Auditor General report reveals alarming state of county hospitals

A new report by Auditor General Nancy Gathungu has exposed the poor state of health services in some of Kenya's top county hospitals.

The report highlights issues such as the shortage of drugs, lack of medical personnel, and broken or outdated equipment, raising serious concerns about the quality of healthcare available to citizens.

The audit focused on county referral hospitals (Level 5) and sub-county hospitals (Level 4) for the fiscal year ending June 30, 2023.

The report was presented to the Senate by Majority Leader Aaron Cheruiyot at the Senate.

The report, which puts governors under pressure, outlines that many hospitals are struggling due to insufficient medical equipment, with some facilities using broken machines that haven't been serviced for long periods.

Expired drugs worth millions of shillings have been found in several facilities, and others are still holding leased medical equipment valued at over Sh63 billion, which has yet to be put into use.

The findings cast doubt on the country's ability to achieve universal health coverage (UHC), which has been a key government priority. The report also uncovers major issues in the procurement process of medicines in some counties, leading to irregularities that affect service delivery.

Understaffing 

In Nakuru County, the County Referral and Teaching Hospital is severely understaffed, which has affected the quality of healthcare services.

With only 26 doctors instead of the required 50, the facility also lacks anaesthesiologists and a radiologist.

The hospital's six intensive care unit (ICU) beds and four high-dependency unit (HDU) beds fall short of the 12 needed for each category in a referral hospital.

"The understaffing and inadequate hospital equipment may have negatively impacted service delivery to the public," Gathungu stated.

Unused renal dialysis equipment at the Nakuru facility has gone months without service due to the expiration of maintenance contracts.

Additionally, the hospital has been found to conduct procurements without an approved budget or procurement plan.

In Laikipia County, the Nanyuki Teaching and Referral Hospital is also facing challenges, as the services it offers exceed the coverage provided by the National Health Insurance Fund (NHIF).

The facility offered services valued at Sh142.51 million, but NHIF only reimbursed Sh66.58 million.

"The cover deficiency may affect the sustainability of services at the facility, which is dependent on continued funding by the county government," the report reads.

Lack of medical supplies

In Homa Bay County, Kendu Bay Sub-County Hospital was found to be out of essential medical supplies.

"Review of the hospital stock cards for controlling stores indicated that the hospital experienced stockouts of medical supplies," the report reads in part.

In Siaya County, the County Referral Hospital waived Sh7.35 million in fees for 485 patients during the year, but 10 per cent of its revenue was lost through these waivers, without proper approval from the health executive, as required by law.

In Kilifi County, Mtwapa Subcounty Level 4 Hospital is facing shortages, including a lack of 70 beds. It does not offer essential services like renal dialysis, mortuary, post-mortem services, or advanced life support.

The hospital also only has two doctors instead of the required 16, and just 13 nurses against the needed 75.

Additionally, the hospital lacks proper storage space for maintaining drug quality.

At Bungoma County Referral Hospital, equipment supplied under the Managed Equipment Scheme (MES) is sitting idle.

The contract between the Ministry of Health and maintenance providers expired, leaving crucial machines, such as those in the imaging and X-ray departments, unused.

"Some equipment were last serviced in November 2023," the report says, raising concerns about the value of the Sh63 billion investment in MES equipment.

Bumula Subcounty Hospital is dealing with a severe shortage of staff, with only three doctors instead of the required 16.

It also lacks essential specialists, including anaesthetists, surgeons, gynaecologists, and paediatricians.

Additionally, the facility requires 75 nurses but only has 27.

"These deficiencies contravene the first schedule of the Health Act, 2017, and imply that accessing the highest attainable standard of health may not be achieved," the report added.

Expired drugs were also found at Bumula Hospital, with around 530kg of expired medicines discovered. Furthermore, there was no proper tracking of drug batches and expiry dates, making it difficult to ensure the correct rotation of medicine stock.

Baringo County Referral Hospital faced a similar crisis, with vital medical supplies running out for periods ranging from three months to three years.

"Review of stock cards revealed that the hospital experienced stockouts of drugs for an average period of 90 to 1,095 days," Gathungu noted.

In Samburu County, the Samburu County Referral Hospital is short of 23 medical staff, including medical officers, radiologists, surgeons, paediatricians, and gynaecologists.

The hospital also lacks essential equipment, including 107 beds, resuscitators, newborn incubators, and ICU beds.