Surveys conducted by the Ethics and Anti-Corruption Commission (EACC) depicts Ministry of Health (MoH) as one of the institutions with high ranking in matters of corruption and unethical conduct. In addition, the extent of corruption and unethical conduct in procurement and financial management in relation to health care projects are not well documented.

It is against this background that the Commission pursued this study so as to undertake an in-depth inquiry into the extent of corruption and unethical conduct in the health care projects especially in procurement and financial management. The study relied on cross sectional research design as its framework for data collection and analysis.

It was conducted in national and county health facilities drawn from 25 sampled counties across the country. Data was collected through face-to-face indepth interviews with the target respondents. The data collected was cleaned, coded and analyzed using International Business Machines (IMB) Statistical Product and Services Solution (SPSS) software

The following are key highlights of the study findings:

a) Magnitude of Corruption and Unethical Conduct

Eighty-six percent (86.3%) of health staff and 80.6 percent of members of the public acknowledged the prevalence of corruption and unethical conduct in the health sector. In addition, 88.0 percent and 93.7 percent of health staff and members of the public respectively admitted that corruption and unethical conduct were widespread in the health sector;
Sixty percent (59.7%) of health staff and 70.0 percent of members of the public indicated there was high prevalence of corruption and unethical conduct in health care provision at the county level; and
Sixty-five (64.7%) and 43.5 percent of the members of the public and contractors respectively admitted that corruption and unethical were widespread in health care projects.

b) Processes Prone to Corruption and Unethical Conduct

Half of the health staff (50.9%) and 43.5 percent of contractors mentioned tendering as the phase of procurement where corruption and unethical conduct were most likely to occur;
Forty-four percent (43.5%) of the health staff identified tender award as the stage most plagued by corruption and unethical conduct. On the contrary, most contractors (34.1%) identified tender evaluation as the stage with the highest prevalence of corruption and unethical conduct;
Thirty-two percent (32.4%) and 33.1 percent of the health staff identified budgeting and project costing as the financial management phase and procedure respectively where corruption and unethical conduct is most likely to occur.

c) Extent of Adherence to Public Procurement and Financial Management Laws

i) Selection Criterion and Public Participation in Health Care Projects

Need-based (25.8) was the most critical factor that guided selection of health care projects to be implemented in the health sector. However, political influence (6.5%) was also mentioned as a factor that determine project selection; and
Sixty six percent (66.2%) of the health staff indicated there was active involvement of members of the public as key stakeholders in planning and execution of health care projects while 78.7 percent of members of the public refuted their active involvement by their respective counties and/ or national health facilities

ii) Development of Specifications and Pricing of Health Care Projects

Forty-five percent (44.6%) of the health staff indicated that specifications and pricing of health care projects were anchored on engineer’s estimates. However, nine percent (8.5%) of contractors revealed that there were instances where prevailing market prices and additional money for facilitation were used as a guideline in determining the value of the contract ; and
Seven percent (6.6%) of health staff indicated that contractors who bid for health care projects were involved in development of specifications and pricing estimates. Similarly, seven percent (6.5%) of contractors indicated that they were involved in the development of specifications.
iii) Budgeting and Project Implementation Period
Majority of health staff (89.2%) indicated that health care projects had been budgeted for. However, 10.8 percent of health staff noted that some projects were not sufficiently funded;
Meru, Tharaka-Nithi and Embu counties had more health care projects that had been completed at costs above planned budget; and
Awareness of health care projects completed beyond the contract period were high in Tharaka-Nithi, Embu and Homa-Bay counties and low in Makueni, Kitui and Turkana. Factors that contributed to late completion of projects were delayed disbursements of funds (53.4%), Covid-19 pandemic (14.2%), change of contract terms (10.3%), change of leadership (8.3%) and corruption (6.9%).

v) Accessibility and Publication of Procurement Opportunities for Projects

Sixty-nine percent (69.2%) of health staff indicated that procurement opportunities were accessible to prospective bidders compared to 30.9 percent who indicated that they were not; and
Makueni, Kakamega and Nakuru counties had the highest levels of accessibility to procurement opportunities as indicated by respondents while Wajir, Garissa and Kajiado had the lowest levels.
v) Procurement Methods Applied in Health Care Projects
Open tendering (78.9%), followed by request for quotations (12.2%) and restricted tendering (4.6%) were procurement methods frequently applied in health care projects as identified by health staff; and
The three main reasons presented by health staff for the choice of the respective procurement method were fairness and transparency (34.7%), competitiveness (22.5%) and procurement law (19.8%).

“The study relied on cross sectional research design as its framework for data collection and analysis. It was conducted in national and county health facilities drawn from 25 sampled counties across the country”

vi) Termination of Health Care Projects before Completion

Sixteen percent (16.4%) of health staff were aware of health care projects that had been terminated before completion. In addition, eight percent (8.1%) of contractors indicated that projects that were undertaken by their firms were terminated before completion; and
Key reasons for projects termination were lack of capacity by contractors (16.5%), contractors abandoning the project (16.5%) and insufficient funds (16.0%). On the other hand, contractors pointed out falsification of regulatory certificates, lack of financial capacity and budgetary constraints in the MoH as reasons for project termination.
vii) Delay, Overpayment and Payment of Incomplete Projects
Majority of health staff (64.6%) acknowledged that there were instances of delayed payments to contractors. Equally, 80.7 percent of contractors indicated that payments were delayed. In addition, 95.3 percent of the health staff observed that there was one or more instances where payments were delayed; and
Five percent (4.7%) and 4.8 percent of health staff stated they were aware of overpayment and instances of payments for incomplete projects respectively. d) Effectiveness of Information Management System
Sixty-two percent (61.6%) of the health staff observed that Information Management Systems (IMSs) were used in procurement and financial management while 38.4 percent stated that they were not in use; and
Sixty-eight percent (68.3%) of the health staff stated that IMSs were effective while 12.9 percent stated they were not. The main reason given for the ineffectiveness of the systems was ease of manipulation of information (58.9%).
e) Anti-Corruption Measures in Procurement and Financial Management
Thirty-four percent (33.6%) of health staff acknowledged existence of anticorruption measures to ensure the integrity of contractors, 49.9 percent were not aware while 16.5 percent indicated there were none;
Forty-two percent (42.2%) of health staff stated that anti-corruption measures to monitor implementation of health care The study relied on cross sectional research design as its framework for data collection and analysis. It was conducted in national and county health facilities drawn from 25 sampled counties across the country. 16 projects were in place, 14.3% indicated there were none while 43.5% pointed out that they were not aware of their existence; and
Forty-one percent (41.2%) of health staff indicated that anti-corruption measures were effective while 4.5 percent disagreed. Forty-three percent (42.9%) of them were indifferent

f) Challenges in the Implementation of Health Care Projects

Financial constraints (27.8%), delay in approval of finances (14.7%), corruption (8.8%), understaffing (8.7%) and political interference (6.0%) were some of the key challenges highlighted by the respondents in the implementation of health care projects

Recommendations

Based on the study’s findings, a number of strategies and measures for addressing corruption and unethical conduct in procurement and financial management of health care projects mainly include:

i) The Public Procurement Regulatory Board debar contractors who mismanage projects and engage in corruption and unethical conduct during project implementation. In addition, debarment from practice and where applicable practicing licenses withdrawn of government officers who collude with contractors in committing procurement and financial malpractices;

ii) Procuring entities for health care projects ensure transparency and accountability in their planning processes, prioritization and execution of projects that address community needs;

iii) Procuring entities ensure there is robust public participation before and during project implementation to enhance transparency, accountability and efficient implementation of health care projects;

iv) The National Treasury to ensure timely disbursement of funds to counties and national health institutions for efficient implementation of projects.

v) Counties and national institutions ensure prompt payments to contractors for health care projects delivered in strict adherence to the terms and conditions of the contract;

vi) Counties and national procuring entities establish and implement anti-corruption measures such as anti-corruption committees, internal control mechanism, automation of revenue collection and procurement processes, anti-corruption codes of conduct and ethics, Conflict of interest, gift and donations policies and registers, declaration of income, assets and liabilities and procedures for prevention of bribery;

vii) Build capacity of officers in National and County health units responsible for the management of finance and procurement functions to ensure compliance with Laws, Regulations, Policies and Codes of Conduct;

viii) Enact a law to compel national and county institutions to fully implement and use Information Management Systems in all procurement and financial management process and procedures;

x) Both levels of government increase funding to the health sector to guarantee service delivery and value for money; and

x) In order to ensure contract obligations are satisfactorily met, counties and national procuring entities establish contract implementation teams (CIT) for works projects as provided in section 151 of the PPADA 2015.