A crisis is looming over the status of various level four hospitals across the country after an audit report revealed serious challenges they are experiencing thus hindering the delivery of services.
Various audit reports for the financial years 2022 and 2023 from the Office of the Auditor General Nancy Gathungu, paint a picture of a sorry state of affairs as some of the hospitals do not have the requisite machines, equipment and doctors to attend to patients.
The reports also show that some of the hospitals lack basic amenities such as water and drainage systems while others have been giving waivers to patients without following the right procedures.
A scan through the reports of about 20 hospitals also shows that some of the hospitals had stock up of expired medicine while in other cases the sustainability of the facilities is questionable.
Among the hospitals indicted by Gathungu include Muhoroni County Level 4 in Kisumu county, Molo Level 4 sub-county Hospital in Nakuru, Mbita Level 4 in Homabay County, Msambweni County Referral in Kwale county, Mukurwe-ini sub county Level 4 in Nyeri County, Mandera County Referral, Makueni County Referral Level Five, Murang’a Level Five, Migosi subcounty in Kisumu county, Machakos Level Five in Machakos county.
Few doctors
The report, for instance, shows that Murang’a Level Five does not have enough medical doctors, operating with a staff of 16 medics yet the required standard is 50, has only four dental officers against a requirement of 30 officers, has seven radiographers against a requirement of 23 has 31 registered clinical officers against a required of 83.
In addition, the hospital lacks the necessary equipment and machines as it only has two functional theatres, maternity, general orthopaedic, paediatric, dental and ophthalmology against a required standard of seven.
It also has four new born units against a requirement of 10, has three maternity department ward against a requirement of six, has a bed capacity of 257 against a requirement of 500 and has two theatres against a requirement of seven.
Reads the report: “The deficiencies contravened the First Schedule of Health Act, 2017 and imply that accessing the highest attainable standard of health, which includes the right to health services, including reproductive health care as required by Article 43(1) of the constitution of Kenya, 2010 may not be achieved. In the circumstances, Management was in breach of the law.”
Expired drugs
The hospital has also been fingered for having drugs worth Sh 965,000 that had expired in the facility as well as its sustainability is doubtful
Reads the report: “Further, the report indicated the hospital records 380 (three hundred and eighty) successful deliveries in a month with a patient flow of 600-800 per day. However, the hospital recorded a total expenditure of Sh1,084,985 during the financial year. lt is not clear how the hospital was able to offer the services to the patients as disclosed in the report. On the circumstances, the effectiveness of internal controls on service delivery could not be confirmed.”
In the case of Makueni five, the report raises concerns over Non-Compliance with Requirements on Universal Health Coverage (UHC).
A review of hospital records and interviews on verification of services offered, showed that the hospital lacked the necessary equipment and machines outlined in the Health Policy Guidelines.
The equipment lacking include adequate number of beds as they have 391 against the requirement of 500 beds, Functional ICU Beds as they have 2 out of a total requirement of 12, High dependency unity beds and Functional ICU beds as they have only 2 against a requirement of 12 for each.
The report has also fingered the hospital as a number of equipment were not functioning at time of physical inspection in April 2024.
The items not functioning include Dialysis Machines where out of five available one was out of service, three Ultrasound Machines, the Digital Mammography Machine and CT Scan which were all out of service as well as autoclave Steriliser and two dental chairs which were malfunctioning.
Reads the report: “These deficiencies contravene the First Schedule of Health Act, 2017 and imply that accessing the highest attainable standard of health, which includes the right to health care services, including reproductive health care as required by Article 43(1) of the Constitution of Kenya, 2010 may not be achieved. in the circumstances, the Hospital will not be able to deliver on its mandate.”
Negative balance
The report raises concerns over the continued operations of the hospital as it is working on a negative balance as the hospital’s current liabilities balance of Sh80.8 million exceeded its current assets balance of Sh63.4 million as at 30 June, 2023, resulting in a negative working capital amounting to Sh17.4 million.
These conditions, the report says indicate the existence of a material uncertainty, which may lead to significant doubt on the Hospital’s ability to continue to sustain its services.
Reads the report: “However, this material uncertainty and any mitigating measures put in place by the Management to reverse the undesirable financial position have not been disclosed in the financial statements.”
The report also raises questions over the deficiencies in implementation of UHC at the Mandera County Referral Hospital.
A review of the hospital records and interviews on verification of services offered, shows that it does not meet the requirements of Kenya Quality Model for Health policy guidelines due to lack of anaesthesiologists.
In addition, the hospital lacks the necessary equipment and machines outlined in the Health Policy Guidelines as they have only four HDU beds against a requirement of six.
The hospital is also facing a number of challenges including inadequate Water Supply and Drainage System as well as has given patients unsupported Waiver of bills.
Hospital revenue records revealed that although social workers at the hospital granted waivers on patients’ bills, the management did not provide for audit review delegated authority to the social workers who granted the waivers and assessment reports to support the patient’s inability to pay for the services rendered.
