State of Sh38b health machines and why governors aren’t smiling

The pomp at the launch of the Sh38 billion project to equip county hospitals with modern equipment is preserved in framed photos in the offices of many governors.

But nearly a year after the smiles and the promise of better health services in the counties, the same governors have released shocking details of how the expensive machines are lying idle in hospitals.

The big issue for the counties is that the project was rammed down the governors’ throats, without considering the special circumstances of different county governments.

The result is that when problems in the rollout arise, the governors have to jump through bureaucratic hoops just to get to the suppliers and the problems fixed. The public just wants services, and the explanation that the government dumped the project on counties doesn’t really fly with most governors.

Power outages

A report by the Council of Governors (CoG) paints an unflattering picture of poor planning and implementation in a matter of life and death such as equipping hospitals at the grassroots.

Some governors say they don’t have trained staff to operate the machines; others moan that the hospitals have an erratic power supply that can’t run the Intensive Care Unit (ICU) machines, and still others gave tenders to cowboy contractors who messed up the whole design, that in the end, rendered whatever structure built unusable. In the latest report of the CoG seen by Sunday Standard, failure of the project and some successes are laid bare. In one hospital in Governor Amason Kingi’s Kilifi County, the renal unit equipment could still be in the boxes, the report says, as it was “supplied but not yet installed”.

In Moses Lenolkulal’s Samburu County Referral Hospital, the radiology machines are installed, but there are no radiographers. The renal unit too, but it has no staff. They are just there. Idle. The county government is worried that it may not have staff to operate the equipment once installation is done in Maralal. The electricity problem is in county hospitals in Nairobi, Vihiga, Lamu, Embu, Elgeyo Marakwet and Wajir, where the line to the hospital is supported by a single-phase transformer, yet it requires a three-phase transformer to run most of the hospital machines.

Governors Evans Kidero, Moses Akaranga, Issa Timamy, Martin Wambora, Alex Tolgos and Ahmed Abdullahi have to pull all stops to ensure the upgrade is done to the transformers. At the Jaramogi Oginga Odinga Referral Hospital in Kisumu, the report notes that the ICU unit is installed and operational. But woe unto you if there’s a power outage in the middle of an operation as there’s no back-up generator.

In Nairobi, fully installed radiology machines (x-rays) to diagnose and give first-line treatment to cancer patients is “not operational because of inadequate power supply”, says the report. The report records a sorry situation at Mbagathi Level Four Hospital, one of the biggest hospitals for the millions of city residents. While one maternity theatre is complete and in use, the second one is not because “the doors are too small and won’t allow a stretcher to pass”. The county needs to enlarge the door. But that is not the only “structural problem” in the unit that has made it unusable. “Scrubbing sink needs to be relocated, floor drainage needs to be done, toilets need doors,” reads the CoG audit on the Managed Equipment Scheme. Even the renal unit built at the same hospital, and which has machines, lacks laboratory space.

At Mama Lucy Kibaki Hospital, a public hospital for city residents, machines have been installed and the theatre is complete and functional. The only pending work is to do with the renal unit which is awaiting design and construction.

In Mandera and Makueni, some of the machines have broken down, and they need repairs. The counties say they have informed the machine suppliers about the breakdown and are now waiting for them to send technicians.

“Newly installed radiology machine has broken down; they brought in some spare parts that did not fit. They promised to replace the whole machine,” reads the Mandera update in the CoG report.

Lamu and Nyamira have not installed some machines because they are yet to finish the buildings in which the machines would sit.

“Equipment for the second theater is yet to be installed and is awaiting completion of the new building. Renal unit yet to be installed and is awaiting completion of new building,” reads the update on Lamu County Referral Hospital.

Where they work

It is in the Faza Sub-County Hospital where some of the machines have not been installed because they are waiting for an upgrade of the power supply line to three-phase.

Kirinyaga and West Pokot have installed the bulk of the machines and these are listed as “operational”, save for the renal unit, which according to the report, have been installed but are idle. In Migori, the equipment has been installed in the theatre, but some sockets and doors are missing, and one anesthetic machine has not yet been delivered. At the Narok County Referral Hospital, the renal equipment has not been installed.

For context, most of the counties like Nyeri, Kakamega, Mombasa, Turkana, Kajiado, Kitui, Kericho, Siaya, Machakos, Taita Taveta, Laikipia, Garissa and Tana River have most of their equipment functional.