Senators hit out at governors for mismanaging health facilities

Senate County Public Investments and Special Funds Committee chairperson Godfrey Osotsi at Bunge Towers, in Nairobi on December 2,2024. [Elvis Ogina,Standard] Senators have put governors on the spot over the deplorable state of many health facilities managed by county governments across the country. In a report tabled in the Senate by the Senate County Public Investments and Special Funds Committee (SCPIFC), it was revealed that most health facilities are poorly equipped and lack essential medical supplies. The Committee, chaired by Vihiga Senator Godfrey Osotsi, pointed out that many medical facilities across the 47 counties are losing revenues running into millions of shillings in revenue due to defective billing systems. "We have established that some facilities, particularly Level 4 and 5 hospitals, are grossly underfunded, with frequent stock outs of essential commodities like drugs and supplies, which has greatly hampered service delivery to Kenyans," said the report. The Senate committee said that healthcare workers often operate in facilities that lack essential resources, such as medical supplies and equipment, necessary for delivering quality care, rendering them ineffective before citizens. The report, which considered audit reports for various facilities for 2021-22, also raised concerns about the quality of drugs supplied by the Kenya Medical Supplies Authority (KEMSA). There have been reports of expired and substandard drugs being delivered. "KEMSA's drug supply has been associated with poor forecasting, leading to stock-outs and delays, which has hindered Kenyans from receiving quality healthcare services they need," said the report. The Senate Committee also found that at the Migori Level 4 Hospital, is grossly underfunded and uses an inefficient revenue collection system, preventing it from maximising collections. During the year under review, the facility experienced underfunding of Sh32.86 million, or 27% of its budget, while the Hospital's Information and Communications Technology (ICT) governance system had critical weaknesses. The ICT system in Migori faces several challenges, including partial automation, poor network infrastructure, lack of system integrity and user logs, inadequate billing, unauthorized bill reversals, missing software licences, lack of antivirus protection, and insufficient physical server controls. The Osotsi-led committee found that Karatina Sub-County Hospital in Nyeri County, is understaffed and lacks essential equipment, affecting its ability to provide proper services to local residents, who end up suffering. The report highlights that Karatina Hospital is not compliant with universal healthcare requirements, as it does not offer some services expected of a Level 4 hospital, such as an Intensive Care Unit (ICU), High Dependency Unit (HDU), and renal dialysis services. In its recommendations, the committee urges Nyeri Governor Mutahi Kahiga to prioritise adequate funding for essential services like ICU, HDU, and renal dialysis to enable the hospital to provide all required services under Universal Health Care. "The Nyeri Governor should speed up the completion of infrastructural projects to provide adequate space and facilities for the new services at Karatina Sub-County Hospital," recommended the report. The committee also found that the hospital lacks permanent staff to manage its Health Management Information System (HMIS), which is used for three key functions: point of sale for patient receipts, clerking of patients, and billing of inpatients at discharge. "The committee discovered that Karatina Hospital has no permanent ICT staff to manage both hardware and software, and that casual employees are tasked with this responsibility, posing a risk to system security and sensitive data," the report stated. At Mount Kenya Sub-County Hospital in Nyeri, the committee noted the facility is severely understaffed, with only 21 registered community health nurses instead of the required 75, and two medical officers instead of 12. The committee also found the hospital lacking essential specialists, including anesthesiologists, general surgeons, gynecologists, pediatricians, and radiologists, in addition to missing necessary operational equipment. In Kwale, at Kinango Sub-County Hospital, the committee found a shortfall of 44 medical staff, with the facility requiring at least 13 additional medical officers, two anesthesiologists, a general surgeon, a pediatrician, a gynecologist, and a radiologist. "The committee observed that the hospital was understaffed, which adversely affected the current employees who raised concerns about staff fatigue, exhaustion, and low morale due to overwhelming duties and responsibilities," said the report. The Senate committee directed Kwale Governor Fatuma Achani to submit a comprehensive plan within 60 days, outlining the specific measures being taken to address the hospital's staffing shortages. The committee also called on the Ethics and Anti-Corruption Commission (EACC) to investigate the untraceable supplies and the possible loss of Sh1.74 million at the Kwale Sub-County Referral Hospital. It was found that individuals who were not hospital staff received medical supplies worth Sh1.74 million. Furthermore, these individuals could not be traced in the Department of Health stores, while the stores officer received supplies without involving a pharmacist or appointed specialist to verify that the supplies met the required specifications. "The Ethics and Anti-Corruption Commission should investigate the untraceable supplies and possible loss of funds amounting to Sh1.74 million and provide an update to the committee within 60 days of the adoption of this report," said the report. The Senate Committee discovered that the hospital received drugs worth only Sh550,355 from the Ministry of Health through KEMSA under the UHC programme, which was insufficient to meet the hospital's needs. The Kinango Sub-County Hospital also experienced stock-outs of essential medical supplies ranging from eight to 117 days (four months) due to inconsistent funds disbursement, and healthcare workers' contracts had expired and were yet to be renewed at the time of the audit. "This committee recommends that the Governor of Kwale County ensure health workers at the Kinango Sub-County Hospital have valid contracts in line with the Employment Act as soon as possible," said the report. The report notes that the hospital's monthly service workload report for the financial year 2021-22 indicated that a total of 52,533 patients were registered, but only 15,106 patients made cash payments amounting to Sh6.02 million. The variance of 37,427 patients, who could not be attributed to NHIF care, has not been explained. The Senate Committee found that at Longisa County Referral Hospital in Bomet County, management failed to account for Sh19.72 million incurred in the purchase of food and rations, with the expenditure not supported by receipts in the stores. The facility also lacked a register for its assets.

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