The health sector ranks as the second most corrupt in Kenya, according to the National Ethics and Corruption Survey, 2021. This is particularly alarming, as health sector decisions have life or death implications. The prevalence of corruption in the sector drains scarce financial resources, undermining operations and procurement of essential supplies. Ultimately, it weakens Kenyans’ trust in health care services, poses significant risks to health outcomes, and exacerbates existing health disparities. To tame corruption, there is need for greater involvement by civil society and citizens through interventions such as expenditure tracking and social audits. This external pressure complements internal reforms such as strengthened audit functions, by providing an independent oversight mechanism.
In 2023, the Ethics and Anti-Corruption Commission (EACC) launched a damning report on the health sector, demonstrating that there is corruption in all four phases of health sector project management: budgeting, commitment, verification and payment. Each phase is marred by inflation of costs, early termination of projects and misappropriation of funds, with costs inflations occurring in 83.7 percent of projects in the budgeting phase.
Corruption has consequences. Research shows that child mortality is more highly correlated with national corruption levels than even vaccination rates. Additionally, countries with high levels of corruption tend to have higher rates of infant, child and maternal mortality. Persistent corruption therefore poses a significant threat to health outcomes in Kenya.
How can corruption be controlled, however? Reform starts with greater transparency. There is an urgent need for frequent monitoring and evaluation of health sector budgets and projects. Public Expenditure Tracking Surveys (PETS) have proven to be instrumental in identifying budget leakages and acting as a catalyst for financial management reforms. In Uganda for example, dissemination of PETS findings led to a decline in leakages of school disbursements from 80 percent to 20 percent. However, experiences from Uganda and other countries indicate that the success of PETS relies on a strong commitment from government to act on the findings.
Furthermore, it is essential that CSOs do more than just execute the technical aspects of PETS: media exposure is essential. CSO’s frequently fail to invest in dissemination and advocacy around the results of PETs exercises, undermining their impact. To be more effective, CSOs can work closely with the media to ensure that the PETS findings receive extensive coverage. Media exposure will generate public awareness about misuse of funds. CSOs can also actively engage citizens by organizing town hall meetings and workshops as platforms to discuss the findings from the surveys.
Transparency is often not enough, however, and must also be coupled with active citizen engagement in direct oversight through mechanisms like social audits. To achieve this, improving public participation within the health sector before and during project implementation is critical. Informing the public about the projects being undertaken in their areas, including timelines and intended impacts, allows communities to have a comprehensive understanding of the initiatives. This information enables citizens to actively engage and hold decision-makers accountable for the management of public resources.
Peru illustrates the potential of social audits to drive change. Proetica, a leading CSO, coordinates citizen audits under the Anti-Corruption Brigades Initiatives. The findings are compiled into publicly accessible reports that are widely covered by the media and shared with authorities, including the supreme audit institution. This puts pressure on the government to act, and the results are clear: citizen oversight has led to a cost reduction of approximately 50 percent in monitored public projects compared to non-monitored ones.
What works in Peru can work anywhere, including here at home where organizations such as Muslims for Human Rights (MUHURI) have successfully conducted social audits. In Kisauni, for instance, a social audit revealed the closure of a vital dispensary for HIV patients which the local Community Development Fund (CDF) committee initially attributed to renovations. However, further investigation revealed that there were no budgetary allocations for the dispensary and the land had been unlawfully sold. The findings were presented to the authorities, resulting in the cancellation of the illegal land transaction.
Subsequently, funding was allocated, and the dispensary was reopened.
External scrutiny by citizens and civil society acts as a catalyst for internal reforms as the pressure compels government officials to proactively work towards improving performance. With greater transparency and accountability, Kenya’s health sector can make strides towards more effective and equitable delivery of health care services to all.
Author – Gladys Wachira, Research Assistant, Institute of Public Finance