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Kenya’s public hospitals ‘as sickly as their patients’

Mercy Mwai @wangumarci

The country’s four major referral hospitals are not only ailing, but also a far cry from being functional health institutions by international standards, a report tabled in Parliament shows.

Their state sums up the break-down in the public health care system, which is now a devolved function, that is synonymous with poor services, lack of equipment and sufficient manpower.

A damning report by Departmental committee on Health chaired by Murang’a Woman Representative Sabina Chege, reveals that the four hospitals— Kenyatta National Hospital (KNH), Moi Teaching and Referral Hospital (MTRH), National Spinal Injury Hospital and Mathari National Teaching and Referral Hospital— are almost on their knees because of debts and inadequate funding.

Leaking roofs

In some instances, the state of disrepair is so dire that roofs are leaking with cracked and paint-starved walls where thousands of desperate and poor Kenyans troop to seek either poorly delivered or non-existent services. 

The equipment, if at all, is old and dysfunctional— and in some worst cases, heaped in some corner under sickening layers of dust.

The Chege committee, which prepared the report after visiting the facilities, blames budgetary cuts, financial constraints and perennial low funding from government since independence for the sorry state of the referral and other public hospitals in the country.

The committee said KNH, which is the country’s oldest and largest referral and teaching facility, is severely constrained because of “perennial underfunding”.

Currently, the hospital, which has a cash flow of Sh1.6 billion with a further Sh2.3b personnel emolument gap, requires Sh3.6b plus additional Sh4.9b to operate properly.

Staffing shortfall

The report also raises concerns over the hospital’s staffing shortfall, which stands at 1,456, terming it a near crisis— and to address the gap, it requires Sh2.6b, money which is not forthcoming.

KNH, which suffers what the committee terms a leadership vacuum after the hiring of a substantive chief executive officer was halted by the court, also lacks critical equipment and is overcrowded, especially by outpatients and those detained for failing to pay medical bills.

“The facility faces a staffing shortfall of near crisis proportions,” says the report.

Mathari Hospital, on the other hand, which has bed occupancy of 119 per cent in the civil unit and 115 per cent in maximum security unit, the report says inadequate staff in all cadres is hurting service delivery. It says, for instance, it found one female nurse, who was in charge of 147 patients.

The report also raised concern over the general status of the hospitals’ buildings which it says are old, dilapidated with cracks on the walls with leaking roofs besides lacking essential facilities such as toilets, bathrooms, sinks, ventilation’s as well as has a poor drainage and sewage system.

Overstaying patients

The maximum security unit, which houses the patients referred from Judiciary, the report says is overcrowded because patients overstay with security challenges since their discharge requires court orders.

“One major cause of its financial challenges is a result of it serving patients referred by the Judiciary for mental assessment for suitability to take plea, services of which are not paid for by the referring agencies,” the committee says.

At the Spinal Injury Hospital in Nairobi, the report says the capacity is overstretched because it also caters for patients referred from hospitals in East and Central Africa region.

And just like the other hospitals, it faces acute shortage of staff in all cadres, adding that stagnation of promotion has also affected morale of the staffers.

The report notes that the facility needs more land for expansion, especially for physiotherapy. It also lacks medical equipment including orthopedic hospital beds, ICU, HDU, laboratory machines, incineration services and spinal operation sets, among others.

The 900-bed MTRH on the other hand, deals with a population of 25 million people from 21 counties in Western and Rift Valley. It experiences daily work load of about 1,500 outpatients and 1,200 inpatients and a bed occupancy of 110 per cent.

According to the report, the hospital’s cash flow has been greatly affected by waivers and bad debts. As at January 31, corporate debtors stood at Sh313.8 million while individual debtors stood at Sh514.6 million.

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