Crisis: Audit uncovers deep funding, staffing woes in public hospitals

Kenya’s public hospitals are grappling with a healthcare crisis, according to a recent audit that exposes deep-rooted problems in staffing, funding, and essential services.

Auditor General Nancy Gathungu’s report covering the period up to June 30, 2025, reveals that despite billions in public resources, hospitals are unable to provide basic care consistently.

Shortages of medical personnel are extreme. Level 4 hospitals, which require 101 staff members each, collectively lack 12,089 healthcare workers, including doctors, surgeons, paediatricians, and radiologists.

Level 5 facilities are similarly understaffed, falling short by 1,207 personnel.

Some hospitals, including Mandera County Referral, Kayole II, Msambweni, and Mtwapa subcounty hospitals, operate with no staff, while most others function with just a handful of employees.

Only a small number of hospitals, such as Lodwar, Wajir, and Siaya county referral hospitals, have more than 90 staff members.

Service delivery across the public health system is patchy and inadequate. The audit found 54 hospitals without surgical units, 51 lacking both paediatric and gynaecology services, 54 without radiology, 73 without dialysis, and 43 unable to manage tuberculosis.

Hospital infrastructure is also insufficient. Level 4 hospitals, which should have 150 beds each, reported only 6,231 beds in total, leaving a gap of 12,669.

Level 5 hospitals face similar deficits, with some, like Samburu Teaching and Referral Hospital, severely understaffed and undersupplied.

Shortages of equipment are widespread. Many Level 4 hospitals fall far short of having the five incubators and five cots required in newborn units, collectively providing only 278 out of 1,360 needed.

Level 5 facilities lack ICU and HDU beds, functioning theatres, and incubators, limiting their ability to handle critical and emergency cases.

Storage for drugs is also insufficient in 14 hospitals, and 13 failed to implement basic inventory practices, resulting in waste and expired medication.

Incomplete projects and idle resources worsen the situation. Twelve hospitals reported unfinished wards and theatres, denying patients the intended services, while 36 hospitals had unused medical equipment and vehicles, even as demand surged.

Financial mismanagement compounds these challenges. Hospitals reported a combined budget of Sh71.36 billion but spent only Sh67.88 billion, leaving Sh3.48 billion unspent.

Meanwhile, seven hospitals overspent their allocations by more than 50 per cent, with Embu Level 5 Hospital exceeding its budget by 243 per cent. Revenue collection is also weak, with Sh955 million never remitted to county revenue funds, Sh214 million unaccounted for, and Sh11.35 billion uncollected.

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Governance and oversight are nearly non-existent in many facilities. Seventy-five hospitals lacked updated fixed asset records, 80 do not have title deeds, nine operated without approved procurement plans, and eight exceeded procurement limits.

Seven hospitals had no audit committees, 13 lacked internal audit functions, 31 had ineffective boards, and 26 had irregularly constituted boards.

In her foreword, Gathungu warned that these challenges are persistent and largely unaddressed, noting the lack of consequences for responsible officers.

She acknowledged funding constraints and tight audit timelines but stressed the urgent need for stronger monitoring and enforcement.

The report calls for improved financial controls, better hospital management, adequate staffing and equipment, efficient procurement and inventory systems, and adherence to national health standards.