Report On The Inspection Tour Of County Referral Hospitals In Kisii, Nyamira And Bomet Counties

CGa lPr"{{d +o"\ @ flo^ ' Aw r Ly .IH I RTEE\TH P,\III,I,,\]I ENT THE SE.\.ATE THE STANDING COMMITTEE ON HEAUI'H PORT ON THE INSPECTION TOUR OF COUNTY REFERRAL HOSPITALS IN KISII. NYAMIRA AND BOMET COUNTIES Lory v (r Ms' tr\ 0\ al}ta.n* zfl= rts 5;= hambcrs. t $uildings, rl _b MAY,2024 R s L- \ I Cler Parli I 2 -g tl -l---- >l rOF ttt sr$ co\o

a TABLIi ()F CONTENT'S List of Annexures List of Abbreviations A. Establishrnent and Mandatc of the Stai,'iing Committee on Health B. Functions of the Conrrnittee C. Govcrnment Agencies arrd Departrnents D. Comnrittee Membership CHAI RPERSON'S FOREWORD ADOPTION OF THE REPORT OF THE STANDING COMMITTEE ON HEALTH OF THE SENATE CHAPTER ONE INTRODUCTION A. Background B. Methodology CHAPTER TWO COMMITTEE PROCEEDINGS A. BOMET COUNTY l. Visit to Longisa County Referral Hospital 2. Submissions by the County Executive B. NYAMIRA COUNTY l) Visit to Ekerenyo Sub-County Hospital 2) Visit to Nyan.rira County Referral Hospital 3) Submissions by Hcaltlr Worker Union Representatives 4) PosrBriefing Meeting at the Govemor's Office C. KISII COUNTY l. Visit to Kisii Teaching Referral Hospital 2. Visit to Kenyenya Sub-County Hospital 3. Post-Briefing Meeting with the Governor CHAPTER THREE COM M ITTEE OBSERVATIONS CHAPTER FOUR COM MITTEE RECOMM ENDATIONS I 2 4 4 4 5 6 8 9 9 I l0 lt 1l ll 1l l3 l5 t6 t6 t7 l8 t9 l9 2t 22 24 24 29 29 1

I 2 List of Anne xures Minutes Copy of the County Visit Prograrn 2 I 2

A&E CBA CECM CHS CHW CRH CS CT DG GIS HR ICU KCB KEMSA KMPDU MES NCD NG NHIF PHS PMS PSC List of Abbreviations Accident and Ernergency Collective Bargaining agreement County Executive Cornmittee Members Conrmunity Hcalth Service Comrnunity Health Worker County Referral Hospital Cesarean Section Cornputed Tomography Deputy Governor Geographic Information System (GIS) Human Resource Intensive Care Unit Kenya Comrnercial Bank Kenya Medical and Supplies Authority Kenya Medical Practitioners and Dentist Union Medical Equipment Service Non-Cornmunicable Diseases National Governrnent National Health Insurance Fund Primary Health Services Performance Managernent System Public Service Commission 3

The and t all nt Purs 2 J 4 5 6 1 8 s)l A Es B. an( F' tet, ,l "'J ,nl m1 ,rl st! o'l 'l Stil u'l obi "l-! ,"1 Md ini Cd s.] 'l Fol .nl rcl C nct oS PRELIMINARIES la(lishment and Mandate of the Standing Committee on Health lin! Committee on Health is established pursuant to standing order 228 (3) ourth Schedule of the Senate Standing Orders and is mandaled to con.sider s rblating to medical services, public health and sanitation. ions of the Committee tanding Order 228(4), the Committee functions to 'estigate,, inquire into, and report on all rnatters relating to the mandate, na$ement, activities, administration and operations of its assigned ministries I dppartments; raf ttre programme and policy objectives of its assigned ministries and ladments, and the effectiveness of the implementation thereof; rdy and review all legislation referred to it: rd/ assess and analyze the success of the ministries and departments igried to it as measured by the results obtained as compared with their stated ectives; nsi]der the Budget Policy Statement in line with the Committee's mandate; poft on all appointments where the Constitution or any law reqr"rires the :atb to approve; rke reports and recommendations to the Senate as often as possiblc, luding recommendations for proposed legislation; nsi]der reports of Commissions and Independent Offices subn.ritted to the ratb oursuant to the provisions of Article 254 of the Constitution; aniine any statements raised by Senators on a matter within its mandate; and llo{ry up and report on the status of implementation of resolution within their nd[te. vernment Agencies and Departments its mandate, the Committee oversees the County Govenrments, the Health and its various Semi-Autonomous Government Agencies Go sing of 4 I In cxe Minis (SAGI 0. 9 I

D. Committee Membership TIre Standing Cornn-rittee on Health was constituted by tl.re House on 2J't' October, 2022, and comprises of the following Members - Jacl<son Kiplagat Manda,eo, EGH, MP Marian-r Sheikh Ornar. MP Erick Okong'o Mogeni, SC, MP Ledarna Olekina, MP, Abdul Moharrmed Haji, MP Joseph Nyutu Ngugi, MP Raphael Chirnera Mwinzagu, MP Han.rida Kibwana, MP, Esther Anyieni Okenyuri, MP E. Cornmittec Secretariat Thc Cornn.rittee Secretariat comprises the following staff - l. Sen 2. Ser.r 3. Sen 4. Scn 5. Sen 6. Sen 7. Sen 8. Sen 9. Sen Chairperson Vice-Chairperson Mernber Member Member Member Member Member Member l. Ms 2. Mr, 3. Mr, 4. Dr. 5. Ms 6. Mr, 7. Ms U. Mr, 9. Mr, 10. Ms ILMr, Mary Chesire Boniface Lenairosl.ri Stephen Gikonyo Christine Sagini Florence Waweru Mitchelle Otoro Lilian Onyari Dennis Amunavi Victor Kimani Hawa Abdi David Muthuri Director, Socio-Economic Services Deputy Director Principal Clerk Lead Committee Clerk Comrnittee Clerk Assistant Legal Counsel Fiscal Analyst Research Officer Audio Officer Sergeant-at-Arms Intern 5

Th aul Th Se Ho dat Sta Mo ls, the cou In SC rep ln the The arc On and I al ancl CHAIRPERSOYS FOREWORD ll Committee on Health conducted a fact-finding tour of Bornet. Nyarnira ll o nties between 30'r'October, 2023, and 3'd November,2023 t S Llr cr triggered by requests for Statements by Sen. Richard Onyonka, MP, County, regarding the state of operations in Kisii Teaching and Ret'crral the closure of Nyamarambe Health Center. At sittings held on divcrse Committee resolved to conduct visits in the neighboring counties, that d Bomet Counties, to assess the state of health care services; understand l1 S, S nding Committee on Health deliberated on the matters arising fi'om thc l.) d resolved to conduct an inspection tour of health ftrcilitics in Kisir t u a hievements, issues, and challenges facing health service delivery in the recornmend remedial measures and interventions by thc Scrratc llt the visits, the Committee met with key parties in rclation to thc hcalth ta o c ry in the respective counties, including: the respectivc Govcrnors or thctr d ln presentatrves s, relevant members of the County Executive Cornmittees, Chief ealth,, members of the County Health Management Tearns and hospital o11l have ["ina sLlpp t rt1 e also reviewed relevant documents and memoranda as sr.rbrnittecl by ec county governments ltt e findings, observations and recommendations arising fionl this process d Ack <,F mcnts f the Committee, I wish to thank the Area Senators of Bornet, Nyarnira o t a thank the respective County Executives led by the County Govcrnors, ty Assemblies led by their Speakers, for the fruitful deliberations that d in the production of this report. to thank the Offices of the Speaker and Clerk of the Senate for their the entire process of considering this matter. IS 6 rll I IS u le lf Ki S tal thc CrlLrnty. The C in this repolt. tfreir full participation and cooperation during the course of tl.re tour. v,

lt is now my pleasant duty and privilege to present this report of the Standing Conrrr.rittee on Health, for consideration and approval by the House pursuant to Standing Ordcr No. 223 (6) of the Senate Standing Orders. Sign a o6 LO Datc SEN. JACKSON KIPLAGAT MANDAGO, EGH. MP CHAIRPERSON. STANDING COMMITTEE ON HEALTH ( 7

Otr\ OF THE REPORT OF THE SENATE STANDING COMMITTEE LTH ON THE INSPECTION TOUR OF COUNTY REFERRAL LS IN KISII, NYAMIRA AND BOMET COUNTIES pend our signatures to adopt the Report- We, here HO AD ON PTI HE, PIT her ,ya N Designation Signature l. Se n.J ackson Kiplagat Mandago, EGH, MP Chairperson lariam Sheikh Omar, MP Vice- Chairperson \J ".--:,/ Se n.E )rick Okong'o Mogeni, SC, MP Member Member li^^.- -l-. 1 I Srn.l ,edama Ole kina, MP Laphael Chimera Mwinzagu, MP Mernber L rL<---\ Scn.J re Nyutu Ngugi, MP Member Se n. I ,bdul Moharnrned Haji, MP Mernber Sen. I-lamida Kibwana, MP Member \ f\tr-" Set r. Lrt ,thdr Anyieni Okenyuri, MF Mernber ndersigned Members of the Senate Standing Committee on Health, do anlc Sen. I _..----- Scn. I I <_---

St o the Ii r1-l CO c Ptr nt )n -) S Co rtt r 5 1 -) 4 r 2 rt ee that is of county-wide, inter-county, national, regional or international this provision, at the sitting of the Senate held on Thr.rrsday, 25,t May, or o S CHAPTER ONE INTRODUCTIO\ o ncl er 53 (l) of the Senate Standing Orders provides that a Senator may Staternent from a committee relating to ally matter under the rrandate ol Richard Onyonka, MP, requested for Staternents fron.t n Health regarding - the Standing ate of operations in Kisii Teaching and Referral Hospital. The Committee quested to- State the reasons for the inordinate delay in opening the mother and child wing of the KisiiTeaching and Referral Hospital; Table a detailed report on the operational capacity of medical equipr.neut in use, the availability of drugs and the capacity of essential hospital facilities, giving reasons for any observed deficiencies; Indicate whether a system has been put in place to monitor and control the distribution of medicines to health facilities in Kisii County, and if not, state when it will be irnplerrented, indicating tl.re timeframes; Disclose how much revenue the hospital has collected since September 2022, stating the specific accounts where funds were deposited; and Ur.rdertake all assessrrent visit to Kisii Teaching and Ref'erral Hospital to assess its operational capacity and the availability ofbasio services such as running water. osure of Nyamarambe Health Center. In the Staternent, the Committec quested to- State the reasons for the closure by Kisii County Govemrnent of Nyarnararnbe Health Center which serves lnany residents of South Mugirango Constituency ar.rd indicate when it will re-opened; Explain the measures in place to ensure that affected residents continue to access goven'rment nedical care for the duration of the closure of the facility; and Table a report on all the Health facilities in Kisii County, stating the number of doctors, clinical officers, nurses, and other healthcare professionals posted to each facility. 9 reqluq ,\. B I] I ilc wa

At ma Mo IS, the In SE Ex Tea Th the pro ld on diverse dates, the Standing Cornrnittee on Health deliberated on the SI from the Statements and resolved to conduct an inspection tour of li s in Kisii County h cr LI c Comrnittee resolved to conduct visits in the neighboring cor"rntics, that d Bomet Counties, to assess the state of health care services; undcrstand hievements, issues, and challenges facing health service delivery in the recommend remedial measures and interventions by tlrc Senate. dology h o LI ln the visits, the Cornrnittee met with key parlies conccrtring thc hcaltlr d Ii ery in the respective counties, including members of the County ve hief Officers of Health, members of the County Health Management al management representatives, and health worker reprcsentatives ee also reviewed relevant documents and memoranda as submitted by IV county govemments ee's findings, observations, and recommendations arising frorn this a p 10 hcaltlr contained in this report. thc countibs; Thc C B.

CHAPTER TWO CO]\I}I I'I'TEE PROCEEDI \GS A. BOMETCOUNTY Tlrc Cornmittee visited Bomet County on Monday, 30'r' October, 2023, in the cornpany of thc Area Senator. Thc Cornrnittee nlet with representatives of the County Executive led by the Govcrnor. Other mernbers of the County Executive present included; the County Secretary, the CEC Member of Health, the Chief Officer of Health, Members of the County Health Management Team and health worker representatives. In addition, the Conrnrittce rnet witlr Members of the Health Cor.nmittee of the County Assernbly of Bonret led by the Chairperson and Vice Chairperson. l. Visit to Longisa County Referral Hospital The Cornn.rittee comnrenced with a visit to Longisa County Referral Hospital where they rnet with Members of the Health Committee of the County Assernbly of Bomet. The Chairperson of the Health Committee of the County Assembly of Bomet extended a warm welcomc to the Senate Cornrnittee on Health on behalf of his Committee, and acknowledged the Senate's role in strengthening devolved health services. He further statcd his cornmitrnent to work with the Senate Health Committee to improve oversight. 11 The Cor-nrnittee then proceeded to conduct a visit of the facilities at Longisa County Referral Hospital where the following observations were made - a\ Mother-Child Clinic: The Committee observed that whereas antenatal services, farnily planning, CS screening, and HIV testing were available at the hospital, there was an apparent staff shortage in the triage services for rnothers with only seven (7) staff mernbers i.e three nurses in the nutrition departrnent, three clinicians for pediatrics and sick mothers, and one lab technician, each working 8 hours per day. The Committee further observed that triage services contained nine service delivery points, against six nurses, thus indicating a defi ciency of three nurses. b) Drugs and supplies: The facility reported a shortage of anti-TB drugs. c) Specialized equipment: The Comrnittee found four staff on duty at the tirne of the visit, and were informed that the CT scan center served l0-15 patients per day, at an average cost of Kshs. 6000 for non-NHIF patients. The Committee further took note that the facility reported occasional downtime with MES equipment and the CT scan, impacting report generation and compromising service delivery. With regards to ultrasound services, the Committee found that ultrasound services were offered on a 24-hour schedule, and that the hospital catered to a

r) d) e) s) h) de Lu 2l la sp wi wl alt th th hi th o co an th pa be Th co VI AS Itu tn tTl In Ve SO th S/ st LI th co C s i) th IZ Th Volume of patients with approximately 60 patients per day. However, therc e feports of downtime owing to software and battery issues. In relation to apove, the Committee observed the need to strengthen the rnaintenancc ar(ment at the hospital to minimize downtirne. oratorv: The Committee found that the laboratory dcparttnent consistccl of st4ff. with 3 under UHC and l7 in pennanent positions, including only one tfchnician. The Committee noted that the hospital providcd routinc and ci{l tests but faced challenges with TB detection due to cartridgc slrortagcs. h [egards to TB detection, at the tirne of the visit, the f-acility had bccn olrt cartridges for two weeks and had resorted to using microscopy as an mftive. [t was further reported that the facility had ordered cartridges from N{tional TB Program but was yet to receive them. afur: The Committee observed that there was a main theater, a maternity t$, and an oncology theater that were well equipped but facing workforce st{aints with only 5 orthopedic surgeons, 2 general surgeons, and I sthetist in the main theater. te*nity: The Committee noted that a high volume of patients was handled at mfternity ward with 540 patients on average per month. During the visit, 46 erits were admitted. against a bed capacity of 39 indicating a need for more s {nd staffing. rirard reported l3 nurses,2 gynecologists,4 medical officers,2 medical cef intems, and l0 clinical officer interns with two doctors and 2-3 nurscs erfng each shift. and handling l5 to 20 deliveries daily. At the tirne of thc t $ nurses were on study leave. It was further reported that thc rnaternity d had a bed occupancy rate of90%o occLtpancy, lcading to bcd sharing niive Cure IJnil (ICU): The Comrnittee fbund that thc ICU had 2 tilptors, l3 nurses (including 3 ICU nurses),5 specialists and 3 pcdiatricians e lof whom included Cuban doctors. The Committee however noted that e lrvas uncertainty regarding the continuation of the Cuban doctors' serviccs he[ were approaching the end of their MOU al tlnit: The renal unit consisted of 5 nurses, 2 medical officers, and I itlonist, along with 2 biomedical engineers. There wcrc a total of I I hlnes. of which 3 were non-operational at the time of the visit. Of the I I hines, 8 were provided by the county while 6 were supplied by MES. The r'frittee further noted that there were reported challenges with machrne (ing which often extended beyond the recommended six-month threshold. Re oC'll tet cnt A l t ll Ir t f h h t c o c S la as rccc ll K B M SA L^ v ty lt d a S II h fi a S a f p c S o lt s c L^ o l1 lr a acccp allcc C ()n1 nt cc t t c dver, the Committee observed that store records were poorly kcpt and that were challenges in producing request documentation ancl rccciving ete orders from KEMSA. In relation to this, thc Committcc notecl that was a need to streamline documcntatioll proccsscs at thc hospital to p l]

irnprove efficiencies, and ensure timely and complete deliveries from suppliers like KEMSA. j) Mortuary.' The Committee noted that the hospital utilized outdated embalming rnethods. Plans for mortuary expansion were reported to be in progress, even as the Committee recommended benchmarking with Ahero Sub-County Hospital which utilized updated preservation techniques which involved draining body fluids followed by pressurized purnping allowing for bodies to be preserved for up to 2l days without refrigeration. The Comrnittee further recornrnended that the hospital adopt updated ernbalming techniques for improved preservation and opcrational effi cicncy. k) Oxygen Plant: The Con.rmittee found that the hospital had an oxygen plant with a capacity of producing 9000 liters of oxygen per hour. However, it was observed that there were challenges with refilling arrangements with the hospital reporting that it had received a 3,000-liter liquid oxygen plant from the Ministry of Health through AMREF. Initially informed that the plant would be refilled for free. the Committee was informed that after two weeks of use, the supplier declined to refill, stating that the hospital was responsible for refilling. In light of the above, the Cornmittee noted the need to clarify responsibilities and agreements with the supplier to ensure continuous oxygen availability at the hospital. 2. Submissions by the County Executive The visit to the county referral hospital was followed by a post-briefing meeting at the Govemor's Office where the Cornmittee was warmly received. The Chair remarked that the committee had a successful visit to Longisa County Hospital. He then went on to inform the County Executive led by the Governor, of the Committee's findings as summarized below - a) Clinical Services Performance.' Longisa Hospital was recognized for its cornrnendable perfonnance in clinical services and treatment, achieving an impressive score of 80o%. h) Recorcl Maintensnce snd Procurement Proces.se.s.' The committee observed challcnges in record uraintenance, noting disorderliness in tlre record-keeping systenr as evidenced by the following -

• Discrepancies in the records, such as information on bill cards not

aligning with actual stock.

• Procurernent processes did not align with the Public Procurement and

Disposal Act which require an inspection and acceptance committee of at least four people.

• Record-keeping irregularities with the receiving process, and reliance on

KEMSA records instead of maintaining facility records for comparison. 13

c) d) s) h) 0 i) j) k) Or prc KE InJ wa exl the Re adr cot the Hrt iml pel clit Mt rec irn An hit of Se sys anr Ittt dis Mt the Ex chi Th LIN tlre IC

• Some procurement officers were found to have expired licenses,

highlighting a need for rectification in procurement procedures. fie\ fin Rale.' KEMSA's filI rate for essential drugs was noted to be low lmfting the Chairperson to commit to addressing this matter directly with IMSA. lra$tructural Capacity Issues: The Chair noted that the current ward design ! intended for 64 patients and was inadequate as the patient load sometilncs enfed to 120. Urgent facility expansion was recommended to accommodate higher patient volume effectively. Ital Deportmenr.' Positive recognition was given to the county's provision of [iti6nat equipment in the renal unit. The Chair recommended the cour-rty frsi{er acquiring a nephrologist to enhance medical expertise and services in refral department. lmbn Resource Development and Training: The cornrnittee stresscd the bofance of comprehensive training opportr,rnities for all healthcarc fsohnel, emphasizing inclusive training initiatives for doctors, nurses., hical officers, and other staffcategories. lrt*sry Expansion: Inadequacy in the mortuary size was noted, witll lonlmendations for expansion and updating embalming techniques for [rdved preservation and operational efficiency noted. ti-f B drugs: Shortages of reagents and consumables in the TB sector were lhllghted. with the Chair committing to take up the rnatter with the Ministry Ft.httt to prevent interruptions in TB patient treatment. lur[ Srnr*, [t was noted that there was a need to reconstruct the sewer Iteilr using an alternative approach that promotes environmental friendliness I cpst-effectiveness. lerfiship: An excess of interns and students at the hospital was noted, with a pr{portionate teacher-intem to patient ratio. Itelnity: Concerns were raised about lack of privacy and sharing of beds in I gortpu.tum and postnatal section of the maternity wing. The County pcrftive Committee assured that issues with privacy and human resource Illdnges would be addressed within 30 days. eoler lJnits and Cuban Doctor in ICU: Increasing the number of theater fts was advised to maximize the use of available surgeon doctors. Further, I di:cislon regarding the retention or replacement of the Cuban doctor in tl.re ! was left to the county's discretion. 14 e) r)

t1i) Management of Expired Drugs ond Commodities: The committee reqr"rested records of expired drugs from the facility to address issues of oversupply and ensurc availability of essential commodities. ln his rernarks,, the Govemor expressed appreciation for the Committee's feedback, and pledged to act where areas for improvement had been identified. He further noted that- - a) The County aimed to elevate Longisa Referral Hospital from a level 4 to a level 5 facility. b) A new mother-child facility, scheduled for completion in November 2023, airned to alleviate congestion, particularly in the maternity sector. c) Action would be taken to address record-keeping and drug procurement processes. d) Regarding sewerage, it was noted tliat tl.rere was an ongoing court dispute for whiclr a resolution was being sought. e) A budget allocation was planned to address upgrading of the lnortuary facilities. f) The County was aware of challenges in the delivery room, including bed-sharing and privacy issues. He noted that vocational training centers had been tasked with producing curtains by March 2024 to address privacy concerns. g) On the retention of Cuban doctors, the Govemor emphasized the need to rer.regotiate with the National Govemment to retain Cuban doctors due to their positive impact on the health sector. h) Issues with equipment, particularly the CT scan were due to contractual problems, and amicable solutions were being sought. He concluded by expressing gratitr.rde to the Committee for their visit and committing to addressing the issues raised. He further emphasized Bomet's readiness to implement Universal Health Coverage (UHC) with a significant investment in community health services. 1E IJ

The c()m an l'l-re po Gov Secr ta Cou 1 Duri SCTVI tlre ty a b The follo a \ AMIRA COUNTY mlittee visited Nyamira County on Monday, 30'r' October, 2023, in the of the Area Senator nlittee met with representatives of the County Executivc led by the bther members of the County Executive present included: the CoLrnty , t[re CEC Member of Health, the Chief Officer of Health, Mcmbers of the eafth Management Team and health worker representatives o nl() V I lir S p ln h it to Ekerenyo Sub-County Hospital ipnpromptu visit en route to Nyamira County, the Comrnittee assessed the livery and general operations at Ekerenyo Sub-County Hospital and made ing observations - a ll ryrnity llord: Three beds were available, with ongoing constructiorl pbrted by the National and Finland governments for facility expansion. The vaiy of patients was compromised owing to the lack of curtains and bed 5L cns ld Wurd: The Committee observed that the male ward had bare winclows I tact of bed screens, highlighting concerns for patient comfbrt and L baratory: The Committee found that the hospital rr'rns a full-tir.ne laboratory th t'is staffed with two lab technicians. Basic tests provided inch.rded h 4tology tests, malaria, and typhoid screening. The Committee observed that th re was evidence of efficient management of laboratory supplies, adeqttate st cl6, and effective records management through the proper use of bin cards ST fir ility, indicating low staff morale li\ation of hospital services: Utilization of the hospital scrvices was very lo particularly in the labor ward where only one patient was obscrved it to )rl1'amira Count.v" Refcrral Hospital o mfttee then proceeded to Nyamira County Referral Hospital where the o$servations were made - arlnacy: The Pharmacist-in-charge took Members through the Pharrnacy D paftment. He confirtned that drugs were sourced from KEMSA, with the pi,tal having two pharmacy stores for oral and injectable drr-rgs K MSe ntt rate was reported to be 60% which marked an irnprovement fiotn 4 o, with essential drugs having a fill ratc of 40oh. ln relation to the sarnc, he St ted that the hospital had received drugs worth Ksh. l3 rnillion against an er of Ksh. 25 million. He confirmed that the hospital used an HMIS system r vacy or lC) T B. ) ) cI d) c) motivation: Lower than expected nurnber of staff wcrc fottnd at the 2) vi ) I

for stock control and that all hospital drugs were branded as GOK to prevent diversion to private phannacies. He however noted that while KEMSA drugs were usually branded, tl.ris was not always the case and that they had raised it as a concern to KEMSA. On the disposal of expired drugs, the Pharmacist reported that the hospital followed the laid down public health procedures. Orr the adequacy of the drug supplies, it was reported to Mernbers that the county had committed a budget of Kshs.40 million forthe purchase of drugs for use across 136 health facilities in the county, against an initial budget of Kshs. 120 rnillion. With regards to the county referral hospital, he reported that through its FIF, Kshs. 42 rnillion had been budgeted for the purchase of drugs against an annual target collection of Kshs. 200 million. Health worker union representatives indicated that they enjoyed a positive working rclationship with the county and urged the Senate to ensure adequate resource allocation to support devolution. However, the union officials raised concenrs about 17 b) Lahoratory Services: The laboratory offered various services including parasitology, budget hematology, renal tests, liver tests, and endocrine tests. The Cornmittee was further informed that laboratory services were chargeable at affordable rates or free. Notably, the Committee found that the laboratory was well-equipped and that it had sufficient reagents. c') Moternity lling: Staffing in the rnaternity section included I gynecologist, 4 nredical officers, l4 nurses,6 clinical officer interns, and I medical officer intcrn. At the time of the visit, the hospital reported approximately 43 deliveries with 13 beir.rg caesarian sections. On average, the hospital recorded 100-200 against a ward bed capacity of42. The newborn unit was well-equipped and had low mortality rates. d1 Mortuary.' At the time of the meeting, the rnortuary was under renovation, with non-functional facilities including fridges. The committee urged the lnanagernctlt to ensure renovations are completed promptly to resume services. e) Hospital Plaza: The Committee observed that a hospital plaza whose construction started 5 years ago was only partially operational and poorly equipped. Whereas the hospital reported that inpatient services were expected to be available from January 2024to alleviate congestion at the main hospital, Mcrnbers noted that while construction was complete, of the sections of the plaza it had inspected, only a fridge and office desk were found. The Committee therefore urged the management to expedite the equipping of the facility, and the engagement of medical specialists and consultants to make it operational. 3) Submissions by Health Worker Union Representatives

a e 2 3 a 2 4 5 ch (t ith inter-county transfers, emphasizing difficulties in obtaining transfers Th on iterated that such issues would be addressed by both thc county and the v t riefing Meeting at the Governor's Office r welcomed the Committee and thanked the comrnittee for their visit to Ny ral o ty o ittee in oversight of the devolved health firnction ancl ernphasizcci thc rolc on, Standing Committee on Health of the Senate, highlighted the work in ensuring that counties are protected and supportcd in cxccuting thcir tc He nyo Sub-County Hospital The facility, operating as a level 4 hospital, should function as a sub-county referral center. However, despite the visit having occurrcd during official working hours, the Committee had arrived at the fbcility to find staffpreparing to leave for the day, indicating low staff morale. While the facility was fairly staffed, uptake of services by the pLrblic was a matter of concern, particularly in the labor ward where only one patient was observed. Patient privacy particularly in the maternity department was a concern owing to lack of curtains or bed screens at the hospital. The cleanliness of the facility was up to standard and was cornrnendablc. Footpaths within the hospital needed improvement and shcltering, especially during thc rainy seasons. ira County Referral Hospital The drugs store was well-stocked, indicating good drug supply, but thcrc were issues with poor record management that needed improvctncnt. Maternity staffing was adequate, but the Comrnittec rccolntnendecl installing curtains and providing bed screerts to enhancc privacy tbr mothers. There was a need to complete the construction and equipping of thc COVID center/doctor's plaza to optimize operations and alleviate hospital congestion. Reopening of the mortuary was advised to cater for mernbers of the public who could not afford morgue services at private facilities. h E N 1B I The ) The Hpalth Human Resource Advisory Council. tc pfovided feedback of the Committee's visit as summarized below - of ihd oi ir,tr A u. TI 4

5. Harrnonization of training across all cadres of doctors was recornrnended to irnprove expertise and morale across the healthcare sector. 6. The county budget allocation for procurement of drugs was insufficient to meet the hospital's needs. Based on the Committee's concems and feedback, the Governor gave the following response - l. He requested the Senate to support counties by acting to ensure that KEMSA is able to supply actual counties' needs, indicating that while the order fill rate had improved, it was still very low. 2. He committed to increasing the budget allocation for drugs significantly. Specifically, the allocation would be raised from Ksh. 40 million to Ksh. 80 million in the supplementary budget. 3. The Covernor assured the committee that the Doctors Plaza would be made operational soon. 4. Regarding the mortuary, the Govemor pledged to ensure that renovations are completed promptly so that the facility could be restored for use by the public. 19

I I On Fr the A aS ltl Ou Kis o lca sub wo the wa sho lIo l11 n1a SC an fac u'lt ret ,t -t d 4 6 1 b ot'\'r'\ ts t tb Kisii Teaching Referral Hospital 3'lNovernber,2023, the Committee visitcd Kisii County in tl.re cornpany of ay nator. ittee commenced with a visit to Kisii Tcaching Rct'crral Hospital (KTRI'l ) er,leral issues and concerns during their totrr olient Service.s.' The hospital served 60-70 outpaticnt patients daily lionr i. {.,JVamira. Homabay. and Trans Mara regions. aslructure snd Maintenqnce: Concerns were raised about the suboptirnal cc itions of the minor outpatient theater,, nursing section furniture, and n$ tiles in various sections of the hospital. Issues observed inclrrded n[ ceilings in the drug store, faulty CCTV in the pharrnacy, and ptimal conditions in the theater and tCU. ta rng ond Workload: Various departments at the hospital faced high kl{ad and staff shortages, including oncology, pharmacy, laboratory, rnarn ter, casualty section, renal unit, and Ncwborn Unit (NBU). Further, thcrc a lack of specialists in some departrnents, irnpacting service delivcry. e(heless, the hospital was playing a commendable role in accorr.rrnodatirtg d and students, contributing to practical learning and prof'cssional q ipment and Facilitie.s.' Multiple departmcnts wcrc cxperiencing equipmcnt ages and faults, such as the Casualty Dcpartrnent which had only onc itdr, limited incubators in the Newborn Unit (NBU), and faulty nrachincs e renal unit. Further, in the radiology department, the CT scan and MRI hi{res were reported as non-functional. This had significantly harnpered ic{ detirery. rnlacy Operations: Drugs and supplies were sourced from KEMSA wrth a I fite of 600/o. It was reported that pediatric drugs were provided fbr ficc, thft this consumed a significant portion of the drug budget, and was often d [vith shortages. Record-keeping at the pharmacy was also sub-optimal tfre facility relying on hard copy records, and experiencing diflicultics rn eving patients' prescriptions due to the absence of an automated systcm. g fi[anagement snd Monitoring: The Committee noted concerns raised h r acles t fllegations of patients being asked to purchase rnedicines fiom privatc h rtdges of anti-TB drugs: There was a shortagc of anti-TB clrugs at tlrc efi hos itdl and surrounding satellite facilities at the tirne of the visit 20 C. KIS Thc C anrl notcd 2 5 lSment.

8. Stores and record-keeping: The central stores at the hospital were in a state of disrepair, with the Committee noting flooding, several leaks in the ceiling and a breaking support beam. Further, drugs and supplies were found placed directly on the damp floor, and various equipment (both new and old) appeared to have been dumped or discarded, including brand new incubators and MES eqr.ripment. In addition, the records-keeping and management system was poorly kept and insufficient. 9. Operationalisation of the new wing: Construction of the new wing of the hospital was ongoing with some finishing work pending completion. l0.Hospital *,aste disposal.'The disposal of waste generated at the hospital did not meet public health standards and requirements with waste, including biological specimens being found in the open. ln addition, the incinerators appeared overwhelmed. ll.Cancer llard: The Committee found that KTRH was ready to start providing cancer treatrnent services pending inspection and certification by the National Cancer Institute of Kenya. 12. Mortuary services: Mortuary services at the hospital were exceptional, with highly motivated staff and a clean environment. l3.Congestion was observed in the Neonatal Unit (NBU) and Intensive Care Unit (lCU) due to a high influx of referral patients. l4.The hospital lacked a blood transfusion center and depended on the National Blood Transfusion Center despite high demand for the services. l5.Suboptimal perforrnance of the oxygen machine during blackouts affected theater operations. 2. Visit to Kenyenya Sub-County Hospital The Committee conducted an irnpromptu visit to Kenyenya Sub-County Hospital with thc objectives of assessing the facility's state, identifying challenges, and providing rccotnmendations for effective service delivery. The following observations were nraile during the assessrnent- l. Infrastructure and Ward Conditiazs.. The hospital was noted to be clean with optirnal structures but was underutilized, particularly in the maternity and postnatal wards which had no patients. Critical observations included suboptimal beds (not adjustable for patient comfort),, lack of curtains, mattresses, and blankets in some wards, rusty cabinets and absence of toilets and bathroorns within the wards. A stalled CDF project affected for the construction of a kitchen was observed at the facility. 2. Hospital Kitchen: The hospital's kitchen was non-operational, requiring patients' relatives to either purchase or bring food from home. 21

The met of thc Oftic thc C sulnln J 4 5 2 J II ab d cx Ilc l) cl K t Irc ST t r.l al nla 3 1 h C o De cc Sra a11 Re no co bc nc b a r e ilal toilets: Extemal pit latrines and bathrootrs were uscd due to thc nce of on-site facilities ert An inadequate water supply to the hospital wards was noted due to a ctive pump at the hospital's borehole, thus necessitating reliancc on thc en[ive Kenyenya Community Water Project fbr the hospital's watcr supply rtue Collection und Managemenl.' Revenuc collection was ccntralized at H., hindering facilities like Kenyenya Sub-County Hospital fiorn managing r own revenue for essential needs or facility improvements Supply and Management: The hospital storc was well-organized and n with up-to-date records. However, the Comrnittee noted reports of e{uate drug supplies at the facility, leading patients to purchase the orlty of medicines from external sources and Management: Thc absence of an in-charge at thc hospital was d, highlighting the importance of hospital managers being prescnt to iv! feedback and address areas for improvemcnt. ost-Briefing Meeting with the Governor ittee convened at the Governor's residcncc olllcc in Kisii County. whcrc it priesentatives of the County Executive led by the Govemor. Othcr metnbcrs rlt Alssembly of Kisii servatlons and recommendations were discussed as provided 1 thc elow - efiralization of Funds: The Cornmittee highlighted concerns about the alization of collection of funds at KTRH, noting that it was hindering r facilities from procuring essential hospital necessities. Members h{sized the need to decentralize funds to enable facilities to irnprove their stucture and purchase necessary supplies orl Management at KTRH: Serious deficiencies in record-keeping were d at KTRH, with poor and insufficient record management systems. The t, c a S ad c S a s h Cd s l1 tlc a t1 c panc c S nt h cc h Ir d Ir t d l' S h b 5 e c lt dru b n c fd ltfor111a o n a t1d Ua oc c s aC S l( 5 l1 h (, c c ffr improvement in this area c D .so r u H Sorrl r l1 h S ora c of o n t'tl ac rde K TR D t n l) cu cil S el re 22 li{uid medicines at KTRH was observed, with health products and supplies g stored alongside construction material. Additionally, the drug storage wlas in a state of disrepair necessitating immediate attention. nfy Executive present included; the CEC Mernber of Health, the Chief H{alth, Members of the County Health Managernent Team ar.rd Mernbers of Critica l 6. A lt

4. Services at KTRH: The committee acknowledged exceptional services provided at K'IRH's Mortuary and ICU,, ernphasizing cleanliness,, operational equiprnent, and dedicated staff. Tlre importance of extending this high standard of service throughout the hospital was emphasized. 5. Stalf Shortage and l{orkloud: High workload due to staff shortages was noted in varions departments at KTRH, impacting TB, Casualty,, Pharmacy, Drug Store, Newborn Unit, Laboratory, and Theater departrnents. 6. Maintenance and Repoir Needs: The committee emphasized the necessity to address maintenance issues such as floor peeling in ICU and theater, installation of CCTV in the pharrnacy, and repair of non-operational machines in the Renal Urrit at KTRH. 7. Idle Medical Equipment at KTRH: Concerns were raised about idle MES at KTRH's drug store, with recomrnendations to redistribute this equipment to lcvcl IV hospitals in the County. 8. Infrastructure Needs at Kenyenya Sub-County Hospital: Critical needs at Kcnyerrya Sub-County Hospital included essential amenities in wards (curtains, blankets, n.rosquito nets), investigation into low turnout in rnatemity ward, and addressing the abandoned CDF project. 9. Water and Kitchen Issues at Kenyenya Sub-County Hospital: Water supply arrd operational kitchen issues were identified at Kenyenya Sub-County Hospital. rcquirirrg urgent attention to ensure patient comfort and nutrition. l0.Waste Managemenl.' The comrnittee emphasized the need to modernize waste management at KTRH. In response, the Governor acknowledged the Committee's concerns, and emphasized his Governrnent's comrnitment to address the challenges facing the sector. He noted that most of the challenges facing the sector were a carryover from the previous regime, and outlined various initiatives and plans to address the identified challenges including autornation of rcvenue collection, improvements in hospital management systcnrs, procurelnent of a new oxygen plant, and allocation of budgets for infrastructure improvements as summarized below - Decentralizstion of Funds: The Governor acknowledged that issues with centralized fund collection at KTRH was hindering other facilities' procurement of basic necessities. He committed to addressing this concern to enable fbcilities to purcl.rase essential needs ar.rd irnprove their infrastructure. 2. Record Management al KTRH: Recognizing the serious lapses in KTRH's record-keeping systern highlighted by the Committee, the Governor committed to implement significant irnprovements in record management to ensure accurate and up-to-date information on drug stock and other essential inventory. a2

-) S r c rage Disorder at KTRH: The Govemor acknowledged disorder in the rdge of non-pharmaceuticals and liquid medicines at KTRH and pledged to ctify this issue to ensure proper storage conditions and prevent ntamrnatron rtices at KTRH: The Governor appreciated the exceptiorral scrvlccs or,iiaea by KTRH's Mortuary and ICU., committing to extend this high ndard ofservice throughout the entire hospital Shortage and lltorkloal.' Addressing the high workloail dr.re to staff ofiages at KTRH, the Govemor highlighted the challenge of a significant rsling gap and emphasized the need to address staffing issues to improve rvfce delivery ahienance and Repair lYeeds'. Cornrnitting to addressing Inailrtenancc ueccls KTRH, thc Governor acknowlcdged the necessity to repair cclr.ripmcnt irl the enial Unit, address floor peelings in the ICU and theater, and install CCTV in e phamacy 'e Medical Equipment st KTRH: The Govcmor supported the Cotntnittee's cornmcndation to redistribute idle MES cqLripnlent at KTRH to lcvcl IV ospitals in the County to optimize resource utilization astruclttrc Ncetls ut Kententu Suh-County Ilttsltitul:.l.ltc (iovcl'trol ll()tc(l p S S S r e infrastructure needs at Kenyenya Sub-County Hospital, inclr.rding water uppty, titcnen operations, and sanitation improvements, pledging budget .lldcation to address these issues (,.ste Managemezl: Acknowledging challenges in waste managentcnt, the oyernor highlighted ongoing collaborations to address waste disposal issucs 'harmacy Security: The importance of drug branding and digitization of hqrrnacy records for enhanced security and traceability other-Child Facility snd Equipment Procurement' Regarding thc ofher-child facility, the Govemor assured the Cornmittee that the cornpletion f the new wing would be prioritized, and procurernent of equipmcrrt initiatcd eqpite outstanding contractor issues. en plant: The Governor highlighted plans to purchase a ncw oxygcn plar.rt o pddress oxygen supply issues at KTRH and emphasized his comrnitment to mfroving healthcare infrastructure and services in the County. +. -5 6. 7 {t. 9. I0. il. ll. 24

Staff shortages.' The Committee noted that most health facilities did not have the requisite number of staff working in critical departments (e.g. maternity), and that various departments in the hospitals were faced with a high workload and staffshortages. 2. Post-gradnate training. The Committee observed that the Fourth Schedule of the Constitution mandates the National Government with the responsibility of capacity-building, including post-graduate training. However, counties had been unfairly burdened with covering the costs of salaries for health workers undcrgoing post-graduate training despite their services being rendered at national ref'erral hospitals. The Cornmittee further noted that the financial strain of funding post-graduate training had significant irnplications for county budgets, and had diverted resources away frorn potentially recruiting additional staff. 3. Cubqn Doctors: The Committee noted that in view of the impending lapse of the contract period for Cuban doctors, there was a need for counties to rencgotiate with the National Government to retain their services due to their positive irnpact on the health sector. 4. Anti-TB commodity shortage: The Comrnittee noted that there was a global shortage of anti-TB drugs and commodities thus posing a significant challenge with TB detection and treatment and putting the country at risk of multidrug TB resistance. 5. KEMSA Order Fill Rate: The Cornrnittee took note that while there had been a reported improvement in KEMSA's order fill rate from 40oh to 60oh on average, counties still faced unmet supply needs, highlighting ongoing challenges in the procurement and distribution of essential healthcare con.rmodities. 6. Stalled ltealth development projects: The Committee observed that counties had started capital-intensive health projects whose construction had since stallcd, or whose operationalisation was yet to be realized. For example, the hospital plaza at Nyamira County Refenal Hospital, and the new wing at Kisii Levcl 5 Hospital. 7 . Expiry and safe disposal of drugs: The Comrnittee noted that there was a need for counties to order drugs in accordance with their actual needs to avoid oversupply, and to ensure that expired drugs in facilities are safely and pronrptly disposed of. 25 CHAPTER THREE COM MITTEE OBSERVATIONS Based on the furegoing, thc Cornrnittee made the following observations: o) Generol Ohservatiotrs

lt S Ilg respect of Bomet County e Committee observed poor-record keeping practices at Longisa County ef{rral Hospital as evidenced by discrepancies between bin cards and actual ock in the central stores. r rt[er to the above, at the time of the visit, the hospital was in the process of cefving KEMSA stock. However, the Committee observed that store records er{ poorly kept, and that there were challenges in prodr.rcing reqtrisitc d d p oourement officers lacked up to date liccnses crimentation in relation to the order, with the hospital relying on KEMSA riirg its visit to the hospital, the Cornmittee found that some of its cofds to receive drugs. rather than conducting proper verification. Further, e Comrnittee noted that the current ward design at Longisa Cor.rr.rty Referral oslital was inadequate as the patient load sometimes extended to almost u$le its capacity. The Committee therefore noted that there was an urgent .d for facility expansion to accommodate the higher patient volurnes eCtlve ly r n e c ont nt ttcc fbu d ha ho Sp a ad v (, duc n h C all ox lt lln lr a ca h pac v o h o ere challenges with refilling arrangements with the hospital reporting that it d received a 3,000-liter liquid oxygen plant frorn the Ministry of Hcalth rough AMREF, but had received conflicting information from the Ministry gafding who was responsible for refilling the plant,, and ensuring continuous v lt f" IC nlortuary departtnent c oltlltl c l1o cd a c h h o S u '/. d o Ll da d nhiI Ill l) l1c o h p t t c 5 h rl I1 was noted that there ternative approach was a need to reconstruct the sewer system using an that promoted environmental friendliness and a c t stleffectiveness e Committee observed that there was lack of privacy and sharing of becls in e fostpartum and postnatal section of the maternity wing at Longisa County efdrral Hospital si[ive recognition was given to the county's provision of additional uiprnent in the renal unit. The Chair recornmended thc cor.rnty consiclcr q{iring a nephrologist to enhance medical expertise and scrvices in the rcnal p{rtment. c) In respect of i\iyamira Counly e ] Committee noted that utilization of services at Ekerenyo Sub-County osfital was very low particularly in the labor ward wherc only one patient as lobserved during the entire visit. e il d 26 9 il u t2 r3. r 16. 4. r5 F ing 9000 liters of oxygen per hour. However, it was observed that thcrc availability at the hospital. I

17. The Cornrnittee notcd that patient privacy particularly in the maternity department in Nyarnira County Referral Hospital was a concern owing to lack ofcurtains or bed screens at the hospital. 18. During its visit to Nyarnira County Referral Hospital, the Cornmittee found the rrortuary was under renovation, with non-functional equiprnent including fridges. Noting that most members of the public could not afford morgue services at private tacilities, the Cornmittee noted that urgent completion of the rerrovations was needed in order to resume services. 19. The Committee observed that a hospital plaza whose construction started 5 years ago was only partiatly operational and poorly equipped. Further, the Cornrnittee noted that whereas the hospital reported that inpatient services were expected to be available at the facility from January 2024 to alleviate cor.rgestion at the main hospital, preparations to facilitate the same appeared lacking. 20. The budget allocation for procurernent of drugs was insufficient to meet the county's needs. For example, the Committee found that the county had committed a budget of Kshs. 40 million for the purchase of drugs for use across 136 health facilities in the county, against an initial budget of Kshs. 120 rnillion. d) ln respect ol'Kisii Countl' 21. The Cornrnittee noted that the centralization of collection of funds at KTRH was hindering effectivc service delivery at satellite facilities, and preventing thern fi'om procuring essential hospital necessities in a tirnely manner. Members observed that there was a need to decentralize funds to enable the facilities to deliver services, improve their infrastructure and purchase necessary supplies. 22. Thc Comrnittee noted serious deficiencies in record-keeping at KTRH, with poor and insufficient record rnanagement systems. The Committee established significant discrepancies between drug bin card information and actual stock levcls, highlighting the need for improvernent in this area. 23. During its visit, the Cornmittee found the central store in a state of disorder with health products and supplies being stored alongside construction material. Further, the store was in a state of disrepair, with the Committee noting flooding, several leaks in the ceiling and a breaking support beam. Further, drugs and supplies were found placed directly on the damp floor, and various equiprnent (both new and old) appeared to have been dumped or discarded, including brand new incubators and MES equipment. In addition, the records-keeping and lnanagement system was poorly kept and insuffrcient. 27

24 25 28 29 30 3r 5Z JJ IIi K La Th sh Itl in n1 SC Th sc Kc 1'h clc tlrc Ilc rcl lr did bio Th M (ll I rh Co Th ap 't'h to thr-- Th the h," tu of atlr supply etc 2B iI at h lworkload due to staff shortages was noted rn various dcparhnents at Store. Newborn Unit, H, impacting TB, Casualty,, Pharrnacy, Drug orptory, and Theater departments Committee found multiple departments at KTRH experiencing equiptnent rtales and faults, such as the Casualty Department which had only onc itfr, limited incubators in the Newborn Unit (NBU), and ftrLrlty rnachincs he renal unit. Furthcr, in the radiology clcpartment, thc CT scan and MIll hifres were reported as non-functional. This had significantly hampered icf delivery. I (ommittee found that KTRH was ready to start providing canccr treatment icNs pending inspection and certification by the National Cancer Institute of v4 Comrnittee noted that KTRH lacked a blood transtr.rsion center and en[ed on the National Blood Transfusion Center despite high demand for ,.lri..r. orp-keeping at the pharmacy at KTRH was suboptimal witlr ing on hard copy records, and experiencing difficulties in enis' prescriptions due to the absence of an automated systcrn. the facility retrieving Qommittee acknowledged exceptional services provided at KTRH's u[ry and ICU, which demonstrated cleanliness, operational equipment, d{dicated staff. The importance of extending this high standard of servtcc ulhout the hospital was emphasized. Committee noted that there was a lot of idle equipmcrrt at KTRH that ld bettcr serve the public by being rcdistributed to levcl IV hospitals in thc nty. Qommittee observed that the disposal of waste generated at tlre hospital n(t meet public health standards and requirernents with wastc, including o$ical specimens being found in thc open. In addition, tlrc incinerators arcd ovcrwhclrnccl Cpmmittee noted concems raised about allegations of paticnts being askcd urfhase rnedicines from private phannacies at the two facilitics it visitcd in county Qommittee noted that there was a critical need for the county to address cfallenges at Kenyenya Sub-County Hospital e.g. lack of esserrtial nif ies in wards ( curtains, blankets, mosquito nets), invcstigation into low oqt in maternity ward, completion of the stalled CDF kitchen project, lack 26 27.

CHAPTER FOUR CONI NI I1']-EE RECOM M ENDATIONS Based on the foregoing, the Cornrnittee recommends that - l. The Ministry of Health in collaboration with the Council of Governors conduct a cornprclrerrsive assessnrent of critical departments in courrty referral health facilities to quantify thc staffing gaps and make recomnrendations for the way forward within a period of six (6) months from the date of adoption of this Report 2. Thc National Governrnent through the Ministry of Health to take over the responsibility of post-graduate training in toto in line with the Fourth Schedule of thc Constitution by the FY 202412025. 3. Counties to cxplore partnerships with academic/training institutions such as the College of Surgeon of East, Central and Southern Africa (COSECSA) for purposes of providing post-graduate training opportunities at county level as applicable. 4. The Council of Governors collaborate with the National Government through the Ministry of Health to renegotiate contracts for the retention of Cuban doctors where needed by the counties with immediate effect. Further, County Governments to allocate specific funds in the county budgets for their retention where applicable. 5. The Ministry of Health through the National TB Program acts with immediate eft'ect to ensure that anti-TB drugs and commodities are available to counties as requircd. 6. The Office of the Auditor-General conducts an assessment of all county health devcloprnent projccts u,ith a view towards identifuing stalled projects and recornnrending remedial rneasures within a period of three (3) months from the date of adoption of this Report. a) In respect of Bomet County the Committee recommends that - 7. The County Government of Bomet takes the necessary administrative actions to ensure that proper record-keeping measures are instituted and that all procurement requirements are followed in accordance with the law at Longisa County Referral Hospital with immediate effect. 29 8. Thc County Government allocate an adequate budget to provide for the expansion of the ward capacity at Longisa County Referral Hospital, the procurculent of curtains arrd bed screens for the maternity departrnent and the reconstruction of the sewer system within a period of three (3) months from the date of adoption of this Report.

9. b lt B met CoLlnty benchrnark with Kisii Teaching Referral Hospital on its a view towards upgrading its equipment and tn rtqary department with r$ving services e $enate through the Standing Committee on Health inquire into thc oxygen pr eft by the Ministry of Health and AMREF with a view towards establishing rh contractual obligations of each party, identifying challenges with the project p[oposing a way forward. Irt spect oJ-Nyamira County the Committee recommends thrtt - an .T il dornty Government of Nyamira acts to allocate an adequate budget fbr the Rfetion and equipping of the hospital plaza and the completion of thc l3 .rh r t"l ltl CO n1 rtdary renovattons founty Govemment of Nyamira acts to ensure that all facilities with tn atibnt services are fitted with modern adjustable beds, curtains, and bed :\L e1s for the dignity and privacy ofpatients. dounty Government of Nyamira acts to increase its budgetary allocation fo thb procurement of drugs from Kshs. 40 million to at least Kshs. 80 milliorr rdpr to adequately meet the county's needs. N rlira Cor"rnty benchmark with Kisii Teaching Rcf-erral upry department with a view towards upgrading its Hospital on its equiprnent and I ITl rolvlng servlces c) n spect of Kisii County the Comruittee recorrrrrtettds that ' Th County Government of Kisii acts to decentralize revenue collection and zltion to enable primary health facilities to procure essential strpplics irr r{ance with their needs. And further, to institute transparent and utrtable governance and financiaI systems at facility level to gr.rarantec thc idnt and effective utilization ofsuch funds. rep c l6 Th qounty Government of Kisii acts to implernent robust record managclllent SYS erils at KTRH and other facilities to ensure accurate docurnentation of drug lnv ntory and stock levels, provide staff training on proper rccord-kecping Pru tiges, and conduct regular service audits to monitor con.rpliance l7 Qounty Government of Kisii acts to allocate funding fbr the irnmediatc ir land renovation of its central stores, and to implement proper storage pro ocpls to ensure the safe and organized storage of pharrnaceuticals and nle icfl supplies. I C[unry Government of Kisii acts to allocate funding for maintenance and ir ireeds at KTRH in such critical departments as the Renal Unit, Radiology a(ment, OPD etc. Th 18. De 30 0. 2 t5 r.rtil I

19. The County Govemrnent of Kisii to assess and redistribute idle medical equiprnent stored at KTRH to Level 5 facilities where there is need for such equiprncnt. 20. The County Government of Kisii acts to address critical infrastructure needs at Kenyenya Sub-County Hospital, and other Level Four hospitals,, including essential ward amenities and water supply and kitchen upgrades. 2l.The County Govemment of Kisii to implement modern waste management practiccs at KTRH and other health facilities to reduce the public health and environmental irnpact, and ensure compliance with regulatory standards. 22.The National Cancer Institute of Kenya acts to irnmediately inspect and certify the provision of cancer treatment services at KTRH. In light of the above, the Committee resolved that - This report be dispatched to the Ministry of Health, the County Government of Bornct, the County Government of Nyamira , the County Govemment of Kisii, the Council of Governors, the Office of the Auditor General and the National Cancer lnstitute of Kcr.rya for purposes of irrplementing its recommendations within tlre stipulated time periods above from the date of adoption of this Report 31

( ( t'Er )r L ) a C N] TI 9/ .Il ,2( S NI E T ien ,en len ien ien ien Ja M Er Jc H Er ruI It \ N,IIN TI{I AI'N lrltL AI}S SEC I 2 3 4 5 6 I 2 J en. en. en. Le Ri AI R] )r. {s rk lk /S 1 2 J 4 I I I I N,IIN lN/ Ch; Fl( Mi Da C t 'tst rrel tch SC 'l'he rn C )tln o1) €xbrx I #E-:€. F THII A I{UNDRI'D AND TWI'NTII'TH SITTIN(; ONI,INE or ING COMMITTEE ON IIEALTH HELD ON N,IONDAY 15IU AT 8.30 A.M on ZOOI\,I ONLINII PLATFOl{N,I kson Kiplagat Mandago, EGH, MP Chairpcrson Vice-Chairperson Member I\4embcr Member Membcr ariam Sheikh Omar, MP ck Okong'o Mogeni, SC, MP e Nyutu Ngurgi, MP ida Kibwana, MP thcr Anyieni Okenyr.rri, I\4P AI'OI-OGY ama Ole kina, MP phaelChimera, MP dr.rl Mohamed I{aji, MP AT e Sagini ce Waweru Otoro Muthuri Member Member Mernber Clerk Assistant Clerk Assistant Legal Counsel Intern H/(t8812024 as callcd to ordcr at 8.4-5 a.m. with a worcl ol'praycl ll'onr thc Cliairperson e)*/+ :'EE&'- i#6,r.8*-- NTO. I srN I)ItIiI,IN,IINARIIiS

I \1<1 +,r)gSA \ II\/SEN/SCH/ 689 12024 ADOPTIO\ OF THE A(;I]NI)A The Agencla u'as aclopted as proposed b1' 5.,.,. I-larnida Kibu,ana, MP and seconclecl by Sen. Erick Okong'o Mogeni, SC, MP as follows- l. PrcLycr 2. Adoptiott of the agettdcL; 3. Considercttiott cutd acloption of Conmtittee nini reports ott Inspectiott cutcl familiarization visits of select health facilities itt Cowtties undertakett cluring the Secottd Sessiott as below- a) Vihigcr and Ki.sunttr Counties,' b) Bonrct, Nyanira and Kisii Counties and; c) Westpokot, Transnzoia and TurkancL Counties 4. Att1, otlrcr business; and 5. Adjoununent/Date of tlrc Next Meeting. The Committee considered reports on Vihiga & Kisumu Counties and the Bomet, Nyamira & kisii Counties. It was generally observed and recommended that there needs to be a budget review by ail Counties so as to allocate more funds to their respective health functions and further that all health facilities should be equipped with curtains, recommended ward beds and bed nets while also ensuring the facilities have running water, electricity and an overall improved security surveillance. N,IIN/SEN/SCH/ 69 II2O24 ANY OTHEII.I}USINIJSS Due to time constraints, the Committee resolved to postpone the consideration of the report orL tlrc Westpokot, Transnzoia and Turkana Counties and further the overall adoption of all reports to Tuesday, l6tt' April,2024. ADJOUITNMENT There being no other business, the meeting u,as adjourned at I1.45 a.m. The next rneeting will bc by notic +_2._ SIGNI'I) HAIITPEITSON 2 I).\TI.]: lv L) S (--\) },IIN/SEN/S CH I 690 12024 CONSIDI'RATION AND ADOI'TION OF CON{MITTEE N{INI REPORTS ON INSPECTION AND FAMILIAIi.IZATION VISITS OII SI'LECT HEALTH FACILITIES IN COUNTIES UNDERTAKEN DURING THB SECOND SESSION \,IIN/SEN/S CIT/ 69212024 L

#!.=*:=9" OF THE A HUNDRED AND TWENTY-SECOND ONLINE F THE STANDING COMMITTEE ON HEALTI-I HELD ON API{IL 2024 AT 10.00 A.N,I ON ZOON{ ONLINII PLr\TF0R[,I P SI ITR AT) 11r ! SE ckson Kiplagat Mandago, EGH, Mp ariam Sheildr Omar, MP dama Ole kina, MP phael Chimera. MP e Nyr-rtu Ngugi, MP dul Mohamed Haji, MP ther Anyieni Okenyr-rri, MP TH APOLOGY ck Olcong'o Mogeni, SC, MP mida Kibwana, MP AT ne Sagini ce Wau,erLr Onyari Otoro Kimani Chairpersotr Yice-Chairpersou Member' 1\4ember Member Member' Member lr4ember Member Clerk Assistant Clerk Assistant Ijiscal Analyst Legal Cor-rnsel Ar-rdio Officer 1 2 698/2024 I'RELIN,iINARIIIS he rn as called to order at 10.20 a.rr. u,ith a u,olcl of prayer frorn the Chairpcr.son 6:i*i0 em, 9 .t J tr I IG!tt E E I 1. 2. 3. 4. 5. o. 1. IN ,1 IT

AI)OPTION OF THE AGENDA The Agencla u,as adoptecl as proposed by Sen. Joe Nyutr-r NgLrgi, MP and seconded by Sen. I\4arianr Sheikh Ontar. MP as follows- l. Prayer,' 2. Atloltriott o.f tltc AgencLcr; 3. Con.sicLercLtiott cLntl crcLoptiott of Contnittee reports on the.foLlorvuys a) \'he petitittn on lhe nrcu'LcL7en'Lerlt ancl use Qf Kenl'6411' tJniversi4, 'factching atrcl Rc.ferraL ctncl ResecLrch HospitaL (KUT-RRH) b1' nrcdiccLl stuclents ot the KenvcitcL Universilt',' b) On aLlegatiot'Ls o.f irregulcLrities irt the procurentent of Lottg- lastirtg insecticide nets (LLINs)' KEMSA; c) Inspectiort cuul .fantilicu'i?atiort visits to hecLLtlt faciLittes irt Viltiga and Kisunm Counties; cL) Inspection curl .fantiLiarizatiott t,isits to hecLlth facilities Bontet. Nyantira and Kisii CoLu ies and: e)Inspectiottanr).fantilicLrizatiotlvisitstoheaLthfaciLities W e s t - p oko t, T r ans - rtzo i cL and TurlcancL C o utt t i e s 4. Any ollrcr br,Lsiness cntd; 5. Adjournntent/Date of the Next Meetiltg. },TIN/StrN/S cHt70012024 CONSIDERA TION AND ADOPTION OII COMN,IITTEE REPORTS ON THB IroLT,OWING- Following a Levieu, of the committee obselvations and recommendations of respective reports ancl clialogue therein the following committee reports were adopted unan irnou s ly; i. The Committee report ott the petition on tlle management and use of Kenyatta University Teaching and Referral ancl Researcl'r Hospital (KUTRRH) by medical stuclents ot th. K.nyutta University having been pr:oposed by Sen.Ledama Ole I(ina, MP and seconded by Sen' Mariam Sheikh Omar, MP; 2. The Cornrnittee report on the allegations of irregularities ir-r the procurement of long-lasting insecticicle nets (LLINs), KEMSA having been proposed by Sen. Joe NyLrtu, MP and secondeci by Sen. Mariam Sheikh Omar, MP: T5e Committee teport on the inspection and familiarization visits to health facilities in Bonret. N)'amira ancl Kisii Courlties having been proposed by Sen' Ir4ariam Sheikh ornar, IvlP anci seconded by Sen.Ledama ole Kina, MP; The Committee repolt on the inspection ancl familiarization visits to health facilities Vihiga and Kisr-tmr.r Counties having been ploposed by Sen' Mar:iam Sheikh Omar. N4P ancl secorrded by Sen. Joe Nyutlr, N4P; 3 4 2 ) rrN/sEN/sCi{/699/2021

The and Nzo Ho and mee The Nair the VI hu oLl \,IIN Iher! willL C omm ee S aken throLIgh rhe Contm ce porl. II h lls pec o I1 t a o e i k lt za oI-I s tS o Co LIn Hea1rh R ferral FaC r1 wC s Po o raII s t v T S kan a C O LInItes Cha ter 3 o Co11111'l tee o .te nct o1t J' p t1 t b to time constraints, further consideration, generation of recommendations was deferred. The Committee therefore resol'ed to scl.redule an online onday, 22"d Aprll,2024 for its consideration and acloption. H/701/2024 ANY OTHER BUSINI'SS e resolved to postpone the inspection to,r of select hearth facilitres in oun v th a ha e n Sc t d b v 2 f ed LI d for Monda 2 Ap 2024 gh o nd f m arv rafr ac C den n o n o th C ef O thc D en Cc F-orcc S ot'l h t fl April,2024 and the consequent declaration of the presiclential three- dav- H/702/2024 other business, the meeting was adjourned at 1.30 p.m. The next meeting t C h I \-.) D CHAIITP ERSON O4.^"1 CIA \ J 3 in-s. Ci 1 AD.IOURNN{]!NT v Dr\ lryl Iil

( ( ol*1+ -'f,d' s.&, S S S S S e ild il Mtr nt C '*S.:_=-=e" OF THE NINETY-THIRD SITTING OF THD STANDING E ON HEALTH HEI,D ON MONI)AY 3OTII OCTOBE 2023 AT BOMET COUNTY ackson Kiplagat Mandago, EGH, MP Chairperson Member Member Member Member Area Senator (Friend to the Committee) rick Okong'o Mogeni, SC, MP oseph Nyutu Ngugi, MP amida Kibwana, MP sther Anyieni Okenyuri, MP akili Hillary Sigei, MP ITH AI'OI,O(;Y ariam Sheikh Omar. MP 9. P AB SI.] ama Olekina, MP aphael Chimera, MP bdul Mohamed Haji, MP AT istine Sagini rence Waweru B nda Wekesa L ian Onyari tor Kimani Jo ephat Ngeno lcrie Anyanje ahim Mohamed Vice-Chairperson Mernber Member Member Clerk Assistant Clerk Assistant Research Ofl'icer Fiscal Analyst Audio Officer Media Relations I ntern Sergeant- at -arms r s s l' s r C Ib Op Sr$ L ). -). 1 ,5. 6. 1 2 J A l. 2. M 3. 4. -5. Ir4r T

lN-AT'IENDANCIl l. Dr. Josepli Sitonik 2. lt,ls. IVIilcah Rono 3. Dr. Adrew Cheruiyot 4. Mr. Felix Lang'at 5. Hon. Stephen Changrnorik 6. Hon. Cheptoo Roseline 7. Hon. RLrto Richarcl 8. Hon. Ivlutai Pcter County Executive (CECM) Ag. Chief Officer Health Services(COHS) Medical Superintendent Hospital Administrator Chair County Health Committee Member County Health Committee Member County Health Committee Member County Health Committee Member County Health Committee Member County Health Committee 9. Hon. Kibet Ngctich I0. Hon. Kiptoo N,IIN/SEN/S cHlst6l2023 PRI.]LIN{INARIIiS The Chairperson of the County Assembly Health Committee extended a warm welcome to rhe Senate Committee on Health on behalf of the County Assembly, Health Committee. The Chairperson, Senate Health Committee opened the meeting underscoring the necessity of effective det,olution oversight noting that the senate inspections was to ensure quality services, understand challenges laced by Bomet County, plans they have in place for Universal Health Coverage rollout, and financiaI progress in facilities, emphasizing transparency in fund utilization. Thc Chair fr-rrthcr inlbrmcd that the visit's aim was to ensure adherence to intended processes ancl identily challenges thercin in the health sector. He observcd that challenges can be resolved through resource addition, enabling legislatives, or policy adjustments and collaborative efforts for the citizcns' benefit. He emphasized a good working synergy is leeded among rhe Counry's hcalth committee, Nationat Health Committee. and Senate Health Comrnittec to maxin.rize benefits l'or Bomet County and the people of Kenya. The Chair fgrther Leassurecl thc stall that regarding human resollrces matters the neu'ly established Ken;,a l{ealth Human Resource Advisory Cor.rncil should be given an opportunity to revier.l, the policies noting that the board serves as an advisory to both the National and )

C TI tes la the sh vlslI v O ernments on staffing and welfa dable and quality healthcare. c}I/st7/2023 re matters and thus aimins to ensure citizens VISIT TO LONGISA COUNTY }I tee observed the following; er-Child Clinic tenatal services, including family planning, CS screening, and HIV and a Maternal and Child Health (MCH) unit, equipped with a small r clinician examinations, comprising of 7 staff members i.e 3 nurscs in department, 3 clinicians for pediatrics and sick mothers, and I lab ach working 8 hours per day. Triage services for mothers revealed a stalf th 9 rooms for mothers and babies served by 6 nurses, indicating a having ordered the cartridges sr.rpplies from the National TB Program. KEMSA. which delivers to the counties. With regards to l'unds Lrsecl ncies. they submitted that emergenc;' funds arc sourccd t'r'orn AIE. 3 staff members an Centre ff members who were on duty during the visit. The facility offers diverse ons, including NHIF billing and cash payments of Ksh. 6000 for non- s, accommodating approximately 10-15 patients. Notably, thcy observed pa tha y, theatre equipment, and CT scan were components of the Mcdical Eq ervices (MES) provided by General Electric (GE) company and exp ccasional down times. Particularly cnconnteling difficulties in general.ine ptc ound d, which was part of the MES equipment, catering to around 60 patients dail g with a24-hour, 10-member staffs. The facility observed that rhey had rienced a two-week downtime due to softwarc and battcry issires, hcnce e MES unit. ato Thc nt consisted of 21 staff, with 3 under UIIC and 17 in permanent pos the luding only one lab technician. Six staff members were present during The 24-hour laboratory conducted 150 ror-rtine and special tests daily. ervices recently introduced were ICU, Arterial Blood Gas tests. and Spe Spe min The istry and reagents for the laboratories. Notably. rhis had lead to errals rther relies on the National TB Program for support. At the time ol the ity had been without cartridges for 1wo rveeks to cletect l.uberculosis- cau bacteria. They resorted to using microscopy as an alternative. Horiever they sLtp .-,) lo a o S I a ln or tn NC nc t a C t o :l St p en -r pe e m LI t p bi n o v o e e rc C c c dLrri recei I RF]ITIiRRAI, HOSI'ITAI, Thc techrl defici b) wirh NFIIF , primarily attributed to network issues. c) Thc Lrl using d) t e

Slorc The store hacl poor lecorcls making it nearly impossible to clearly trace incoming and or.rtgoing products. 0 Theatre There was a main theatre. a maternity theatre, and an oncology theatre equipped witlt anesthetic machines. operating and pandemic tables. Despite this, the department faced worklorce constraints. There were 5 orthopeclic surgeons, 2 general surgeons, and 1 anesthetist in the main rhearre. The maternity ward usr.rally handles 540 patients in a month with a bed capacity of 39, inclucting deliveries and gynecotogical cases. During the visit, 46 paticnts were present, indicating a need for more beds and staffing. The ward had 13 nurses, 2 gynecologists. 4 doctors, 2 medical officer interns, and l0 clinical olficer ipterns rvith Two doctors and 3 to 2 nurscs per shift, handling 15 to 20 deliveries daily. Thc wards, usually have gOVo occupancy leading to bed sharing. At the time of the visit 5 ni.rrses were on study leave. o) Intcnsivc Care Unit (ICU) It had 2 ventilators, 13 nr,rrses, including 3lCU nurses, and 5 specialists and 3 pcdiatricians. Thcy submitted that there was uncertainty regarding the continuation of the Cuban doctors' contracts, as they are approaching the end of their MOU. h) Il.enal Unit Thc unit consists of 5 nurses, 2 medical officers, and I nutritionist, along with 2 biomedical engineers with all nurses trained. There were a total of 11 machines, with 3 currently not operational. Of these, 8 were provided by the county, and 6 were suppliecl by I\{ES. The challenge however lay in the extended time taken for machinc scrvicing, ideally recommended every 6 months. Store/Procurement The unit at the time of the visit was receiving KEMSA stock and was in the final stages o[ inspection by an acceptance committee. However, the store faced a challenge in producing its own request documentation for comparison with the received items from KEMSA. Despite having a softcopy from the online ordering system, numerous essential drugs and non-pharmaceuticals requested from KEMSA were nof supplied. The chair requested the lacility to submit the order details for what was placed and what had not been iulfilled. The lacility also highlighted a national shortage of anti- TB dlugs. j) Nlortuarv The facility acknowledgecl thc consideration o[ alterial embalmment bLrt reported using a modificd mcthocl in the embalming process. However, that u'as deemed ogtdated by the committee. The committee advised the facility to benchmark in Ahero SLrb colutry hospital morgLre preservation technique. which involved draining the body flLrids lbllou,ed by pressurized purnping rvithout refiigeration. allou'in,e the body to be ltrescrvecl fbr up to 2l da1'5. However. the facility submitted that a comprehensivc plan 4 e) i)

( fl r o LI y expansron, contlngent on constructing a water pumping station. \\,as ln rc ith a prepared Bill of Quantities (BQ) x en l)lant Llc 9,000 liters per hour with a single cylinder of 50 kgs. They submitted that h cently received a 3,000-liter liquid oxygen plant liom the Ministry of ugh AMREF. Initially being informed that it woulcl be refilled for free, ter a two-week use, AMREF declined to refill, stating that the hospital was for refilling. h NS H H cwsr8t2023 I'OSl'IltUIit t\(; \tI..t.t't I\(; .\1' GOVERNOR'S OFFICIi. or extended a warm welcome to the committee thanking them for the undertake the oversight visit n- Scnatc Hcalth Cornrnittcc rclnarl<s marked that the committee had had a successful visit to Longisa County nfortunately, the committee was r-rnable to visit the mothcr and child nter due to time constraints due to the scheduled visit to Nyamira Level 4 e meeting was informed on the following; te Hcalth Committee observations and recornmcndations isa was recognized for its commendable performance in clinical services atment, receiving an impressive score of 807o committee noted that they observed challengcs in record maintenance, ving that during the visit, that the record-keeping systetn wus somovhat erly. Discrepancies were identified for instance, that information on lrill did not align with the actual stock. Additionally, therc were issues with ow of items between the laboratory, storage area, and the counter cy, posing a significant challenge erning procurement, it was observed that the facility's receiving process ot align with the Public Procurement and Disposal Act. The Act requircs spection and acceptance committee, appointed with a threshold of at least people. Notably, the facility was relying on KEMSA records instead of taining their own records for comparison u,ith received itcrns. ermore, it was noted that KEMSA's fill rate for essential drugs was kably low. The committee committed to addressing this nrat"ter with SA directly. Additionally, irregr"rlarities were identified in thc rement process, as some of the procurement officers were found to have d procurement licenses. Thc comn.rittee noted that it highlights a nccd Ibr ication in the procurement procedures. the facility. required expansion. with the currcnl. design of thc u,ards. u'ith acity intended for 64 patients. was insr-rfficient as the actual patienr load ded to 120. This had resulted in con-gestion. emphasizins the Lrgent neecl ) (, bI N to s r c n lta CS o d p d F f a e a p e fe 'f t I res deci The lt l'r c) (l) K I l)

for an expansion of the facility to accommodate thc higher patient volume cff'ectively. e) A positive observation was made in the renal area, where the provision of additional equipment by the county was recognized as a commendable effort' The committee belicved that counties had reached a level where they could inclependently design their management equipment processes to ensure the availability of necessary equipment for medical use' Moreover, the committee recommended that the county consider acquiring a nephrologist to enhance the medical expertise and services in the renal department. f) The committee emphasized the critical importance of cohesiveness and concurrent growth in human resource development, particularly noting the need for comprehensive training opportunities for both doctors and other staff members. It was observed that in some visited counties, only doctors were undergoing training, while nurses, clinical officers, and other staff categories rvere excluded from stlch developmental programs. The committee stressed the significance of inclusive training initiatives to ensure a well-rounded growth and professional development of all healthcare personnel. g) The committce loted that while the mortual'y was clean, its size howeyer remained inadequate. There was a pressing need for expansion, along with the acquisition of equipment lor fluid extraction and treatment of bodies. It was suggested that this could be addressed through the Facility Improvement Fund, which had already been approved. The fund could then be utilized to facilitate tl.re expansion of the mortuary and the procurement of necessary equipment to enhance its capabilities. h) The committee further identified the T.B sector as a critical area that required immediate attention lrom the county. There were shortages of reagents and consgmables which not only adversely affected the county but also contributed to the global challenge of T.B, a concern aligned with the goals of WHO and SDGs airned at eliminating tuberculosis. Despite orders being placed for the needed consumables, the facility had not received timely supplies additionaliy despite sltpport from the donors and the National government program, there were delays in the provision of essential items. The committee stressed the urgency lbr the County's intervention to ensure the continuous operation of the T.B service. prevetltiltg interruptions in the treatment of T.B patients. i) Further, there was need to re-construct the sewer system and recogllize its need for attention. Although it was explaincd that the delay was occasioned by a land, the committee recommended steering away from the septic tank approach and usc an alternative that l'rot only promoted environrnental friendliness but also presentcd an opportrutitv fbr the county to explorc a soh-rtion that was cost- effective in the overall establishment process. 6

( The lmp thei C mmittee observed that the number of interns exceeded the number of at ll s, resulting in a teacher-intern [o paticnt ratio that was not proportional this, the committee acknowledged that the excess interns provided dd tl nal human resources to support the health system, which was deemed en fi ial to the county. To address thc crowding issue and further leverage the d n oLr d onsider setting up another hospital to ease the patient load at Longisa o imize the benefits of having interns in the healthcare systcm h C mmittee observed that the maternity wing was commendably clean qu lr d with three delivery beds. However, concents were raised aboLrt thc OS p Llm and postnatal section where mothers were sharing beds r tl nally, there was lack of privacy in the general ward with no e ations or curtains in the maternity area, leaving it open. The committee d that they were assured by the County Executive Committee (CEC) il e issue of curtains and cabins would be addressed within 30 days nally, that there was ate attention. a challenge in human resources that needed , the committee noted that the facility had four surgeon doctors and two- aters. They advised the county to consider increasing the number of units to maximize the use of available human resources. mmittee observed that the decision regarding the Cuban doctor in the o er h e Care Unit (ICU) rested with the county. The county could either h to train someone else to replace the CLrban doctor in the ICU or decidc the Cuban doctor as part of the county's medical personnel mmittee further informed that they had requcsted records o1 cxpircd o om the facility, recognizing a tendency for KEMSA to over-supply a ommodities. The committee expressed its commitmcnt in assisting un to resolve the issue to ensure the availability of cssential commodities expressed appreciation for the comments flom thc Senators, conveying 1 to embrace constructive feedback. Similarly. in areas u,here were needed, the county pledged to proactively seek ways to cniancc nce, reflecting a continuous commitrncnt t-o progress and improvement. mitted as follows t the County expressed hope in elevating Longisa Rcfenal Hospital, ently a level 4 facility to a level 5 and further noting that the new her-child facility, scheduled for completion in November 2023. tacilitv ed at allcviating congestion. particularly in the maternity scctor': arding administrative challenges. the governor expressed confidence the facility could readily address issues related to l'ccord-kcepinu ancl uring proper processes. particularly in drug procurement. He requested a 7 m rf eo nul.l l Hc i) Sges of having interns, the committee recommended that the county k) rf unr m) S n) ) ]

report from the facility'"r,ithin a two-day period to assess and sddlsss these concerns promptly. 3. Regarding sewerage. the governor mentiolled an ongoing dispr.rte with a court case. assuring that a resolution was forthcoming 4. He informed that there was to be a br-rdget allocation to address the mortuary upgrading mattels: 5. Fr.rrther, he agreed that the delivery room faced challenges' including mothers sharing beds and privacy issues. Further mentioning that vocational training centers had been tasked to produce curtains which were expected to be ready by March 2024. Additionally, he acknowledged the need for improvements, particularly in replacing old cabins' 6. The Governor additionally, emphasized the need to re-negotiate with the National Government to retain the Cuban doctors, acknowledging the positive impact to the health sector. 7. The Governol highlighted challenges with equipment, specifically citing issues with the CT scan due to contractual problems. He expressed dissatisfaction with the responses received when the county faced equipment-related problems, despite substantial financial investments ranging from 200 to 210 million. \,I IN/S EN/S C H / 5 19 / 2023 ANY OTHER BUSINI'SS The county extended gratitude to the committee for their visit and committed to acldressing the raised issues, emphasizing Bomet's readiness to implement Universal Health Coverage (UHC) with a substantial number of community health promoters. There being no other business, the committee proceeded to Nyamira County' AI).IOURNN{I'NT There being no other business. the meeting was adjourned at 3' 00 p.m. The next mecting will be on notice. SI(;NI]I) CI.IAIIIPI.]RSON t L,, 8 I)r\TIl Nr IN/Sl.tN/S CHI 520 I 2023 Y

( ( \r ]T rI A is I 2 3 4 5 ) l1 T Sen Sen en en en I Ji E Jr H E w It o M FI B L Itr NIil P CO 4 ,,\I} SE ,#i,::' O}' THE NINETY.F-OURTH SITTING OIT THI' STANDING E ON HEALTH HIILI) ON \,IONDAY 3O1II OCTOI}EIi 2023 AT NYAMII{A COUNTY ckson Kiplagat Mandago, EGH, MP ick Okong'o Mogeni, SC, MP seph Nyutu Ngugi, MP amida Kibwana, MP ther Anyieni Okenyuri, MP H APOI,OGY ariam Sheikh Omar, MP ma Olekina, MP phael Chimera, MP dulMohamed Haji, MP AT istine Sagini rence Waweru a Wekesa ian Onyari tor Kimani ephat Ngeno hammcd Ibrahim Chairperson Member Member Member Member Vice-Chairperson Member Member Member Clerk Assistant Clerk Assistant Research Officer Fiscal Analyst Audio Off icer Media relations Scrgeant-at-arnr s IN- \c}. in attendancc shcet attachcd Or Srtr t. 2. 3. 1. I 2 -) 4 -5 6 7 N,ls I\'I s. I\I N{ I\I r. r. r. I lt

\ IIN/SEN/S CHI 52112023 I'RELI}IINAI{IES The committee resolvecl to commence with Nyamira hospital visit and then have a debriefil_e meeting at the Governor's office. Enroute to the hospital the committee resolved to do an impromptu visit to Ekerenyo Health center to assess its service dclivery and general operations N{IN/SEN/SCW52212023 VISIT TO I.]KERENYO SUB-COUNTY HOSPITAL a) l\,Iatcrnitv Ward The committee observed that there were three beds available, but an ongolllg maternity wing construction fol facitity expansion was underway, supported by the National goventmellt and the Finlancl government. The committee notcd that privacy ol' the patients was compromised due to lack of curtains, prompting the need for improvement in that aspect. b) Male Ward The committee noted that the male ward had no windows and curtains. c) Laboratory It was a 24-hour laboratory with two stafl members. The Lab. efficiently handles a range of medical tasks, specializing in Hematology tests, malaria, typhoid white utilizing a streamlined system. Notably, they requisition using a business card, ensuring effectivc record management. Additionally, their adept handling of drug supplies ensures that the facility is well-stocked for various medical needs. VISIT TO NYAMIRA COUNTY RI'FERITAL HOSPIl'AI,. The lbllowing sections were visited and observations therein were as follows; a) Pharmacy Thc pharmacist in char-se took members through the drugs available at the hospital including clrLrgs lbr non-cornmunicable cliseases. The managenlent team also confirmed that thc hospital got drugs f'rorn KEMSA and that the hospital had two pharrracy stores. classilied for oral drugs and lbr injectable. ) N,I IN/SIiN/S CH/5 23i2023

fill rate was reported to be at 6070 an improvement from45Vo. The fill g in August 2023 and they received drugs worth Ksh. 13 million an order of Ksh.25 million; with the hospital having paid only Ksh. 2.-5 control, the hospital was using the HMIS system from the Ministry ol' as supplied to minimize the tendency of KEMSA supplying what was co rnt li o br d t' c m s L^ e Ile committee also conducted a pin check of the drugs that were available in l) e committee also noted that the drugs that were in the hospital were not GOK to avoid the medicine getting to the private pharmacies. The ct dicated that the drugs from KEMSA were usually branded but in somc e re not and that they had raised this concern with KEMSA e pr d drugs, the pharmacist indicated that they had a room where they xpired drugs for the facility and the register of the same was with the tl c pub e rh officer and that there was a process of disposing the expired drugs The p a st also confirmed that the she receives the drugs that have been procurecl by iri y jointly with the inspection team. The chair also reqlrested for the itcc rm fbr the last procurement and was provided. The chair also indicated ag ment team of the importance of counter checking on what they ordered 1i t The o icer indicated that the county had budgeted Ksh. 40 million lor the rugs across the 136 health facilities in the county. 'fhe chiel oflicer the initial request was Ksh. 120 million. The Nyamira county refcrral hosp h the Facility Improvement Fund had budgeted lbr Ksh. 42 million r to hat n array of services snch as: parasitolo-ey. hematology. renal tests livcr e tests among others. The committee was further informed that thc itt -.) CStS. o d fl ( The rale essential drugs was reported to be at 407o with the last consignment of drug$ thc rh. the store. cases I On thb to the lgainst not lt pulcha$c incl icatetl against uf,nrut target collection of Ksh. 200 million. b) I

laboratory services off'ered r.r,ere chargeable at affordable rates rvhile others were lree Notable was that the lab was well equipped with reagents' c) Store for Laboratorv rca cnts Tl.re cornmittee observed that the store \\'as a bit congested d) )latcr nitv u'ins Thc maternity section had I gynccologist.4 medical officers, l4 nr.rrses,6 clinical olficer irlrerns. 1 meclical ol'ficcr intern. On a weekly basis there were approximately 43 deliveries, 13 being caesarian sections. The hospital recorded 100-200 deliveries monthly with a ward bed capacity of 42. lt was also observed there was a new born unit with low mortality rates. The committee further observed that there were no mosquito nets an indication there was no privacy for the mothers. e) Nlortuarv The mortuary was observed to be r-rnder renovation and the management indicated that the facitities that were in the mortuary were not working including the fridges. The chair of the committee urged the chair of the board of management to Strick and ensure the renovations are done and services are resumed. r) Co'r,id centre Which was consrructed 5 years ago but was partially operational. The facility lacked equipment to make it fully operational. The management however assured the committee that the inpaticnt services in the facility would be available as from January 2024.The center had been built to ease the congestion at the main hospital. POST I}RIIiFING MI'I'TING AT GOVERNOR'S OFFICE. Thc governor welcomed the committee and thanked the committee for their visit in the various health facilities. The Chair. Senate health committee highlighted the work of the committee with regards to oversighting the functioning of health facilities in all counties. Further emphasizing the role, the scrtate can play to etlstlre that cottnties are properly sr.rpported in execr.rting their mandate. The committec gave the follou,ing observations and recommendations: Ekercnyo Sub Countv Hospital l N{IN/SEN/S C TVs 24l2023

t CTI S ln h h ll n S t p d rcl c a ss al o C re ittee observed that the facility is a level 4 and should be operating as a sub rral but the committee noted that: h re were few staff in the center, seemingly some had left for the day. r bably an indication of low staff morale hospital had very few patients especially in labour ward, where at the time f e visit there was only one patient further observing there was no privacy in C wards since there were no curtains. The committee therefore recommendcd a curtains be put up hospital was fairly staffed but the uptake of the services by thc public was oncern which the committee recommended that the county management look int cleanliness of the facility was up to standard and commendable athways of the hospital needed to be repaired and if possible be sheltered se of the rains oun I{cl'crral Hos i tal ttee observed and recommended as follows; the drugs store was well stocked an indication the hospital had a good y of the drugs, however there was a poor record management system that to be improved on; ing of the drugs was not consistent and the committee rccornmended on sing their fill rate especially on the essential dmgs aternity staffing was fairly good however it was recommended that be installed to improve privacy among the mothers; e covid centre/ doctor's plaza should be cornpleted and be well equippcd mize operations and ease congestion: e mortuary should be re-opened to accommodatc peoplc who cannot the morgne services at private facilities mmittee lurther recommendcd that training nccded to be harmonizcd in es of doctors so as to improve their expertise and as a morale booster the whole sector; ocation of money for the purchasing of the drugs was too lor.v to supply N T -t ty with the required drr"rgs -l'hc count t. 2. to 5 6. the I 5 I 2 3 4 1 il

a The Chairperson. Senate Health committee then invited the union lepresentatlves to make a bricf sr.thrnission: Submission l'rom tttritltt rcprcscntntivcs The union representative indicated they had a -qood working relationship with the county and urged the senate to ensLlre that the Counties get enough lesources to Support devolution as much has beer.r gained since devolution started. They however raised an issue regarding inter-county transfers and indicated that it was difficult 1br someone to be granted transfers, to which the chairperson, senate health committee reiterated that such issues can be handled by both the county and the Kenya Health Human Resource Advisory Cor.rncil. On the issues raisecl, the Gor,'ernor then responded and assured the committee as follows; l. He urged rhe senate to support KEMSAand ensure they are able to supply the drugs as required 2. He assured the committee that the doctors plaza would be operationalized soon 3. The governor also indicated on the issue of the mortuary that they will ensure that the renoval.ions are completed and the mortuary is back in use. 4. With regarcis to thc br-rdget allocation for drugs, the governor assured the committee that the allocation would be increased from Ksh. 40 million to Ksh. 80 rnillion in thc supplementary budget. \II\/SEN/SCH/s2sl2023 ANY OTHIiR I}USINESS There was no othcr business I,IIN/SEN/S CHJ 526 I 2023 AI).I OUITNN,II]N'I There being no other business. the meeting was adjourned at 8.00 p.m. The next mcetlng u'ill be on notice SI(}NIiD: c't{.\I l{I'}l.,l{so\ ) I (r I)A-II'l: ......./rl /

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rS#, \r I N,I t t'I r0 I 2 I. e e e e mt 5 i #F,-,€ OF THE NINETY.T-IFTH SITTING OIT THE STANDIN(, E ON HI,ALTI{ HIiI,D ON FITII)AY 3IID NOVEMBIiR 2023 AT T KISII COUNTY I) \I C 10. AI} SE f TH APOLOGY ariam Sheikh Omar, MP dama Olekina, MP hacl Chimera, MP dul Mohamed Haji, MP amida Kibwana, MP AT istine Sagini FI rence Waweru Li ian Onvari A ette Khayela tor Kimani Jo ephat Ng'eno Chairperson Member Member Member Area Senator (Friend to the Committee.) Vice-Chairperson Member Member Member Member Clerk Assistant Clerk Assistant Fiscal Analyst Research Officer Ar"rdio Officcr Media Officer Sergcant at Arms s S s r r S II wa Abdi J[ckson Kiplagat Mandago. EGH. MP (rick Okong'o Mogeni, SC, MP Jfseph Nyutu Ngugi, MP lsther Anyicni Okenyuri, MP flichard Onyonka, MP . Scn I 2 3 4 5 I 2 -) 4 5 6 7

IN-AT1'I.,NDANCI.] l. Governor Simba Arati 2. I\4r. Ronald Nyakweba 3. Mr. Otucho J. Oburu 4. Ms. Gladys Amin-ga 5. Hon Henry Moracha 6. Hon. Shem NyamweYa 7. Hon Richard Nanani 8. Hon. Wycliff Sircha 9. Hon. Michael Motuma 10. Hon. Malack Matara I 1. Prof. Joseph Abuya 12. Dr. Oimeke Maruta Governor Kisii County CECM Health Chief ol Stafl Chief Oflicer Health Leacler of Majority MCA MCA MCA MCA MCA KTRH, Board Member CEO, KTRH VISIT TO KISII TIiACHING REITI.]RITAI, N{ I N/S E nN/S C H / 527 I 2023 PIIEI,IN,IINAI{IES The committee resolved to kick start the activity with the Hospital tour and then finish off with a briefing at the Governor's office MIN/SEN/SCHI52812023 HOSI'ITAI, (KTITI{) l. The Committee was briefed on the status of outpatient services at KTRH. The hospital scrved 60-70 outpaticnt patients daily from Kisii, Nyamira, Homabay, and Trans Mara regions. 2. The Committce commended the hospital for taking in interns and studerlts, acknowledging its contribution to practical learning and prof'essional development. 3. 'Ihe committce expressed concern over the suboptimal conditions of the minor outpaticnt theater and recognized the need for urgent repairs and maintenance. In addition, the nursing section had suboptimal furniture, which created a non-conducive workirrg environment for nurses. Thc Committee also noted peeling tiles in theater ancl ICU sectiolt. teaking ceiling at the drug store and faulty CCTV at the pharmacy. 4. On stalf shortage, the Committee noted high worktoad in varions departments including thc oncology, pharmacy, laboratory, drug store, main theatre, casualty section, renal unit, and New Born Unit (NBU) owing to staff shortage. The hospital also lacked spccialists in some departments. 5. Thc facility raised concern on limited and faulty equipment in various department. For instance, the Committee noted that the Casualty Department had one mor.ritor. which hinderecl service dclivcry. The New Born Unit had lirnited incubators as it received ult to 80 patients. excceding its capacity ol 30. In thc renal unit c.rut ol l2 machines. -5 l )

, faulty, hindering service delivery. In addition, the CT scan and MRI machine in diology department were not working. committee was briefed on the current state of pharmacy operations at Kisii hing and Referral Hospital (KTRH). It was noted that medicines were sourced a ability of pediatric patients' medications pharmacy relied on hard copy records which posed dilficultics in tracking and ro gh the Medicine Committee from the Kenya Medical Supplies Authority SA) and other private firms. KEMSA refill rate was at 607o. rvith essential Committee further noted that the pediatric drugs consumed a significant portion f c a c e e a o n o ug budget of KTRH. These drugs were provided free of charge to patients, ad g to shortages in the section IV n the challenges faced in the pharmacy, it was suggested that the Committcc to a formal request to the County for additional financial support to ensure atients had been instructed to purchasc medicine from or-rtside. Instead. in cases h e a particular drug was unavailable, a requisition was generated and fbrwarded to ging drugs inventory. In addition, the pharmacy faced challcnges in retrieving tl nts' prescriptions due to absence of an automated system in the hospital Committee raised concems on allegation that the pharmacy askcd paticnts to hase medicine from outside sources. The pharmacy administration clarified that Committee was informed that the Inspectorate Deparl.ment was in placc to itor the movement of drugs in the hospital. The officers in the department utilizcd ards that contained information on thc person who rcquestcd supplies. qr-rantity of s supplied, and the remaining drugs at the storc cerns were raised about idle Mcdical Equipment and Supplies (MES) cquipment in the facility. The committee sought information on the specific equipment that identified as idle and the reasons behind their inactivity. Committee observed congestion in the Neonatal Unit (NBU) and Intensivc Care (ICU), owing to high influx of referral patients. her the Committee noted that the hospital lacked a blood transfusion centcr ancl nded on the National Blood Translusion Ccnter Committee observcd suboptimal performance of the oxygen machinc, aI'fccting -) c 6 1. 8. 9. l0 ll ll l.l ll 1.5 ll ( covering 50Vo. Procurcment department. theater operations during blackouts.

I The Chairpersol a11d other Committee members introduced themselves. stating the purpose ol'theil visit to Kenyenya Sr-rb-CoLrnty Hospital. The objectives included, assessing the state ol the health facility, identifying challenges, and providing recommcndations. while o\/erseeing the executive for effective service delivery' l. The committee noted that the hospital rvas clean and had optimal structures but was ,ncierutilized. Most of the wards, including male and f'emale, were operational. However, the maternity and postnatal rvards had no patients' 2. During the assessment of the hospital's infrastructure, the Committee made several critical observations regarding the conditions within the wards: 3. beds were in suboptimal conditior.rs (not adjustable for patients' comfort)' 4. Some wards lacked curtains, mattresses and blankets, which impactcd the overall patient experience. 5. Absence ol'toilets and batl"rrooms within the wards. 6. Rusty cabinets 7. Furthcr-, the facility's kitchen was non-operational forcing patients' relative to either purchase or bring food from home. The hospital relied on external pit latrines and bathrooms for its wards, and a CDF project had stalled. 8. The Committee observed an inadequate water supply to the hospital wards due to a defective pump at the hospital's borehole. This made the hospital to rely on the expensive Kenyenya Community Water Project for water supply. 9. Regar.cling re\/cnue collection, the Committec observcd that the hospitals did not ntonug" their ou,n revenue. Instcacl, the County maintained a centralized accottnt for ..r.ni" collection at KTRH, hindering other facilities from procuring essential needs ol improving thcir facilities. 10. The Committec praised the hospital's store for being well-organized, clean and with an gp-to-date record. However, the facility noted that they experienced inadequate drug supplies which made patients to buy majority of medicines from external sources. ll.The Comn.rittee observed the absence of an in-chalge at the hospital and emphasizcd the importance of hospital managers being present to receive feedback on areas Ibr irnprovement. l \,IIN/SEN/S CH/529l2023 VISIT TO KENYENYA SUB.COUNTY HOSPITAI,.

a ( p e r I rc c d e nt d tt p ov n k p c T c F b S d c St S tt f h hi \I E cH/s30t2023 P()ST I}ITIEFI\(; }IEETING AT GOVIiIINOR'S I{I.]SII)I'\CIJ OITFICE. r welcomed Committee members to Kisii County and apologized for any ces. He introduced himself and other executive members present. y, he invited the Chairperson of the Senate Health Committee to introduce his team. ommittee observed that the centralizcd collection of fttncls at KTRIJ red other facilities from procuring basic hospital necessities. Members asized the need to decentralize funds to enable facilities to purchase tial needs and improve their facilities ommittee raised concerns about KTRH's record tnanagemcnt systelt'l, that it was poorly kept and insufficient. A serious Iapsc in record- ng system underscored the inadequacy. For instance, out of 10 drug bin , only one was up to. Additionally, the Committee noted a significant ce between the information on the bin cards and the actual stock in the er, the Committee observed disorder in the storage of non- aceuticals and liquid medicines at KTRH, as they were st<trcd alongside uction remains. Additionally, the drug storage area had a leaking ceiling ommittee acknowledged and applaudcd the exceptional services providcd TRH's Mortuary and Intensive Care Unit (lCU), emphasizing their high ard of cleanliness, operational eqr-ripment, and dedicated stafl. The rtance of extending this high standard of scrvice throughout the entirc Committee noted high workload experienced at KTRH's TB, Casualty, cy, Drug Store, Newborn Unit, Laboratory, and main Theater ments owing to staff shortage intenance and repair, the Committee noted the necessity to address floor s in the ICU and theater, install CCTV in the pharmacy, and repair the on-operational machines in the Renal Unit at KTRH committee highlighted the presence of idle Medical Equipment and ce (MES) at KTRH's drug store and recommcnded rcdistribution of thcsc Committee noted the absence of essential amenities in the KTRI] and enya Sub-County Hospital's warcls. inclLrding cLlrtaills. u'alrn blankets -5 The r nco rl Subse hirlsc q l. l. sflital was also underscored. 6 ipment to level IV hospitals in the Cor-rnty. l. -) 5 1 s

t aud mosqlrito nets. emphasizing their significance for patient comfbrt and well- being. 9. Members raised concerns about the lor'v tumout in maternity rvard at Kenyenya Sub-County Hospital. The Committee suggested investigating whether factors such as family planning or home conceiving could be influencing the low turnout. l0.N{ernbers raised concerns abollt the abandoned Constituency Development Fund (CDF) project at Kenyenya Sub County Hospital. ll.The committee noted the lack of water at Kenyenya Sub County Hospital and identified the necd to replace a broken pump as a priority to ensure consistent water supply. l2.Concerns were raised about the non-operational kitchen at Kenyenya Sub County Hospital. which is impacting patient nutrition. Patients were forced to Durchase I'ood from outsidc or have relatives bring food from home. l3.The Committee emphasized on need to modernize pit latrines at Kenyenya Sub Cor,rnty Hospital for improved hygiene and sanitation. 15.In response to issues raised by the Committee, the Governor stated that the County successfr.rlly automated the hospitals' revenue collection system. resulting in an increase from 47 million to 179 million KES. 16.He noted that the County had initiated changes in hospital management systems to including the mortuary to address challenges faced by the previouslv unstnrctnred KTRH. l7.The Govcrnor further noted that the County had planned to purchase a new oxygen plant to address oxygen issues at KTRH. with a procurement process in placc. 18. Rcgarding \\'astc managemcllt. thc Governor mentioned that thc county lackecl a clcsignated waste disposal site. Hou'evcr, a collaboration in progress n,ith a donor company to acldress the issuc. 6 14. l'he committee underlined the need of branding drugs to deter theft or smuggling, ensuring the security of pharmaceuticals within the County hospitals. In addition, the Committee emphasized on digitize pharmacy records to enhance drug traceability and streamline inventory management.

( oted a gap of 800 nurses at KTRII, emphasizing the challenge of a S bs antial wage bill. The county's lack of a public service board further ounded these issues C rning the mother-child facility, he noted that equipmenr procuremenr was l1 IN leted. However, the contractor had not yet handed over the pro.jcct. citing al ce owed R (,D ing idle MES equipment at KTRH, the Governor stated that out of the anesthetic machines, the county had donated one to Nduru Hospital c a c 1'h Th e overnor also noted that the County had allocated budget to improve the K at Kenyenya Sub County Hospital cH/531/2023 ANY OTHIIR I}USINI'SS other business H/532/2023 At) OUITNMI'NT o other business, the meeting was adjourned at 9.00 p.m. The next mc irl be on notice CHAIIII'IiRSO S D ). 7 () I 0. 2 2.2. 2 NED:.. \I TE:........ r{[ T

P€J\{6t ( e RI.]I'I.J I}T,IC OT' KT]NYA S-"'- T I I I RI' I.] I.] N'I' I I I'A RI, I A M I] N'I' I S E CO N D S I'] S S I O N 't'ilu sllNAl'll D I RT]CTORAT T] O F' SOC Io- ECONOM IC COM M I'I"I' EES I'R()(;ITAM INSPT]C]'IONTOUR oI" COUN]'Y REI"EIIRAI, IIOSPITAI,S I]Y 1'IIT] S'I'ANI)ING COMMI'I''I'EI'], oN III']AUI'II BoMEI' AND NYAMIIIA COTJN'I'IES 29IIr'l'o 3l'r oct'oltl.lR, 2023 nrbcrs. Parliamcnt lluildings' ocTolillR,2023 a t NT Op SE!I Cl 'r'hc l:irst s

s K/ry,t)l \4, PROGRAM suNDAY, 29rH ocToBER, 2023 Dcparturc from Nairobi bv road MONDAI30 10.00 am 10.30 am 11.30 pm 12.30 pm 1.00 pm 2.00 pm 2.30 pm 3.30 pm 4.30 pm 5.30 pm Courtesy call to the Governor, Bomet County, and county health officials Courtesy call to the Speaker of the County Assembly of Bomet Visit to Longisa County Referral Hospital Lunch Departure for Nyamira CountY Courtesy call to the Governor, Nyamira Counfy, and counry health officials Meeting with Health Worker representatives as follows -

• Community Health Promoters
• Doctors
• Nurses
• Clinical Officers

Visit to Nyamira County Referral Hospital Visit to Igenaitambe HosPital Visit to Keroka Level 4 HosPital ocToBER,2023 31. D U T S E Dcparturc fr;r Nairobi via Kisumu END OF PROGRAMME Pr<lgrammc Coordi nators Dr. Christinc Sagini Ms. lilorcncc \Warvcru N4r. Ibrahim I lusscin Lead Clcrk Clerk Assistant II Scrgcant-at-r\rms OCTOBER,2023 I t 1

()c'I'()BEIL, 2023 S ITI lha atc. or. BI, RI.],PU BI,IC OT' KT],NYA 'iE>-€ THIRTEI,IN'I'II I',ARLIAMENT I SECOND SllssIoN 1'IIF] ST]NAI'D DI RI],CTORA'I'T], o[' SOCIO-ECONOMIC COMM I'I"[T]ES PRo(;ITAM INSPT]CTION TOUR OF KISII COUNTY I}Y TIIE S'I'ANI)ING COMMI'I'TEE ON IIEAI,TII FRI l)AY, 3R" NOVtlMBllR, 2023 bcrs, l,6 sr$F (l 'l'lrc 1 Tor t lrirst I)arliamcnt tlu ild ings.

, PRO RAM THURSDAY,2 NOVEMBER,2023 I)cparture from Nairobi FRtoey, s* NOVEMBER,2023 10.00 am 10.30 am 11.00 am 11.30 pm Courtesy call to ttre Governor, Kisii County Courtesy call to the Speaker, County Assembly of Kisii Meeting with the Health Committee of the County Assembly of Kisii Meeting with Health Worker representatives as follows -

• Community Health Promoters
• Doctors
• Nurses
• Clinical Officers

Visit to Kisii Level 5 Hospital Visit to Marani HosPital Visit to Ogembo Health Center Visit to Nyamarambe HosPital Visit to Masimba HosPital Debriefing meeting at the Governor's Office 12.00 pm 1.00 pm 2.00 pm 3.00 pm 4.00 pm 5.00 pm SATURDAY,4 NO\rEMBER,2023 Dr. Christinc Saginr Ms. Ijlorcncc Wawcru Lcad Clcrk Clcrk ,\ssistant I I 2 Departure for Nairobi END OF PROGRAMME Programmc Coordinators I