OPINION: KEMSA is not a lost cause; it can deliver world-class supply chain solutions

A country's health system is often described as one of the vital pillars of national sovereignty.

The Covid-19 Pandemic was perhaps one of the most vivid justifications for the need to prioritise health systems' resilience and view them as strategic security installations, almost mirroring investments in the national defence systems.

At the heart of a country's health system is the national drug stores and, in our case, the Kenya Medical Supplies Authority (KEMSA), which maintains statutory obligations. As outlined by law, these responsibilities include the procurement, warehousing and distribution of health commodities to all public health facilities in the country.

This statutory responsibility requires KEMSA to operate world-class supply chain facilities and provide solutions that keep the local health system running. With KEMSA as the heart of our national health body, our more than 11,500 health facilities are our first-line defence mechanisms and arteries for primary health care and disease management. The Government should not tolerate failure to pump these arteries with the relevant health commodities through operational inefficiencies and other management challenges.

With a base of more than 11,500 health facilities, KEMSA is best placed to procure health commodities at wholesale volumes and in good quality. Such procurement efforts allow the Authority to enjoy better pricing, passed on as a benefit to the health facilities ordering through KEMSA while fiercely protecting the patient from substandard products.

Of course, this also makes fertile grounds to make the compelling argument that, as with any other strategic and critical public installation or agency, the stakeholders can't afford to throw the baby out with the bath water. KEMSA is not a lost cause. It may not have met its mandate as efficiently as expected. Still, recent transformation efforts, management focus and integrity enhancement measures have proved that KEMSA can once again rise from the ashes like the proverbial phoenix and deliver world-class supply chain solutions.

It is no mean feat to bring life back to a giant and complex institution like ours, and the road to reforms has been long and winding. For almost a decade or more, various stakeholders have voiced their concerns about KEMSA's capacity to support our national health needs as required.

From funding partners to local clients, including county governments running health facilities in Kenya, the stakeholders have been unanimous that KEMSA is barely meetings its mandate. Some stopped calling the spade a big spoon and affirmed that KEMSA was dysfunctional, almost on its deathbed, requiring urgent resuscitation.

One of the stakeholders that have continued to take the state of KEMSA with the seriousness that the matter deserves, and rightly so, is the Government of Kenya which is also the main funding partner for the Authority through the exchequer.

The various state agencies, from the Ministry of Health to the Cabinet and beyond, have constantly maintained their heartbeat check on KEMSA's performance, leading to several task forces, committees and other reform teams.

Externally, independent bodies such as the Office of the Auditor General (OAG) and several multilateral bodies affiliated with the Development Partners for Health in Kenya (DPH-K), including USAID, and the Global Fund, among others, have all released detailed reports on the state of affairs at KEMSA.

Besides the operational challenges, the State Corporations Advisory Committee (SCAC) and the OAG, on their part, have consistently raised the alarm that KEMSA is overstaffed and inefficiently operating with three times above its approved staff establishment level of 378 employees.

All these reports have almost unanimously confirmed the existence of systemic challenges that had eroded KEMSA's operating capacity, particularly the ability to meet its statutory mandate to procure, warehouse and provide last mile delivery of health commodities.

Against this background, the Ministry of Health established a KEMSA Immediate Action Plan and Medium-Term Reforms Working Committee in mid-2020. It delivered a detailed report outlining the need to activate urgent reforms at KEMSA. The KEMSA Reforms Implementation Committee swiftly followed this committee (KRIC) commissioned to spearhead priority reforms.

These reforms focused on six thematic areas: procurement, warehousing and distribution, transport management, donations management, financial management, information communication and technology, product regulation, tax exemption, and legal and governance.

To ensure efficiency in the rollout of the reforms, the KRIC team further distilled the six thematic areas into five priority reform areas focusing on Financial, Governance and Risk Management, Procurement and Regulatory, Warehousing and Logistics Management (WLM), including Order Processing, Inventory, Distribution and Transport Management, Donations and Tax Exemption Management for Programme commodities, IT and Support Systems (ICT). The KRIC team has successfully implemented more than 85% of the priority reforms in slightly more than a year.

With the pace of the reforms gaining steam and KEMSA beginning to fire on all cylinders with improved order fulfilment, end-to-end visibility, accountability, and transparency, the Authority has also moved to adopt a new organisational structure. The structure is geared at accelerating the pace of the reforms by improving the Authority's governance, integrity and efficiency by addressing some systemic challenges. 

A new organisational structure, whilst introducing inter-departmental alignment and roles definition, will also consolidate the gains made in process mapping and systems re-engineering and re-focuses institutional orientation towards achieving results by design and re-instilling the much-needed service mentality throughout the organisation.

The new organisational structure will be competitively filled, and the first batch of vacancies was recently advertised. It is instructive to note that despite the stakeholder disenchantment, most KEMSA staff are highly qualified, experienced and passionate persons of integrity. While we acknowledge that we have lots of work to do in co-creating the correct values and driving accountability, we are conscious that we have dedicated staff members. Many of these staffers have invested in their credentials and continue to offer committed service. We wish to incentivise such staff members by ensuring they have the first bite of the cherry in getting new jobs in the new structure, provided they participate in the rigorous recruitment process we have rolled out.

The reform agenda at KEMSA must be sustained to guarantee service delivery for Kenyans yearning for adequate health services. This is a commitment that the reforms team at KEMSA continues to hold dear and is dedicated to achieving. Indeed, success is not about never failing, but it is found in how often you get up after a fall, dust yourself up, and keep moving.

Ms Ramadhani is the Chief Executive Officer at KEMSA. Email: ceo@kemsa.co.ke