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Wednesday, December 8, 2021

KEMSA reforms to strengthen Universal Health Coverage delivery

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The Board of the Kenya Medical Supplies Authority (KEMSA) confirms that organisational reform efforts have been stepped up to position the Authority as an effective player in the local healthcare system.

KEMSA is a strategic State Corporation mandated to undertake roles and responsibilities to ensure supply chain excellence for Health Products and Technologies (HPTs).

Currently, KEMSA serves over 8,000 health facilities from the Embakasi National Supply Chain Centre complemented by an additional devolved network of 11 warehouses, four in Nairobi and seven spread across the towns of Eldoret, Kakamega, Kisumu, Meru, Mombasa, Nakuru and Nyeri.

These facilities provide last-mile delivery services for our national medical supplies serving communities as close as Mukuru Kwa Njenga in Nairobi County and as far as Manda Bay in Lamu County or Kibish in Turkana County.

New board appointed

The Board was appointed vide a Gazette Notice on April 28th, 2021 and inaugurated early May 2021. Following the inauguration, the Board immediately commenced a process to institute an organisational rejuvenation strategy. The formulation of this strategy has been widely consultative internally and externally. Indeed, the Board is grateful for the support provided by the Public Service Commission (PSC), State Corporations Advisory Committee (SCAC), Ministry of Health, Ministry of Public Service and Gender Affairs, KEMSA Staff and Management, among other stakeholders.

In early July, a multi-agency Taskforce was formed to provide an independent operating recovery strategy for KEMSA to facilitate organisational effectiveness. The KEMSA Immediate Action Plan and Medium-Term Reforms Working Committee (KIAPRWC) comprised a panel of local public service administration experts backed by international counterparts drawn from the World Bank and the Africa Resource Centre.

KIAPRWC had been tasked to: 

  1. Review the current organisational structure to determine its efficacy
  2. Review current staff establishment and staffing norms
  3. Establish if the current career guidelines were responsive to the current client needs and mandate of KEMSA
  4. Determine whether the current HR policy and procedures were properly attuned to the Constitution, Labour Laws and other relevant legislation.
  5. Assess prospective modalities for the reorganisation of KEMSA to meet its mandate, current challenges and demands of clients.
  6. To review the KEMSA Reforms Implementation Committee (KRIC) reports and take into account the immediate action report thereof.

Findings

The Committee has now completed its assignment and has provided a detailed report to the Board. The report has revealed challenges in critical functions within the Authority that deserve to be expeditiously addressed.

The challenges identified in the report confirm that KEMSA is currently grossly underperforming and largely unable to meet clients’ urgent needs, particularly the delivery of essential Medicines and Products to the Counties, Referral Hospitals and Programs.

This has endangered the lives of Kenyans and is gravely threatening the realisation of Universal Health Coverage (UHC), which is critically predicated on a successful and optimally operating KEMSA.

The key challenges are divided into four buckets:

  1. Financial Crisis – This is manifest through lack of Financial Controls, with a Debt Crisis arising from structures that are not optimised to collect.
  2. Supply chain Crisis – This has led to a low Order Fill Rate and a High Turn Around Time (TAT)
  3. Warehousing and Distribution Chaos – This is manifest through deadstock, Purchase of non-priority items and Poor optimization of distribution models.
  4. Procurement chaos – We experience Long Lead Times as a result of operating inefficiencies.

After a review of the report, the Board holds that these challenges will require further review of KEMSA around three key areas:

  1. Structure – The organisation structure establishes the degree to which it is constrained in achieving the strategic objectives.
  2. Governance – To determine the best-fit approach to leadership and oversight across the organisation.
  3. Processes – To determine gaps in the organisation processes, procedures and technology.

As the review gets underway and in compliance with legal requirements governing labour management, the Board has issued General Notice Letters to all staff working with KEMSA this morning. As per the General Notice Letters issued, all non-core staff members have been released to work from home with immediate effect as the progress of the necessary consultation.

The core operating teams under a caretaker management team have been notified, appointed and mobilised to ensure seamless operations in the intervening period. The Board confirms that the necessary interventions have been put in place to avoid undue disruptions to service delivery and day to day operations.

The release of all staff to work from home is a procedural formality to facilitate the review of the organisational structure and will be undertaken expeditiously to ensure that the staff complement is fit for purpose and within the approved staff establishment levels. Attendant sensitivity and empathy will be maintained as the Board is committed to ensuring a smooth review, and the following support measures have been put in place:

  1. Continuous staff engagement and consultations within the next 30 days-Ensure Departmental & team engagements are undertaken. Ensure communication of internal meeting schedules and communication with staff via official channels and through supervisors.
  2. Commitment to inclusivity– All staff will be engaged and appraised throughout the notice period.
  3. Psychosocial support. The necessary counselling and psychological support will be availed to all staff.

The Board is committed to aligning the organisational structure to industry-accepted standards for a health commodities and technologies procurement organisation.

It also calls for the introduction of global best practices, which include: acceptable span of control, transparent reporting relationships and command structures, compounding related functions for strengthened accountability and a re-determination of optimal staffing levels and norms. 

Ultimately, I am encouraged that the KEMSA staff, management, and other operating partners have expressed a commitment to supporting the envisaged reforms. These reforms will provide the foundation for achieving the Big Four Health Goals, including the realisation of President Uhuru Kenyatta’s much cherished UHC programme. 

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