republic of kenya homa bay county assembly second …

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REPUBLIC OF KENYA

HOMA BAY COUNTY ASSEMBLY

SECOND ASSEMBLY- SECOND SESSION

REPORT

OF THE

HEALTH SERVICES COMMITTEE

ON THE STATUS OF SUB-COUNTY HOSPITALS

Published by: DEPARTMENT OF LEGISLATIVE AND COMMITTEE SERVICES COUNTY ASSEMBLY OF HOMA BAY, ON 25TH JUNE, 2018

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TABLE OF CONTENTS

1.0 Preface…………………………………………………………

1.1 Committee Membership……………………………… 3

1.2 Committee Mandate………………………………….. 4

1.3 Acknowledgement……………………………………. 5

1.4 Committee Adoption List……………………….,,,,,,,, 6

2.0 Overview of CIDP 2013-2017………………………………. 7

3.0 Findings on CIDP 2018-2022…………………………………..7-8

4.0 Recommendations……………………………………………… 8

5.0 Prayer……………………………………………………………. 9

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1.0 PREFACE

1.1 Committee Mandate

The Health Services committee is a Sectoral committee established pursuant to

Standing Order No. 191. It is mandated to consider all matters related to County

Health Facilities and pharmacies, Ambulance services, promotion of primary health

care, licensing and control of undertakings that sell food to the public, veterinary

services (excluding regulation of the profession), cemeteries, funeral parlors and

crematoria and refuse removal, refuse dumps and solid waste disposal.

1.2 Committee Membership

The Committee was constituted by the County Assembly of Homa Bay on

Wednesday, 27th September, 2017 and reconstituted on 28th January,2018 comprising

of the following Members:

S/No Name Of Hon Member Ward Designation

1. Hon. Morice Ogwang K/Bay Town Chairperson

2. Hon. Jessica Otieno Nominated V/Chairperson

3. Hon. Richard Ogindo Kwabwai Member

4. Hon. John Njira West Karachuonyo Member

5. Hon. Owaka Nicholas Kosewe Member

6. Hon. Benard Obondo Central Kasipul Member

7. Hon. Joshua Nyabola East Kamagak Member

8. Hon. Peter Kaula Wangchieng Member

9. Hon. Philemon Onyango Kagan Member

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10. Hon. Michael Nyangi Kochia Member

11. Hon. Walter Were Muok Kanyadoto Member

12. Hon. James Okeyo East Kabondo Member

13. Hon. Paul Okuku Miregi Rusinga Island Member

14. Hon. Godfrey Juma Kabondo West Member

15. Hon. Nereah Amondi Nominated Member

16. Hon. Kevin Onyango Nominated Member

17. Hon. Jane Kiche Nominated Member

18. Hon. Susan Onyango Nominated Member

19. Hon. Lorna A. Owino Nominated Member

20. Hon. Nelly Odek Nominated Member

21. Hon. Amina Osmail Nominated Member

22. Hon. Salome Awino Nominated Member

Committee Secretariat

S/No Name Designation

1 M/S Verah Oteng Clerk Assistant

3 Mr. Tobias Opana Clerk Assistant

4 Mr. Calvince Agola Sergeant-At-Arms

5 Ms. Leah Lieta Executive Secretary

1.3 Committal to the Health Services Committee

Pursuant to standing order No. 40, Hon. Lorna Owino raised a matter of topical

concern on the poor state of health facilities in the County on Tuesday 27 th March,

2018. Following this the speaker committed the statement to the health services

committee to report back to the house within 21 days.

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1.5 Committee Meetings

The committee had its first sitting on 10th April, 2018 and developed a work plan on

modalities of collection of data, engagement of various stakeholders in the County

Health Sector and resolved to widen the scope to cater for all the Sub county

Hospitals, randomly selected Health Centers and Dispensaries. They were to obtain

data through interviews, questionnaires and observation from the site visits,

The overall goal of the baseline assessment was to review the current status of health

facilities in Homa-bay County, identify strength and weakness and make

recommendation how the County Government can improve the service delivery in

the public health facilities. The final meeting was held on, between 7th to 10th June,

2018 where the report was compiled, adopted and ready for tabling. During the

investigation the committee made visits to the following selected health facilities from

3rd to 8th May, 2018.

NO Name of Facilty Level Sub-County Ward

1. Homa Bay Teaching and

Referral Hospital

5 Homa Bay Town Homa Bay Central

2. Ndhiwa Sub-County Hospital 4 Ndhiwa K/Kosewe

3. Mbita Sub-County Hospital 4 Suba North Kasgunga

4. Rachuonyo North Hospital

(Kendu Bay)

4 Rachuonyo North Kendu Bay Town

5. Rangwe Sub-County Hospital 4 Rangwe GemWest

6. Sindo Sub-County Hospital 4 Suba South Kaksingri West

7. Rachuonyo South Hospital

(Oyugis)

4 K/Kasipul West Kamagak

8. Marindi Hospital 3 Homa Bay Town Homa Bay East

9. Ogongo Sub-County Hospital 3 Suba North Lambwe

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10. Wiga Dispensary - Homa Bay Town Homa Bay Central

11. Magunga Health Center 3 Suba South Gwasi South

12. Kitare Health Center - Suba North Gembe

13. Koduogo Dispensary - Homa Bay Town Homa Bay West

14. Miniambo Dispensary - Homa Bay Town Homa Bay Arujo

15. Kauma Dispensary -

16. Kokwanyo Dispensary

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1. HOMA BAY COUNTY TEACHING AND REFERRAL HOSPITAL

The facility is the only level five hospital doubling up as the Teaching and Referral in

the County. The hospital is located in Homa Bay Town, Homa Bay Central Ward in

Homa Bay Town Sub-County. The facility serves averagely 500 patients on a daily

basis.

1. The facility offers the following services

i. Laboratory Services are offered to averagely 150 patients per day. The unit

works on a 24hr service and the records are electronically kept. The laboratory

has a standby generators sponsored by partners. However, the unit lacks viral

load test equipment and the parasitology room roof is leaking.

ii. Dental Services are offered by three dentists. The department lacks modern

dental equipment and the roof of the dentist is leaking.

iii. Maternal Child Health services offered to an average of 100 children per day.

However, the room is dilapidated and the roof is leaking.

iv. X-ray and renal services are efficiently offered.

v. Physiotherapy services are offered. The department records an average of five

patients daily with an increase of between 10-15 patients on Wednesdays.

However, the department lacks modern physiotherapy equipment.

vi. Maternity services are offered to about 15-20 expectant mothers on a daily

basis and the area is manned by three nurses 24hrs daily.

The Delivery room is very clean however the admission room is squeezed and

untidy. The post-natal clinic is congested, beds are shared and the place is

untidy. There are six incubators at the new born unit.

vii. Inpatient section has the following units; Pediatric ward which has 33 beds and

the room is clean, a male ward and a female ward in which patients are served.

however, the ward linen are worn out and

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viii. The main theatre has two surgeons and seven nurses who are responsible for

daily operations. Presently the male surgical ward is under renovation.

ix. Pharmacy services are not offered for 24hrs.

x. The MRI unit is functional; however there is no radiologist to interpret the

results, no CT scan in the facility hence the CT scan services not offered.

xi. Mortuary services are offered in a squeezed room which has a capacity of only

40 corps yet the facility is a regional referral. The present condition is also

wanting as the structure is dilapidated and the machines are worn out.

2. The facility has the following staff establishment

S.No

DESIGNATION EMPLOYED

BY COUNTY

GVT

EMPLOYED

BY

PARTNER

1 Medical Doctor 19 20

2 Dentists 03

3 Pharmacists

Pharm Techs

4 Laboratory Techs 18 10

5 Nurses 124 18

6 Clinical Officers 13 22

7 Community H.W

8 Physiotherapy 08 0

9 Administrators 02 0

10 Accountants

11 Public Health

Officers

05

12 Radiographer 01

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13 Medical Engineers 01

14 Community Dv

Offifers

31

15 Community oral

Officer

16 Drivers

17 Secretaries

18 Support Staff

3. The hospital faces the following challenges

i. The hospital has security lapses right from the main gate up to the wards. The

hospital fence is porous hence patients and hospital facilities are not safe.

ii. The blood bank has not been completed and operationalized this poses a great

challenge to patients who are in need of blood across the county.

iii. The facility has no standardized pediatric ward.

iv. The facility uses the old laundry machine. However the new laundry machine

purchased by the County Government was taken back by the supplier due to

lack of payments.

v. The oxygen processing plant is not functional.

vi. The facility does not offer a CT scans and the patients are always referred to

Agakhan Hospital in Kisumu for the tests.

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2. RACHUONYO SOUTH SUB- COUNTY HOSPITAL

The facility is located in West Kamagak Ward, Kasipul Constituency Rachuonyo

South Sub County and servicing a range of 250 -350 patients daily. It is the second

largest facility in Homa-Bay County.

The following were the findings of the committee:

1. The Hospital has Board of Management appointed on February, 2018 awaiting

gazzetement. The Board is composed of nine members, six male and three

female.

2. The facility has the following functional departments, out -patient consultation,

inpatient, laboratory, pharmacy, mortuary, X-ray and catering services.

3. The hospital has outsourced cleaning, security and catering services. The

outsourced services were up to the standard when the committee visited.

4. The hospital has the following staff establishment

S.No DESIGNATION EMPLOYED

BY COUNTY

GVT

EMPLOYED

BY

PARTNERS

1 Medical Doctor 5( 2 in Sch) 0

2 Dentist 02 0

3 Pharmacists 01 0

Pharm Techs 02 0

4 Laboratory Techs - -

5 Nurses 48 37


7 Community H.W - -

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10 Accountants 02 -

11 Public Health

Officers

10 09

12 Radiographer 01 --

13 Medical Engineers 03 -

14 Community Dv

Offifers

15 03

15 Community oral

Officer

03 -

16 Drivers 03 -

17 Secretaries 02 -

18 Support Staff 06 -

5. The hospital is faced with the following challenges;

i) It lacks enough staff for efficient service delivery, for example the hospital

has 24hr working pharmacy, but there are only 2 pharm technicians who

cannot dispense during the day and night, one radiologist who can only do

X-Ray but cannot perform Ultra Sound which needs a Sonographer.

ii) Lack of enough health products-Health products like Drugs, Non-Pharms,

Lab-Reagent, these products forms key components of Quality Health

Services Provision, the supply of these products are erratic and insufficient

since the last supply was done once this financial year in October, 2017. The

County Government supplied Drugs and Non-Pharms leaving the

hospital to purchase Lab –Reagent from FIF which is very expensive. There

is need for the Hospital to get KEMSA supplies quarterly.

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iii) Infrastructure-The hospital has limited Offices for staff, for example one

office is shared by two HAOs and two Accountants, Pediatric ward needs

to be renovated, Outpatients Building needs to be completed and the

drainage system needs to be improved.

iv) Pending Bills -The Hospital has debts of approximately Ksh. 9,000,000

accrued of a long period of time. Due of this most supplies have lost

confidence and are not ready to supply the hospitals with any commodity

putting the hospital jeopardy.

v) NHIF Capitation Amount- Currently about 60% of patient access free

health care and free maternity, because the hospital has been credited to

offer these services, but the NHIF only pays Ksh. 325 per person per

Quarter which is not enough to cater for costs of free drugs, free lab test,

free non-pharms and other products. Considering the fact that,CS

Deliveries charged at KSH 5,000 in public hospitals yet in Privet Hospital

NHIF pays for the same service at KSH.17, 000.

vi) Erratic supplies of grants from County Government and NHIF-The

hospital has not received funds from the County Government for a long

time. This has made it difficult for the facility to support its services,

County and National Governments owe the facility about Ksh. 15,000,000.

NHIF does not pay claims promptly.

vii) The X-ray department is currently downgraded due to disconnection of

electricity due to accumulated bill of approximately Ksh. 300,000.

viii) The mortuary section is too small to enable the hospital provide effective

services given the wide coverage of the facility. The department generates

much revenue yet the condition is wanting.

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ix) The Hospital does not have a functioning ambulance and entirely depends

on the ambulance attached to Nyangiela Dispensary. This is quite

inconveniencing given the fact that the facility is a level four hospital.

3. NDHIWA SUB- COUNTY HOSPITAL

The facility is a level four hospital located in Kanyamwa/Kosewe Ward, Ndhiwa Sub

County. The hospital offers services to a range of between 100 -150 patients on a

daily basis.

1. The facility has the following departments;

i) Outpatient consultation; this is where patients register and all

correspondence are managed. The facility has a fully operational department

and the services are offered at affordable cost.

ii) In patient (ward)-: This department has been temporarily downgraded, this

means it doesn’t receive any admission and can only be reinstated if the

facility receives more staff. It contains male and female ward, pediatric ward

and recovery room.

iii) Laboratory; the facility has a moderately equipped laboratory and the

following tests are done at the facility, routine Analysis and blood screening

for HIV/AIDS, urinalysis test, blood sugar and sputum etc.

iv) Theatre: the facility doesn’t have an operational theatre

v) Maternity; the facility has an operational maternity wing constructed by the

County Government. This department is well staffed to provide ultimate

quality services to our mothers.

vi) Pharmacy ; the department has highly effective stocked pharmacy , the bin

cards are well managed to show the stock levels , the major challenge facing

this department was lack a drug store for the facility as the building under

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use was constructed by the county government as a mortuary for the

facility. Through a resolution of the health services management committee

resolution resolved to use the building.

2. There is availability of social determinant of health such as safe water and

adequate sanitation in the facility this facility is very essential to any health care.

The facility is hygienic condition of the facility is up to standard.


4. The facility faces the following challenges;

i) Staffing in the facility-The facility in understaffed in terms of essential

health professionals. The inpatient department was not operational as at

the time of visit as a result of withdrawal of staff by Medicine San Frontiers

as from 3rd of April,2018.


BY COUNTY

GVT

EMPLOYED BY

PARTNERS


2 Pharmacist Tech 03 0


4 Nurses 08 03


6 Community H.W 27 02

7 Physiotherapy 0 0


8 Accountants 03 0

9 Casual Workers 01 0

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ii) Poor management of linen- In this facility the maternity department only

had three pieces of linen which were in pathetic conditions. The nursing

officer informed the committee that the order had been done severally but

supplies not yet received from the county offices. This situation leaves both

mothers before and after delivery with no choice but to sleep on bare

mattresses.

iii) Security challenges- The facility is not fenced. This posed human –animal

conflict as animals roam in the hospital compound. The hospital is also not

safe at all.

iv) Mortuary : The hospital lacks a modern mortuary

v) X-ray : The facility lacks a functioning x-ray department

vi) Kitchen and catering department: the hospital does not have the kitchen

and catering department to serve the in patient

4. MBITA SUB- COUNTY HOSPITAL

The facility is a level four hospital situated in Mbita Town, Kasgunga , Suba North

Sub-County .

1. The Facility offers the following services;

i) The sub county hospital offers limited laboratory services. The

laboratory lacks major detergents and equipment. The laboratory has

very few technical staff hence the services take too long. This could be

one of the reasons for low patient enrolment at the sub county hospital.

ii) The sub county hospital has two wards for the males and the females.

However, the wards are in a wanting state. The rooms are dilapidated,

not partitioned, no lavatories, no modern standard beds, mattresses, bed

covers and food for the inpatients. There is a newly constructed 44

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capacity ward which was constructed long ago but has not been

operalationized.

iii) Maternity services are effectively and efficiently offered at the facility.

However most of the personnel in this department are sponsored by the

donors.

iv)

2. The Hospital has the following Staff Establishment


i) The sub county hospital does not offer X-ray services.

ii) Machines and Equipment are not being regularly serviced and

maintained. This leads to some being stalled and non-functional for


BY

COUNTY

GVT

EMPLOYED

BY DONORS


2 Pharmacists 01 07


4 Nurses 14 05





8 Accountants 01 0


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example the standby generator has not been serviced since September,

2017 and the ambulances which are mechanically grounded.

iii) There is no running water in the Sub-County Hospital. This seriously

affects operations at the Maternity and theatre.

iv) The facility is porously fenced, a security firm is contracted to offer

security services. There is human –domestic animal conflict as the

community insists on grazing within the hospital compound.

v) The Sub-County Hospital entirely depends on NHIF reimbursement

for the running of the facility. Very little money comes from the County

Government.

vi) Drugs are periodically supplied by the County Government this

therefore means that at times the hospital operate without essential

drugs.

5. KENDU- BAY SUB DISTRICT HOSPITAL

The facility is located in Kendu Bay Town, in Kendu Bay Ward in Rachuonyo North

Sub-County. The facility records a good number of enrollment rate an average of 80

to 150 patients per day.

1. The general hygienic condition of the hospital is low.

2. The Facility offers the following services

i) The facility offers outpatient services, immunization services, maternity

services and HIV test.

ii) The facility has functional laboratory and does not operate 24 hours but

lack power back up system and has 7 officers attached to it.

iii) The facility has female and male wards but they lacks linen, torn beds and

curtains are dirty.(See appendix)

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iv) The facility has female and male wards but they lacks linen, torn beds and

curtains are dirty.

3. The facility has the following staff establishment Staff Establishment

S.No DESIGNATION EMPLOYED BY

COUNTY GVT

EMPLOYED

BY

PARTNERS


2 Pharmacists 03

3 Laboratory Techs 07

4 Nurses 16

5 Clinical Officers 13

6 Community H.W 02

7 Physiotherapy - -

7 Administrators 01 -

8 Accountants 02 -

9 Casual Workers 07 -

4. The hospital is faced with the following challenges

i) The general security of the facility is inadequate and there is no proper

fencing of the facility.

ii) There is no power back up system hence services cannot be offered when

there is blackout in the facility.

iii) The facility lacks X- ray, pharmacy and mortuary services.

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6. RANGWE SUB-COUNTY HOSPITAL

Rangwe Sub-district Hospital is a County Government health centre located in

Kamagawi sub-location, Gem West Ward.

1 Services offered at the facility include;

i) Ante-natal care, Anti-retroviral therapy, Basic emergency obstetric care,

Curative In-patient Services, Curative Outpatient services, family planning,

ii) Growth monitoring and Promotion, HIV counselling and Testing, Home

based care, Immunization, Integrated management of Childhood illnesses,

Prevention of mother to child transmission of HIV, Tuberculosis

Diagnosis, Labs and treatment.

The team was taken round the Hospital by Anne Orao-Sub-county Public

Health Nurse, Edmond Onditi-Health Aministrator and Evance Odoyo-

Clinical Officer.

iii) The Hospital has one Ward shared by Males and Female .which Ward has a

capacity of 10 beds and is generally very clean .The Ward was last supplied

with linen in 2009. All nurses employed on permanent basis but 4 have not

been paid their salaries since December 2017.

iv) The Laboratory room is too squeezed making it impossible to handle some

modern lab equipment due to its size. The Lab occasionally runs out of

reagents because they don’t have enough supply.The Laboratory has 4(2

County Government, 2 Elizabeth Glazer Pediatric Foundation) staff

attached to it. The staff were initially 6 but 2 were transferred by the county

government and are yet to be replaced.

v) The Pharmacy doesn’t operate 24hours. The Drugs are to be supplied

quarterly but the hospital experiences delays.

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vi) Nutrition department has only one employee. The department is supplied

by NHP and KEMSA and handles around 20 clients daily, mostly

pregnant women, post-natal and adults.

2 Maternity wing was built by the County Government, handles an Average of 5

patients per day and generally very clean, it is very well equipped by Elizabeth

glazer foundation fitted with power backup generator. It has 7 nurses.

However, the maternity theatre doesn’t have a surgeon so not operational.

The facility has the following staff establishment


BY COUNTY

GVT

EMPLOYED

BY

PARTNERS

1 Medical Doctor

2 Pharmacists

3 Laboratory Techs

4 Nurses

5 Clinical Officers

6 Community H.W

8 Public Health Officer

7 Physiotherapy

7 Administrators/ H.R.O

8 Accountants

9 Casual Workers

3 The facility faces the following challenges;

i) Infrastructural Development

ii) Understaffing in almost all the Departments

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iii) The hospital hasn’t received new lined since the inception of County

governments with the last supply being done in 2009

iv) The Hospital doesn’t have a pediatric Ward

v) There is irregular transfer of County government staff without replacements

vi) Hospital doesn’t have a functional incinerator

vii) The entire hospital doesn’t have a medical doctor.

7. SINDO SUB-COUNTY HOSPITAL

The facility is located in Sindo Town, Kaksingri West Ward in Suba South Sub-

County. The Hospital offers servives to approximately 150-200 patients on a daily

basis.

1. The Hospital offers the following services;

i) The laboratory, Pharmaceutical.

ii) It has two general wards for both male and female and one pediatric

ward.

2. There are enough drugs in the facility, though the non-pharmaceuticals are

lacking.



BY

COUNTY

GVT

EMPLOYED

BY

PARTNERS


2 Pharmacists 01 02


4 Nurses 26 0

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8 Public Health Officer 01 0

7 Physiotherapy 0 0

7 Administrators/

H.R.O

01 0

8 Accountants 0 0



i) There is new mortuary which has not been operationalized with

plumbing work and remaining to done.

ii) The hospital has a poor drainage system.

iii) The entire facility looks worn out hence require overall renovation.

8. MARINDI SUBCOUNTY HOSPITAL.

The facility is located at Marindi Centre in Homa Bay East Ward, Homa Bay Town

Sub-County. The hospital offers services to approximately 50-70 patients on a daily

basis. There are no charges for the services offered in the facility.

1. The facility offers the following services

i) It offers out-patient, post-natal, anti-natal services among others.

ii) The facility has three wards each room with three beds.

iii) The facility received drugs sometimes back from KEMSA

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iv) The facility lacks enough laboratory reagents which are very expensive to

the facility.

v) Lack of adequate space for storage of drugs.

The facility has the following staff establishment


i. Poor access control since it has no fence.

ii. The facility has accumulated a lot of pending bills on supply of foodstuff and

Casual staff wages since some have not been paid since August 2017.

iii. .


BY COUNTY

GVT

EMPLOYED

BY DONORS


2 Pharmacists 01 0


4 Nurses 06 03


6 Community H.W 0 0


7 Clerks 05 0

7 Administrators/

H.R.O

02 0

8 Accountants 0 0


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iv. Lack of enough staff like the Laboratory needs additional lab technician.

v. The facility does not meet the standard of a Sub County hospital for it does not

provide other services hence should be upgraded.

9. OGONGO HEALTH CENTER

Ogongo Health Center is a level three hospital situated in Lambwe Ward in Suba

North Sub-County. The facility serves averagely 100-120 patients on a daily basis.

1 The hospital offers the following services;

i) Ward Services- the facility has two wards, male and female where

the services are being offered. However, the facility lacks a

pediatric ward forcing the pediatric patients to be mixed with

adult patients an exercise which is not acceptable in medical

services practice.

2 The hospital has the following staff establishment

.No DESIGNATION EMPLOYED

BY COUNTY

GVT

EMPLOYED

BY DONORS


2 Pharmacists 01 0


4 Nurses 03 01




7 Physiotherapy 0 0

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7 Administrators/

H.R.O

01 0

8 Accountants 0 0


2 The hospital faces the following challenges

i) The facility suffers from lack of non-pharmaceutical items. The county

government does not regularly supply the facility with these essential

materials.

ii) The hospital does not have sewerage system, this hampers ward

operations especially at the maternity wing. At the same time the facility

lacks running water which is a basic requirement for a health facility.

iii) The facility offers maternity services in a squeezed room; there is urgent

need for construction of a new maternity block to serve the ever

increasing number of the patients.

iv) Lack of technical personnel to undertake critical responsibilities in the

facility. The hospital is seriously understaffed and most services are

offered by staff who are contracted by development partners.

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COMMITTEES GENERAL FINDINGS

1. ALLOCATION FOR THE DEPARTMENT

In the FY 2017/2018 the Department of Health Services was allocated

Kshs 1,854,743,955 for recurrent and Kshs 300,000,000 for development,

this was revised upward through the Supplementary Budget Estimate for the

FY 2017/2018 to Kshs 1,976,385,816 for Recurrent and Kshs.340,000,000

for Development.

2. PENDING BILLS

The County Government is obliged by Article 43 of the COK 2010 to provide

highest attainable standard of health, which includes the right to health care

services including reproductive health care. In light of this the committee

noted huge pending bills in all the sub county Hospitals, This undermines

access to medical commodities and food for inpatients sometimes leaving

patients hungry due to lack of supplier confidence and non-committal by the

County Government to meeting all its obligations with regards to pending

bills.

3. LACK OF LINEN

In today’s medical care Linen management plays a great role in patient satisfaction

since it doesn’t only reduce the infection rate but also physical satisfaction.

Linen lose is a huge issue in the health sector in our county. This is causing serious

patient dignity issue and has been bad enough in the recent past. most of the sub

county hospitals are experiencing challenges due to lack of linen making the patients

to sleep on mattresses without cover like in Ndhiwa sub county Hospital which has

only three pieces of linen. This occurs due to lack of funds to procure the linen by the

County Government.

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4. SUPPLY AND UNAVAILABILITY OF ESSENTIAL DRUGS

AND MEDICAL EQUIPMENT’S

The Kenya health system is structured in a stepwise manner so that

complicated health cases are referred to a higher level. Dispensaries and

health centers are the lowest units followed by the sub county or sub district

hospital. The committee noted that Kenya Medical Supplies Agency

(KEMSA) is the major supplier and distributor of drugs in Homa-bay

County since it provide medical supplies to public health facilities at

affordable cost. Despite that there is frequency of drug shortages which has

led to negative impact on patient care, burden on health care providers and

affected facility finances causing the huge pending bills.

There are allegation that sometimes KEMSA decline to supply the drugs

because of huge debt owed by the county Government and diversion of

fund disbursed for free maternity services to other areas , further worsening

the situation in the health sector .

The health workers reported lack of essential drugs for treating diseases

such as pneumonia and diarrhea in most of the facilities and further

confirmed that patients buy drugs from elsewhere making service delivery a

challenge, despite the orders done, the drug supplies are received over three

months later after making an order. Reorder period should be improved.

5. UNDER STAFFING

The County Government is trying its best to manage the wage bill in

order to comply with Section 107(2) (a) of the PFM Act 2012, the

department receives highest allocation for personal emolument. There is

poor nurse to patient ratio as major factor undermining the provision of

safe and high quality health care. In most sub county hospitals the nurses

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are often asked to cover more patients than they should be handling or

working longer hours.

There is urgent need by the department to analyze the existing workforce in

this department to avoid payment of salaries to ghost workers.

6. LACK OF FUNDS

It is observed that some of the sub county hospitals have not received

any fund from the County Government this financial year thereby

making it difficult to operate due to accumulated bills.

This leaving the facilities with no option but to pay their expenses from

amount received from Linda Mama, collection from FIF and remittance

received from National Hospital Insurance Fund (NHIF) which is never

enough to run all the operations in the sub county hospitals. There

should be a serious internal audit carried out by the department on the

use of funds and authenticate the pending bills in the sub county

hospitals to avoid any embezzlement of public funds.

7. FENCING AND ACCESS CONTROL

Security is a very important aspect in a facility, the committee noted that

most of the of the sub county hospitals are not fenced for access

control. However most facilities have outsourced for security services as

a way of managing security but this is never enough since it doesn’t

prevent trespassing and encroachment of public land hence putting the

nurses and patient life at a great risk.

8. SUPPORT PARTNERS

The committee would wish to acknowledge the support given by the

following partners MSF, EGPAF, FACES , Kenya Red cross/ADS,

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LVCT, and AHF Amongst others in our health facilities for their

contribution towards the health sector. We fully appreciate the

importance of support partners in rebuilding the health sector and

looking forward to cooperate on the basis of accountability, transparency

and comprehensiveness to support our County Government health care

standard.

9. GAZETTMENT

In accordance with legal notice No 151 of 2013 the health facility

management committees for both referral hospital and level four hospitals

were selected as per the selection procedure given out in the in the notice ,

once the nomination process is completed the CECM in charge of Health

services should gazette the list to enable the board assume office. This

procedure has not been followed by the department and there is urgent

need for the department to approve and gazette the board member.

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6.0 COMMITTEES RECOMMENDATIONS

1. The Department should consider coming up with the Health Services Bill to

provide for the implementation of Section 2 of the Fourth Schedule of the

Constitution of Kenya 2010, which would provide legal framework for promoting

access to health services, facilitating realization of right to health care as provided

under Article 43 of the Constitution and facilitating realization of Consumer

Health Right in accordance with Article 43 of the Constitution of Kenya 2010.

2. The County Treasury in collaboration with the Department of Health Services

should set up technical team to authenticate the stock of pending bills and ensure

that all the pending bill in Sub County Hospitals are included in the budget for the

FY/ 2018/2019,to ease the debt burden for the Sub County Hospitals.

3. There is urgent need for the department to review its County list of essential drugs

and medical commodities in consultation with the management committee in each

Sub County Hospital as this would avoid shortages, prevent excess stocks and

improve the supply of essential drugs in our Health Facilities.

4. County Executive Committee Members to provide Quarterly Reports on the

Status of Health Facilities to the County Assembly in line with the provisions of

Article 153(4) (b) of the Constitution of Kenya, 2010 as read together with

standing order No 182.

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5. There is need for skill audit in this Department to enable it have right staff with

right skill hence the CEC in charge of health services to submit a report on the

County Assembly on the number of staff in the department and their specific

work stations.

6. The County Treasury should ensure that all spending entities receive funds as

Appropriated.

7. There should be more allocations to the Health Sector by the County Treasury

and the department to come up with strategies to strengthen existing partners and

incorporate more partners.

8. The department should submit to the assembly details of staff establishment in

PRAYER

The health services Committee prays that this Honorable House do adopt

this report.

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APPENDIXES

Homa Bay County Teaching and Referral Hospital (Delivery Bed at the Maternity

Wing)

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republic of kenya homa bay county assembly second …

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