Dr Cleopa Kilonzo Mailu: Swallowing bitter pills

Dr Cleopa Mailu seemed ideal for the job of Health Cabinet Secretary – he had the right academic credentials and training as a medical doctor. Apart from a history of several high-level jobs, both at home and internationally, he had worked for Nairobi Hospital, which is among the top medical facilities in the country and in the region, lately as its CEO.

He represented the high calibre of leadership and management expertise President Uhuru Kenyatta was looking to tap to not only enhance service delivery, but also to solidify his legacy during his first term, which was due to lapse in about two years, and set the foundation for his second one.

And the appointment seemed just right, coming in the wake of corruption allegations that had swept out of office several Cabinet secretaries and senior civil servants. Dr Mailu was tapped to replace James Macharia, who had been redeployed to Transport in the reshuffle.

Indeed, when Dr Mailu took up the appointment announced in December 2015, he set off on the path of corporate bigwigs who leave huge salaries in the private sector to try their hand at public service. Few of them understand that the foundation of their new big jobs is often set in politics, a murky and unpredictable world that only a few “outsiders” have managed to successfully navigate.

Born in 1956, Mailu credited his success to a difficult childhood in a 2013 interview with The Standard newspaper ”My early life was full of struggle. I lacked most basic things. I remember changing schools three times between Form One and Form Four,” he told The Standard. He lost his father in 1973 but got a lot of support from his mother to further his education.

“I remember I got a zero out of 20 in CRE while in Form Three. I walked home and proudly placed the papers on the table. A neighbour saw the papers and asked my mother whether I was still interested in learning,” said Maiu in the interview.

“My mother answered inthe affirmative, “He can still do well.”

He exuded confidence during his vetting by MPs before his confirmation as he talked about his 12 years at Nairobi Hospital and his Ksh5 million salary a month, and didn’t appear to imagine that his new job might be for a short time, and full of trouble while it lasted, and that he might soon need a soft landing in the more familiar world of diplomacy.

Dr Mailu served as Cabinet Secretary for two years, just like his predecessor and successor Sicily Kariuki, a testament of how hot Kenya’s Health portfolio is. It seems it was the right job, but coming at the wrong time.

He was among the first-term Cabinet members replaced in February 2018 and redeployed to head diplomatic missions as President Kenyatta started his second term. The other Cabinet secretaries dropped from the government at the time were Prof Judi Wakhungu (Environment), Dan Kazungu (Mining), Phyllis Kandie (Labour), Hassan Wario (Sports), and Willy Bett (Agriculture).

Dr Mailu’s tenure at Afya House, the nerve centre of Kenya’s health affairs, was generally controversial. A reputed corporate manager, his arrival at the Ministry of Health could not have come at a worse time. In just two years, he took more flak than his predecessors who had served longer, and probably more than all his working life.

The health docket is key in both government ranking of portfolios as well as in terms of its role in matters of life and death. It gets huge budget allocations and thus is always on the radar of civil society and investigative agencies. Every Health minister or Cabinet Secretary has almost always found trouble or scandal to deal with.

The promulgation of the new Constitution in August 2010 effectively ushered in devolution as the highest form of decentralisation in Kenya. The health sector was the largest service sector to be devolved under this new governance arrangement, giving county governments control over healthcare. The sector is big, and so are its troubles when they emerge.

For almost a year, it was smooth sailing for Dr Mailu until October 2016, when it came out that top Ministry of Health officials had stolen more than Sh5 billion in a scheme involving diversion of funds, double payment for goods and services, and manipulation of the Integrated Financial Management System (IFMIS). According to the report, widely publicised in the media, the scam was executed through payments of millions of shillings to phony suppliers in the financial year 2015/2016.

Dr Mailu found himself in the thick of things. Whether he knew about the deals or they were executed before he came in remains unclear. But the bulk of the blame was placed on the desk of his Principal Secretary, Dr Nicholas Muraguri, the accounting officer.

Nonetheless, the CS appeared for questioning before the Ethics and Anti-Corruption Commission (EACC), a dark moment for any government official keen on preserving his reputation. It was confirmed that Dr Muraguri was the one at the centre of the Afya House scam after he was secretly recorded threatening a journalist in an effort to kill the exposé.

The EACC investigated the alleged misappropriation of funds by ministry officials, but no one was arrested or jailed.

Dr Mailu later denied claims that billions of taxpayers’ shillings had been lost. The case remains unsolved to date.
In March 2017, Dr Muraguri was transferred to the Lands ministry in a mini-reshuffle that seemed to target mostly PSs who were seen to be working at cross-purposes with their CSs. Dr Muraguri was replaced by Julius Korir from the State Department of Industry and Enterprise Development. Dr Mailu and Dr Muraguri did not get along. Their differences spilled out into the open during the doctors’ strike which started in December 2016. Dr Mailu complained that his PS was insubordinate and had ignored his orders to negotiate with the striking doctors on behalf of the ministry.

Dr Mailu’s management skills and patience were put to the test during the 100-day doctors’ strike, one of the longest industrial action by doctors and nurses in Kenya during which patients suffered as union and government officials engaged in a battle of wits.

The Kenya Medical Practitioners and Dentists Union (KMPDU) called off the strike on March 14, 2017 after signing a return-to-work agreement with the Council of Governors and the Ministry of Health. Under the deal, doctors received an additional Emergency Call Allowance plus a new Medical Risk Allowance of Sh20,000 a month, backdated to January 1, 2017.

Dr Mailu defended himself from accusations of playing arrogant with a delicate issue. “We were dealing with union officials who wanted to take advantage of the situation to fleece the government,” he told the Defence and Foreign Relations Committee in February 2018 during his vetting for his new diplomatic appointment as Kenya’s ambassador to Switzerland and Permanent Representative to the United Nations Office in Geneva.

Painful as it was, the strike opened a new chapter in the profession’s relationship with the government and injected new life into a sector that had become synonymous with industrial action. “We just could not meet what the health workers were asking for. But that also got us to come up with legislation that will help this country. In future, we will never witness such strikes,” he told the committee.

It took the intervention of the President and multiple other players, including the Law Society of Kenya, the Kenya National Commission on Human Rights, the Central Organisation of Trade Unions, and the Inter-religious Council to end the strike. This put Dr Mailu on the firing line as it appeared he had lost control of the situation.

“It is regrettable that it took so long and we cannot begin to fathom the extent of the pain that Kenyans suffered. Those 100 days will remain black in the history of medicine in this country and that is not a record we want to keep,” he said.

Dr Cleopa Mailu, with the then acting Commissioner for Refugee Affairs Kenya Mr. Kodeck Makori, ready to deliver Kenya’s statement at 70th Session of the Excom in Geneva.

Despite all controversy and bad publicity that came with the strike and the infamous Sh5 billion Afya House scandal, President Uhuru Kenyatta in December 2016 honoured Dr Mailu with an Elder of the Order of the Golden Heart (E.G.H.), the highest presidential honour in Kenya. It came in the thick of the doctors’ strike and sparked an uproar among Kenyans who saw it as a reward for failure.

A pronouncement of the Ministry of Health, in a statement issued in December 2017, rattled merrymakers in Nairobi and the coastal city of Mombasa. Dr Mailu banned the importation, manufacture, advertising, and sale of shisha in Kenya. Shisha includes tobacco products that may be flavoured and which are consumed using a single or multi-stemmed smoking apparatus that contains water or other liquid through which the smoke passes before reaching the smoker and whose syrup tobacco content includes molasses, honey vegetable, glycerol and fruit flavours, including apple, grape, lemon, and mint.

The argument was that shisha had encouraged peddling of hard drugs. Unscrupulous entertainment joint owners would infuse outlawed drugs into the mix and pass if off as shisha to beat law enforcers. Kenya became the fourth country in East Africa to prohibit shisha, after Uganda, Tanzania, and Rwanda. Yet shisha is still widely sold in the country, especially at nightclubs, and is popular among socialites and sportspersons. The pronouncement was not backed by an effective enforcement mechanism.

It was during Dr Mailu’s tenure that the quest for Universal Health Coverage (UHC) gained momentum. The government integrated UHC as a goal in the national health strategies, the Health Policy goal, and the Kenya Health Sector Strategic Plan theme.

The Universal Health Coverage programme was started after President Kenyatta took office in 2013 with the launch of the highly acclaimed free maternity programme dubbed “Linda Mama”, which currently benefits over one million women annually.

To ensure the successful implementation of UHC, the government has been pumping investments into health infrastructure and development of a digital health platform to support the effective monitoring of the sector.

A key achievement on this front during Dr Mailu’s tenure at Afya House was the launch of the e-portal, Port Health Services, in April 2017, after the Ministry of Health established an electronic portal to improve processing of import and export health certificates. The paperless information system dubbed Port Health Services e-Portal has enhanced service delivery and improved processing of port documents to just 12 hours from six days. The system – which is integrated with other government agencies, including the Kenya Trade Network Agency (KENTRADE) – serves as a platform for all ports of entry to share information.

Dr Mailu oversaw an intensified campaign to accelerate access to adequate sanitation and hygiene facilities in all counties to end open defecation in Kenya (ODF) by 2020. By 2017, and over a period of three years, Kenya had increased the number of ODF-free villages from 1,231 in 2014 to 5,434 in 2016.

The target was to make 69,299 villages in the country open defecation-free by the year 2020. “In the spirit of ‘leave no one behind’, we call upon all county governments and implementing partners to end open defecation in their counties by the end of year 2017,” he said. That target has yet to be attained, two years past the deadline.d
On November 1, 2016, a medical team from the College of Health Sciences of the University of Nairobi (UoN) and Kenyatta National Hospital (KNH) successfully separated conjoined twins.

The girls – Blessing and Favour – were born joined at the sacral region of the lower spinal cord. They were separated by a team of 60 doctors with various specialties after a 23-hour surgery. The entire process cost more than Sh160 million. Despite the huge financial implications, it was a heart-warming story in a ministry steeped in controversy.
It also marked a medical milestone in Kenya, being the first such successful surgery in the county. Other than South Africa, very few successful separations have been performed in sub-Saharan Africa. Dr Mailu assigned a team of health workers to monitor the twins after their discharge from hospital to aid their recovery and assist the family in rehabilitating them. They remain a beacon of hope in the country’s healthcare system. If only the ministry itself can undergo such a milestone surgery to separate it from its twin troubles of controversy and corruption!

Given his short stint, Dr Mailu did not do much in terms of transforming the sector nor leave behind legacy projects. Looking back, he arguably sees more bitter pills than doses of success. He handed over the docket to Sicily Kariuki, who served between 2018 and 2020 before passing the baton to Mutahi Kagwe.

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