Every election season, politicians proudly tell voters that they have brought “development” to their constituencies while their opponents have done little or nothing. Sometimes those claims are true. Sometimes they are not.
But there is a far more important question that citizens rarely ask:
At what cost?
Development should never be judged merely by the number of projects launched, buildings commissioned, or equipment delivered. It should be judged by whether it provides value for money, meets genuine public needs, and remains sustainable over time.
A project that appears impressive on paper can become an expensive burden if it is poorly conceived or deliberately distorted for private gain.
The Managed Equipment Services (MES) programme is perhaps one of Kenya’s clearest lessons.
The Original Vision
During the drafting and implementation of the Constitution, the thinking behind health devolution was remarkably logical.
First, because health workers are a national resource whose skills are needed across the country, there was a proposal to establish a Health Service Commission (HSC) to rationalize deployment and management of human resources for health. The Kenya Medical Association even participated in drafting the proposed HSC Bill. Unfortunately, the commission was never established.
Second, government recognized that Kenya has more than 8,000 health facilities, each with different equipment needs.
The proposed solution was simple and economically sound.
Each health facility would identify the equipment it genuinely required through a structured needs assessment. The Ministry of Health would then aggregate these requests nationally and procure the equipment centrally, benefiting from economies of scale.
For example, if fifty hospitals required ultrasound machines, the Ministry would negotiate and purchase all fifty together, obtaining substantial discounts before distributing them to the facilities that had requested them.
This approach would have achieved two important objectives:
• Health facilities would receive equipment they actually needed.
• Government would save billions through bulk procurement and efficient resource allocation.
It was a practical application of sound public finance principles.
What Actually Happened?
Somewhere along the way, that vision changed.
Instead of purchasing equipment identified through needs assessments, the country adopted the Managed Equipment Services (MES) leasing model.
The national government negotiated long-term leasing contracts and counties were subsequently required to participate, despite health services having been devolved. Governors who questioned the arrangement faced significant pressure. Isaac Ruto, then Chairperson of the Council of Governors, publicly resisted signing the agreements because of concerns over the structure of the programme.
The principle had shifted completely.
Instead of counties determining what equipment they needed, equipment was supplied through centrally negotiated lease arrangements that often bore little relationship to local health priorities.
The consequences became increasingly evident.
• Expensive equipment was delivered to facilities that neither required nor could effectively utilize it.
• Counties accumulated enormous lease obligations for equipment they had not prioritised.
• Payment delays attracted additional contractual penalties.
• After the lease period, counties inherited equipment whose maintenance and servicing costs were difficult or impossible to sustain.
• Some equipment remained underutilised or became non-functional while continuing to impose financial costs on the public.
What began as a potentially good idea had evolved into a programme whose implementation raised serious concerns about efficiency, governance and value for money.
In 2019, the Presidential Commission of Inquiry into the Managed Equipment Service Project, chaired by Mutula Kilonzo Jr., raised significant concerns regarding the programme’s procurement, implementation and governance.
The Real Lesson
The tragedy is not that improving access to medical equipment was a bad idea.
It was an excellent idea.
The tragedy is that a sound policy concept was transformed into an expensive procurement model whose costs far exceeded its benefits in many settings.
This is how public resources are often lost.
A noble idea is rarely presented to the public as corruption.
Instead, it is gradually modified until it becomes an opportunity for those controlling procurement and administration to benefit, while taxpayers bear the financial burden.
The original objective remains attractive.
The implementation quietly changes.
The beneficiaries change.
The public pays.
We Must Learn to Ask Better Questions
Whenever government announces a major programme, citizens should ask more than whether it has been launched.
They should ask:
• Was there a genuine needs assessment?
• Was the chosen model the most economical?
• Were alternative options considered?
• Who benefits financially?
• What are the short-, medium-, and long-term costs?
• Will taxpayers still be paying long after the political speeches have ended?
These questions are not anti-development.
They are pro-accountability.
A Familiar Pattern
Today we are witnessing another ambitious national programme under a different administration.
The actors appear familiar.
The language has changed.
The branding has changed.
The packaging is different.
But the critical question remains exactly the same:
At what cost?
Over the coming days, I will examine several major government programmes through this lens—not to oppose development, but to encourage evidence-based public debate.
Kenyans deserve development.
But even more importantly, they deserve development that delivers value for every shilling they contribute as taxpayers.
The true measure of leadership is not how many projects are announced, but how wisely public resources are managed for the benefit of present and future generations.
Dr Simon Kigondu is a Gynaecologist a commentator on Kenyan Health Policy