit on Friday because we have a meeting on Friday, we complete and send our people to go back and work. Thank you, Your Excellency. Thank you.
Do we have any other representative of healthcare workers? Any clinical officer? Okay, he's up there. Proceed. Just proceed.
Yes, man. I'm very excited, Your Excellency, to be here today. I think the other time we met, Your Excellency, before you became president, in Catholic University, I'm the one who gave you the memorandum on behalf of my good friends from the unions. And we have the other unions for public health and the other unions within the health sector with us here today. Your Excellency, there's something that you promised, and I remember you said that we keep the photos so that in case you forget, we remind you in the photos. And Your Excellency, I think now I'll have to delete it. I was keeping it, but I never actually expected that we would have this forum. And you know, this is the first time we are having the head of state seated with us to discuss the matters health. We have been, as the unions for healthcare workers, even from the time our peers, Dr. Miskella, was a unionist like myself, Your Excellency. We were asking for health to be elevated to be a national agenda, and you have done that. And you promised when we met, you said that you are going to push for bold and deliberate reforms. And I'm happy that today, even those who are critical, and Your Excellency was one person who was critical at the start, one thing we agree on: they are bold and deliberate reforms. Maybe the other things that we are discussing is the implementation of the same. But where we are now, and you'll note that now the criticism has gone down, is because we have seen that it's working. I want to pick it from where my brother Miskella and Seth Pako have left. And sorry, I forgot to introduce myself. Peterson, the national chair, Kenya Union of Clinical Officers. There is an opportunity within the constitution, even without having to reverse ourselves to the national government, in Article 189, the one that has been used to have cooperation agreements between counties and national government. It also provides that we can actually have joint authorities, either under the 47 counties or the 47 counties with the national government. And because what we are looking for is a unified system to manage healthcare workers so that we have uniform standards across the board, for us, Your Excellency, we see a quick opportunity that if you can be able, through the intergovernmental coordinating summit, deliberate under Article 189, it is actually possible to have a joint authority to be able to manage the health workers across the 47 counties under one authority. And Your Excellency, I must thank you because you inaugurated the KHRAC, the Kenya Health Human Resource Advisory Council. Since 2017 when the Health Act was actually enacted, this very important body that looks at the healthcare workers' welfare and the many things that are taking us on strike was very dormant. Did not even have a board. But you took the step and you put it in place, and now we have an opportunity to be able, within that system, to provide some of the solutions that are needed for the same. So, Your Excellency, for us, because you promised that you are going to be an arbiter, what we request is that you assist us so that we can have a joint authority. Within this joint authority and within the mandate of the KHRAC, we can be able to bring our specialists from the counties to that authority so that they can be available across all the counties, because the Health Act 2017 provides that our specialists are supposed to be a national asset, and that means that they should be available across the country. But with the current setting, that is impossible. If we have an authority, then they will be under that authority and can be deployed across the board. Lastly, Your Excellency, it is not only nurses who are on strike. We also have clinical officers, public health officers, and all the other workers other than the doctors. And especially the case of clinical officers is much easier because we had already agreed on a CBA, but there are some counties that have taken long to sign. We were supposed to sign on 2nd of February, and there was an invite from the Council of Governors. But as we sit here, only 16 counties have actually signed. We don't understand why the others have not signed, and it's something that, Your Excellency, if you can be able to mediate, we can be able to conclude very fast. Thank you, Your Excellency.
Thank you, Peterson. Now, that's quite a handful of issues, but I think it is very good feedback. Let's begin. Let's begin. And I agree that machines, computers, medical commodities are all good. But without the personnel, they remain items and they cannot, you know, they cannot amount to service. For it to amount to service, people must be there. At the heart of health delivery is the health workers. And let me say the following. Peterson has put me squarely on what I said when we had the health summit before the last election, and I'm very happy to see you, Peterson. We have not met since that time. The problem, you forgot to come with the photographs. And I already gave you the leave. I told you keep these photographs so that in case I forget, remind me, tell Mr. President to... picture. But I guess you also agree that 80%, 90% of the things we agreed at Catholic University, we have implemented. There are some outstanding issues, among them the issue you have raised, and I'm going to see how we can navigate so that we can take this forward. So human resource is a critical part, possibly the most critical part of the delivery of health as a service, to give it to the counties. And when I said I'm going to be an arbiter, you can confirm, and the Chair of the Council of Governors here and the governors can confirm that the relationship between the national government and the county governments is way better than it has ever been because I deliberately chose to work with the counties, to engage in dialogue. And I must also say the counties have been very understanding. Whether it is the payment of CHVs, we've done it together. Whether it is the passing of the laws, they were always in the committees. Whether it is the equipment, the national equipment service, we have an intergovernmental partnership agreement and everything else, we have worked together. Now, up to that point, we are good. You have raised, Dennis, and my good friend Seth have raised issues that I'm sure the Council will want to respond because this is not a place for judgment. This is a place for feedback so that we are encouraged for the things we are doing right and we are pointed out the things that are not going on in the right direction so that we can improve. It is true what I said yesterday, and the Chair of the Council can confirm that we have transferred all the resources for last year. We never crossed with any shilling belonging to counties, and the money for July was already paid. The Chair explained yesterday the reasons why some counties have not paid the July salaries. But what these good people, representatives of health workers, Dennis and Seth, are saying is also correct. You know, if today is the 19th, right? 19th of August, and salaries of July have not been paid, there is a problem, you know. So we need to tidy up that because otherwise we demotivate the most critical aspect of our health delivery. I agree with you, and if there is anything that the national government can do to support the counties on that matter, we are willing to go out of our way to support the counties so that that matter can be sorted out. The next issue is the issue you have raised on deductions and that by the 9th, when SHA says that you haven't paid and therefore you cannot get service. I thought we created a bridge. I thought we, Mercy, you know, because it is not right that we don't provide service because an employer has not remitted the money which they are going to remit anyway, you know. So I think we had that conversation. I don't know whether Mercy or somebody or... Yes.
I'm being told to do it, Your Excellency. So, because it's hot, Your Excellency, yes, we did have that conversation and we agreed to move from the 9th to the 25th. We just need to tie up an agreement with Treasury and then be able to work that round. So we haven't implemented it yet, but you did initiate those discussions and give us the instructions that we sit with Treasury and move from the 9th to the 25th, at which date Treasury had committed that all monies would be with the counties and we wouldn't run into this problem. So it is on us, Your Excellency, we will need to implement that.
Yes. So this is a matter that we have discussed a number of times, that healthcare workers who are treating Kenyans on the 9th themselves are locked out. And when we were at the summit, I think, why we kept is that, and the Chairman was there at the summit in December, we found out that majority of the counties were committed to paying before the 9th. Wajir is one of them that has been paying before the 9th. I think what we are not discussing here is the flow during the transition of the two financial years. But Treasury have been dodgy. We just need to do an MOU with the National Treasury. We are the ones who pay both the national government and they pay the county government. At times even we have a problem with our own civil servants, the chief contribution. So I think this is a matter that ourselves and the Chair can now get just a final commitment with the National Treasury, and we should not discuss it anymore. I think the healthcare workers, you can assure them of that commitment. Okay. Next two weeks. All right. So let me tell the representatives of our healthcare workforce that this is feedback that had come to me and I had already given direction on what we should do because it is not correct that a healthcare worker is providing a service to others which they themselves cannot benefit from. It's a contradiction. And secondly, this is a healthcare worker who has a contract. They're not about to run away in between the month. So whether it is the 9th or the 20th or whatever, they will pay finally. So to the good people, Dennis and Seth and Peterson, that is good feedback. I will deal with it and we will make sure that no health worker is locked out on account of the county having not remitted their deductions.
Then we will see how to work this out with the counties. Right. Dennis, this is not a demonstration. Then the third issue which has been raised, and I will give you chair, you know, I will give you time to respond and also Abdul Sat. The third issue is by way of feedback that has come to us is the outstanding CBA agreements with nurses and with other healthcare workers and the need for us to bring on board the Salaries and Remuneration Commission. The Salaries and Remuneration Commission, as we all know, is an independent institution, but we will socialize them to the need for us to have an agreement with the Council of Governors and with the health workers. So again, that is some homework for me. I will make sure that the SRC comes on board. I'm sure the Council of Governors will also do their bit and they here, they will speak for themselves. Finally, is on the issue of the staff, former staff of UHC. We did make available resources to transition these good people to permanent and pensionable. We made the resources available. We just have a minor issue between us and the counties which we should be able, I think chair, ladies and gentlemen, let us sort this out and let's give ourselves a maximum of a week and sort this out. I have given options. I have said if the counties have a problem absorbing these workers, the national government will absorb them. So it is up to us, but I would really, you know, because I know the risk of us absorbing them as a national government because it will undermine service at the counties because we will basically be transferring staff from our county facilities to national government facilities and yet at the county facilities they are providing service to Kenyans. In any case, we don't have national government Kenyans and county government Kenyans. We only have Kenyans. So, I think this is something that between me, I undertake that between me and my good brothers and sisters at the county, we will look at it chair and then April Sand.
Your Excellency, let me have a first go at it and then my colleagues will back me up. Your Excellency, we are good friends with these union people because you spend a lot of time with them as governors navigating these matters. But the things said here should not take away from what counties have been able to achieve in this sector. This morning when we were in the other hall there, we took cognizance of the fact that in 2013 in the run-up to the first elections under devolved system of government, we had about 900 doctors in district hospitals. Today we're talking of close to 5,000 doctors in county hospitals. Your Excellency, you very well know that I'm a returning governor. I served in the first term. I was out for 5 years and I'm now here. I inherited Wajir with one doctor. I think that one doctor is here. Dr. S, I don't know whether he's here. He was in the hall today. Today we have over 70 doctors of which over 20 are specialists. I remember advertising for a consultant three times and no Kenyan was interested to come and work with and I went and sat in the office of General Kaiseri and I said you need to give this Ethiopian doctor a work permit because he's a consultant I can't find a Kenyan consultant and that Ethiopian doctor was the only consultant in my county for years until we sent our own doctors to go and specialize and become consultants. He died in a road accident. He's called Exai. People know him in the medical profession. So the things people say here about counties and devolution are not, it's not what it is. Your Excellency, there are things I think this reaction first of all emanated from what Governor Sakaja said about people being sent to private facilities and I'll respond that last. It is true Your Excellency and I said it here last night since you came into office. We have not had instances of crossing over and merging finances of one fiscal to the other. It was very ordinary in the past for June allocation to be paid in July or in August. We have our June money. We have our July disbursement. But there's another matter, Your Excellency, of the treatment by independent offices and commissions and especially the matter of COB with respect to county governments. We have asked for an IBEC which His Excellency the Deputy President chairs. An IBEC will happen on Monday. This will be one of the issues that will be discussed. As for those counties that are yet to submit a budget, Your Excellencies, those are the vagaries of democracy. Budgets are drawn by the executive but they approved by the county assemblies and sometimes they take their time and sometimes, you know, we don't meet certain deadlines but the financial architecture has taken care of that even when a county has not passed a budget the law PFM Act allows that county to access 50% of the last year's budget within the first 6 months. So those are things that we will navigate. This particular incident here of 33 counties not being able to pay salaries as I said last night is just as a result of the fiscal year transition from one to the other. Once all these budgets are approved and uploaded into it happens once a year so it will not be an issue. Most of the time in the past it has been an issue of disbursement and releases of money. In this particular case treasury has disbursed. We are having crossover issues which we will deal with on Monday with COB and at IBEC. Your Excellency, on the issue of CBAs, as far as I'm concerned Your Excellency, the only active issue strike which is not in all the counties nurses are not striking. My county for instance we have talked to them and we are doing their promotions we have promoted most of them they have no issue they at work but in some of the counties nurses are striking. The CBA that they're asking us to enforce today Your Excellency and I can easily provide a copy to you was signed in 2017 and when they came to see me I also blamed their leadership I said the clinicians came and formed a union after this CBA and they still had their matters largely sorted out if the counties that have not signed because we have already made that commitment at COG level. That's an issue you don't have to call a strike for. You just need to speak to me and tell me which counties. But Your Excellency, this CBA of 2017, I asked the union leaders how many chairs of council have been here. President Ruto was not even the president then. How many ministers of health have been here? You are raising it now. But the amount we asking for is what was to have increased from 2017 to date when a shilling has not increased. So we met as a leadership and we made a very good offer and we also told them how we will move to where we ought to be given that nothing has moved. Not a dime from 2017 to date and they are to come back to us on the offer that we made to them. As chair of council, I am determined to ensure that we have an understanding with the nurses. But I want to say here now that the CBA which they are asking me to effect was signed in 2017 and nothing had moved on it. Your Excellency, the question of whether health should be managed at national and county level is a constitutional matter. But I just want to give you an analogy Your Excellency because there's another elephant in the room and that's the one of supervision and master is my good friend Your Excellency every time because no sitting president of this country understands Kenya more than you do because no one visits the periphery and every county more than you do. Whenever there is an attack of some sort, a bandit attack, an opportunistic attack by al-Shabaab in a place like Mandera, Wajir, by virtue of proximity to the boundary, teachers, some of whom are 300 kilometers from where the incident happened, come and demonstrate in front of TSC to be demanding to be taken out of the region. Yet the incident happened where 300 km between Busia. So it's something happening here and somebody in Busia asking to be transferred out of Busia because of insecurity. Those are the shenanigans we will be dealing with if we go the way Masaka wants us to go. Counties have no problem managing healthcare. Five or six of His Excellency's cabinet secretaries were governors managing counties. There is not a single governor today who cannot manage a docket at national level if he gets the opportunity from His Excellency the President. That is not the problem. The problem is systemic issues that we have to deal with the approval of funding by COB and the like. Your Excellency coming to the last matter which is the matter of conflict of interest. Conflict of interest and I know this is a very, very and should I say sensitive matter. Your Excellency, the problem you have in this country which is a good problem is that you are running a very democratic country and democracy limits your hands in dealing with certain things just the way it also limits my hands as a governor. We have a situation in our counties where doctors who have been trained with government money, some of whom are consultants that counties have been paying their salaries and sometimes they're away for as many as 5 years. I have one who was away for 9 years. He specialized and specialized further and then COVID happened. He stayed longer. When they come, what do they do? They set up specialist clinics next to our hospitals and they want to use the government salary as a retainer as a safety net but earn more money running their private practice. And these are the issues that we are having with our doctors. And I don't want to raise it here, but we are having a frank conversation. Those are the issues that we need to deal with. If you are in public service, there's a clip that is going around the last two days. I don't know whether you have seen the pediatrician in Turkana, a Kenyan, I don't know whether that was on national TV saying he met this pediatrician in Turkana who does 4 days a month in Turkana. He does 4 days a month Your Excellency. Is it fair for the Kenyan taxpayer to pay a consultant 400,000, 500,000 and there are consultants who earn 700,000. I know consultants who earn more than deputy governors Your Excellency and I can provide you with this data to work for 4 days a month. I think those are the things we need to discuss with. Having said that, Your Excellency, I will make an effort as chair of council to even get into an arrangement for the purpose of salaries so that we allow counties that are having challenges paying salaries to also have a soft arrangement like some of us do with Kenya Commercial Bank so that they pay salaries on time. I can face Pako because I have paid my salary. I have paid my staff. I never delay in doing it. But you cannot come and generalize things here. I thank you Your Excellency.
Thank you very much. Governor, do you wish to say something? Please help me. The chair of committee of council of governors briefly.
I think we know each other with the union leaders on first name basis and I think the number of calls that I get from them and communication is probably more than what I discuss with you. I want to start an example is Peterson Kenya Union of Clinical Officers. The last conversation I had with Peterson was actually just yesterday. Your Excellency and it was myself together with Governor Sang that actually negotiated the return to work formula. There's some things Your Excellency that are beyond us. SRC is a constitutional body. I have to go out of my way and the secretariat, the able secretariat of the Council of Governors have to go out of their way because we need a no objection from SRC. I signed other counties have been able to sign others are in the process of being able to sign. But even after that goodwill, you're still being told that and I actually had to call him and tell him there's a level of goodness that we can also be able to do because if we have signed and have done our part, there's really so much that we can be able to do the doctors. In fact, I know that I'm meeting them on Thursday actually, Your Excellency, which is tomorrow. Is it tomorrow? Oh yeah, on Thursday I'll be meeting the doctors. Some of the issues that we've been able to do and work on today we're implementing a CBA including paying salary arrears including we actually had to personally call the head of the ministry of public service for purpose of getting a special code for ensuring that we pay the salary adjustments and so forth. The issue of SHA is Your Excellency. Prior to the strike being in place, the Council of Governors had already put a team and they were already negotiating. Negotiations had already started and even without anything else, the nurses opted that yes, they want to go on strike. I've had the issues that have, you know, and it is okay. It is okay because of positions that we hold. Sometimes it is important for unions to be more tough on counties like because of the fact that maybe we speak on behalf of the other governors. But I like the governor of Wajir, I think probably because of this transition for the first time I delayed salaries by 2 days or 3 days. I have no debt with any single employee in the county government including statutory deductions and everything else. The issue that we are trying to make sure that it does not happen. You need to ask yourself, Your Excellency, what are the conditions that made a CBA to be signed in 2017 that every government that has been able to come through has not been able to do a CBA like that. When you sign a CBA when you're in a position that you're under duress because that CBA was signed on an election year that CBA held people at ransom. Allow me, you know, and it is the reason why Your Excellency we, I sat down with the two gentlemen at the council offices and we gave them an offer and we said this is our offer. The least that would have happened is we're coming back now. Even as we speak right now, there are so many who have gone and broken court orders because of the fact that there's actually a court case that they actually meant to return. Because when you speak to someone and you're holding a gun on their head, you're dictating, you're not speaking. You speak under equal terms. And if we've shown that level that we want to be able to speak, the same way I've been able to speak to the Kenya Union of Clinical Officers, the same way I've been able to speak to the doctors, we were able to sort out strikes and we were able to amicably solve issues to do with many other cadres that are out there. And I think Your Excellency amongst the things that are being discussed at IBEC on Monday. One of them is the issue you were talking about on SHA that if a county has not been able to pay what happens in a scenario like that. It is something that is being resolved on Monday as we speak in IBEC. The other issue that is also being talked about, I know Mombasa is not one of them, but it is only fair that I speak on behalf of the other governors, Your Excellency. The issue that is being discussed on Monday is also issues to do with COB. When a county like Nairobi and many other counties have not had their budgets approved and COB opts and decides that, you know, it is just a plotting or something but anyway COB has decided not to do some of these other things in time and Your Excellency there's actually a notice that COB themselves have actually put out that there would be a crisis on salaries and it's not salaries just for nurses or doctors or clinical officers alone. It is nurses including the governors and the deputy governors and the CECs and chief officers and everyone else. So and, you know, for those governors the same way we have doctors out there who decide not to go to work which is a fact. They decide not to go to work despite the fact that they're being paid salaries. One of the reasons why you hear that SHA is not working. Your Excellency and this is through a true story on my part. I went to a hospital and someone could not be discharged because the way SHA works is and it has been beautifully designed so that there's no fraud. The person, you know, the clinical officer or the doctor has to be able to sign them and it is because it's geo-fenced when that person is not there then you're told that SHA is actually not working but as a matter of fact there's a person who was meant to do what they need to do when they were not there. Now as much as there are doctors who spoil the image if there's one or two who have decided that, you know, they're not paying statutory deductions as my chair has said that is the price of democracy because someone voted for them. It does not mean that the system is wrong. It means that there's someone who did wrong. We do not know the kind of president we'll have after 2032, Your Excellency. We pray for your long life up to 2032 that we take. But what happens when we get someone else who's going to be rogue? Does it mean that the system will have to be now reversed that things have to go back again to counties? Have we not had situations where this country has had teacher strikes and teachers national government? So Excellency this is a conversation and I think the issue of human resource is something we need to sit down and I'm glad you've actually given us a deadline and a timeline. There's a discussion we're having with CS Duale on the issue of UHC. There's no one who does not want it is only that we do not want a situation where we can have a problem of continuity. That is all that we are saying. But we value every single healthcare worker. We value every sweeper. We value every fireman. We value every single employee who works for our county governments. And please let's reciprocate on the same. Thank you very much.
Thank you. Thank you chair. I think that is a fairly balanced conversation from where I sit. Very balanced. I think everybody has said their peace and very respectfully but also very authoritatively. And I think we have agreed on a way forward on the CBAs that are outstanding. What I must say is even as we agree here, I am a very big supporter of the Salaries and Remuneration Commission. We must respect their mandate because they help us to balance between recurrent expenditure and all the other expenditures. So even as we negotiate let us take their view into account so that we balance things out. I agree with the Council of Governors that sometimes we have challenges with the approvals from the Controller of Budget and I'm happy that you have set a meeting for Monday so that that can be ironed out and we can have the counties to discharge their responsibility as is expected of them. Let me say two final things on this matter. There is somebody who said that there's an issue about how much I think it was Pako who said some people when they go and they are being means tested. Sometimes they do not get the right, you know, testing because maybe they said they have this maybe the assessment was not accurate and that kind of thing. I think that's homework for us. We need to continuously sharpen the means testing instrument. That is homework for at least my office especially Mai and the professionals who work with me so that we can assist the ministry to sharpen the means testing instrument. Is that correct Mai? Yes. I want to just promise you that we're still collecting data on making sure that when we do an assessment of a citizen on how much they pay, we must be as near accurate as possible so that we do not pardon a citizen who has a certain ability and we misjudge them to have a different ability. So that is a good feedback but already it is in our radar that we have a means testing instrument. We are still gathering data and we are using, we're trying to access data from different sources so that we can have a much more accurate means testing instrument. Let me however say that there are people who have means and you know this is Kenya, you know there are people who earn more salary, they have better businesses but you will find them complaining that they want to pay the least when in actual fact they can, they should be able to pay more because the assessment that they go through says is a different thing. So we must continuously not burden and I must say this the people who earn salary everybody knows their salary but there are people who make as much money doing business but they don't want to pay as much as those who have a salary pay. They want to pay less. That is unfair. In fact, the court instructed us that we must be fair. You know, those who have a salary must pay. Those who don't have a salary must also pay and they must be assessed correctly. So, I think that is an area that we will keep improving as we go into the future. One final thing that was said is on the matter that Peterson raised. I think when we were in that summit when I made commitments, I said we will find a mechanism which will bring the county governments and the national government into a place where we can discuss health human resource issues. You remember Peterson and that is the reason why we set up the KHRAK right the advisory council. Maybe it is not doing exactly what maybe it's not very effective. I think we should find a way of making that body much more robust and active before we can explore the opportunity you have said that maybe under article 189 I don't know whether that is possible for us to set up an inter something to deal with human resource but I think the best place to start is the advisory council that we have let's see whether we can put energy into that organization and see whether we can manage the human resource issues collectively as the national government and as the county governments and I think we have agreed on the UHC staff within a week myself and these good friends of mine governors we will agree on how these workers are going to work and move forward. We have also agreed on statutory deductions. That is my homework that I will sort it out. We have to because it's not right for us to deny citizens who are working access to health on account that their deductions have not been received by us. Yet they have already been deducted and they will be paid anyway. We must find a solution with the treasury without treasury Aden please sort that out if you need some ideas on how look for me I will give you some ideas. I think those are the issues I don't know whether they are messy thank you.
Thank you Mr. President, I think we have discussed the healthcare workers quite cooperatively. Next I'd like us to have a conversation on renal care. It's an important conversation because in there are issues of non-communicable diseases such as diabetes and hypertension that can cause, you know, complications on renal care, the issues of dialysis, the issues of transplant and also the immunosuppressive medications that transplant patients sometimes require. So I think we can unpack all of that and have a conversation around it. So we can start by somebody with a lived experience on renal care. All right, you're already up. Please, the floor is yours.
Thank you. Thank you, Mai. Your Excellency, distinguished ladies and gentlemen. My name is John Gono. I am the president of the Renal Patient Society of Kenya. I'm also the vice chair of the Non-Communicable Diseases Alliance of Kenya. I am a kidney patient myself living with a kidney transplant. I got my kidney transplant in 2015 at the Kenyatta National Hospital and I'm proud to say that between then and now the good people at Kenyatta National Hospital have taken good care of me and other patients and that's why I have known nothing but good health in those 11 years. Your Excellency I represent a number of people, a group of people who are considered to be the greatest beneficiaries of the Social Health Authority and I say this because the cover we have for both dialysis and transplant is honestly speaking quite generous. A patient on dialysis in Kenya is covered for two sessions every week. Each session at 10,650. If you total that for one year it's 1.1 million shillings per year. Now a lot of people would not be able to pay 1.1 million shillings to pay for two sessions per year. And therefore the 7 or 10,000 people currently living on dialysis literally owe their lives to the Social Health Authority and we don't take that for granted. The patients who are lucky and able to get a transplant like myself we have a SHA package which covers one again 1.1 million that is for pre-transplant evaluation. Then there is the transplant surgery itself. There is the donor nephrectomy that's removing the organ from the donor and then there's a post transplant management. If you total up all those figures you come to about 1.1 million shillings and therefore we are very grateful to the government and to SHA for this package and we would like to encourage SHA to continue supporting us. We would like to encourage her to speak to us regularly because sometimes there are challenges particularly access challenges that need to be ironed out so that whatever is not going on well can be sorted out and I would like to pick a few issues. The dialysis package like I've said is two sessions but if a patient gets admitted, if a dialysis patient gets admitted to hospital they are only covered for one session and this is a bit strange because if you are on dialysis you are already a patient who is unwell. But if you now need to be admitted, it means your health has deteriorated, which could probably mean you need more dialysis than the two. Remember, international best practice recommends three dialysis sessions, but we only give two because that is what we can afford for now. And we understand that very well as patients that we only get two despite recommendation of three dialysis sessions. We get two because that is what we can get for now. But and I'm talking about now a patient who is getting one session because they have been admitted. So they will even get more sick because if they are not able to pay for the extra one while they in hospital then they will not get well very soon. But what is even worse Your Excellency there's a condition called acute kidney injury and this is a sudden onset of kidney failure either from an infection, an injury, an accident or something like that. If acute kidney injury is tackled quickly and intensive care given which would involve for example five full days of dialysis there is an 80% chance that the condition can be reversed kidney function will be regained and the patient can go home well. But now when we only allow one dialysis session for this patient because they are an inpatient what we are, I'm imagining the reason we are doing this is so that we save some money but what we end up doing and this is very sad is that we are saving 50 or 60,000 at the risk now of sending this patient to full-time dialysis for which we will need 1.1 million per year and they will have a very bad outcome and a reduced quality of life. So these are some of the things we would like that SHA to reconsider so that people get the care that they need at the time that they need it because some of the access rules unfortunately are not fair to the patients. We have like I've said a post transplant package. This is a package which supports now the medication and the clinics that we need after transplant. I would like to thank your government and SHA because this is new. This came with SHA. We had a dialysis package and a transplant package before within NHIF. When SHA came in, we made a plea and it was accepted. We now have pre-transplant evaluation and post-transplant care that we attribute to your government and Social Health Authority. Again, we have some challenges with access. Some of them are from the system particularly the DHS system. We have a very very cumbersome, you know, system where we have to give a lot of paperwork. KNH has now gone paperless. You know, things have improved things move quick but when it comes to SHA I have to go with six documents which I have to submit then they have to be scanned and even the physical part of doing that and taking them through all this takes a lot of time sometimes the system hangs. We would like the SHA system and the DHS system to be streamlined so that we can also go as smoothly as the rest of the things and we do sometimes we are forced to go home without drugs because the system hacked. And to respond to CS Duale who mentioned about, you know, sometimes people switching off the system so that we can pay cash, a lot of time when the system goes down you can't even pay cash it goes down it goes down nothing can happen it is a very difficult and sad situation and people at KNH for example wouldn't do that and like I have said I've been with them for over 10 years so I know them they cannot switch off a system to make you pay. So whenever it happens it's a genuine problem.
Yeah. Let me just finish because the president gave us a challenge to talk about beyond 2030 and I have not heard anyone talk about it. So I would like to make some asks on that and what I would like to ask Your Excellency and some of these things I would like to seek your personal intervention is that we need a renal registry. We need that because we would like to make data-driven decisions around kidney disease. We do not have a registry as yet. So a lot of figures we throw around are imaginary. But before we get there, I would like to make a plea to Dr. Mwangangi and the gentleman from the DHS. I know if you go into your system you can be able to tell us for example how many people accessed post-transplant medication in one period how many people access dialysis and if you can share that information with us including with Dr. Mwangangi and her team, they would be able to make better plans and I'll tell you why. Currently, that post-transplant package is only available at KNH and MTRH. But they can tell you how many people they have transplanted since they started. But they cater for people who are transplanted in other hospitals including outside the country. So they cannot be able to predict properly today how many people will come to post clinic next Tuesday if they do not have this data and so they find themselves into problems which they are not able to solve because there is some darkness around how many patients needs have this service and how do we prepare for them. So we would like Your Excellency for that. We propose that this registry is domiciled at the Center of Excellence for Urology and Renal Disease Services which we have been promised will be commissioned very soon and I saw CS Duale inspecting that compound recently so I know there's something in the works and if this can be domiciled there then we can be able to interact with that and we will have to have like I said data-driven interventions and preparations. Now I would like to bring to your attention Your Excellency that the Kenya Blood Tissue and Transplant Service has for very many years been trying to come up with a deceased organ donation program and the reason we're doing this is because currently if someone needs a kidney transplant they can only get a donor from within the family. So previously before the post transplant cover that I've said came with SHA a lot of people are preferring to stay on dialysis because when they're on dialysis they don't pay anything other than their subscription but if they do a transplant they need to buy medication and they feel they cannot be able to do that. Now we have some money coming in coming our way and the question is why haven't we seen an uptick in people seeking transplant services. The reason is kidney disease is a family disease so if I am still being requested to go back to my family to look for a donor there's a high likelihood that most of them will not qualify because if it's a genetic disorder then they are all affected. And that now keeps people on dialysis because the only exit from dialysis is a transplant. So if you cannot get it, you're stuck in dialysis. We think that your quality of life will deteriorate if you are on dialysis for more than 5 years. So the cure for that then is a deceased organ program where we can be able to take organs from our dearly departed and then we can use this for transplant. We can also relax the rule that requires me to go to the family so that now my friend or my neighbor can donate to me. The Kenya Blood Tissue Transplant Services has been working on a framework to operationalize the law that is in the 2017 Health Act and this process has been stuck since 2023 because of lack of funds. I would like to make a special appeal to Your Excellency and the Honorable CS for Health. Please make sure that this effort is funded so that we can be able to finish that the technical working group that was working on this is able to finish his work so that we can expand the donor pool in the country and more people will be able to exit dialysis and go for transplant.
Just two more. Just two more.
Thank you. Let's allow others.
Let me talk about NCDs. I would like to request that I know we having a census in 2025. Again, looking for data. We don't know how many for sure how many people are living with NCDs in the country today. But I would like to make a request that during the census the next coming census that we put a question on NCDs so we can have some semblance of data of the people living with NCDs in the country. And finally, I would like to make a plea for meaningful involvement of people living with NCDs at the decision making level so that we can contribute towards some of these decisions using our lived experiences. And that is the end for me. Thank you.
Thank you. Thank you very much Gono. You have packed quite a lot of things and I could see the president taking notes. We will address that later. Allow me to also just pick two or three more lived experiences. Those are couples and yesterday we had a conversation on seeking care in public hospital and those who go to private hospital. Both experiences in a private or public hospitals that wanted to share that story. Oh, he's here.
You can just come. Thank you, Dr. Mwangangi. You can just. Thank you. Your Excellency. My name is Joseph Mindu. With me, I have my wife.
Yes. We got involved in a road accident on 1st of March this year on our way back to school. We are teachers in profession at TSC and we were admitted in Machakos Level 5 but because of logistics of surgery. I was the one who was left at Machakos Level 5 and then my wife was referred to German Medical Center in Machakos. So we went through surgeries because I had a stab fracture at my right leg. Then my wife had a femur fracture on right leg also. And through the process of treatment I took around 3 weeks to have everything taken care of because of mid injury and also some scars you can see in my head. She took one week in German Medical Center. The bill that was there in Machakos for me it was 224,000 and ours was 145,000 and comprehensive medical cover which is also really in SHA everything was settled by SHA around 369, almost 370,000 and no single cent we paid for that service. We have also been going for clinics and also for the checkups on MRI, CT scans, X-rays in image center at Machakos and everything has been taken care of by SHA. So we are here to witness and confirm that through that detection Mr. President you said yesterday that across all the civil servants we benefited fully without paying any single cent and I'm sure every civil servant here can also confirm the same and I have to congratulate you also Mr. President for being in the forefront to launch that program for emergency services because for example in our case where we got the accident it was somewhere in the bush area somewhere where we were going in.
Work and it south of the Good Samaritan, we survived in that accident. So thank you so much, Mr. President, for being at the forefront to ensure that all the care in this country is working well, and we truly say we appreciate that service. Thank you. Thank you. Thank you very much.
Um, Mr. President, yesterday we spoke about Linda Mama, Linda Jam. And on my corner here I can see a few moms and their babies. If there's any who would want to give the experience...
For me, I would like to talk on behalf of mothers with children with disability. Uh, personally, I'm a beneficiary for Tenwe and Bethany Kids. Those two hospitals. Um, my son has benefited. He has benefited from the surgeries. The three surgeries that were done for him, uh, it was around 300,000, and all of them are sorted out, both in Tenwe and both in Bethany Kids. So personally, Mr. President, I'm so concerned when it comes to early interventions for children with disability, especially when it comes to therapies. I really ask if SHA can help us in accommodating our kids on therapies because that is where we have a lot of challenges. Mr. President, again, um, we have issues with diapers. Yes. Yesterday you guys talked about diapers. Our children also need diapers because that is where we have so many challenges. We have mothers who are still wrapping their big children with clothes because they lack diapers, and that one is like lacking hygiene. And again, we really, as caregivers for children with disability, we really like if we can have a mental health rehabilitation because we have a lot of challenges when it comes to raising children with disability. And also, I would really like to add SHA, if they can help us in assistive devices. If assistive devices can be placed at SHA also so that most of our parents can see a better option when it comes to orthopedic area. And lastly, I really like you, Mr. President, to consider our national days when we celebrate disability days. Like in September, we will be celebrating World Hydrocephalus Month. So if you can celebrate with us, we'll really appreciate that. Thank you.
Thank you, thank you very much. We have a team from... And I know sometimes people who are Kenyans who live at the periphery have access... Okay.
And my SHA was temporary and it has already expired. So if I can renew it, 'cause am I underage?
Just hold on. Can you begin? I didn't get your first part of your conversation please.
I'm Stephanie, Stephanie Muya. I'm 18, and I gave birth at Mama... I gave birth at Mama Lucy on January 2nd, and I used temporary SHA, and it has already expired. Can I renew the temporary? And then... Apart from SHA, I'm a dropout, and I'm a young mother. I want to go back to school. That's all.
Okay. Um, I thought... first, okay. Let us begin. Maybe we can begin with Stephanie. Yeah. Stephanie. By the way, I have a daughter called Stephanie. So, Stephanie, back to school. You will go. Yes. Um, I want somebody to answer Stephanie about her temporary cover. You remember yesterday I said the government of Kenya is going to pay for our teen mothers. Mothers who do not have an ID, they cannot pay for themselves. And so the government of Kenya is going to pay.
Yes. Yes. Your Excellency, you made true to your commitment. We, SHA does have 1 billion Kenya shillings that you've availed to ensure we cover teenage mothers. And to date, we've covered about 100,000 of them through that program. And that is what Stephanie is talking about, the temporary SHA program. This program runs until the teenage mother is 18. And so it serves any teenage mother from the age of 13 all the way to 18. Once the mother turns 18, we expect her to get an ID and then to be able to pay into SHA. So in Stephanie's case, she's told us she's already 18 right now. So we need to help her get her ID and then now we need to find a mechanism of supporting her. The program that we currently have, Your Excellency, has served 100,000 teenage moms in the country. Fully paid premium for them and for their family up until they turn 18. So if a mother is 14, she gets cover until the time she turns 18 together with her family.
So, um, so what do we tell Stephanie? Stephanie is now worried about herself and her child, and I think we'll take care of her going to school. That becomes the Ministry of Education's assignment. We will make sure that we find a school for you and pay for your school fees.
But then what happens to Stephanie and the child? So, Your Excellency, because Stephanie is yet to go to school, it means she doesn't have an income. So we can enroll her in the SHA sponsorship program that you've also availed resources for.
So does she qualify under the program we have for indigent?
Yes, she does. She does qualify for the indigent sponsorship program.
Okay. So, Stephanie, you remember yesterday I said we have 560,000 Kenyans who we pay for. So we will make it 560,000 and 1, and Stephanie. So please include her in that program.
We shall do so. Yes. Now, um, on... I think one gentleman has been... First, let me thank Mr. and Mrs. Mutinda. Thank you very much, Mr. and Mrs. Mutinda, for saying two things that you've actually proven to us that whether it's a private hospital or a public hospital, I've kept on telling the people of Kenya this, that once you are registered in SHA, you can go to any facility, and as long as the facility is registered with SHA, then we should be able to cover your bills, for you and your wife. You have also given me one more confirmation. I had a very candid conversation with the Teachers Service Commission and the teachers unions, both KUPPET and KNUT, and I persuaded them that they were better off in SHA than in private insurance. I think what Mr. and Mrs. Mutinda have shown is that that is actually correct, because today, teachers who had access to one level five or level six hospital, today they have access to all the hospitals. We've expanded cover. Teachers can go to as many facilities as are available in their locality, and we've made the cover much, much better. And congratulations to Malimo and Paul for the accident. Now we have one wonderful gentleman, Mr. Gono there. Thank you very much, Mr. Gono. You are a wonderful Kenyan. You have given us so much feedback. I have written on my page and I've turned over the page to write some more on some of the feedback that you have given us. I like the fact that you agree that we have improved on the cover from what was 400,000 for transplant, it's now 1.1 million. That's correct, Mr. And from what was covered in dialysis, we have enhanced the amount, so you can access more facilities, and we have done many other things to make the life of people like yourself and others who are living with non-communicable diseases bearable and better. You have however raised a couple of issues which I want us to address by way of feedback. You have raised the issue of acute situations that if we handled them differently, maybe we would have a better outcome. I don't know whether my team has any views. Is it something we can carry as feedback and homework for us to go and think about by way of improving the cover? Because I think the suggestion he's making is yes, we may be making a little saving by limiting the number of dialysis sessions, but if we dealt with it early, maybe we'll have a bit more sessions, we could actually save the kidney. Is it something that doctors can verify that that is the case? And if it is, is it something that we can onboard as a different approach to this, as Mr. Kono said?
Thank you. Thank you, Your Excellency. Um, yes, we actually have the head of all the kidney doctors in the room. If Dr. Wala is in the room... Oh, good. Dr. Wala can confirm that acute kidney injury, he's a specialist. Please talk about it before here.
