The News Brief: Audit bares sick state of county hospitals
These are the stories making the headlines in the Star
9mon agoEMMANUEL WANJALANews
Patients seeking treatment in county hospitals go there to die. Or, at best, their conditions worsen.
There’s hardly anyone to attend to them and no certainty the medicines they would be given are genuine.
Some could be expired or fake.
The health facilities lack enough medical staff and equipment, amid frequent stockouts of essential commodities.
That is the damning finding of the Senate.
“Healthcare workers frequently work in facilities that lack essential resources such as medical supplies and equipment, necessary for delivering quality care.”
The hospitals lose millions of shillings due to defective or lack of proper billing systems.
Some of them, mainly Level 4 and 5 hospitals, are grossly underfunded.
A report of the County Public Investments and Special Funds Committee on the consideration of audit reports for various facilities for 2021-22 was tabled in the House.
The senators doubt the quality of drugs supplied by the Kenya Medical Supplies Authority.
“Kemsa’s drug supply has been associated with poor forecasting, which leads to stockouts and delays,” the panel chaired by Vihiga Senator Godfrey Osotsi says.
“The quality of drugs supplied by Kemsa has also been questioned, with reports of expired or substandard drugs being delivered.”
At Karatina subcounty hospital in Nyeri, the committee established the facility is understaffed and lacks essential equipment.
“The hospital is not compliant with the requirements of universal healthcare as it does not offer some services expected of a Level 4 hospital such as ICU, HDU, and renal dialysis services,” the report states.
“This non-compliance impacts the hospital’s role in providing primary healthcare services under the Kenya Health Information System (KHIS).”
The committee asks Governor Mutahi Kahiga to prioritise adequate funding for essential services like ICU, HDU, and renal dialysis among others to enable the hospital to offer all the required services under the UHC.
“The governor should expedite the completion of infrastructure projects to provide adequate space and facilities for the new services.”
Further, the hospital lacks a permanent staff to run its Health Management Information System.
The software is used for three major purposes in the hospital, namely, point of sale in the hospital which is for receipting of patients, clerking of patients, and billing of inpatients at the point of discharge.
“The committee observed that the hospital did not have a single permanent employee in the IT department to manage both hardware and software in the hospital and that the responsibility was bestowed upon casual employees, posing a risk to the security of the system and sensitive data.”
At Kinango subcounty hospital in Kwale, the committee established the facility has a shortfall of 44 medical staff.
They include 13 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 on staff fatigue, exhaustion and lack of morale due to overwhelming duties and responsibilities,” the report reads.
The panel directs Kwale Governor Fatuma Achani to submit a comprehensive plan outlining the specific measures taken to address the hospital’s staffing shortages within 60 days.
At Kwale subcounty referral hospital, the panel wants the Ethics and Anti-Corruption Commission to investigate untraceable supplies and possible loss of Sh1.74 million.
The committee established the supplies were received by individuals who were not hospital staff and could not be traced.
The store’s officer received supplies without the involvement of a pharmacist or appointed specialist to verify if the supplies met the required quality specifications.
“The committee recommends that the Ethics and Anti-Corruption Commission investigates the untraceable supplies and possible loss of funds amounting to Sh1.74 million and give a status on the same to the committee within 60 days of the adoption of this report.”
The hospital received drugs worth only Sh550,355 from the Ministry of Health through Kemsa under the UHC programme, but that was insufficient to sustain its needs.
The hospital, the report says, faced stock-outs of essential medical supplies of between eight and 117 days due to inconsistency in funds disbursement.
The healthcare workers’ contracts had expired and were yet to be renewed at the time of the audit.
“The Governor of Kwale County should ensure that the health workers have valid contracts in line with the Employment Act,” the report states.
The hospital leaks revenues running into millions.
Monthly service workload for the financial year 2021-22 indicated a total of 52,533 patients were registered but only 15,106 made cash payments amounting to Sh6.02 million.
The variance of 37,427 patients, who could not be attributed to NHIF, has not been explained.
“There should be an investigation by the Ethics and Anti-Corruption to account for the monetary value of the 12 escaped inpatients and payments made by the 37,427 patients. Those found culpable should be prosecuted by the Office of the Director of Public Prosecution,” the committee says.
Further, the hospital has a shortfall of 101 health workers, which the management attributed to budgetary constraints.
“The committee observed that the hospital was understaffed, which adversely affected the current employees.”
The hospital also stocked expired drugs valued at millions of shillings.
“The committee observed that 1,249 units of various drugs of undetermined value expired between August 2021 and June 2022 due to the failure of the store's officer to apply the First Expiry, First Out (FEFO) principle when issuing supplies,” the report says.
In Bomet, Longisa County Referral Hospital management failed to account for some Sh19.72 million incurred in the purchase of food.
The expenditure was not supported by receipts in the stores.
The facility lacks a register for its assets.
At Migori Level 4 Hospital, the panel established the facility is grossly underfunded, thus affecting the delivery of services.
During the year under review, the facility had underfunding of Sh32.86 million or 27 per cent of the budget.
The committee also pokes holes in the revenue collection system used by the facility to maximise collections.
“The committee observed that the hospital’s ICT governance system had critical weaknesses, including partial automation, poor network infrastructure, lack of system integrity and user logs, inadequate billing, unauthorised bill reversals, missing software licenses, lack of antivirus, and insufficient physical server controls,” the report states.
In Nyeri, Mt Kenya subcounty hospital is acutely understaffed.
The hospital has 21 registered community health nurses against the required 75 and two medical officers instead of 12.
It lacks anesthesiologists, general surgeons, gynecologists, pediatricians, and radiologists.
“The committee observed that the query remains unresolved as the hospital suffers significant understaffing across multiple specialties,” the report says.
In addition, the committee observed the hospital has inadequate operational equipment.
“Despite assurances from management that efforts were underway to address the issue, no evidence was provided to support this claim, and the situation remained unchanged over the period.”
