Auditor-General Nancy Gathungu has questioned how the Ministry of Health spent Sh493.95 million to train Kenyan doctors undertaking family medicine training in Cuba.

In a report for the financial year 2022/2023 Gathungu regretted that there were various anomalies noted in how the said funds were utilized.

The anomalies include lack of approval to train in foreign based institutions and training of employees of the county government and not those from the ministry.

Of the money in question is Sh15.2 million incurred on 35 doctors training expenses.

Reads the report: “Note 7 to the financial statements reflects use of goods and services of Sh7,339,616,756 out of which Sh493,954,203 was for training expenses which includes Sh15,168,550 incurred on 35 Kenyan doctors undertaking family medicine training in Cuba. However, unsatisfactory matters were noted.”

With regards to the training in Cuba, the report shows the ministry entered into a contract to train 50 doctors in family medicine for two years at a cost of US$2,147,625 (Sh214,762,500) without evidence that the course was not available in Kenya before granting approval to train in a foreign institution.

Train in foreign-based institutions

This, the report says is contrary to Paragraph 4.2.1 of the Guidelines on Managing Training in Public Service, 2017, which provides that an approval to train in foreign-based institutions will only be granted in instances where the courses applied for are not available in local institutions.

Reads the report: “In the circumstances, Management was in breach of the guidelines.”

On training County Government Employees, the report states a review of human resource records revealed that the trained doctors are not employees of the Ministry but are employed by various County Governments, which manage their human resource matters including training.

Despite the move, the report regrets that the management did not provide the criteria used in identification, selection and award of scholarship and why the training could not be done by the respective County Governments.

ln addition, the report regrets that since the Ministry does not manage the payroll for these employees, the recovery of 20 percent training levy for the sponsored doctors was not made, although Management had requested various counties to recover the training levy, a move that is contrary to Section H.5(2) of Human Resource Policies and Procedures Manual for the Public Service, 2016 which states that officers attending courses lasting more than four weeks in institutions outside the country will contribute at the rate of 20 percent) of their basic salary per month for the duration of the course.

Adds the report: “ln the circumstances, Management was in breach of the Human Resource Policies and Procedures Manual for the public service.”

The report also raises concerns over the failure by the Ministry Operationalize institutions. The institutions include National Spinal Injury Referral Hospital, Mathari Teaching and Referral Mental Hospital, Kenya Tissue and Transplant Authority and Kenya institute of Primate Research.

Legal Notice

 On Mathari Teaching and Referral Mental Hospital, the report states that although Paragraph 3(1) of Legal Notice 165 of 2017 states that there is established and paragraph 16(2) states that the accounts of the Referral Hospital shall be audited and reported upon in accordance with the Public Finance Management Act, 2012 and Public Audit Act, 2015, six years after the Legal Notice, the Referral Hospital had not been operationalized, despite the existence of a fully constituted board.

On the National Spinal Injury Referral Hospital, the report says that although the executive Order No.1 of 2023 on organization of the Government of Kenya listed the Hospital as one of the institutions under the State Department for Medical Services, the institution has not been operationalized and is managed by a Hospital Management Committee.

The existence of the hospital is not supported by legislation either in the form of an Act of Parliament or a legal notice.

The Kenya Tissue and Transplant Authority, the report says despite being established a State Corporation, the Authority had not been constituted and did not have a Board of Directors while the Kenya institute of Primate Research which was established under Legal Notice 273 of 2017, the report regrets that six years after the Legal Notice the institute had not been constituted and did not have a Board of Directors.