On 14 January 2020, His Excellency President Uhuru Kenyatta reshuffled his Cabinet and nominated Mutahi Kagwe to take charge of the Ministry of Health. This was barely one month after the first cases of Covid-19 were reported in China. As the rapid spread of the disease began to cause alarm across the world, Kenyans’ attention was fixed on Kagwe to see which direction he would take against the disease’s onslaught.
The new Cabinet Secretary (CS) was sworn in on 28 February 2020 and he subsequently assumed office as the Jubilee government’s fourth Health CS. He took over from Sicily Kariuki, who had been transferred to the Ministry of Labour. On the same day that Kagwe was sworn in, the President issued Executive Order No. 2 of 2020 that occasioned the establishment of a National Emergency Response Committee (NERC). The Executive Order addressed, to some extent, the rising anxiety about Kenya’s preparedness to combat the coronavirus that was fast crossing borders and claiming lives. Aside from facilitating the establishment of NERC, the Executive Order subsumed the Cabinet’s Ad-Hoc Committee on Health and the Inter-Ministerial Technical Committee on Government Response to the Coronavirus Virus Outbreak into NERC. Kagwe was named chairperson of the newly created committee.
Among other key roles, Uhuru tasked the commission with: (1) coordinating capacity building of medical personnel and professionals for quick and effective response to suspected cases; (2) coordinating national and county government health facilities for isolation and treatment; and (3) ensuring surveillance at all ports/points of entry in Kenya.
The work began immediately for the NERC chairperson. His first statement, aimed at preparing the country psychologically for the impending pandemic, was made on 5 March 2020 during a meeting with the Council of Governors. In an attempt to rally the county heads to ensure adequate and proper preparation, he told them that the onset of the coronavirus in Kenya was “a matter of when, not if”. Kagwe set the whole country on alert mode with his statement. Indeed, the level of awareness and anxiety would be revealed about a week later, when a video of a plane allegedly landing from China on March 11 appeared on social media platforms.
The video elicited strong reactions from members of the public, prompting Parliament’s Departmental Committee on Health to summon key members of NERC, including Kagwe, CS for Transport, James Macharia, and Principal Secretary (PS) for Interior and National Government Coordination, Karanja Kibicho. Kagwe assured the House and Kenyans at large that the government was sufficiently prepared to handle any coronavirus cases. He exuded confidence when he announced NERC’s strategies for building the capacity of health workers and facilities to respond to the virus. He also explained that even before creating NERC, the President had directed that an isolation and treatment facility be put up at Mbagathi Hospital in Nairobi and that all Level 5 and referral hospitals should follow suit.
Kagwe was no stranger to the demands of public service, having previously served in President Mwai Kibaki’s Cabinet as Minister for Information, Communication and Technology (ICT). He returned to the Cabinet during Uhuru’s tenure under the 2010 Constitution, a new dispensation in which the bulk of Cabinet secretaries was drawn from non-political individuals. Kagwe made a comeback after losing his Senate seat in Nyeri County in the 2017 General Election, bringing with him the experience he had acquired during his stint in Kibaki’s Cabinet.
Kagwe was also a Member of Parliament (MP) for Mukurwe-ini Constituency (2002–2007), during which time he chaired the powerful Parliamentary Committee on Finance, Trade, Tourism and Planning. This no doubt boosted his qualification for a seat in Uhuru’s Cabinet when the time came.
While heading the ICT docket under Kibaki, Kagwe spearheaded the construction of the Transitional East African Marine System (TEAM), the first fibre optic project in East Africa, which heralded the dramatic digital revolution experienced in the country. It was also during his tenure as the ICT minister that Kenya’s flagship mobile money transfer platform, M-Pesa, was launched. The transformative platform quickly set the pace for economic growth and development.
Having been awarded the prestigious Elder of the Golden Heart honour for his exemplary service, Kagwe’s appointment to the Health docket in 2020 seemed a masterstroke of sorts.
On 12 March 2020, Kenya confirmed its first case of the coronavirus. The newly-appointed Health CS announced that the case was a Kenyan citizen who had just returned from USA through the United Kingdom on 5 March. The CS informed the public that the case was being managed at the Infectious Disease Unit at Kenyatta National Hospital. Meanwhile, the National Influenza Centre Laboratory, an important facility at the National Public Health Laboratory, was activated and resourced to lead the fight against the virus. In his calm but exacting manner, which would prove vital as the government began to provide daily updates about the spread of the disease, Kagwe assured the country that the government had put measures in place to curb any spread in Kenya. As most countries began to close their borders, Kenyans became increasingly worried about their relatives still stuck in foreign countries, including China where the disease originated. Kagwe again expressed confidence in the government’s preparedness to ensure that Kenyans all over the world remained safe.
The World Health Organization’s requirement that all countries provide daily updates on new cases of Covid-19 made Kagwe a regular fixture on national television. He spoke passionately each time, explaining the government’s efforts to fight the disease and rallying Kenyans to strictly follow the guidelines issued by the Ministry of Health. He was soon christened “the Covid CS” and people began to joke that whenever he appeared on national television, even children would frown as they waited with bated breath for new details on the fast-spreading virus.
Within no time, international observers had taken note of Kagwe’s hands-on management of the crisis. In one of its articles, The Wall Street Journal singled him out as a voice that provided hope and helped the world adjust in response to the pandemic. The article described him as an unlikely coronavirus hero. “Kenya’s unlikely coronavirus hero is Health Minister Mutahi Kagwe, a businessman with an MBA who had been washed out of elective office. In politics, Mr Kagwe was seen as a technocrat; too ordinary and emotionally distant. In his coronavirus briefings, these traits became assets,” read the article, further stating that his calm demeanour and emphasis on facts earned him an 8/10 rating on crisis leadership.
The Covid-19 pandemic tested global health systems to the limit. In Kenya, citizens looked to the government’s policies on health as grounds to test the resilience of the national health system. Under the banner of ‘Continuing the Transformation’, the 2017 Jubilee Party manifesto shared the dream to build a healthy nation and a productive workforce. The manifesto recognised the close link between health and economics, promising to reduce healthcare costs that were quickly driving many Kenyan families into financial crises.
The government had also promised to extend free, high-quality primary healthcare to all Kenyans by continuing the drive towards universal healthcare coverage. The President’s target was to get more than 13 million Kenyans on health insurance through the National Hospital Insurance Fund (NHIF) by 2022. There were also plans to increase access to health facilities at community level, scale up the Managed Equipment Programme and establish a cold chain system for the delivery of drugs and vaccines. Other government efforts included reducing maternal and child mortality rates through free maternal delivery services in public health facilities. The Ministry of Health also made strategic interventions to implement the rolling out of the Universal Health Coverage pillar of the Big Four Agenda (the others being Food Security, Affordable Housing and Manufacturing) and waged war against malaria through awareness campaigns and distribution of insecticide-treated mosquito nets. The government managed to significantly reduce the incidence of malaria from 31 per cent to 18 per cent.
The devolution of health services was another landmark legislation in Kenya’s healthcare system. The 2010 Constitution envisaged this as a step towards building capacity across the country as county governments were given the responsibility to manage health facilities, promote primary healthcare, and coordinate disease surveillance and response at county level. The national government retained the role of policy making, financing, monitoring and evaluation, education, and management of national referral hospitals and agencies such as the Kenya Medical Research Institute (KEMRI) and the Kenya Medical Supplies Authority (KEMSA). Despite teething problems with the devolution of health services, many counties have since made significant progress towards establishing standard health facilities, developing comprehensive healthcare standards and creating strong healthcare workforces.
It is against this background that Kagwe readied the resources at his disposal to combat the coronavirus, which was already ravaging some of the world’s most advanced healthcare systems. China, the United Kingdom and USA had rapidly become red spots on the Covid-19 statistics map. These were no ordinary times and extraordinary measures beckoned. Under Kagwe, the Ministry of Health consistently issued directives and guidelines to help curb the spread of the virus, including the strict observance of hand and respiratory hygiene, social distancing and isolation where necessary. The government also moved quickly to close schools, businesses and markets, and reintroduced new measures for public events and the use of public transport vehicles. When some individuals, institutions and businesses were slow to take up the crisis measures, Kagwe’s voice rang out, warning that if the country chose to treat the disease normally, it would in turn treat Kenyans abnormally.
Riding on his background and experience as a media practitioner, the CS worked with his ICT counterpart to create a comprehensive media strategy. The Media Council of Kenya joined in to launch a one-stop-shop portal for media professionals to ensure the availability and dissemination of accurate and timely information on Covid-19. The government invested heavily in awareness campaigns and by June 2020, about KES 3.77 billion had been spent on advertising and other awareness creation strategies as Kagwe rallied his team to adopt a ubiquitous presence across almost all media platforms to make sure accurate information on the virus was being disseminated at all times. This strategy would eventually encompass a meticulous tracking and certification system once vaccines started being administered in the country.
Inevitably, the strict Covid-19 prevention measures led many countries into socio-economic crisis. With markets, businesses and offices closed, millions of people lost their economic footholds and faced the very real threat of starvation and death. The Government of Kenya under President Kenyatta proved resolute and decisive in the crisis by maintaining close coordination with key stakeholders — both local and international — thereby attracting donations in cash and kind to aid the fight against Covid-19. Kenya became one of the icons of hope in Africa with regard to leading the war against the virus. During a virtual conference dubbed KUSI Ideas Festival in December 2020, sponsored by the Nation Media Group, the President called on his African peers to embrace collaboration and partnership in the war against the pandemic.
Back home, he had taken several measures to cushion the population against the economic and social impacts of the disease. Just four months after Kenya recorded its first case of Covid-19, the President rolled out his 8-point Economic Stimulus Programme worth KES 53.7 billion. Among other things, the stimulus targeted infrastructure — KES 5 billion was set aside for the rehabilitation of access roads, footbridges and other public infrastructure. This was partly to ensure that accessibility was not a hindrance to the government’s emergency response to Covid-19 in terms of medical supplies or relief food.
The Ministry of Health also benefited from the stimulus programme as the President secured the services of an additional 5,000 healthcare workers to enhance the Covid-19 response capacity. Some KES 1.7 billion were also set aside to expand the bed capacity in public hospitals. Medical research and development institutions such as KEMRI also received critical financial support to speed up the search for local solutions in the war against Covid-19.
Thanks to the government’s coordination with KEMRI, Kenya was among the first African nations to secure deals that would see vaccines arrive in the country. These and similar efforts went a long way in ensuring that Kenya was able to slowly wind its way out of the extreme danger stage of the disease and allow for a phased reopening of the economy.
Kagwe’s most visible legacy at the helm of the Health docket shone through during one of Kenya’s darkest times. Once the country began to come out of the Covid-19 woods, his attention switched to the recovery of the devastated healthcare system and preparatory measures to mitigate any future unprecedented crises.
Since assuming office in 2013, Uhuru’s agenda for healthcare had pointed towards providing countrywide access to affordable healthcare. Under the Universal Health Coverage agenda, launched on a national scale in February 2022, he elaborated his vision for investing in public health facilities, thereby increasing the number from 4,429 to 6,342 in 2022. In Nairobi County alone, the President commissioned five new hospitals in the slum areas of Gichagi, Gatina, Tasia, Mukuru Kwa Rueben and Mukuru Kwa Njenga in July 2021.
The Ministry of Health also worked with KEMRI and KEMSA to develop the Kenya Essential Medicines List, Kenya Medical Laboratory List and Essential Medical Supplies List to ensure the availability of essential medicines and supplies in the country.
Outside of the country’s capital, Kagwe had proved himself to be the perfect arbitrator at the height of a healthcare crisis in Kisumu County following months of industrial action by medical workers, travelling to the lakeside city to help resolve the matter through an amicable and pragmatic solution.