First published Saturday Standard, September 22, 2018. Kindly reproduced here with permission from the Standard Group
The pendulum of public approval can be treacherous for populist leaders. Nairobi Governor Sonko recently found this out in the calamity of Pumwani. What started as an action to expose Pumwani staff negligence has left the entire management of our county health system exposed to public scrutiny. The question is, what can the Governor do next?
Pregnancy, child-birth and after-care comes at great risk for most babies and their mothers. Twenty mothers still die giving life each day across our country. 75% of all infants who don’t make it die in their first seven days. Maternal health-care is the critical priority for all our 47 county governments.
At 9.27pm on Sunday September 16, Governor Sonko received a whistle-blowing call claiming the Pumwani’s life-support machines had been switched off. Eleven babies had died as a result. It needs to be acknowledged that he moved quickly to act personally and publicly. Within hours of the visit, the Hospital Board and key staff had been interdicted and suspended. When the Cabinet Secretary, Health Minister, Chief Officer and the County Attorney contradicted his analysis, they too were immediately suspended. Now that the dust has cleared, it is clear that the Governor misfired based on partial information and Pumwani Maternity Hospital has bigger problems.
Based on various accounts, it is now clear that babies were not killed by staff negligence and the deaths have now all been accounted for. The hospital is, however, poorly managed, under-funded and resources are poorly allocated. While recognizing that reforms have been underway for almost a decade, too many of the staff at Pumwani are not directly involved in patient care. Out of a workforce of 800, there are only 12 doctors and 116 nurses. There are only five obstetric gynecologists. Absenteeism, demoralization, poor supervision and staff tensions are rife.
While health is allocated 21.5% of the County budget, huge budget cuts have directly affected Pumwani. The autoclaving machines broke down twice that week. The lack of a working incinerator, body-bags and a morgue is only part of the problem. New-borns often share the same beds and the neo-natal unit is run down. Medical recordkeeping is weak, a factor that might have led to the Governor’s heightened suspicion during his televised raid.
There is nothing more dangerous for the reputation of an elected leader then to get it so wrong in full view of the public. For other professions, it is the equivalent of a brain surgeon operating on the wrong person or a Fire-Marshall operating a fire engine with no water. In moments like these, honesty and corrective action is the only way out. In his characteristic way, Sonko turned to personal philantrophy to address the real public health challenge that lies squarely at his door. His personal donation and delivery of cooler boxes may be an admission that he now understands how the eleven babies ended up in plastic bags.
Political populism has its strengths. Its listening for the needs of vulnerable communities is important in a world where too many of the powerful listen too little. It also has a disruptive capacity to shake up bureaucracies that are too self-interested to consistently act in the public interest.
By his own admission, Tanzania’s President John Magufuli is Sonko’s role-model. The charismatic leader broke onto the international stage in 2015. His management style has been decisive with corrupt or inefficient officials and wasteful expenditure. He has also locked pregnant girls out of school, banned and used excessive force on opposition rallies, arrested journalists and clamped down on social and mass media to drown out uncomfortable public discussions.
Political populism has its weaknesses therefore. If leadership is guided only by the personal priorities and styles of the leader, he or she will inevitably overreach and make mistakes that affect many people’s lives. Over-reactiveness without fact verification never gets to the source of the bad governance. Failing systems can only be rescued by institutional approaches not personal populism and blame raids.
Now that the complexity of the problem that Sonko tried to respond to last Sunday is clear, there are some new choices he could make. Reinstating the County health and legal leadership would be an important one. Involving them, the Nairobi chapters of the Doctors and Nurses Unions and other oversight bodies on creative new ways of addressing old problems would be another. A reliable and open feedback and complaints management system that can verify rights denials would also go a long way to catalyzing the whole County Government to act.
Postscript: As this story was published, a new statement by the Governor indicates he plans to privatize the public hospital and rename the hospital after himself barely one week after the drama. The agreement will be signed on September 25 and groundbreaking will take place on November 20. The new development suggests that a deeper interest lay behind the drama last week. Public health interest advocates must slow this down and expose the conditions and agreements being signed for public scrutiny and participation. Private investors Agha Khan University Hospital & Nairobi West Hospital must tread carefully lest they too find themselves embroiled in public asset stripping without the tendering required by law.