Report On The County Oversight And Networking Engagements To Mandera, Wajir And Marsabit Counties

TABLEOFCONTENTS

| LISTOFABBREVIATIONS | LISTOFABBREVIATIONS | 2 | |------------------------------------------------------|------------------------------------------------------|------------------------------------------------------| | PRELIMINARIES | PRELIMINARIES | 3 | | EstablishmentandMandateoftheCommittee | EstablishmentandMandateoftheCommittee | 3 | | CommitteeMembership | CommitteeMembership | 3 | | CHAIRPERSON'SFOREWORD | CHAIRPERSON'SFOREWORD | 4 | | CHAPTERONE | CHAPTERONE | | | 1.INTRODUCTION | 1.INTRODUCTION | 7 | | 1.1.COUNTYPROFILES | 1.1.COUNTYPROFILES | 8 | | 1.1.1. | Mandera County | 8 | | 1.1.2. | Wajir County | 9 | | 1.1.3. | Marsabit County | 11 | | CHAPTERTWO | CHAPTERTWO | 12 | | 2. COMMITTEEOBSERVATIONSANDSTAKEHOLDERSUBMISSIONS 12 | 2. COMMITTEEOBSERVATIONSANDSTAKEHOLDERSUBMISSIONS 12 | 2. COMMITTEEOBSERVATIONSANDSTAKEHOLDERSUBMISSIONS 12 | | 2.1. MANDERACOUNTY | 2.1. MANDERACOUNTY | 12 | | 2.1.1. | Mandera CountyTeaching and Referral Hospital | 12 | | 2.1.2. | TheKhadijaDispensary | 16 | | 2.1.3. | TheADRAHealthCentre(ElwakHealthCentre)) | 16 | | 2.1.4. | TheElwakSub-CountyHospital | 18 | | 2.1.5. | Meetingwith the Governor,Mandera County | 19 | | 2.2. WAJIRCOUNTY | 2.2. WAJIRCOUNTY | 22 | | 2.2.1. | WajirManyattaTBCenter(Sub-CountyHospital) | 22 | | 2.2.2. | Hodhan Dispensary | 25 | | 2.2.3. | Wajir CountyDumpsite | 26 | | 2.2.4. | WajirCountyReferralHospital(WCRH) | 27 | | 2.2.5. | MeetingwiththeCountyExecutive | 29 | | 2.3.MARSABITCOUNTY | 2.3.MARSABITCOUNTY | 32 | | 2.3.1. | MeetingwiththeCountyExecutive | 32 | | 2.3.2. | MeetingwiththeGovernor,MarsabitCounty | 36 | | CHAPTERTHREE | CHAPTERTHREE | 38 | | 3.ANALYSISOFCOMMITTEEOBSERVATIONS | 3.ANALYSISOFCOMMITTEEOBSERVATIONS | 38 | | 3.1.1. | Infrastructure and Resource Gaps | 38 | | 3.1.2. | HumanResourcesforHealth(HRH) | 39 | | 3.1.3. | Health SectorFunding | 40 | | 3.1.4. | HealthProducts and Technologies(HPTs) | 41 | | 3.1.5. | EmergencyandAmbulanceServices | 42 | | CHAPTERFOUR | CHAPTERFOUR | 43 | | 4.COMMITTEERECOMMENDATIONS | 4.COMMITTEERECOMMENDATIONS | 43 | | 4.1. | To the Governor,Mandera County | 44 | | 4.2. | To the Governor,Wajir County | 45 | | 4.3. | To the Governor,Marsabit County | 46 |

7

LISTOFABBREVIATIONS

A&E

Accident and Emergency

CECM

CountyExecutiveCommitteeMember

CHS

CommunityHealthService

CHW

CommunityHealthWorker

CHP

CommunityHealthPromoter

CPSB

CountyPublicServiceBoard

CoG

Councilof Governors

CS

Cesarean Section

DG

DeputyGovernor

EMR

ElectronicManagementRecords

FIF

FacilitiesImprovementFinancing

FY

Financial Year

HDU

High Dependency Unit

HMIS

HealthManagementInformationSystem

HPTs

HealthProducts and Technologies

HRH

HumanResourceforHealth

ICT

InformationCommunicationandTechnology

ICU

Intensive Care Unit

KEMSA

KenyaMedical SuppliesAgency

KMPDU

KenyaMedicalPractitionersandDentist Union

MEDS

MissionforEssential DrugsSupplies

MES

Medical EquipmentService

MoH

Ministryof Health

NG

National Government

NHIF

National HealthInsuranceFund

SHIF

Social HealthInsuranceFund

UHC

Universal Health Coverage

WCRH

Wajir CountyReferral Hospital

WHO

WorldHealth Organization

PRELIMINARIES

EstablishmentandMandateofthe Committee

TheStandingCommitteeonHealthisestablishedpursuanttostandingorder228(3) and theFourthScheduleoftheSenateStandingOrdersandismandatedtoconsiderall mattersrelatingtomedicalservices,publichealthandsanitation.

PursuanttoStandingOrder228(4),theCommitteeisspecificallymandatedto-

• 1)investigate,inquireinto,andreportonallmattersrelatingtothemandate management,activities,administrationandoperationsoftheMinistryofHealth anditsdepartments;
• 3)studyandreviewall legislationreferredtoit;
• 2)studytheprogrammeandpolicyobjectivesoftheMinistryofHealthandits departments,andtheeffectivenessoftheimplementationthereof;
• 4)study,assessandanalyzethesuccessoftheMinistryofHealthanddepartments assignedtoitasmeasuredbytheresultsobtainedascomparedwiththeirstated objectives;
• 5 considertheBudgetPolicyStatementinlinewiththeCommittee'smandate;
• 6 reportonallappointmentswheretheConstitutionoranylawrequirestheSenate toapprove;
• 7 makereportsandrecommendationstotheSenateasoftenaspossible,including recommendationsforproposedlegislation;
• 8 considerreportsofCommissionsandIndependentOfficessubmittedtothe SenatepursuanttotheprovisionsofArticle254oftheConstitution;
• 9)examineanystatementsraised bySenatorsonamatterwithinitsmandate;and 10)followupandreportonthestatusofimplementationofresolutionwithinits mandate;and
• 11)followupandreportonthestatusofcommitmentsmadebytheCabinet SecretariesintheirresponsetoquestionsunderStandingOrder51C

Committee Membership

TheCommitteeiscomprisedofthefollowingmembers-

• 1.Sen.Jackson K.Mandago,EGH,MP

Chairperson

• 2.Sen.MariamSheikh Omar,MP

Vice-Chairperson

• 3.Sen.Justice(Rtd.)StewartMadzayo,EGH,MP-

Member

• 4.Sen.Ledama Olekina,MP

Member

• 5.Sen.David Wakoli,MP

Member

• 6.Sen.Richard Onyonka,MP

Member

• 7.Sen.TabithaMutinda,MP

Member

• 8.Sen.HamidaKibwana,MP

Member

• 9.Sen.Joseph Githuku,MP

Member

CHAIRPERSON'SFOREWORD

At itsmeetingheldonTuesday,10April,2025,theStanding CommitteeonHealth Mandera,MarsabitandWajircountiestoacquaintitselfwiththeprovisionofhealthcare servicesinthecounties aspartofitsoversightfunction.Thesevisitstookplacefrom 28thApril,2025to30thApril,2025.

ThisreportcontainsarecordoftheCountyOversightandNetworkingEngagements conductedbytheCommitteeinMandera,WajirandMarsabitcountiesbetweendates 28thApril,2025to1stMay,2025.These visitswere designed toprovidefirsthand insightsinto the stateof healthcareinfrastructure,service delivery and thechallenges facedbyhealthcareprovidersand thecommunitiestheyserve.

The Committee engagementsinvolved site visits tokey healthcare facilities,direct interactionswith countyleadership,healthcare workers andmembers ofthe public. Through these interactions,the Committeegathered critical evidence on the adequacy ofhealthcarepersonnel,thestatus ofmedicalequipment andsupplies,theeffectiveness ofemergencyandreferralsystemsandtheimplementationofdigitalhealthrecords.

TheCommitteesought toacquaint itselfwith theinformation andunderstand the operationalization of health financingmechanisms including theSocial Health InsuranceFund (SHIF)and theFacilityImprovementFund(FIF).The Committee furthersought toassess thecounty'scompliancewithrelevant healthsector policies and regulations.

TheCommitteenoted thattheinfrastructureacrosshealthcarefacilitiesinthecounties wasdilapidated ascharacterized byleakingroofs,broken tiles,useofbannedasbestos, leadingtosevereovercrowding andforcingpatients,particularlyinmaternitywards,to sharebeds.Compounding thisissystemicdeficienciesacrosskeyareasofdevolved healthcare delivery,startingwithchronicstaffshortagesofqualifiedpersonnel and specialists,whichresultsin overwork,lowmoraleduetopoorcontractual terms and delayedstipends,and theunauthorizeduseofunqualifiedstaff,likeCommunityHealth Promoters(CHPs)fortaskssuch asdispensingmedication.

Thisreportpresents a comprehensive analysisof these issues and offers actionable recommendations to the threecounty governmentsandother stakeholders.These recommendations are aimed at strengthening healthcare systems,enhancing accountabilityand ensuring thatinvestments inhealthcare translateinto tangible improvements in service delivery andhealth outcomes.

Acknowledgements

OnbehalfoftheCommittee,IwishtothankSen.MohamedAbassSheikh,MP,Senator forWajirCounty,Sen.RobaAliIbrahim,MP,SenatorforMandera CountyandSen. ChuteMohammedSaid,MP,SenatorforMarsabitCountyforthesupportextendedto the Committee by their county offices during the oversight visits.Their input and contributions enabled the Committeecarryoutitsoversightmandateandfunctions effectivelyinthethreecounties.

The Committeewishes toextend its appreciation to the Governorsof Mandera,Wajir andMarsabit Counties and theirrespectiveExecutiveCommitteesMembersfortheir input,submissions andevidenceproducedduringtheoversighttours.

Further,theCommitteealsoextendstheappreciationto theSpeakersoftheCounty AssembliesinthethreecountiesandMembersoftheCountyAssemblycounterpart committeesonhealthfor theirfacilitation andparticipation.TheCommitteeisalso grateful to themembersofstaff andotherstakeholdersinthehealthcarefacilitiesvisited during the tour for their submissions,which have greatly enhanced the evidence analyzedduringprocessingofthisreport.

Finally,I acknowledge and appreciate the Members of the Committee for their dedication and commitment duringgatheringofevidence,drafting of thisreport and settingoutconclusionsandrecommendations.

Further appreciationgoesto theOfficeof theSpeaker of theSenate and theOfficeof theClerkoftheSenatefor theircontinuoussupport tothe Committee duringexecution ofits mandate.

Itisnowmypleasantduty andprivilegetopresent thisreportoftheStandingCommittee onHealth,forconsideration and approval bytheHousepursuant toStandingOrderNo. 223(6)oftheSenateStandingOrders.

Col6

Signed

Date....

SEN.JACKSONK.ARAPMANDAGO,EGH,MP, CHAIRPERSON,STANDINGCOMMITTEEONHEALTH.

ADOPTIONOFTHEREPORTOFTHESTANDINGCOMMITTEEON HEALTHOFTHECOUNTYOVERSIGHTANDNETWORKING ENGAGEMENTSINMANDERA,WAJIRANDMARSABITCOUNTIES.

We,theundersignedMembersoftheStandingCommitteeonHealthoftheSenate,do hereby append oursignaturestoadopt thisReport-

• 1.Sen.JacksonK.Mandago,EGH,MP

• 2.Sen.MariamSheikhOmar,MP

• 3.Sen.Justice(Rtd.)StewartMadzayo,EGH,MP

• 4.Sen.Ledama Olekina,MP

• 5.Sen.David Wakoli,MP

• 6.Sen.Richard Onyonka,MP

• 7.Sen.Tabitha Mutinda,MP

• 8.Sen.HamidaKibwana,MP

• 9.Sen.Joseph Githuku,MP

1.INTRODUCTION

• 1.Article96(1)of theConstitutionmandatestheSenatetorepresent thecountiesand serve toprotect theinterestsof thecountiesand theirgovernments.Article124(1) ontheotherhandprovidesthateachHouseofParliamentmayestablishcommittees, andshall makeStandingOrdersfortheorderlyconductofitsproceedingsincluding the proceedings of its committees.
• 2.TheStandingCommitteeonHealthisestablishedpursuant tostandingorder228(3) andtheFourthScheduleoftheSenateStandingOrdersandismandatedtoconsider allmattersrelatingtomedicalservices,publichealthandsanitation.
• 3.ToexecuteitsmandatetheCommitteehasadopteddifferentmodesofoperation which include County Oversightand Networking Engagements.Through these engagements,the Committee is able to augment the evidencegatheredwithin the precinctswithsitevisits.
• 4.At its meeting held on Tuesday,10th April,2025,the Committee resolved to undertake a County Oversight and NetworkingEngagements(CONE) inMandera, MarsabitandWajircountiestoacquaintitselfwiththeprovisionofhealthcare servicesinthecountiesaspart ofitsoversightfunction.Thesevisitstookplacefrom 28hApril,2025to30April,2025.
• 5.The specificobjective of these engagementswas tovisit selecthealthcarefacilities inthethreecountiesinorderto-
• a)assess the state and quality of the infrastructure,facilities,hospital equipment andprovision ofemergencyservices;
• b)asses the automation of healthcare provision systems for patient, drugs and commoditymanagement;
• ? assesstheavailabilityofrequisitehealthcarepersonnel,thegapsandchallenges, ifany,these countiesfaceinregard tohealthcareworkers;
• P assesstheavailabilityoftrainingandcapacitybuildingprogramsandavenues forhealthcareworkersin emergencyhealthcare andspecializedservices;
• e assess the availability of drug andmedical supplies in healthcarefacilities in the counties andpendingbillswith theKenyaMedical SuppliesAgency;and
• f seekinformation ontheSocial HealthAuthority(SHA)reimbursementsclaimed andaccreditationforcountyhealthfacilitieswithSHA
• 6.Consequently,the Committeevisited thefollowinghealthcarefacilitiesin the three aforementioned Counties-
• 1)ManderaCountyReferral Hospital,KhadijaHealth Centre,ElwakSub-County andADRAHealthCentreinManderaCounty;
• 2)Wajir TBManyatta,HodhanDispensary andWajir CountyReferral Hospital in Wajir County(WCRH);and
• 3)Marsabit CountyReferral HospitalinMarsabit County(MCRH.).

CHAPTERONE

1.1.COUNTYPROFILES

1.1.1.ManderaCounty

• 7.Mandera CountyislocatedinNorthernKenya,borderingEthiopia to theNorth, SomaliatotheEastandWajirCountytotheSouth.TheCountyhasasurfacearea TheEconomyoftheCountyispredominantlybasedonpastoralismandagriculture, with persistentchallengesrelated to insecurity andharsh climaticconditions;
• 8.Mandera Countyhasmade significant stridesinhealthcareprovision,particularly sincetheadventofdevolution.Themajorhealthfacilitiesinclude:ManderaCounty Referral Hospital,Rhamu Sub-County Hospital,Mandera Central Sub-County Hospital,KotuloSub-CountyHospital,BanisaSub-CountyHospital,ManderaWest
• 9.Sinceadventofdevolution,theCountyhasoperationalizedcomprehensivematernal andchildhealthcareunits,gazettednewhealthfacilities,andincreased thenumber offunctional healthcare facilitiesand healthworkers.Further,the Countyhas reported an increase in the number of ambulances,establishment of ICU infrastructure,procurement of dialysis machines and increased the specialized personnel.Theseinterventions,among othershaveseen the countyimproveinits healthindicators.
• 10.ManderaCountyReferralHospitalisthebiggesthealthcareandreferralfacility fortheentireCounty.It hasanestimatedtotalbedcapacityof128and5cotsserving thepopulation'shealthneeds.Accordingtorecordsfrom thehealthdepartment,it collectsapproximatelyKshs.60million annuallyfrompatients.
• 11.TheManderaCountyHealthServicesImprovementFinancingAct,2023allowsthe mainpublichospitalsincludingMandera CountyReferralhospital toretain their quarterlycollections anduseitforprocuredrugs andequipment.Thisregulationhas madethehospitalssemi-autonomousevenasthecountyadministrationstrivesto provide quality healthcare services;
• 12.ManderaCountytotalestimatedbudgetforFY2024/25amounts toKshs.14.89 billion comprisingKshs.12.05billion share of the equitable share,Kshs.1.19 billion as additional,Kshs.336.5million as own source revenue ofwhich Kshs.57.92 millionwillbecollectedfrom thepublichealthfacilities;
• 13.IntheFY2024/25,theCountyhasallocatedKshs.2.65billion to thehealthsector ofwhichKshs.2.165billion(82.4per cent)is for therecurrentexpenditure and Kshs.492million(17.6percent) allocatedforthe developmentexpenditure.Upto thesecondquarterofFY2024/25,thecountyhadonlyspentKshs.980millionof itsrecurrentbudgetand spentKshs.131million spentondevelopment asreported by theOfficeoftheControllerofBudget(OCOB).

• 14.InthefirsthalfofFY2024/25,theCountyhadcollectedKshs.10.2millionfromthe FIFthatwasutilizedbyManderaCountyReferralHospitalwherethefundswere collectedasreportedbytheofficeofthecontrollerofbudget.InthefirsthalfFY 2024/25,thecountyhadspentKshs.89.06millionon thepharmaceuticalsupplies andKshs.59.76millionon thepurchaseofnon-pharmaceuticalsupplies;
• 15.Nonetheless,therecentreportsbythe Officeof theController ofBudgetindicates thatsubstantialportion ofManderaCounty'shealthbudgetis allocatedtorecurrent expenditure,particularly personnel emoluments(salaries and wages),leaving comparativelylessfordevelopmentandservicedelivery.Thispatternlimits resources available for infrastructure,equipment,and essential medical supplies, whicharecriticalforimprovinghealthoutcomes;
• 16.The Countyis alsoreported tohave accumulated significant pendingbills,including for health-related goods and services.These unpaid bills affect suppliers willingnesstoprovide essentialmedical commodities andservices,further straining healthcaredelivery.Further,ithasnotmetitstargetsforcollectingown-source revenue,whichlimitsthefunds availableforhealthsectorinvestmentsandincreases relianceonnationaltransfers and conditionalgrants.

1.1.2.WajirCounty

• 17.WajirCountyislocatedintheNorthernKenyaregionwith asurfaceareaof55,840.6 sq.Km.WajirisaBoranaword thatmeanscomingtogether,bequeathed tothispart oftheCountrybecauseofthedifferentclans andpastoral communitiesthatused to congregatein areasaroundWajirTown towatertheiranimalsfrom theabundant anddependableshallowwellsthatcharacterizethegenerallandgeomorphology. The Countyhas an estimatedpopulationof781,263persons accordingto theKenya NationalBureauofStatistics(KNBS)2019 census.
• 18.TheCountyhasoveronehundredgovernment-managedpublichealthfacilitieswith countyandsub-countyhospitalsspreadacrossthewidthandthebreadthofthevast County.Themajorhealthfacilitiesinclude;Wajir CountyReferral Hospital,Eldas Sub-County Hospital,Buna Sub-County Hospital, Bute Sub-County Hospital, GriftuSub-CountyHospital,Tarbaj Sub-CountyHospital,HabasweinSub-County Hospital,Dadajabula Sub-County Hospital, Abakere Sub-County Hospital and LeheleySub-CountyHospital.
• 19.WajirCountyReferralHospitalisthelargesthealthcarefacilitywithanestimated 8ICU beds,and50isolation beds serving the population'shealth needs.Thefacility reportedlycollectsthelargestamountofmoneyasFIFfollowingtheenactmentand operationalizationoftheCountyFIFActin2023.
• 20.In the FY 2024/25,the County hadprojected toundertake severalmajor developmentprojectsdedicated tothe healthsector.Thetablebelowgivesthemajor projectsinthehealthsectortobeimplementedinFY2024/25.
• 21.WajirCountytotalestimatedbudgetforFY2024/25amountstoKshs.13.76billion comprisingKshs.10.21billion share of the equitable share,Kshs.2.4billion as additional,Kshs.200 million as own sourcerevenue,ofwhichKshs.120million will becollectedfromthepublichealthfacilities;
• 22.In theFY2024/25,theCountyallocatedKshs.3.782billionto thehealthsector of whichKshs.2.983billionisfor therecurrentexpenditureandKshs.798.7million allocatedforthedevelopmentexpenditure.UptothesecondquarterofFY2024/25, the Countyhadonly spentKshs.1.486billion of itsrecurrentbudget andKshs.441 millionondevelopmentspentondevelopmentasreportedbytheOfficeofthe ControllerofBudget.
• 23.InthefirsthalfofFY2024/25,theCountyhadcollectedKshs.41.33millionfrom theFIFthatwasutilizedbythehospitalsasreportedbytheOCOBthough the facilitiesdidnotsubmitareportonitsutilization.In thesameperiod,theCounty spentKshs.120.4milliononthepharmaceutical andnon-pharmaceutical supplies.

| Table1:MajorhealthsectorprojectstobeimplementedinFY2024/25 | Table1:MajorhealthsectorprojectstobeimplementedinFY2024/25 | Table1:MajorhealthsectorprojectstobeimplementedinFY2024/25 | Table1:MajorhealthsectorprojectstobeimplementedinFY2024/25 | Table1:MajorhealthsectorprojectstobeimplementedinFY2024/25 | Table1:MajorhealthsectorprojectstobeimplementedinFY2024/25 | |--------------------------------------------------------------|------------------------------------------------------------------------|--------------------------------------------------------------|--------------------------------------------------------------|--------------------------------------------------------------|--------------------------------------------------------------| | S/NO. | Project | Contract sum | Allocation in FY2024/25 | Amount paid todate | Completion status (%) | | 1 | Construction of Accidents & Emergency atWajir County Referral Hospital | 465,608,595 | 229,814,413 | 407,488,253 | 88 | | 2 | Upgrading of Arbajahan Health Centre to Level4 Hospital | 137,524,21 | 119,646,159 | 119,646,159 | 87 | | 3 | Upgrading of Makaror Health Centreto Level4 Hospital | 76,129,872 | 58,522,157 | 58,522,157 | 77 | | 4 | UpgradingofKutulo Health Centreto Level4Hospital | 41,168,957 | 41,168,957 | 20,500,000 | 75 | | 5 | UpgradingofTarbaj Health Centre to Level4Hospital | 34,950,956 | 19,703,408 | 19,703,408 | 56 | | 6 | Construction of MaternityWardat Giriftu Sub County Hospital. | 19,261,870 | 19,261,870 | 17,335,683 | 100 | | 7 | UpgradingofBuna Health Centre to Level4Hospital | 28,850,000 | 16,623,600 | 16,623,600 | 58 |

Source:Wajircounty treasury

1.1.3.MarsabitCounty

• 24.Marsabit CountybordersEthiopiatotheNorth andNorthEast,WajirCountytothe East,IsioloCountytotheSouthEast,SamburuCountytotheSouthandSouthWest and LakeTurkana to thewest andNorthWest inavast area spawning70,961.3km2. Ithasanestimatedpopulationof489,785personsaccordingtotheKenyaNational BureauofStatistics(KNBS)2019census.
• 25.The major health facilities in the County include;Marsabit County Referral Hospital,MoyaleSub-CountyHospital,SololoSub-CountyHospital,KalachaSubCounty Hospital,and Laisamis Sub-CountyHospital.Marsabit County Referral Hospitalhasanestimatedtotalbedcapacityof109inpatientbeds,42maternitybeds, 5emergencycasualtybeds,3ICUbeds,3HDUbeds and12isolationbeds;
• 26.Oneof themajorprojectsthatwastobeimplementedinFY2024/25included the completionofSololoSubCountyHospitalwherethecontactsumwasKshs.21.69 million andsofar,Kshs.21.68hasbeenpaidout andcompletionratereported at 95%.
• 27.MarsabitCountytotalestimatedbudgetforFY2024/25amountstoKshs.10.34 billion comprisingKshs.7.83billionshareof the equitable share,Kshs.1.35billion as additional,Kshs.251.16million asown source revenue,of which Kshs.141 millionwill becollectedfrom thepublichealthfacilities;
• 28.IntheFY2024/25,theCountyallocatedKsh.2.087billiontothehealthsector of whichKshs.1.848 billion is for therecurrent expenditure andKshs.239million allocatedforthe developmentexpenditure.Upto thesecondquarterofFY2024/25, the countyhad only spentKshs.1.071billion of itsrecurrentbudget andzerospent ondevelopmentasreportedbytheOcoB.
• 29.In thefirst halfofFY2024/25,theCountyhad collectedKshs.50.8millionfrom theFIF thatwasutilized bythefollowinghospitals asreported bythe OCOB.The total amountutilizedincludeunspentbalancesoftheFIF.

| S/NO. | Hospital | Approved budget forfacility (Kshs.Million) | Actual expenditure asDecember2024 (Kshs.Million) | |---------|----------------------------------|----------------------------------------------|----------------------------------------------------| | 1 | Marsabit CountyReferral Hospital | 76.16 | 39.21 | | 2 | Moyale Sub-County Hospital | 45 | 12.23 | | 3 | Kalacha Hospital | 10 | 1.9 | | 4 | Laisamis Sub-County Hospital | 10 | 1.875 | | | Total | 141.16 | 55.23 |

CHAPTERTWO

2.COMMITTEEOBSERVATIONSANDSTAKEHOLDERSUBMISSIONS 2.1.MANDERACOUNTY

2.1.1.Mandera County Teaching and Referral Hospital

• 29.The Committee visited theMandera County Referral Hospital (MCRH)on Monday,28t April,2025.The MCRH,formerly known as Mandera District Hospital is theprincipalpublichealthcarefacilityin the County and serves as the mainreferral andspecializedcare centerafterbeingupgradedfromlevel4facility tolevel5in2016.TheHospitalprovidesa comprehensiverangeofinpatient and outpatient services,including,general medical and surgical care,maternal and child health services,emergency andreferral services and specialized clinics and diagnosticservices.
• 30.Duringthevisit theCommitteewasableto tourdifferenthospitaldepartments including the outpatient, inpatient,Intensive Care Unit (ICU),radiology department,thelaboratory,thematernity,therenalunit,thepharmacy,theblood bank,the Tuberculosis(TB) clinic and specialized clinics such as dental unit.
• 31.During thevisit the Committee wasinformed that Mandera CountyReferral Hospital-
• a)has a catchmentof 148,000peoplelivingin and around thecountyand also serves cross-border patients from neighboring Ethiopia and Somalia, reflecting the uniquegeographic and epidemiological context in the County.

Picture1:TheCommittee delegationinMandera County on28April,2025

• b) )isa training center forhealthworkers andactivelyparticipatesindisease outbreak response and control, especially for communicable diseases prevalentin the borderregion;and

2. C hasabedcapacityof 209whichincludedgeneralinpatientbedsand specialized units.It has two hundred and sixty-three (263) members of andonehundredand ten(1i0) nurses

Picture 2:During theoversightvisit to Mandera County TeachingandReferral Hospital

32.FollowingtheoversightvisittheCommitteeobserved that-

• b)The Hospital faces water scarcity which is exacerbated by recurrent droughts, andpoor distribution and storage infrastructure and facilities which was severely affecting hygienein thehospital andpatientcare.
• a)TheMCTRHoffers arangeof specializeddepartment andunitssuch asthe maternity,renal,mental health,oncology,critical care,diagnostics,and surgery,which aredesigned toprovide comprehensivehealthcareservices and serve as a training andresearch centerfor thecounty;
• c)Therewere also absenceofwater taps and showerheadsin thehandwash basins and bathrooms.This glaring absence was prevalent in thematernity wing a cleardeviationfromHealthInfrastructureNorms and standards(2017) setbytheMinistryofHealthrequiringthatall healthfacilitieshavesufficient
• d)The maternitywards further lackbasicnecessities such as adequate beds,and sufficientbabycotsto adequatelyservetheneedsof thepatientsand thereby compromisingcarequalityofneonatal care and ability to safely accommodate newborns especiallygiven therole of thefacility as areferral center;

Picture3:The Committee inspects theMandera County ReferralHospital Renal Unit

• e) There was a critical shortage ofnursing staff and midwives at the maternity wards to adequatelyserve thenumberofexpectantmothers atthefacility.This was coupled with absenteeism,difficult working environment,poor remuneration and unpaid wages to casual labourers;

2. Whereas theRenal Unit was functioning,it had several dialysismachines that were unfunctional,broken down and required repairs.However, it was available five(5) and theunit required at least ten(10) dialysismachines.

Picture 4:Mandera County ReferralHospital Theater.The Committee observed thatHospital has made significant strides in equipping and upgrading the critical unit.

• g)There is no functional laundry unit to ensure patients always have access to cleanlinen at the facility despite somerecent infrastructuralupgrades.The Committeeobserved that thiswaslikelytoincrease theriskofhealthcare onhospital operations;
• h) The health data management and patient records remain manual and the facilityrelies onpredominantly on manual health records.The Committee observed discrepancies in themanual health records at the maternity wards withrecordednumberofpatientsbeingdifferentfromthosephysicallypresent at thefacility.Thismade it hard to trackpatienthistory,affected efficiency, data accuracy and timelyaccesstopatientinformation.
• i) The waiting bays at the facility are not properly furnished and lack adequate seating areas andfacilitiesforpatients andvisitors.Itwasobserved that thisshortfall wasgreatly affectingpatientcomfort;
• TheHospital faces challenges related to the management of drug issuance andpharmacy records,severalrecords including a recordof drugs related to control of Alcohol andDrug Dependency(ADD) containing discrepancies.The Committeeobserved thatconcernshadbeenraisedonpossiblediversionof medicinetoprivatepharmaciesowingtolaxcontrolsintheissuancechain.

Picture5:The Committee inspects the drugsrecords at theMandera County Teaching and Referral Hospital health.The drugsrecords remain manual andthefacilityreliespredominantlyonmanualhealthrecords.

• k)The Committeeobserved that therewere expireddrug stocks on the shelves and the concerned healthcare personnel expressed uncertainty over proper protocolsforremovingand/ortrackingexpiredinventory.

2.1.2.The Khadija Dispensary

• 33.TheCommittee touredKhadijaDispensarywithin theManderaTownonMonday, 28tApril,2025andwas informed that thefacility serves approximately10,000 peoplefrom thelocalcommunity.Thefacilityhas ten(10)membersof staff majority ofwhomare the CommunityHealthPromoters(CHPs);
• 34.During thevisittheCommitteeobserved that the facilityhadwellmaintained infrastructure,clearly accessiblefacilities andwell-marked directionsforguidance. Further thestaffmembers atthefacility appearedwellversedwith theirrespective roles.However,thefacilitydidnothave a pharmacistor apharmacy technologist to dispense drugs and as such was utilizing theCHPs to dispense drugs;

35.The Committeefurther observed thatKhadijaDispensary-

• 1)1 lacks a functional incineratorforproper and safe disposal ofmedicalwaste whichis likely to contribute to unsafewastemanagement practicesin addition toposinghealthrisksto staff and theneighboringcommunity,and
• 2) Thereisnoperimeterwall atthefacilitywhichislikelytoimpactonthe facility's security,theftofmedical supplies,equipment andmedicine as well asvandalism.

2.1.3.The ADRA Health Centre (Elwak Health Centre))

• 36.TheCommitteeconductedanoversightvisit toADRAHealthCentreinElwak Sub-Countyon29April,2025andwasinformed thatthefacilitywasincepted by

• theAdventistDevelopment and Relief Agency (ADRA) and hasbeen providing healthservicesinMandera and otherneighboringcounties.
• 37.TheCommitteewasinformed thatthefacilitywas collecting theFacility ImprovementFinancing(FIF)fundsfollowingtheoperationalizationof the County Health Services Improvement Financing Act,2024.However,the facility managementcommitteewasnotdully constitutedwhichhadcaused delaysin decisionmaking.
• 38.DuringthevisittheCommitteeobserved that-
• a)ADRA Health Centre faces challengesrelated to poorphysical conditions whichincludelack ofproper infrastructure and equipment which is likely to compromisepatientcomfort and care quality;
• b) There isgeneral scarcity of qualified health workers in thefacility;it lacked a qualifiedpharmaceutical technologistand drugswerebeingdispensedbya communityhealth assistant;and
• There waspresence of expired drugs in the shelves,coupledwith improper storage of hazardousmedicalwastesandpoordrugmanagement

Picture6:TheCommittee observes dilapidatedinfrastructure and equipment toprovide adequatehealthcareservicesattheADRAHealthCentre

Picture 5:There existent discrepancies between recorded drugs and medicine stocksand theactual stockon the shelveswhich compromised theaccuracy ofstockrecords

2.1.4.TheElwakSub-CountyHospital

• 39.The Committee conducted an oversightvisit to theElwakSub-CountyHospital,a level 4publichealthfacilityinElwakTownon29April,2025.TheCommittee wasinformed thatthefacilityreceivescrossborderpatientsmanyofwhomarenot vaccinated,lackofproper documentationandpresentscommunicationchallenges due tolanguagebarrier.
• 40.TheCommitteewasinformedthat thefacilitywasimprovedin2024which included an upgrade ofitsinfrastructure and services.Consequently,thefacility has abed capacity of approximately onehundred and three(103) bedsincluding beds including bedsinIntensive CareUnit (ICU) and High Dependency Unit (HDU).Additionally,there are three operating theaters dedicated to trauma, maternity andgeneral surgery.
• 41.DuringthevisittheCommitteemadethefollowingobservations-
• a)TheElwak Sub CountyHospital faces significantchallengesrelated to water scarcity.However,the facility was utilizing water trucking and rapid response maintenance teams were supplying portable water to mitigatetheimpactsofscarcity;
• b)Thematernity ward supportedby thenewborn unithandlesmultiple deliveriesdailyestimatedtobe between10and 15.However,the Committeewasinformedthatmothersattendmaternityservicelate,often arrivingincritical condition.Thisis associatedwithweakreferralsystems, poor road infrastructure andinsecurity whichhinders timely access to healthfacilities.

Picture6:TheElwakSub County Hospital faces significantchallenges relatedtowaterscarcity

2.1.5.Meetingwith the Governor,Mandera County

• 42.The Committeeheld ameetingwith theGovernorMandera CountyonMonday, 28hApril,2025andwasinformed that-
• a) Mandera Countyhadmade significant stridesinimproving theprovision of healthcare services focusing on accessibility,quality and infrastructure development tomeet theneedsof itsconstituents;
• b The Countyhas equippedandupgraded theMCTRHtoenhanceitscapacity toprovide specialized andreferralservicesincludinginmaternalandchild health,renal analysis and emergency care;
• C The Countyhasincreased healthcareworkersincludingmedical officers and there areplans tohiremorenurses.Further there are continuousefforts to train and deploy more healthcarepersonnel in critical areas;and
• P The County faces challenges due toporousborders including outbreaks of diseases.However,the Countyhasmanaged and controlled these outbreaks throughcoordinatedpublichealthinterventions.

Picture7:Sen.MariamOmar,MPsignsvisitors'bookduringthecourtesycall tothe Governor,ManderaCounty

• 43.During themeeting theCommittee informed theGovermor and the County Executivethat-
• a)Itwas evident there wassomeremarkablegrowth inHuman Resourcesfor Health(HRH)whichwasmatchedwith theincreaseinhealthcare facilities in the County.However,there was widespread neglect and unsanitary preventionmeasures;
• b) Whereas,the County had made significant investments in upgrading and expandingitsmaternity serviceschallengesrelated to insufficient staffing limited facilities,poor referral system,frequent stock-outsandgeneral cleanlinesspersistswithpossibleeffectsonpatient experience andsafety;
• Thehealthcarefacilitiesfacesignificantchallengeswithrecordkeeping and healthinformationmanagement.Therewere discrepancies and inconsistencies across all departments with likely effect to quality and reliabilityofhealthdata.Themanualrecordsalsoimpendedeffectivehealth informationflowwithindepartmentsaffectingpatientcaremanagement;
• (P Community Health Promoters (CHPs),nurses and other unqualified and untrainedstaff were dispensing drugs in healthcare facilities without supervisiondue toshortageandorabsenceofqualifiedpharmaceutical personnel.TheCommitteeobservedthatthiswasaviolationofthePharmacy andPoisonsAct,thegoverninglawregardingdrug dispensing;

• e)There existentdiscrepanciesbetween recorded drugsand medicine stocks andtheactualstockontheshelveswhichcompromised theaccuracyofstock records.There were expired drugs on the shelves an indication ofpoor pharmaceuticalwastemanagement;
• 44.TheCommitteefurtherinformedtheGovernorthattherewasneed toconducta thoroughassessmentofcurrentstaffinglevelsagainsttheapproved staff establishmenttoidentifyvacanciesandgapsbeforerecruitmenttoensurethereisa balanceincadres;
• 45.TheCommitteefurtherobservedthattherewasanon-siteoxygengeneration equipmentattheManderaCountyReferralHospitalbutitwasnotcleariftheplant wasgeneratingoxygenforhospitaluseandiftherewereanypersonneltrainedto operate andmanageoxygensystemssafelyand effectivelyatthefacility.

2.2.WAJIRCOUNTY

2.2.1. Wajir Manyatta TB Center (Sub-County Hospital)

• 46.TheCommitteeconductedanoversightvisittotheWajirManyattaTBCenteron Tuesday 29th April,2025accompaniedbyMs.HabibaAli Maalim,the County Executive CommitteeMember(CECM) in chargeof Health Services and hostof officersfromtheHealthDepartmentintheCounty.
• 47.TheCommitteewasinformedthattheTBManyattawasstartedinthelate1970sby ItalianNunwhorecognized theunique challengesof treatingTuberculosis(TB) in theregion.TheCenterwasbuiltliketraditional dwellings(Manyatta)in order to createavillagelikeenvironmentwherepatientscouldstaythefullcourseof directoryobservedtherapyrangingbetweenfourtosixmonths.
• 48.DuringthevisittheCommitteemadethefollowingobservations-
• a)There is astalledmodern incineratorproject which was envisaged to address ongoing challenges at the facility and neighboring healthcareinstitutions including the improper disposal of medical waste.The Committee was informedthattheprojecthadstalledduetolitigationbydifferentstakeholders includingthelocalresidentswhohadraisedconcernsandfearsaboutpotential healthhazards;
• b) TheTB Manyatta treatspatientsfrom Wajir and theneighboring counties including those from neighboring counties.However,the cottages are dilapidatedwhichposessignificantchallengesrelated tosafetyand adequacy ofinfrastructureforthepatients.Indeed,manyof thecottageshadreportedly been condemnedfor demolition and therewasnorecentrefurbishmentor upgrading;

Picture8:Thecottages at theManyattaTBCentreusedasquarantinecottagesfor patients.

• ? TheTBManyatta lacksaproperperimeterwall/fencewhichposedsafety and securityconcerns tothepatients,staff andmedical supplies at thefacility.The Committeeobservedthatthiscould alsohindereffectiveinfectioncontrol and expose thefacility torisksof unauthorized access;
• (P TheTBcenter lacksproperPersonnel ProtectiveEquipment(PPE) such as protectivegownsandfacemaskswhichcompromisethesafetyofhealthcare workersandpatients.Further thereisnomodernlaboratorytohandleTB specimenssafely;
• The Center suffersfrom thepoorrecordkeepingwhich hampers efficient patientmanagement,trackingof treatmentprogressandoverall accountability ofpatientsanddispenseddrugs.TheCommittee observed thatuntrained personnelwereinvolvedindispensingmedication and theCountypharmacists could notsufficientlyrespond tobasicconcernsbytheMembers;
• ThepatientsattheTB Centercomplained andexpressed dissatisfaction about poor diet citing quality,adequacy and nutritional value and general mistreatment by themembersof staff.Theyfurther complained aboutpoor safetyconditions,lackofessential supplieslikemosquitonetsandneglect whichexacerbated hardshipsduringtreatment.

Picture9:The Committee inspects the Wajir TB Manyatta Centre pharmacy.Thecentersuffersfromthepoorrecord-keepingwhichhampers efficientpatientmanagement,trackingoftreatmentprogressandoverall accountabilityofpatientsanddispenseddrugs

Picture10:PatientsatTB Centercomplained and expressed dissatisfaction about poor diet citingits quality andnutritional value

Picture1l:ThedilapidatedkitchenattheTBCenter

HodhanDispensary

• 50.TheCommitteewasinformedthat thedispensaryisasmalloutpatienthealth facilityusuallymanagedbya clinical officer andregisterednurseswhoprovide primaryhealthcareservices.Thedispensaryservesbetween20and40patients daily anddonothaveinpatientbeds.
• 49.The Committeevisited HodhanDispensaryinWajirEastSub Countywithin the Township andwas received by thefacility in-charge,a clinical officer by training. TheDispensaryprovides sbasic outpatient health services,including immunizations,familyplanningand treatment of common illness.
• 51.Duringthevisit theCommittee observed that thedispensarylacksapharmacist and/orpharmaceutical technologist anddrugsareusuallydispensed bycommunity healthpromoters.Indeed,mostservices atthefacilitywerebeingprovidedbythe communityhealthpromoters under theguidance of theclinical officer in-charge.
• 52.TheCommitteelauded theefficiency and theperformance oftheclinicalofficerin chargeandobserved thatwhilethefacilityhadapotential toserveabigger catchmentarea it lackeda space for expansion and therewasno significant infrastructuralinvestmentbytheCountyGovernment.

Picture 12:The Committee Visit to Hodhan Dispensary in Wajir County,a

2.2.2.Wajir CountyDumpsite

• 53.The CommitteeconductedanoversightvisittoWajirCountyDumpsitein the outskirtsoftheWajirTownonTuesday,29tApril,2025andobserved that there was evidence of improper dumping of hazardous and toxic wastes including biomedicalwastes andpesticidesraisingconcerns aboutcontamination ofsoil and watersourcesconsideringthewaterlevelsinWajirTown.
• 55.The Committeeobserved that therewasmismanagementof the dumpsite and that rawsewagewasalsobeingdumpedatthedumpsitebecause the townlackeda properseweragesystem exacerbatinghealthrisks and limitingaccesstosafewater.
• 54.The Committeewasinformed that theneighboring communityhad alsoraised concerns about possible health hazards including respiratory issues,skin and bloodinfectionsfrom directcontactwithcontaminatedwater andwastesfrom the dumpsite.The sitehasalsobeenlinked toperiodicoutbreaksof communicable diseases like cholera due to improperwastemanagement.
• 56.TheCommitteeobserved that the dumpsitewaspoorlymanaged ascharacterized bylack of security,absence ofproper fencing andinadequate investment in modern waste management infrastructure.It was evident that animals and unauthorizedindividualshavefree access tothedumpsite.

Picture13:Inspection of theWajirTown dumpsite.Improper dumpingofhazardous and toxicwastesatWajirCountyDumpsite

• 57.TheCommitteewasfurtherobservedthat theproximityofthedumpsiteto residential area and improperfencing caused significantenvironmentalissuesdue touncontrolled accessbylivestock and wildlife,who graze on solid waste. Further,plasticaccumulationis likelytoleadto environmental degradationand poses additional health challenges.

Picture14: Thedumpsiteispoorlymanagedascharacterizedby lackof security,absenceofproperfencingandinadequateinvestment in modernwaste management infrastructure.

2.2.3.Wajir County Referral Hospital (WCRH)

• 58.The Committee conducted anoversightvisit to the Wajir County Referral Hospital(WCRH),a level 5hospital on Tuesday 29tApril 2025 andwas received byDr.DahirSomon,the ChiefExecutive Officerof theHospital;
• 59.TheCommitteewasinformed thatWajir CountyReferralHospital hasa totalbed capacityof onehundred and fifty-four (154)inpatient beds and astaff complimentof about one hundred and three(103)healthcare personnel.The Hospital provides a range of services including maternity care,emergency treatment,renal servicesand increasingly cancer care.The Hospital was also a key centerformanaginginfectious diseasesincluding therecentsurge ofkalaazaroutbreak;

60.During thevisit,the Committee observed that-

• 1)Wajir CountyReferralHospital offerscancerrelated therapies in effort to manage the prevalence of cancer cases in theregion.However,the Hospital

• lacks a full oncologyworkforce and most patientsrequiring advanced treatmentwerereferred toregional centerin Garissa County;
• 2) There is inadequate pharmaceutical management and oversight.It was observed thatuntrainedpersonnelwereinvolvedin drugdispensingandthey utilizedmanualrecordkeepingposingariskoferrors. Thereexisted discrepanciesbetweenphysical stocks on the shelvesandrecorded stocks;
• 3) There was poor storage of drugs classified as controlled substance and requiring strict handling and storage conditions.The Committee specifically observeddiscrepancy in theinventory onDiazepam,one suchcontrolled drug. Fewerphysical stockswere availableasopposed torecordedinventoryraising concerns on possible pilferage andmisuse;
• 4)The Hospital offers maternity services includingprenatal andpostnatal care andisSHA accredited indicating it meets certain quality standards.However, there were several challenges related to understaffing and inadequate infrastructure.The maternity wards didnothave mosquito nets alongside unmaintained laundry equipment which was identified as main challenge affectingmaternal and newborncare;
• 5)Thematernitywardsdonothaverunningwater severely affectinghygiene andposingchallengesofinfectioncontrol andoverall qualityofmaternalcare. The Committeeobserved that therewererisksofneonatalinfectionsand

Picture15: Inadequatepharmaceuticalmanagementandoversight andpoor storageof expired andunusedmedication and medicalproductsin oneoftherooms atManyatta TB Center

• inadequatewatersupplymadeitdifficult tocleanrooms,equipmentand linens properly compromising care delivery;
• 6)The Committee observed that WCRH was upgrading its infrastructure including,maternityinfrastructure andamodern accident and emergencywing whichwasnearingcompletion.Itwasobserved that thisfacilitywould support alreadyexistinginfrastructure and enhancematernityand otherhealthcare services.

Picture16:DilapidatedWASHinfrastructureat theWajirTB Manyatta

2.2.4.Meeting with the County Executive

• 61.TheCommitteehelda debriefingmeetingwith theGovernor,Wajir Countyon Wednesday,30"April,2025 topresent itspreliminaryfindings to the County Executive.During the meeting,the Committee informed the Governor that during the oversight visit to different healthcare facilities,the followingpreliminary observationshadbeenmade-
• 1)TheWajir CountyReferral Hospital is undergoing significantinfrastructural upgradesincluding constructionof a newmaternity block as a broader part to modernizehealthcareserviceprovision and todecongest the existinghealthcare infrastructure;
• 2) There was evidence of possible complacency,sense of entitlement staff attendance amonghealthcareworkersat thepublichealthcarefacilitieswhich waslikelytoaffectservicedelivery;
• 3)Thehealthcarefacilities are heavilyreliant onmanual systemswith little tono automationofhealthcareservicesdespitetheCountyGovernment'smissionto provide technology driven and evidence-based health services.There was

• manual record keeping and paper-based system affecting the inventory management, patient records and service delivery efficiency;
• 4)Thepublichealthcarefacilities suffer frompoorwater supply and sanitation infrastructurewith majority ofwards lackingwater,missing taps and shower heads in thebathroom and especiallymaternitywardswhichposed arisk of waterborne diseases;
• 5)The healthcare facilities lackclearly established,purpose-built,functional and nutrition services to patients including those in hospitals and stabilization centers;
• 6) The healthcare facilities lack fully functional laundry facilities including washingmachines,dryers and ironers impacting on their ability to maintain clean linens and garments which is critical for patient care and infection prevention;
• 7) The maternity wards do not have fixed mosquito nets leading topossible shortage and/orinadequate protection against mosquito borne diseases such as malaria.Further,the maternity wards do not have sufficient beds and baby cotsforusebynewbornbabiesand theirmothers;
• 8)Therewasneed toestablish adedicateddepartment,unitorasectionwithinthe healthcare facilities to address routine maintenance and repair in each healthcarefacility
• 62.TheGovernorinformed theCommitteethattheCountyGovernmentofWajir-
• 1)hadconvertedtheCovid-19Centerintoalevel4healthcarefacilityinabidto decongest theWajir CountyReferral Hospital andaspartofitsstrategic expansioninhealthcareservices.Further the County Governmenthad elevated severallevel threefacilitiestolevelfourcentersandconstructedamodern accident and emergency wing;
• 2)hadprocured six(6) dialysis machines,which were scheduled tobe delivered andinstalledbeforetheendofthe2024/25FinancialYear.Theprocurementis partofthe effortstoimprovespecializedmedicalservicesincludingrenal care and to address the shortage andmalfunctioning of dialysismachines;
• 3)hadconstructedandfurnished a satellitebloodbankwhichhasalsobeen provided with essential equipment;a refrigerated centrifuge and apheresis machineby theNational Governmentmakingit the onlyhealthcarefacilityin theregioncapable of preparingblood and blood products;
• 4)hadcompleted the constructionofa state-of-the-artaccident and emergency facility which is currently being equipped as part of the broader efforts to enhance emergency healthcare services,improvepatient outcomes and provide advancedemergencycloser;
• 5)was in the process of constructing and equipping a modernkitchen at the Wajir County Referral Hospital as part of its ongoing healthcare infrastructure

upgrades and significant budget allocations have been made.It is envisaged that the kitchen will enhance the hospital's capacity to provide overall healthcarequality;

• 6)hasprioritized theconstruction ofa perimeterwall aroundWCRH aspart of its security and infrastructure enhancement.In addition,there are plans to constructandequipamodernmortuary.
• 63.TheCommitteewasfurtherinformed thattheCountyGovernmentwouldfacilitate public and stakeholder engagements inbid to unlock theimpasse surrounding the incineratorprojectattheWajirTBCenter.Further the CountyGovernmentwould developapolicyonexpireddrugs.

2.3.MARSABITCOUNTY

2.3.1.Marsabit CountyReferral Hospital

• 64.TheCommitteeconducted theoversightvisitinMarsabitCountyonWednesday, 30thApril,2025 and was able to tour theMarsabit County Referral Hospital (MCRH)andwas taken through differentdepartments to acquaintitselfwiththe service provision in theHospital.

65.Duringthetour,theCommitteeobservedthat-

• b)The high-riskmedication such as Diazepam was neitherrecorded or stored unauthorized access and ormisuse;
• a)Therewas a major variance between thephysical stock and recorded stock in the hospitalpharmacy with a significant difference between the actual quantityof medicine on theshelves and the amounts listed ininventoryrecords. Further,thehospital pharmacykept theirrecordsin amanual paper-based logs, system andregistersrather than electronic or automatedsystems;
• c)Prevalence ofexpired drugs and medications stored openly in the shelves, availed atwards andeven stored atinappropriatelocationssuch as disused lavatoriesandinopenfields

Picture17:TheDumping ofmedical waste at theMarsabit County Teaching andReferral Hospital

Picture 18:Expired drugs storedin a disused lavatory at Marsabit CountyReferral Hospital

• d)Cancer testresults experience significant delaysbecause thefacilitylackslocal analysiscausingprolonged turnaround timeforresults;
• e)The Hospital infrastructure was dilapidated with evidence of continued neglect being witnessed in the leaking roofs,falling ceiling boards,missing electricbulbs andnaked livewires;

Picture19: Dilapidated infrastructure at the Marsabit County Teaching andReferralHospital

Picture 20:Thephysiotherapyroom atMarsabit CountyReferralHospital hasbeen convertedinto a storage area for usedbiomedicalwastes and hazardousmaterial

• f)Medical hazardous waste was dumped in undesignated pointposing a risk ofexposure toinfectious agents amongthepatients,healthcarepersonnel and the surrounding community.The Committee observed thatbiomedical waste including infectious and hazardousmaterials was discarded in the backyard nearthemortuary;
• g)Thekeyhealthcarepersonnelwere absentfrom theirdesignatedworkstations during publicduty time,the notable onesinclude the Medical Officerof Health,thePharmacistand thePediatrician.TheCommitteeobserved thatthis had led to disruptions in careprovision,increasedpatient waiting times and reducedservicequality;
• h)The Committeeobserved that therewasweaksupervision and accountability ofhealthcarepersonnel in theHospital.Reportsindicated thatkeyhealthcare personnel including doctors,clinical officers and nurses,sometimes operate privateclinicsorpharmacieswhilebeing on the County Governmentpayroll;
• i)Therewerenobathroomsinside thefemale surgicalwards andno cleanwater points within the ward reflecting critical infrastructural and sanitation deficiencieswithin thefacility andseverely affectingpatienthygiene,dignity andinfection control;
• j)Therewerewheelchairsandotherbrokenfurnitureleftscatteredand strewnall over thewalkwaystodifferentunitsofthefacilitywhichindicatedchallenges in equipment management and storage;

Picture 21:The Committee obsrves thehazardous disposal ofmedical waste,as the hospital lacks anincinirator.

• k) There were run down ambulances which appeared to have been poorly maintained and/ornolonger operationalwithin thehospitalcompound.Some of these ambulances have been repurposed as temporary storage facility rather thanservice theirintended emergency transportfunction;

2. D There was overgrown grass and unkempt compound andyards all over the facilityreflectingpoor maintenance and increasingrisks of harboring disease vectorslikemosquitoesandrodents 3. m)Thecasualsreported that theyhad notreceived theirwagesforupto three(3) months leading to significant dissatisfaction and negatively affected the personnel morale andwelfare.The Committeedirected the CECin charge of Health toensure that thecasualswerepaidpromptly and those that hadvoiced theirconcerns during thevisitwerenotvictimized.

Picture22:Grounded ambulances.

2.3.2.Meeting with the Governor,Marsabit County

• 66.The Committee held a meetingwith the GovernorMarsabit County on30"April, 2025andwasinformed thattheCountyGovernmentofMarsabit-
• a)hademployedninehundred andnineteen(919)healthcarepersonnelsince2017 todatebringingthetotalnumberofhealthcarepersonnel intheCountytoone nephrologynursing,radiologists,anesthetists;

• b)had establishedonestopMotherand Child ComplexattheMarsabitTeaching andReferralHospitalinorderto addressthehighmaternal andmortalityratio;
• c)hadfurther constructed and equipped aBioSafetyRegional Laboratorywhich provide advanceddiagnosticcapabilitiesensuring the safetyofpatientsand healthcareworkers.
• 67.TheCommitteewasfurtherinformed that-
• specialized personnel to run and interpret advanced diagnostic equipment. Further,the department experiences frequent power outages making it difficultfor thehealthcareworkerstousethedigital x-rayunit;and
• b) The renal and dialysis units were established on 17h July,2018 and equipped with equipment provided through the MES program.Since then,great milestones had been achieved including six (6) renal dialysis machines, increased clients accessing dialysis services to thirty-six(36) and increased the staffattheunit.

CHAPTERTHREE

3.ANALYSISOFCOMMITTEEOBSERVATIONS

3.1.1.Infrastructure andFacilityConditions

• 69.Developmentandmaintenanceofhealthcarefacilitiesinfrastructureisafunctionof thecountygovernments.Adequateinfrastructure enhances accesstohealthcare and contributestohighqualityofoutcomes.Thethreecountieshavemadenotable stridessinceadventofdevolutionwithManderaCountyoperationalizinga comprehensivematernalandchildhealthunitwhileWajirCountyhasreportedly developedoveronehundred(1oo)publichealthfacilitiesandconstructed anew maternityandemergencyunits.
• 70.However,acrossthethreecounties,thereisnotableprogressandreportedpersistent challengesand disparitiesininvestmentintoincreasingandimprovinghealthcare facilities.Spendingin theall the three countieshasprioritizedrecurrentexpenditure with key spending driversbeing personnel emoluments,salaries andwages leaving a limited share for development,infrastructure and equipment.Forinstance,in FY 2024/25,ManderaCountyallocatedonly17.6%,Wajir21%andMarsabit11.5%of theirhealthbudgetstodevelopment.
• 71.Thisunderinvestment is evidentinslowprogress on expansion andmodernization ofexistinghealthcareinfrastructure aswellasinability tofullyequip existing facilities.Indeed,the actual development spendingin the three countieslagsbehind allocations.Bythe2ndQuarterofFY2024/25ManderaCountyhadspentKshs.131 million on development,Wajir CountyKshs.441 millionwhileMarsabit County hadspentnothingondevelopmentdespitebudgetaryallocations.
• 72.BothManderaandWajirCountyfacilitiesfacesacutewaterscarcitycoupledwith inadequateplumbingcharacterizedbymissingwater tapsand showerheadsin the wardsvisited.InMarsabit County,there arenobathroomsinside thefemalewards andno clean water points reflectingcriticalinfrastructural and sanitation deficiencieswithin thefacility and severely affectingpatienthygiene,dignity and infectioncontrol.Thegardenswithin theMarsabit CountyReferral Hospitalwere unkemptwithovergrownshrubsandgrassvisiblearoundallwalkways.
• 73.InManderaandWajirCountytherewerenobabycotstoadequatelyservethe maternitywards'needs.This shortage appeared tohaveaffected thequalityof neonatal careand abilitytosafelyaccommodatenewborns.InWajirCountythere werenomosquitonetsin thematernitywardsleading topossibleinadequate protection against mosquito borne diseases such asmalaria.The infrastructure gap manifests inlack offunctionallaundry and kitchens and poorlymaintained ambulanceservices.
• 74.In all the three counties,there areglaring gaps inessential and specialized equipment and incomplete basic infrastructure projects.In Mandera for instance,several dialysismachineswereunfunctional,brokendown and/orrequiredbasicrepairsor reagents.

• InWajir,the Committeewasinformed that six(6) dialysismachinehad been procuredandwerescheduledtobedeliveredbeforetheendof2024/25Financial Year.InMarsabit CountyReferral Hospital therewere only three (3)Intensive Care Unit(ICU)beds.
• 75.BothMandera andMarsabitcountiesreportedsignificantinfrastructuredecaywith healthcare facilities suffering from leaking roofs,missing electric bulbs,exposed wiring andpoorlymaintainedwards.In all the three counties,thewaitingbays are poorlyfurnished.Majorityofhealthcarefacilitieslackperimeter wallsincreasing thevulnerabilitytotheft,vandalism andinsecurity.
• 76.All the three countiesrelyheavily onmanual,paper-based healthrecords which hampers efficientpatientmanagement,inventory control and data accuracy.The Committeeobservedthatdataretrievalandpatientmanagementinallhealthcare facilitiesled todelaysinservicedelivery andcomplicated administrativeprocesses. The Committeefurther observed thatmanual recordsareproneto damage,loss and errorswhich compromisedcarecontinuity andtheaccuracyofhealthdata.

3.1.2.HumanResources forHealth (HRH)

• 77.Countygovernments through theirrespectivedepartmentsof healthareresponsible for undertaking Human Resources for Health (HRH) management processes including recruitment,deployment,capacity building,performance appraisals, promotionsandpaymentsofsalaries.Across thethreecountiesvisitedby the Committee,thereis evidenceofchronicstaffingshortageandskillsgapsinvirtually allthedepartmentswithcritical unitslikethedialysisunitsoperatingbelowcapacity due toinsufficient trainedpersonnel.Support serviceshadfurthergaps andstaff absenteeismwasnoted.
• 78.In all the three counties,healthcare facilities have untrained personnel dispensing medication,includingcommunityhealthpromoterswithoutbasicpharmacytraining raisingconcernsaboutpatientsafetyandqualityofcare.WajirandMarsabit countiesparticularlystruggleswithstaffingdeficitsinspecializedareassuch as cancercareunits.Thisis attributedto anumberoffactorsthatincludehighcostof remunerationofhealthcareworkers,natural attritionsuchasretirement,deathand
• 79.It isobserved thatretentionandmotivationof healthcare workers remain problematic due toharsh workingconditions,insecurityandinadequate support infrastructure.The lack of continuous professional development,training and promotionopportunitiesin thesecounties discouragehealthcareworkers from stayinglong-term.InMarsabitCounty,theCommitteeobservedthatcasualworkers who had been engaged to provide support services such as cleaning, gardening and othermanual taskshadnotbeenpaidforinordinatelongperiodexceedingmorethan twomonths.Delayinwages,poorworkingconditions,lackofprotectiveequipment underminedstaffmorale.Absenteeism andworkingatprivateclinicwhileonpublic payrollwerereported.

• 80.Inall the threecounties,specialist health workerswerereportedtobescarce undermining thequalityandaccessibilityofhealthcareservices.Thisshortagehas constrained thecapacitytodeliver specialized andqualityhealthcare services and the abilitytofunctionefficiently.Itwas observedthatpoorinfrastructure,lackof essentialequipmentandsupplieslimitstheabilityof specialiststopractice effectivelyandmakepostingsinthosecountiesunattractive.
• 81.In Mandera County,there were sophisticated equipment in specialized departments lackinghumanresourcetooperate themwhileinMarsabit Countykeypersonnel suchasMedical OfficerofHealth,theCountyPharmacistandPediatricianwere absentduringthevisit.
• 82.Therewerealsoskeweddistributionofhealthicareworkerswiththecountyreferral hospitalsappearingtobefavoredinstaffingallocationsleavingprimaryhealthcare facilitiesunderstaffedandunderresourced.Itwasobservedthatthishasexacerbated delaysin treatmentandincreases theburden onreferralhospitals,whichbecome overcrowdedandoverstretched.Lapsesinfacilitymanagementandweakstaff supervisionhavehamperedservicedeliveryandperpetuatedinefficiencies.

3.1.3.HealthSectorFunding

• 83.Acrossthethreecountiesitwasreported thatdelayedexchequerreleases andSocial expendituresofthehealthcarefacilities.Further,therewereconcernsthatsome reimbursement to the county governmentsby the defunct National HealthInsurance Fund(NHIF)maybelost.It wasreportedthatthehealthsectorfacedinadequate budgetallocationsduetolimitedfiscalspaceandunpredictabledisbursement.
• 84.Itisfurtherobserved thatthereis amismatch andinconsistencyin adherencetothe countygovernmentsbudgetmakingandimplementationprocesswithrecurrent budgetaryallocationmakingupthebiggestpercentageofthetotalhealthsector budgetsinthethreecounties.Healthsectorbudgets arenotalignedwithhealthplans or targetsleadingtopossiblewastageofresourcesasevidencedbypresenceof expireddrugsindifferenthealthcarefacilities.
• 85.The threecountiesreceivedreimbursementsunder theSocialHealthAuthority (SHA)with reports indicating thatWajir County hasreceived more thanKshs.11 millionfromSHA.However,the threecountiesindicated that therewere delaysin approving thereimbursementvisiting the facilities withchallengesrelated to operationalcapacity.
• 86.TheFacilityImprovementFundActwasenactedin2023toprovideforpublichealth facilityimprovementfinancing and themanagement and administration ofown sourcerevenuegeneratedbypublichealthfacilities.Thethree countieshavemade effortstofulfil theFIFAct'srequirementstoenhancethemanagementofown source revenue.However,some facilities operatewithout fullyconstituted management committees,delaying important decisions and affecting service delivery.

• 87.ManderaCountyhasenacted theManderaCountyHealthServicesImprovement FinancingBill,2023whichprovidesadetailed frameworkfor thecollection, retention,anduseofrevenuegenerated bythehealthcarefacilities.On theother hand,Wajir Countyreported that therewereeffortstoautomatemostrevenue streamsto enhance ownsourcerevenuecollection,retention andreduceleakagein additiontoimprovingaccountabilityinrevenuemanagement.On theotherhand, MarsabitCounty.

3.1.4.HealthProductsandTechnologies(HPTs)

• 88.Access toHealth Products and Technologies(HPTs)iscritical toprovision of efficient primary healthcare.However,quality,access and affordability and provision of HPTs poses significant challenges in the three counties. The main suppliersofhealthproductsandtechnologiesinthecountiesisKenyaMedical Supplies Agency(KEMSA).However,across the threecounties,concernswere raisedon theabilityofKEMSA tosupplyall requiredHPTswhichforced them to purchasefromothersuppliers.Nonethelessall thecountiesvisitedrelyon external supplies due to limited local manufacturing.
• 89.In Wajir County,the Committee observed that the TB Manyatta lacks proper Personnel ProtectiveEquipment(PPE)such asprotectivegownsand facemasks which compromise thesafetyofhealthcareworkers andpatients.Similarly,in the MarsabitCountyReferralHospitalsendsmostdiagnostictests tofacilitiesoutside care.Further,in all the three counties, there is poor management and storage of equipmentlikewheelchairs.
• 90.Duringthevisitwidespread shortageofessential drugs andmedical supplies across the three countieswasreported.However,expired drugs were also found on shelves in severalfacilities indicatingpoor stockmanagementandoversight.In some instances,theseexpireddrugswereimproperlystoredand dumpedinopenfieldsor unused toilets,highlighting failures in waste management and incineration infrastructure.InMarsabitCounty,expireddrugsandsanitizerswerefoundatthe wardsindicating theirroutine use.Significantpending billsmayhave affected procurementandtimelysupplyofmedicineandnon-pharmaceuticalresources.
• 91.All facilitieshadchallengesinimplementingautomatedmanagementof the pharmacyandnon-pharmacystorefrom thereceiptofsupplies todispensingto patientsandhospitalstaff,asituationthatexposedthemtolosses,unavailabilityof supplies andpoordecisionmaking.Facilitiesoftenlacktrainedpharmacypersonnel. Across all thecounties,absenceofpharmacistsortrainedstaffwasobservedwhich is likely to compromiseproper handling,storage and dispensing of health products and technologies.Forinstance,inMandera County,communityhealthpromoters werefounddispensingmedication.
• 92.Across thethreecounties,therequisiteinfrastructuretofacilitateintegrationand effectiveuseofdigitaltechnologieswaslacking.Indeed,inonehealthfacility,the healthcarepersonnelwereusingtheir own personalcomputers tokeyin detailsof thecommoditiesintheirpharmacyonsimplerecordkeepingcomputer applications suchasexcel.

The Committee observed discrepanciesin the availablemanualrecords both in pharmacy andwards.Thisinaccuratedata couldhavebeen aresultofinconsistent data formats, missing data and/or duplicate records.

3.1.5.Emergency and Ambulance Services

• 93.In all the threecountiesvisited,theCommitteeobserved that thehealthcarefacilities donothave the optimumnumbersof ambulances andrequisitefacilitiestoprovide emergency services.There are no structures to facilitatereferralof emergency servicesfromonehealthcarefacilitytotheother.
• 94.TheCommittee observes thatWajir Countyhas constructed amodern accident and emergencywing aspart of itshealthcare infrastructure upgrades,aiming toprovide specialized emergency units and trauma centers.Further in response to recent emergenciesincludingkala-azar diseaseoutbreaktheCountyhadlaunchedarapid emergencyreliefinitiative tosupportpatients andvulnerablehouseholds.However, there is no evidence that basic emergency care facilities toreduce reliance on distant referral hospitalshavebeen established atthesubcountylevel.
• 95.InMandera County,the Committee wasinformed thatmothers attend maternity service late,often arriving in critical condition. This was associated with weak referralsystemsandpoorroadinfrastructurewhichhindered timelyaccesstohealth facilities.
• 96.InMarsabit County,therewererun down ambulance which appeared to have been poorlymaintained and/orno longer operational within theMarsabit CountyReferral Hospital.Someof these ambulanceshavebeen repurposed as temporary storage facilityrather than servicetheirintended emergency transportfunction.

CHAPTERFOUR

4.COMMITTEERECOMMENDATIONS

96.With theforegoing,theCommitteerecommends that theCouncilof Governors shouldensurethatall countygovernments-

• a) Aligntheirbudgetallocationswith the CountyIntegratedDevelopmentPlans (CIDP) to ensurelong termhealthcare infrastructureinvestments and ensure thatineachFinancialYearatleast30%ofthecountyhealthsectorbudgetsgo towardsdevelopmentprojects;
• b) Expeditiouslyroll-outfullyautomateddigitalhealthrecords systemsinall healthcare facilities to improve efficiency,allow quick access to patient history,enhance remote consultations and specialist care,enhance referral system,track disease and outbreak trends,and allowreal time tracking of medical supplies;

3. ? Develop a county-wide master plan for healthcare infrastructure upgrades, prioritizing primary healthcare facilities,maternity and child wards, emergency units and hospitalkitchens; 4. (P and packaging that align with international bestpractices and national standards to ensure safehandling,minimize health risks and protect the environment; 5. Implement incentive programs to attract andretain specialist doctors especiallyinfarflung counties throughcontinuousprofessional development, fair and timelyremunerationforall healthcarepersonnel including casual workers;

• f) Implementstrictinventoryauditstoremoveexpireddrugs and alignrecorded stockswithactualinventoryandfurtherdevelopapolicyonexpireddrugs disposal topreventmisuse andenvironmental hazards;
• g) Create an integrated referral infrastructure linking pre-hospital hospital, seamlesspatienttransfer and care continuity;and
• h) s laboratories andhealthcarefacilities,collaboratingwith National regulatory bodiesforqualityassurance.

9. 97.TheCommitteerecommendsthattheCountyAssembliesshoulddevelop specific legislationthatclearlydefines therolesofthecountygovernmentsonregulating healthfacilities,pharmacies andlaboratoriesincludingretailoutlets.

4.1.Governor,Mandera County

• 98.TheCommitteerecommendsto theGovernor,ManderaCountyto-
• a)ensure a continuous and adequatecleanwatersupply and expeditiouslyinstall functional water taps andshowerheadsin all healthcare facilities and especiallyinhospitalbathroomsandmaternitywardstomeetandcomply with basichygienestandards;
• b)allocate sufficientresources toMandera CountyReferralHospital to expand the ICU and dialysisunitstofull operational status,procuresufficientbed and babycotsinmaternity andneonatal units;
• establisha functional laundryunit to maintain clean linen for patients especiallymothersandnewbornchildrenandsupporthygieneandreduce infectionrisksand constructperimeterwalls around all healthcarefacilitiesto safeguardpremises,patients,healthcarepersonnel,and medical supplies;
• d allocate sufficientresources toimplement and upgrade digitalhealthrecords andautomationinorder tofullytransitionfrommanualrecordstodigital health management information systems for better patient tracking and
• e allocate sufficient resources to renovate and equip primary healthcare facilitieswithbasiclaboratory andmaternityequipmenttoreduceincidences wheremothers accessprenatalandmaternity serviceslateoften atcritical condition;
• f patient health data between ambulances,emergency departments and healthcarefacilitiesforeffectivepatienttriageandreferrals;
• g) allocate sufficient resources to recruit additional healthcare workers by targeting to increase the nurses,clinical officers and specialists by at least 20%withinthe2025/2026FinancialYearandfurtherinitiatequarterly capacitybuildingworkshops and training;
• h) recruitqualifiedpharmacistsand/orpharmaceuticaltechnologiststodispense drugs instead of relying on Community Health Promoters,ensuring compliancewithPharmacyand PoisonsActandfurther enforcestrict inventoryauditstoremove expired drugs and alignrecorded stockswith actualinventory;
• i) establishindependentmonitoring teamstoconductperiodicauditstoassess hospital infrastructure conditions,track planned renovation progress and ensurefunds allocated for healthcare facilityupgradesand hospital infrastructure areproperlyutilized;and

• j) implement smart energy solutionsby considering solar photovoltaic(PV) panels togenerateclean renewableenergyinorder toimprovehealthcare facilitiespower supplyandreduce operationalcosts.

4.2.To theGovernor,Wajir County

• 99.TheCommitteerecommends to theGovernor,WajirCountyto-
• a)resolvelitigation andfullyimplementthestalledincineratorproject atWajir Manyatta TB Center;
• b) rehabilitateWajir County dumpsitebyresolvingimpendinglitigation disputes through stakeholder engagement and allocatingsufficientresourcestoprevent environmental contamination andpublichealthhazards;
• rehabilitate dilapidated cottages, to procure rapid TB diagnostic equipment, provide adequate Personnel Protective Equipment (PPE),ensure reliable water supply,constructgender accessiblewashrooms,hiremorelaboratory technologist andconstruct aperimeterwall atWajirManyattaTB Center;
• d implementElectronicMedical RecordsattheWajirManyataTBCenterin and evaluation,and streamlinereferralprotocols.Further,providenutritional support to all TB admitted patients and launch TB awareness programs;
• e) recruit additional healthcare personnel especially specialists,nurses, laboratory technologistsand pharmacistsandimplementcontinuous professional developmentprograms to upskill healthcareworkers;
• f) installfunctional cleanwaterpoints and ensure consistentcleanwatersupply and providemosquito nets inmaternity wards to protect newborns and mothersfrommosquito-borne diseases;
• roll-outfully automateddigital healthrecordsystemin all healthcarefacilities introducestrictpharmaceuticalinventorycontrolsand audits;
• h) establishandmaintainacentralizedambulancedispatchsystemforrealtime coordination of emergency response and ensure adequate ambulance are provided and properlymaintained andin operationfor emergencyreferrals;
• i) upgradehospitalkitchenstoprovidequalityandnutritiousmealsforadmitted patients andfurther establish strategies to addresscomplaintsregardingpoor diet andmistreatmentofpatientsinhealthcarefacilitiesinreal time;and
• j) establish routine maintenance and repair programs toimplement scheduled maintenanceplansforhospital buildings,equipmentand utilities andfurther create dedicated hospital maintenance units tohandle repairs,plumbing, electricalworksandsanitation.

4.3.To the Governor,Marsabit County

• 100.The Committeerecommendsto the Governor,Marsabit County to-
• a)u tapsinMarsabit CountyReferral Hospital and ensure all wardshavefunctional bathrooms,clean water supply and proper ventilation.
• b)expeditiouslyconstructbathroomsinsidefemale surgicalwardsforimproved hygiene and patient dignity;
• c)leverageontechnology andutilizedigital tools tocentralizedocumentstorage, automate checklists and securebackupfor quickretrievalofmedicalrecords and data;
• d)establishaframeworkforregular andperiodic auditscoveringcriticalareas in healthcare provision such as prescribing practices, controlled substance managementandpharmacyrecordstoalignwiththebestpractices;
• e)collaborate closely with thePharmacy and PoisonsBoard (PPB)and other compliance checksofpharmacies andhealthproductoutlets;
• f adequately equippedfor different emergency cases;
• g)increase thenumberof available ambulances tomeetintermational ambulanceto-populationratio andmaintainacentralizedambulancedatabaseforefficient deploymentandmonitoring;
• h)enforce strict regulationsrequiring that biomedical waste is treated and properlydisposedof within amaximumrecommendeddurationfrom generation toprevent accumulationandreduce healthhazards;
• i)create a policy to prohibit improper storage of untreatedbiomedicalwaste and dumping ofmedical hazardous wastes in beyondstipulated time and undedicated places,stipulating clear sanctions for non-compliance including penaltiesforindividuals and facilities;
• j)developclearpoliciesthatregulatedualpractice andconductregular and periodicmonitoringofattendanceandperformancetoensurethathealthcare workersfulfil theirpublic sector obligations;and
• k)resolve delayed salariesfor casualworkers,ensuring timely remuneration and foster positive employees'relations through regular feedback,supportive

13THPARLIAMENT|4THSESSION

MINUTES SOFTHE SEVENTEENTH SITTING OFTHESTANDING COMMITTEEONHEALTHHELDONMONDAY,28THAPRIL,2025AT12.00 PMINHEALTHCAREFACILITIESANDTHEOFFICE.OFTHEGOVERNOR, MANDERACOUNTY

MEMBERSPRESENT

• 1.Sen.Jackson K.Arap.Mandago,EGH,MP

• Chairperson

• 2.Sen.Mariam Sheikh Omar,MP

-Vice-Chairperson

• 3.Sen.David Wakoli,MP

-Member

4. Sen.Richard Onyonka,MP

• -Member

• -Member

• 5.Sen.Tabitha Mutinda,MP

ABSENTWITHAPOLOGY

• 1.Sen.Justice(Rtd.)StewartMadzayo,EGHMP

-Member

• 2.Sen.Ledama Olekina,MP

-Member

• 3.Sen.Joseph GithukuKamau,MP

-Member

• 4.Sen.Hamida Kibwana,MP

-Member

INATTENDANCE

• 1.Sen.Mohammed Abbas,CBS,MP

• -Friendofthe Committee

SENATESECRETARIAT

• 1.Mr.HumphreyRingera

• -SeniorResearch Officer

• -Clerk Assistant

• 2.Mr.David Ngamate

• -Audio Assistant

• 3.Mr.Ian Otieno

• 4.Mr.Ibrahim Odindo

• -Serjeant-At-Arms

• 5.Mr.Kevin Lomenen

• -MediaRelations Officer

INATTENDANCE

MANDERACOUNTYEXECUTIVE

-Governor

• 1.Hon.Mohamed AdanKhalif

• 2.Mr.BillowIssack Hassan

-CountySecretary

• 3.Ms.MumtazaBishar Somo

-CountyExecutive CommitteeMember,

Health Service

• 4.Mr.Hussein Adam Somo

• -County Attorney

• 5.Mr.Bashir Ibrahim

• -CountyExecutive CommitteeMember,

EducationandHuman Capital Development

• 6.Mr.Ali Dakane

• -CountyExecutive CommitteeMember,

Trade and CooperativeDevelopment

• 7.Mr.HusseinAdamSomo

• -CountyAttorney

• 8.Mr.Okash Abdullahi

• -ChiefExecutive Officer(CEO)

Mandera CountyTeaching andReferral Hospital

• 9.Hon.OmarMohammedMaalim

Speaker,Mandera CountyAssembly

MIN/SEN/SCH/095/2025

PRELIMINARIES

The Committee congregated at the Office of the Governor,Mandera County for a courtesy call andproceedingscommencedwithawordofprayer.ThereaftertheCommitteeproceededfor oversightvisitstodifferenthealthcarefacilitiesasscheduled.

MIN/SEN/SCH/096/2025

OVERSIGHTVISITTOMANDERA COUNTYTEACHING ANDREFERAL HOSPITAL

• 1.The Committee visited the Mandera County Referral Hospital (MCRH) on Monday, 28th April,2025 accompanied byMr.BillowIssack Hassan,the.County Secretary,Ms Mumtaza Bishar Musa, the County Executive Committee Member (CECM) in charge of HealthServices andwasreceived at the hospital by the ChiefExecutive Officer;
• 2.The Committee was informed that MCRH,formerly known as Mandera District Hospital,is theprincipal publichealthcare facility inMandera County.It is located in Mandera Town and serves as the county'smainreferral and specializedcare centerafter being upgraded from level,4facility tolevel.5:in2016.Thehospital provides a comprehensive range ofinpatient and outpatient services,including, general medical and surgical care,maternal and child health services,emergency andreferralservices and specialized clinics and diagnostic services;
• 3.TheCommitteewasfurtherinformed thatthehospitalhasacatchmentof148,000 people living in and around the County.It also serves cross-border patients from neighboring Ethiopiaand Somalia,reflecting gthe unique geographicand epidemiologicalcontextintheCounty.The hospital is also a trainingcenterforhealth workers and activelyparticipates in disease outbreakresponse and control,especially for communicable diseasesprevalentintheborderregion;
• 4.The Countywas informed that the hospital has a bedcapacityof 209whichincluded generalinpatient bedsand specialized units.It has twohundredand sixty-three(263) membersofmedical staffwhoinclude,twelve(12) specialists,twenty-two(22)doctors andonehundred and ten(110)nurses;

• 5.The Committee toured different hospital departments including the,outpatient, inpatient,Intensive Care Unit (ICU),radiology department,the laboratory,the maternity,therenalunit,thepharmacy,thebloodbank,theTuberculosis(TB)clinic and specialized clinics such asdentalunit;
• 6.The Committeewas informed that therenal unit has three(3)functional dialysis machines and during the currentFinancial Year(2024/2025),five(5) more havebeen procured;
• 7.The Committeewasfurther informed that theCountyowesKenyaMedicalSupplies Authority (KEMSA) approximately Kshs. 82.93million in unpaid medical supplies debts;
• 8.TheCommitteewasinformed thatthehospital isprimarilyfunded through,equitable share from National Government,conditional grants,Managed Equipment Services own sourcerevenue (FacilityImprovementFund);
• 9.The Committeewasinformed that themain challengesfacing theMCRH include-
• (1)ErraticsuppliesbytheKenyaMedical SuppliesAuthority(KEMSA)which leadsto missingkey supplies likeradiology,laboratory supplies;
• (2)Inadequate Skilled Personnel associated with the insecurity and harsh working conditionswhichhaveled topoor attraction andretentionofskilled healthworkers;
• (3)Poor Infrastructure and EquipmentUtilization,while the hospital has received advanced medical equipment such as dialysismachines,CT scanners,there isunder utilization due tolackof trainedpersonnel,inadequate supportinginfrastructure such as space andpower supply,and maintenance challenges;
• (4) severe staffing shortages due to high resignations especially in nursing and clinical departmentsleading to criticalgapsinservice delivery atthefacilityincluding the referral hospital;
• (5) theUniversal Health Coverage (UHC) staff in the County are employed on contract termswithlow stipendsrather than permanent andpensionable termswhich leads
• (6) the Hospital is significantly affected by the persistent,frequent,prolonged and severe power outages and interruptions which disrupts hospital operations, including critical servicesthat depend on continuouspower suchasemergency care, diagnostic and refrigeration ofmedicine andvaccines;
• 7) delays in receiving reimbursements from Social Health Authority (SHA) which strains the cashflowand operational capacity;and
• 81 manyessential diagnostic testsrequire sending samplestoNairobi causing costly delays in receiving results and affects timely clinical decision-making.

MIN/SEN/SCH/097/2025

OVERSIGHT VISIT TO KHADIJA DISPENSARY

• 1.The Committeeconducted an oversightvisit toKhadijaDispensarywithin theMandera Town andwasreceived at thefacilitybytheClinical Officerincharge.The Committee wasinformedthat the facility serves approximately10,o00people from thelocal community;
• 2.The Committeewasinformed that thefacilityhas ten(10)membersofstaff majorityof whom are the Community Health Promoters(CHPs).However,the facility lacks a pharmacistorapharmaceutical technologist anddrugs aredispensed bytheCHPs.

MIN/SEN/SCH/098/2025

MEETING WITH THE GOVERNOR, MANDERACOUNTY.

• 3.The Committee held asmeetingwith the Governor,Mandera after the oversightvisit for a debriefing and sharing of the preliminary findings with the Executive and informed the Governor that during the oversight visit,thefollowing observations had been made-

About Mandera County Teachingand Referral Hospital

• 1) The Committee observed that the MCTRH offers a range of specialized department and units such as the maternity,renal,mental health,oncology, critical care, diagnostics, and surgery,which are designed to provide comprehensivehealthcare services andserve asa training andresearch center for.the County;

2. 2)Thehospital faceswater scarcitywhich isexacerbatedbyrecurrentdroughts, and poor distribution and storage infrastructure and facilities.Thiswas severely affecting hygiene in thehospital and patient care,as such there isneed for rehabilitation and expansion ofwater infrastructure in the hospital including installation of missingwater taps.and showerheadsin the handwash basins and bathrooms; 3. 3)The Committee observed glaring absence of tapwater and shower heads in the maternity wing a clear deviation from Health Infrastructure Norms and Standards(2017) set by theMinistry of Health requiring that all healthfacilities have sufficient and clean pipedwatersupply at all timesfor drinking,personal hygiene; 4. (t The maternity wing doesnot have fixedmosquito nets installed over beds. However,it wasobserved that theCounty Governmenthasbeen actively distributinginsecticidetreatedmosquitonetstomotherswithnewbornswhen they leave hospital;

• 5)Further,thematernitywardslack sufficientbaby cotsto adequately serve the maternitywards'needs.It was observed that such shortageislikelyto affect the quality of neonatal care and ability to safely accommodatenewborns especially given the role of the facility as a referral center;
• 7)The health data management and patient records remainmanual and the facility relies onpredominantly on manual health records affecting efficiency,data accuracy and timely access to patient information;
• 6) There is no functional laundry unit to ensure patients always have access to clean linen at thefacility despite somerecentinfrastructural upgrades.Thisis likely to increase the risk of healthcare associated infections,compromise patient comfort and dignity and place strain on hospital operations;
• seating areas for patients andvisitors.This shortfall affects patient and may contribute to discomfort;
• 9)Whereas the renal unit hasfive dialysis machines,only three were operational whichcoupledwith staff shortage limited the capacity of thefacility to provide adequate dialysis treatment to patientswith chronickidney disease;
• 10)The facility faces challenges related to the management of drug issuance and pharmacyrecords,several recordsincluding a record ofexpired drugs and controlled substances contained discrepancies.

About Khadija Dispensary

• 4.The Committeehadobserved that thehealthcarefacilitywaswell maintained and clean.However,theCommitteeobserved that-
• 1)thefacilitydidnothave apharmacistnor apharmacy technologisttodispense drugs and assuchwas utilizing the CommunityHealthPromoters to dispense medicine;
• 2)thefacilitylacks a functioningincinerator forproper and safe disposal of medical waste which islikelytocontribute tounsafe waste management practices and poses health risks to staff and theneighbouringcommunity; and
• 3 thereisnoperimeterwall at thefacilitywhichislikelytoimpactonthefacility's security, theft of medical supplies, equipment and medicine as well as vandalism.

Submissionby theGovernor

• 1) The County has made significant strides in improving the provision of healthcare services focusing on accessibility,quality and infrastructure development to meet theneedsofits constituents;

2. 5.TheGovernorinformed the Committeethat-

• 2)The County has equipped and upgraded theMCTRH to enhance itscapacity to provide specialized andreferral servicesincluding inmaternal and childhealth, renal analysis and emergency care;
• 3)The County has increased healthcare workers including medical officers and there areplans to hiremore nurses.Further there are continuous efforts to train and deploymore healthcare personnel in critical areas.
• The County faces challenges due to porous borders including outbreaks of diseases.However,the County has managed and controlled these outbreaks throughcoordinatedpublichealthinterventions.

MIN/SEN/SCH/099/2025 ADJOURNMENT/ANYOTHERBUSINESS

There being no other business, the meeting was adjourned until the following day.

2025

SIGNED...

..DATE..

SEN.JACKSONK.ARAPMANDAGO,EGH,MP (CHAIRPERSON,COMMITTEEONHEALTH)

13THPARLIAMENT4THSESSION

MINUTESOFTHEEIGHTEENTHSITTINGOFTHESTANDINGCOMMITTEE ONHEALTHHELDONTUESDAY,29TAPRIL,2025INMANDERACOUNTY

MEMBERSPRESENT

• 1.Sen.JacksonK.ArapMandago,EGH,MP

-Chairperson

• 2.Sen.Mariam Sheikh Omar,MP

-Vice-Chairperson

• 3.Sen.David Wakoli,MP

-Member

4. Sen.Richard Onyonka,MP

-Member

• 5.Sen.Tabitha Mutinda,MP

• -Member

ABSENTWITHAPOLOGY

• 1.Sen.Justice(Rtd.)StewartMadzayo,EGHMP

-Member

• 2.Sen.Ledama Olekina,MP

-Member

• 3.Sen.Joseph Githuku Kamau,MP

-Member

• 4.Sen.HamidaKibwana,MP

• -Member

INATTENDANCE

• 1.Sen.Mohammed Abbas,CBS,MP

• -Friend ofthe Committee

SENATESECRETARIAT

• 1.Mr. Humphrey Ringera

• -SeniorResearch Officer

• 2.Mr.David Ngamate

• -ClerkAssistant

• 3.Mr.Ian Otieno

• -AudioAssistant

• 4.Mr.Ibrahim Odindo

• -Serjeant-At-Arms

• 5.Mr.KevinLomenen

• -MediaRelations Officer

INATTENDANCE

MANDERACOUNTYEXECUTIVE

• 1.Hon.Mohamed AdanKhalif

• -Governor

• 2.Mr.BillowIssackHassan

-County Secretary

• 3.Ms.Mumtaza Bishar Somo

• -County Executive Committee Member, Health Service

MIN/SEN/SCH/100/2025

PRELIMINARIES

TheCommitteecongregatedattheOfficeof the Governor,Mandera Countyfora debriefing meetingandpresentationofitspreliminaryfindings andproceedingscommencedwith aword of prayer.Thereafter thosepresentintroduced themselves.

MIN/SEN/SCH/101/2025

VISITTOADRAHEALTHCENTERELWAK

• 1.The Committee conducted an oversightvisit to ADRA Health CentreinElwak Sub County on 29th April,2025andwasinformed that the facility was inceptedby the Adventist Development and Relief Agency (ADRA) and has been providing health servicesinManderaandotherneighbouringcounties.
• 2.The Committeewasinformed that thefacilityrecently submerges during.heavy rains andfloods.TheCommitteeobserved thatthefacilityfaceschallengesrelatedtopoor physical conditions which include lack ofproper infrastructure and equipmentwhich compromises patient comfort and care quality;
• 3.TheCommitteeobserved thatthereisgeneral scarcityofqualified healthworkersin the facility;it lacked a qualified pharmaceutical technologist and drugs were being dispensedbycommunityhealth assistant.Further theCommitteeobservedpresenceof expireddrugsin theshelvesandimproperstorage of hazardousmedical wastescoupled withpoordrugmanagement;and
• 4.TheCommitteefurtherobserved thefacilitywascollectingtheFacilityImprovement Funds (FIF) following the operationalization of the County Health Services ImprovementFinancingAct,2024.However,thefacilitymanagementcommitteewas not dully constitutedwhich delayed decision making.

VISITTOELWAKSUBCOUNTYHOSPITAL

MIN/SEN/SCH/102/2025 (LEVEL4)

• 1.The CommitteeconductedanoversightvisittoElwakSubCountyHospital,a level4 publichealthfacilityinElwakTownprovidingoutpatient,inpatient,maternity,surgical and emergencyserviceson29thApril,2025.Thefacilityreceivescross-borderpatients whoregularly cross to seekhealthcareservices.Manyofthesecross-borderpatients are notvaccinated,lackproper documentation andpresentscommunication challenges due to language barrier;
• 2.TheCommitteewasinformedthatthefacilityhasabedcapacityofapproximatelyone hundred and three (103)beds including bedsin Intensive CareUnit (ICU) and High DependencyUnit(HDU).Further thefacilityhas threeoperatingtheaters dedicated to trauma,maternity and general surgery.
• 3.TheCommitteewasinformed thatthefacilitywasimprovedin2024whichincluded an upgrade ofits infrastructure and services.However,the hospital faces challenges typical of theregion including staff shortage,equipmentbreakdowns and supply constraints.

• 4.The Committee observed that thehospital facessignificantchallengesrelated towater scarcity.However, the facility was utilizing water trucking and rapid response maintenanceteamsweresupplyingportablewater tomitigatetheimpactsofscarcity.
• 5.The Committee observed thematernityward supportedby thenew born unit handles multipledeliveriesdailyestimated tobebetween10and15.However,theCommittee was informed that mothers attend maternity servicelate,often arriving in critical condition.This is associatedwith weakreferral systems,poor road infrastructure and insecuritywhichhinderstimely accesstohealthfacilities.

MIN/SEN/SCH/103/2025 ADJOURNMENT/ANYOTHERBUSINESS

Therebeingnootherbusiness,theoversightvisitsended and the delegationthanked the hostsfor theircooperation duringthetours.

SIGNED...

..DATE.

SEN.JACKSONK.ARAPMANDAGO,EGH,MP (CHAIRPERSON,COMMITTEEONHEALTH)

13THPARLIAMENTI4THSESSION

MINUTES OF THE NINTEENTH (19TH) SITTING OF THE STANDING COMMITTEE ONHEALTHHELD ONTUESDAY,28TAPRIL,2025AT11.00 A.M.INHEALTHFACILITIES,INWAJIRCOUNTY

MEMBERSPRESENT

• 1.Sen.JacksonK.Arap Mandago,EGH,MP

• Chairperson

• 2.Sen.MariamSheikh Omar,MP

-Vice-Chairperson

• 3.Sen.David Wakoli,MP

-Member

• 4.Sen.Richard Onyonka,MP

• -Member

• 5.Sen.Tabitha Mutinda,MP

• -Member

ABSENTWITHAPOLOGY

• 1.Sen.Justice (Rtd.) Stewart Madzayo,EGH MP -Member

• 2.Sen.Ledama Olekina,MP -Member

• 3.Sen.Joseph GithukuKamau,MP -Member

• 4.Sen.Hamida Kibwana,MP

• -Member

INATTENDANCE

• 1.Sen.Mohammed Abbas,CBS,MP

SENATESECRETARIAT

• 1.Mr. Humphrey Ringera

• -SeniorResearch Officer

• 2.Mr.David Ngamate

• -Clerk Assistant

• 3.Mr.Ian Otieno

• -AudioAssistant

• 4.Mr.Ibrahim Odindo

• -Serjeant-At-Arms

• 5.Mr.Kevin Lomenen

• -MediaRelations Officer

INATTENDANCE

• 1.Ms.Habiba Ali

• -CountyExecutive CommitteeMember(CECM)

Health Services

• 2.Ms.Fardosa Bishar

-Chief OfficerforMedical Services

• 3.Dr.Dahir Somo

-ChiefExecutive Officer(CEO)

WajirCountyTeachingandReferral Hospital

• 4.Mr.Jimale Hassan -Deputy CEOWajir CountyTeaching andReferral Hospital

WAJIRCOUNTYEXECUTIVE

MIIN/SEN/SCH/104/2025

PRELIMINARIES

TheCommitteedelegationcommencedthetourof healthfacilitiesWajir Countybyconverging andpayingacourtesycall toFCPA.AhmedAbdulahi,EGHandthereafterproceededtovisit healthcarefacilitieswithintheCounty.

MIN/SEN/SCH/105/2025

VISITTOWAJIRMANYATTATB CENTREWAJIRTBMANYATTASUBCOUNTYHOSPITAL)

• 1.TheCommitteevisited theWajirManyattaTBCentreonTuesday29thApril,2025 accompaniedbyMs.HabibaAliMaalim,theCountyExecutiveCommitteeMember (CECM)inchargeofHealthServicesand ahostofofficersfromtheHealthDepartment intheCounty.TheCommitteewasreceivedatthefacilitybyMr.HusseinMohamed
• 2.TheCommitteewasinformedthattheTBManyattawasstartedinthelate1970sby Italian Nun who recognized the unique challenges of treating Tuberculosis (TB) in the region.TheCentrewasbuiltlike traditional dwellings(Manyatta)nexttoa healthcentre in order tocreate avillagelike environmentwherepatientscouldstaythefull course of directory observed therapyranging betweenfour tosixmonths.This arrangementwould allowdailysupervision ofmedication andimprovednutritional support;
• 3.DuringthevisittheCommitteemadethefollowingobservations-
• (1)Thereisastalledmodernincineratorprojectwhichhadinitiallybeenfunded by theWorldBank.Oncompletiontheprojectwould addressongoingchallengesat the facility and neighbouring healthcare institutions including the improper disposalofmedicalwaste.The Committeewasinformed that theprojecthad stalled duetolitigationinCourtsbydifferentstakeholders;
• (2)The TB Manyatta treatspatients from Wajir and theneighbouring counties including those from neighbouring country. However,the cottages are dilapidatedwhichposes significant challengesrelated tosafety and adequacyof infrastructureforthepatients,indeedmany of the cottageshadreportedlybeen condemnedfordemolition and therewasnorecentrefurbishmentorupgrading;
• (3)The TB Center lacks aproper perimeter wall/fence whichposed safety and securityconcernstothepatients,staffandmedicalsuppliesatthefacility.The Committee observed thatthis could alsohinder effectiveinfection control and expose thefacility torisks of unauthorized access;
• (4)The TB CenterlacksproperPersonnel ProtectiveEquipment(PPE) such as protectivegownsandfacemaskswhichcompromise thesafetyofhealthcare workersandpatients.Further thereisnomodernlaboratorytohandleTB specimens safely;

• (5)The Centre suffersfrompoor recordkeepingwhichhampersefficientpatient management, tracking of treatment progress and overall accountability of patients and dispensed drugs.The Committeeobserved thatuntrainedpersonnel were involvedin dispensingmedication and the Countypharmacistscouldnot sufficientlyrespond tobasicconcernsby the Committee;
• (6) The Centre was also being used as a dumping ground and a store for expired drugs and medications improperly.This was coupled with inadequate drug storage and expired drug disposal measurers raising concerns about safety and pharmaceutical management;
• (7)ThepatientsattheTB Centrecomplained andexpresseddissatisfaction about poordiet citing quality,adequacy andnutritional value andgeneralmistreatment by themembersofstaff.Theyfurther complained aboutpoorsafetyconditions, lack of essential supplies like mosquito nets and neglect which exacerbated hardships duringtreatment.

MIN/SEN/SCH/106/2025

• 1.The Committee visited Hodhan Dispensary, a public health facility classified as a dispensary that provides basic outpatient health services,includingfamily planning ad was received by the facility in-charge, a clinical officer by training.

YISITTOHODHANDISPENSARY

• 2.The Committeewasinformed that thedispensaryisasmall outpatient healthfacility usuallymanagedbya clinicalofficer andregisterednurseswhoprovideprimary healthcareservicessuch asimmunizations,familyplanningand treatmentofcommon ailments.Thedispensaryservesbetween20and 40patientsdaily anddonothave inpatient beds;
• 3.The Committee observed that the dispensary lacks a pharmacist and/or pharmaceutical technologist and drugsareusuallydispensed by communityhealthpromoters.Indeed, mostservicesatthefacilitywerebeingprovidedbythecommunityhealthpromoters under theguidance of the clinical officerin-charge;
• 4.The Cormmitteelauded the efficiencyandperformanceoftheclinical officerin-charge andobservedthatwhilethefacilityhad apotential toserveabiggercatchmentareait lacked a spacefor expansion and therewasno significant infrastructural investment by theCountyGovernment.

MIN/SEN/SCH/107/2025

• 1.The Committee conducted an oversightvisitWajir County dumpsitein the outskirts oftheWajirTownonTuesday,29thApril,2025;

VISITTO THEWAJIR COUNTY DUMPSITE

• 2.1 DuringthevisittheCommitteeobservedevidenceofimproperdumpingoftoxicwaste whichposedenvironmental healthrisks.TheCommitteeobservedhazardous andtoxic wastes including biomedical wastes and pesticides raising concerns about contamination of soil andwater sourcesconsidering thewater levelsinWajirTown;
• 3.The Committee was informed that the neighbouring community had also raised concerns aboutrespiratory issues,skininfections and observed thatraw sewagewas alsobeingdumped atthedumpsitebecause thetownlackedaproperseweragesystem.

MIN/SEN/SCH/108/2025

VISITTOWAJIRCOUNTYREFERRAL HOSPITAL(WCRH)

• 1.The Committee conducted an oversightvisit toWajir County Referral Hospital (WCRH),a level5hospitalonTuesday29thMay2025andwasreceived byDr.Dahir Somon,the ChiefExecutive Officer oftheHospital;

2. TheCommitteewas informed thatWajirCountyReferralHospital hasa total bed capacityofonehundred andfifty-four(154)inpatientbedsand a staffcomplimentof about one hundred and three(103)healthcare personnel.TheHospital provides a range of services including maternity care, emergency treatment,renal services and increasingly cancer care.Thehospital was also akey center formanaginginfectious diseasesincludingtherecent surge of kala-azar outbreak;

• 3.TheCommitteeobserved that-
• (1)Wajir CountyReferral Hospitalofferscancerrelated therapiesineffort tomanage theprevalenceofcancercasesin the County.However,thehospital lacks afull oncologyworkforce and most patientsrequiring advanced treatment were referred toregional centerin Garissa County;
• (2) There isinadequate pharmaceutical management and oversight.It was observed that untrainedpersonnel wereinvolvedindrugdispensingand theyutilizedmanual record keeping posing a risk of errors. Indeed, the Committee observed discrepanciesbetween physical andrecorded stocks;
• (3) There waspoor storage of drugs classified as controlled substance and requiring strict handling and storage conditions.The Committee specificallyobserved discrepancy in the inventory on Diazepam,one such controlled drug.Fewer physical stockswere available asopposed torecorded inventoryraisingconcerns onpossiblepilferageandmisuse;
• (4)TheHospital offersmaternity services includingprenatal andpostnatal care andis SHA accreditedindicatingitmeetscertain quality standards.However,therewere several challengesrelated tounderstaffing and inadequateinfrastructure.The maternitywards didnothave mosquito nets alongside unmaintained laundry equipmentwhichwasidentified asmain challengeaffectingmaternal andnew born care;

• (5)Thematernitywards donot haverunningwater severely affectinghygiene and posing challengesofinfection control and overall quality ofmaternal care.The Committeeobservedthattherewererisksofneonatalinfectionsandinadequate water supply made it difficult to clean rooms,equipment and linens properly compromising care delivery;
• 6 The Committee observed thatWajir CountyReferral Hospitalwasupgradingits infrastructure including,maternity infrastructure and a modern accident and emergencywingwhichwasnearing completion.Itwas observed that thisfacility would support already existinginfrastructure and enhancematernity andother healthcareservices.

MIN/SEN/SCH/109/2025 ADJOURNMENT/ANYOTHERBUSINESS

Therebeingnootherbusiness,theoversightvisitended atsixo'clock

SIGNED.

SEN.JACKSONK.ARAPMANDAGO,EGH,MP (CHAIRPERSON,COMMITTEEONHEALTH)

13THPARLIAMENT4THSESSION

MINUTES OF THE TWENTIETH I(2OTH)SITTING OFTHESTANDING COMMITTEE ONHEALTHHELD ON TUESDAY,30TH APRIL,2025AT8.00 A.M.INWAJIRCOUNTY,GOVERNOR'SBOARDROOM

MEMBERSPRESENT

• 1.Sen.JacksonK.ArapMandago,EGH,MP

-Chairperson

• 2.Sen.Mariam Sheikh Omar,MP=

-Vice-Chairperson

• 3.Sen.David Wakoli,MP

-Member

• 4.Sen.Richard Onyonka,MP

-Member

• 5.Sen.Tabitha Mutinda,MP

-Member

ABSENTWITHAPOLOGY

• 1.Sen.Justice(Rtd.)StewartMadzayo,EGH MP -Member

• 2.Sen.Ledama Olekina,MP

-Member

• 3.Sen.Joseph Githuku Kamau,MP

-Member

• 4.Sen.Hamida Kibwana,MP

-Member

SENATESECRETARIAT

• 1.Mr.Humphrey Ringera

• -SeniorResearch Officer

2. Mr.David Ngamate

• -Clerk Assistant

3. Mr.Ian Otieno

• -AudioAssistant

• 4.Mr.Ibrahim Odindo

• -Serjeant-At-Arms

• 5.Mr.KevinLomenen

• -MediaRelations Officer

INATTENDANCE

• 1.FCPA.Ahmed Abdulahi,EGH

-Governor,

• 2.Mr.HillowIssack

-County Secretary,

• 3.Ms.Farhiye Abdille

-CountyExecutiveCommitteeMember(CECM)

PublicServiceand CountyAdministration

• 4.Ms.Habiba Ali

-CountyExecutiveCommitteeMember(CECM)

Health Services

• 5.Ms.Fardosa Bishar

• -ChiefOfficerforMedicalServices

• 6.Dr. Dahir Somo

• -ChiefExecutive Officer(CEO)

Wajir County Teaching and Referral Hospital

WAJIRCOUNTYEXECUTIVE

• 7.Mr.JimaleHassan

MIN/SEN/SCH/110/2025

• -Deputy CEO Wajir CountyTeachingand Referral Hospital

PRELIMINARIES

Thecommitteeheldade-briefingmeetingwith the Governorand theCountyExecutiveon Wednesday,30thApril,2025at8:00am.Themeetingcommencedwithawordofprayerandthose presentintroducedthemselves.

MIN/SEN/SCH/111/2025

MEETINGWITHTHEGOVERNORAND THECOUNTYEXECUTIVE,WAJIR COUNTY.

• 1.The Committee held a de-briefing meeting topresent itspreliminary report and informed theGovernor thatduringthevisittodifferenthealthcarefacilities,the followingobservationsweremade-
• 1) The Wajir County Referral Hospital is undergoing significant infrastructural upgradesincludingconstructionofanewmaternityblockasabroaderpart to modernize healthcare serviceprovision and to decongest the existing healthcare infrastructure;
• 2) However,there was evidence of complacence and sense of entitlement among healthcareworkers at thepublichealthcarefacilitieswhichwaslikelytoaffect service delivery;
• 3 TheHospitalisheavilyreliantonmanual systemswithlittletono automation of healthcare services despiteitsmission toprovide technology driven and evidencebasedhealth services.Therewasmanual recordkeepingandpaper-based system Forinstance,while the Committeewas informed thehospital conducts an average often(10) deliveries,only twowererecorded;
• 4)TheHospitalandotherpublichealthcarefacilitiessufferfrompoorwatersupply andsanitationinfrastructurewithmajorityofwardslackingwater,missing taps and showerheadsinthebathroomandespeciallymaternitywardswhichposed ariskof waterborne diseases;
• 5) The healthcare facilities lack clearly established,functional and operational kitchens implying challenges in providingin-house patient nutrition services.Most ofthefacilitiesoutsourcefood;
• 6)Thehealthcarefacilitieslackfullyfunctional laundryfacilitiesincludingwashing machines,dryers and ironers impacting on their ability to maintain clean linens and garmentswhich iscritical forpatientcare and infectionprevention;
• 7)Thematernitywardsdonothavefixedmosquitonetsleading topossible shortage and/or inadequateprotection against mosquito borne diseases such asmalaria. Further,thematernitywards donot have sufficientbabycotsforusebynewborn babiesand theirmothers;
• 8)Therewasneedtoestablishadedicateddepartment,unitorasectionwithin the healthcarefacilities to addressroutinemaintenance andrepairin eachhealthcare facility;
• 9)Thereisneedfor spatial and structural planningof thereferral hospital.There are somanybuildingsscattered all over theplot;

2. TheCommitteewasinformed thatthe CountyGovernmentofWajir-

• (2)wouldundertake thepublicparticipation on theincineratorproject andalso develop a policy on expired drugs; and
• (1)hadconverted theCovid-19 Centreintoalevel4healthcarefacilityinbidto decongest theWajir CountyReferral Hospital;
• (3)hadpurchased a laundrymachine thatwasexpected tobedeliveredwithinthe month and therewerefurther planstodeliverdesalinationequipment;

MIN/SEN/SCH/112/2025 ADJOURNMENT/ANYOTHERBUSINESS

There beingno other business,themeeting ended at 10'o'clock and the Committee proceedingfor oversightvisitstoMarsabitCounty.

018Q0.2.

SIGNED..

.....DATE.

SEN.JACKSONK.ARAPMANDAGO,EGH,MP (CHAIRPERSON,COMMITTEEONHEALTH)

13THPARLIAMENTI4THSESSION

MINUTES OF THE TWENTY FIRST (21)SITTING OF THE STANDING COMMITTEE ON HEALTH HELD ON WEDNESDAY,30TH APRIL,2025 AT 10.00A.M.INHEALTHFACILITIES,MARSABITCOUNTY

MEMBERSPRESENT

• 1.Sen.JacksonK.ArapMandago,EGH,MP

• -Chairperson

• 2.Sen.Mariam Sheikh Omar,MP

• -Vice-Chairperson

• 3.Sen.David Wakoli,MP

• -Member

• 4.Sen.Richard Onyonka,MP

• -Member

• 5.Sen.Tabitha Mutinda,MP

• -Member

ABSENTWITHAPOLOGY

• 1.Sen.Justice(Rtd.)StewartMadzayo,EGH MP

-Member

2. Sen.Ledama Olekina,MP

-Member

• 3.

• Sen.Joseph GithukuKamau,MP

• -Member

• 4.Sen.Hamida Kibwana,MP

• -Member

SENATESECRETARLAT

• 1.Mr.Humphrey Ringera

• -Senior Research Officer

• 2.Mr.David Ngamate

• -ClerkAssistant

• 3.Mr.Ian Otieno

• -Audio Assistant

• 4.Mr.Ibrahim Odindo

• -Serjeant-At-Arms

• 5.Mr.KevinLomenen

• -MediaRelations Officer

MARSABITCOUNTYEXECUTIVE

• 1.Mr.Malicha Wario

• -CountyExecutiveCommitteeMember(CECM)

Health Services

• 2.Dr.Arero Halkano

-Chief OfficerMedical Health

• 3.Dr.Duba DoyoAbduba

-Sub CountyMedical OfficerofHealth

• 4.Mr.DeleaEdward

-Director ofAdministration

MIN/SEN/SCH/113/2025

PRELIMINARIES

The Committeedelegationcommenced thetourofMarsabit CountyHealthfacilitiesby paying a courtesy call to Hon.Mohamed M.Ali,the Governor,Marsabit County and thereafterproceeded to theMarsabit CountyReferralHospital.

MIN/SEN/SCH/114/2025

OVERSIGHTVISITTO MARSABIT COUNTYREFERRALHOSPITAL

• 1.The CommitteevisitedMarsabit CountyReferral Hospital onWednesday30thMay 2025 andwasreceived byDr.DubaDoyoAbduba,theSub CountyMedical OfficerofHealth and theChief Executive OfficeroftheMarsabit CountyReferral Hospital;
• 2.The Committeewasinformed thatMarsabit CountyReferral Hospital,formerlyknown asMarsabitDistrictHospitalisalevel 5facility thatservesastheprimaryreferralcenter forMarsabit County and also caters aspatientsfrom neighboringcounties.The hospital has a bed capacity of one hundred and three (103) providing both inpatient and outpatientservices.
• 3.The Committeewasinformed that theHospitalhasundergonesignificantupgradesas part of thebroaderhealthsectormodernizationinitiative,whichincludes improvements. in infrastructure,expansion of healthcare access and enhancement.of service delivery systems. To this end, the County Government has also recruited.an additional nine hundred andnineteen(919)healthcareworkers since2017bringing the total healthcare providers in the county to One thousand, three hundred and fifty-three (1,353);
• 4.Duringthe oversightvisit theCommitteemade thefollowingobservations-
• (1)therewas.a major variancebetween thephysical stock and recorded stockin the hospitalpharmacy.witha significant differencebetween theactualquantity of medicine on the shelves and the amountslistedininventoryrecords;
• (2) the high-riskmedication such asDiazepamwas neitherrecorded or storedsecurely in lockedcupboardswhich would havepredisposed themtounauthorizedaccess and ormisuse;
• (3)theHospital pharmacykept theirrecordsin a manual paper-based logs,system and registersratherthanelectronicorautomatedsystems.The Committeeobserved that thiswouldlead tostockoutsoroverstockingifnotcarefullymanaged;
• (4) Cancer test results experience significant delays because thefacilitylacks local diagnosticcapacity andmosttestsmustbesenttodistantlaboratoriesforanalysis causingprolongedturnaround timeforresults;
• (5)Therewas overgrown grass andunkempt compound andyards all over thefacility reflectingpoormaintenance and increasingrisks of harbouring diseasevectorslike mosquitoes androdents;

• (6)Therewerenobathroomsinsidethefemale surgical wards andnocleanwaterpoints withinthewardreflectingcriticalinfrastructural and sanitationdeficiencieswithin the facility andseverely affectingpatient hygiene,dignity andinfection control;
• (7)Therewerewheelchairsleft scattered and strewnall over thewalkways todifferent units of the facility which indicated challenges in equipment management or storage;
• (8)Thefacilitylacksproper and safedisposal of biomedicalwasteincludinginfectious and hazardousmaterials which were discarded in the backyard near themortuary;
• (9)While the County Government and the Hospital management had reported employing pediatricians and other specialists during thevisit,they were not physically present at thefacility.Upon inquiry,the Committee was informed that somewereengagedin otherplacesofworkwhileothersoperatedprivatefacilities inMarsabit Town;
• (10)There were expired drugsin thefacility with some being stored ininappropriate placessuchasabandoned andunusedlavatorywhileotherswere actuallypresentin the wards indicating they were routinely being used posing significant risks to patients;and
• (11)The casuals reported that they had not been paid for up to three(3) months leading to significant dissatisfaction.

MIN/SEN/SCH/115/2025 ADJOURNMENT/ANYOTHERBUSINESS

Therebeingno otherbusiness,the tourended atonep.m.and the Committeeproceeded to a de-briefingmeetingwith the Governor.

2025 08

SIGNED

...DATE.....

SEN.JACKSONK.ARAPMANDAGO,EGH,MP (CHAIRPERSON,COMMITTEEONHEALTH)

13THPARLIAMENT4THSESSION

MINUTESOFTHETWENTY SECOND SITTINGOF THE STANDING PMINGOVERNOR'SBOARDROOM,MARSABITCOUNTY

MEMBERSPRESENT

• 1.Sen.Jackson K.Arap Mandago,EGH,MP

-Chairperson

• 2.Sen.Mariam Sheikh Omar,MP

• -Vice-Chairperson

• 3.Sen.David Wakoli,MP

• -Member

• 4.Sen.Richard Onyonka,MP

• -Member

• 5.Sen.Tabitha Mutinda,MP

• -Member

ABSENTWITHAPOLOGY

• 2.Sen.Ledama Olekina,MP
• 1.Sen.Justice (Rtd.) Stewart Madzayo,EGH MP -Member
• 3.Sen.Joseph Githuku Kamau, MP
• 4.Sen.HamidaKibwana,MP

SENATESECRETARIAT

• 1.Mr.Humphrey Ringera
• 3.Mr.Ian Otieno
• 2.Mr. David Ngamate
• 4.Mr.Ibrahim Odindo
• 5.Mr.Kevin Lomenen

INATTENDANCE

• -Member
• -Member
• -Member
• -SeniorResearch Officer
• -Audio Assistant
• -Clerk Assistant
• -Serjeant-At-Arms
• -Media Relations Officer

MARSABITCOUNTYEXECUTIVE

• 1.Mr.Mohamud Mohamed Ali

• -Governor

• 2.Mr.Solomon Riwe

• -Deputy Governor

• 3.Mr.Galma Galma

• -ChiefofStaff

• 4.Mr.MalichaWario

• -County Executive Committee Member Health Services

• 5.Mr.Issa Garone

• -County Executive Committee Member,

Roads,Transport and PublicWorks

• 6.Dr.Arero Halkano

• -Chief OfficerMedicalHealth

MIN/SEN/SCH/116/2025

PRELIMINARIES

Themeetingwascalled toorder at two o'clock and theproceedingscommencedwith a word of prayerfollowed by a round of introductions.

MIN/SEN/SCH/117/2025

MEETINGWITH THE GOVERNOR, MARSABITCOUNTY

• 1.The Committeeinformed that the County Government-
• 1)had employed nine hundred and nineteen (919) healthcare personnel since 2017 todatebringing thetotalnumberof healthcarepersonnelin the County toone thousand, three hundred and fifty-three (1,353).These include thirty (30) nephrologynursing,radiologists,anesthetists;
• 2)had established one stop Mother and Child Complex at the Marsabit Teaching andReferral Hospital in order to address the highmaternal andmortalityratio;
• 3)hadfurtherconstructedand equippedaBioSafetyRegional Laboratorywhich provide advanced diagnostic capabilities ensuring the safety of patientsand healthcare workers.

2.The Committeewasfurtherinformed that-

• 1) the imaging department was grosslyunderstaffed with poor power supply making it difficult for the healthcare workers to use the digital x-ray unit;and

2. 2)therenal and dialysisunitswere established on17t July,2018and equippedwith equipment provided through theManaged EquipmentServices (MES)program. Since then greatmilestoneshadbeen achievedincluding six(6)renal dialysis machines,increased clients accessing dialysis services to thirty-six (36) and increased thestaff at theunit. 3. 3.The Committeeinformed the CountyExecutive that during thevisit'thefollowing preliminary observationshad been made-

• 1) The hospital infrastructure was dilapidated with evidence of continuedneglect beingwitnessed in theleakingroofs,fallingceilingboards,missing electricbubs and naked live wires;

5. 2)Medical andhazardouswastewas dumped in undesignated point posing a riskof exposure to infectious agents among the patients,healthcare personnel and the surrounding community; 6. 3)The hospitalrelied onmanual health records in itsunits and wards which hamperedefficientpatient management and inventory control andmay have contributed topoor trackingofmedical commodities; 7. 4)Thekeyhealthcarepersonnel were absentfrom theirworkstations,thenotable ones include theMedical Officer of Health,the County Pharmacistand the Pediatrician;

• 5)Prevalence ofexpired drugs andmedications stored openlyin theshelves,availed at wards and even stored at inappropriatelocations such as disused lavatories and in open fields;and
• maintainedand/orno longer operational within thehospital compound.Some of these ambulances havebeen repurposed as temporary storagefacility rather than service theirintendedemergency transportfunction

MIN/SEN/SCH/118/2025 ADJOURNMENT/ANYOTHERBUSINESS

There being no other business, themeeting ended at four o'clock.

SIGNED...

Q

.....DATE...

SEN.JACKSONK.ARAPMANDAGO,EGH,MP (CHAIRPERSON,COMMITTEEONHEALTH)

13THPARLIAMENT4THSESSION

MINUTES OF THE FORTY FIRST (41ST)SITTING OF THE STANDING COMMITTEEONHEALTHHELDONFRIDAY,1TAUGUST2025AT3.30P.M IN FORODHANI MEETING ROOM,WHITESANDS HOTEL,MOMBASA COUNTY.

MEMBERSPRESENT

• 1.Sen.Mariam Sheikh Omar,MP

• -Vice-Chairperson

• 2.Sen.Justice(Rtd) Stewart Madzayo,EGH,MP

-Member

• 3.Sen.David Wakoli,MP

-Member

• 4.Sen.Tabitha Mutinda,MP

-Member

• 5.Sen.Joseph GithukuKamau,MP

• -Member

ABSENTWITHAPOLOGY

• 1.Sen.Jackson K.Arap Mandago,EGH,MP

• -Chairperson

• 2.Sen.Ledama Olekina,MP

• -Member

• 3.Sen.Richard Onyonka,MP

• -Member

• 4.Sen.HamidaKibwana,MP

• -Member

SENATESECRETARIAT

• 1.Mr.Humphrey Ringera

• -SeniorResearch Officer

• 2.Mr.David Ngamate

• -ClerkAssistant

• 3.Mr.Gilbert Juma

• -Legal Counsel

4. Mr.David Munene

• -Research Officer

5. Mr.Ian Otieno

• -Audio Assistant

• 6.Mr.Ibrahim Odindo

• -Serjeant At Arms

MIN/SEN/SCH/213/2025

PRELIMINARIES

The Chairperson called themeeting to order at half past three o'clock and the proceedings commencedwithawordofprayersaidbytheChairperson.

MIN/SEN/SCH/214/2025

ADOPTIONOFTHEAGENDA

Theagendaof themeetingwasadoptedwith amendmentsafterbeingproposedbySen. DavidWakoli,MP,andseconded bySen.TabithaMutinda,MP,aslisted below-

• 1) Prayers;
• 2) Adoption of the Agenda;

3. a)17th and 18th Committee Sittings held on Monday,28thApril, 2025;

• 3) Confirmationof theMinutesthepreviousCommitteeMeetings-

5. b)19th and 20h Committee Sittings held onTuesday,29th April,2025; and 6. d)38thSittingheld onTuesday,29thAugust2025; 7. c)21st and 22ndCommitteeSittings held onWednesday,30tApril,2025 8. 4 Matters arisingfrom theMinutesof thePreviousCommitteeMeeting; 9. 6 Consideration andAdoptionoftheCommitteeReport on the CountyOversight and Networking visits toMandera,Wajir and Marsabit counties(Committee Paper 139); 10. 5) Consideration andAdoptionoftheCommitteeReporton theTobaccoControl (Amendment)Bill,2024(SenateBillsNo.35of2024(CommitteePaperNo.137) 11. 7 Any other business;and

• 8) Adjournment/Date of theNextMeeting.

MIN/SEN/SCH/215/2025

CONFIMATION OF THEMINUTES OF THE38THSITTINGHELD ON29TH.07.2025

• 1.The Minutes of the 17th and 18th Sitting heldon Monday,28th April,2025were confirmed after beingproposed beingbySen.Tabitha Mutinda,MP and seconded by Sen.David Wakoli,MP;
• 2.The Minutes of the 19th and 20thSitting held on Tuesday,29th April,2025were confirmedafterbeingproposedbeingbySen.DavidWakoli,MPand seconded bySen. Tabitha Muitnda,MP;
• 3.TheMinutesof the21st and 22ndSittingheldonWednesday,30thApril,2025were confirmed after beingproposed beingbySen.TabithaMutinda,MPand seconded by Sen.David Wakoli,MP;and
• 4.TheMinutesofthe38hSittingheldonheldonThursday,29thJuly,2025wereconfirmed afterbeingproposed being bySen.Tabitha Mutinda,MP and seconded bySen.David Wakoli,MP.

MIN/SEN/SCH/216/2025

UnderMIN/SEN/SCH/201/2025

MATTERSARISINGFROMTHEABOVE MINUTES

-CONSIDERATIONOFTHETOBACCO CONTROLAMENDMENTBILL,2024 (SENATEBILLSNO.35OF2024)

• 1) TheCommitteeobserved thatowingto thevariedcharacterizationofthenicotine pouches from the traditional tobaccoproducts,there is need tovestpowers to the Cabinet Secretary,to prescribe standards on the requirements to be met by manufacturers orimporters to ensure that these aremuchless available and lessprone to misuse;

2. 2)TheCommitteethatnoteddifferentstakeholdershadopposed thebanofcharacterizing flavours and additives including fruits, spices,herbs, alcohol,menthol and related flavours.However,the Committee concurred with the sponsor of thebill for the completebanof theseflavours.Thejustificationforthisbeing that theseflavours make the appealingtousersleading to theabuseof theproducts;and 3. 3)TheCommitteenoted thatthereisneedforan amendment toprovidefortheutilization ofmoniesremittedto theTobaccoControl Fundand thatan amountbeutilisedforthe treatmentof thechronicillnessescausedbytheuseof tobaccoproducts

MIN/SEN/SCH/217/2025

• 1.TheSecretariatpresented the amended Reporton theTobacco Control (Amendment) Bill,2024and theproposed CommitteeStageAmendments for consideration and adoption;and

2. Following its consideration,theReport on the Tobacco Control (Amendment)Bill, 2024was adopted unanimously.The Report was proposed for adoption by Sen.Justice (Rtd).StewartMadzayo,EGH,MPand seconded bySen.TabithaMutinda,MP.

| CONSIDERATIONANDADOPTIONOF | |----------------------------------| | THE COMMITTEE REPORT ON THE | | TOBACCOCONTROL(AMENDMENT) | | BILL,2024 (SENATE BILLS NO.35 OF | | 2024) |

MIN/SEN/SCH/218/2025

| CONSIDERATION ANDADOPTIONOF | |------------------------------------------------------| | THECOMMITTEEREPORTONTHE | | COUNTY | | OVERSIGHT AND | | NETWORKING VISITSTOMANDERA, WAJIRANDMARSABITCOUNTIES |

• 1.The Committee Secretariat presented the amended Report on the County Oversight and Networking visits toMandera,Wajir and Marsabit counties for consideration and adoption;
• 2.During deliberations,theCommitteeobserved thatinclusionofthephotoshadgreatly enriched its report on oversight visits.The Committee further observed that consideration and adoption inPlenaryof itspreviousreportson similar oversightvisits was takinginordinatelylong time;and

• 3.Followingits consideration,theReport on the County Oversight and NetworkingVisits to Mandera,Wajir and Marsabit Counties was adopted unanimously after being proposed by Sen.DavidWakoli,MP and seconded by Sen.JosephKamau Githuku, MP.

MIN/SEN/SCH/218/2025

ANYOTHERBUSINESS

TheCommitteewasinformedthataletterhadbeensentfromtheMinistryofHealth,State Department for Public Health and Professional Standards,requesting the Senate to nominateMemberswhowouldjoin theMinisterialdelegationattheTokyoInternational Conference onAfrican Development (TICAD-9).

The Committee observed that priority to attend theConference shouldbegiven toMembers whohavenotundertaken anyvisit in the currentparliamentarySession.The Committee furtherdirected that thematterbeplacedin theagendaof thefollowingmeetingfor consideration andresolution.

MIN/SEN/SCH/219/2025

ADJOURNMENT

Themeetingwasadjournedathalfpastsixoclock.Thenextmeetingwouldbeheld in Kilifi CountyonSaturday,2ndAugust,2025.

2ORS

.DATE...

SIGNED:

SEN.JACKSONK.ARAPMANDAGO,EGH,MP (CHAIRPERSON,COMMITTEEONHEALTH)

KEYPROJECTS/ACHIEVEMENTS2017-2025, COUNTYGOVERMENTOFMARSABIT.

1.HEALTHWORKFORCE:

SummaryofHRHnumbersrecruitedsince2017todate

| CADRE | BEFORE2017 | 2017-DATE | TOTAL | |---------------------|--------------|-------------|---------| | Doctors (MOs) | 9 | 23 | 32 | | Doctors(Specialists | 1 | 10 | 11 | | Nurses | 227 | 306 | 533 | | RCOs | 32 | 55 | 87 | | Pharm techs | 8 | 24 | 32 | | Nutritionists | 11 | 85 | 96 | | CHAS | 31 | 185 | 216 | | Lab Techs | 32 | 34 | 66 | | Radiographers | 4 | 8 | 12 | | COHO3 | 3 | 4 | 7 | | PHOS | 32 | 65 | 97 | | HRIOS | 7 | 22 | 29 | | Pysio&OC | 4 | 7 | 11 | | PlasterTechnicians | 1 | 1 | 1 | | Socialworkers | 0 | 3 | 3 | | Clerks | 4 | 17 | 21 | | mortuaryattendants | 0 | 2 | 1 | | Drivers | 11 | 34 | 45 | | ProcurementOfficers | 0 | 5 | 5 | | Accountants | 3 | 7 | 10 | | HR Officers | 0 | 5 | 5 | | HouseKeepers | 1 | 1 | 1 | | Security Officers | 2 | 5 | 7 | | SupportStaff | 11 | 11 | 22 | | TOTAL | 434 | 919 | 1,353 |

Specialist Trainings:

• 30-nephrologynursing,radiologist,anesthesia and specialists including gynecologists epidemiologists,pediatrician,oncologistand
• 2familyphysicians-Cuba andKenyatta University teaching and referral Hospital.
• Currently-10 doctorson study leave-add topool of Local specialists including Obs/Gynecologists,orthopedicsurgeon,pathologist,Ophthalmologists,

2.Health infrastructure:

• a)Onestopshopmother andchildcomplex at Marsabit County teaching andreferral Hospital:The complex has also addressed the high maternal and mortalitiesratio inMarsabit County,which is 1,127deaths availabilityof life-savinginterventions,suchasblood transfusions,hashelpedreducematernal deaths. Additionally,the complex hasimproved access toprenatal and postnatal care,which has contributed to a declineinmaternalmortalityrates.
• b)Kenya Medical Training College.
• c)Regional Lab:The construction and equipping oftheBioSafetyRegional LaboratoryatMarsabit County Teaching and Referral Hospital hasbeen a major achievement in theHealthSector.The state-of-the-art facility provides advanced diagnostic capabilities,ensuring the safety of patients and healthcare workers.
• d)Procurement anddistributionof 10portableultrasoundmachinesfor8H/C and2beyondzeroVans
• e)Fully equippedandoperationalizedMarsabit countyregional blood bankwith supportfromTHC-world bank.
• f)Procured50PortableHBmachinesforANCmonitoring
• g)Procurementof 2utilityvehiclefor CHMT's support supervisionand1ToyotaHiluxwitha canopy to support blood donation campaigns(THS supported.
• h)Setup and operationalizeRenal Unit(EquippedWith6machines) at Marsabit teachingand referral Hospital.
• i)Theatre atKalacha and LaisamisSub-CountyReferral Hospital
• j)Procurement of 7newAmbulances-to support emergency services across the county.
• k)Inpatientward,maternal theratre andx-rayblock-well equipped atLaisamisReferral Hospital
• 1)Received3beyondzeroVans through theoffice of thefirstLadytosupport RMNCAH services
• m)Procured12laptopsforRHandHRIO's
• n)Procurement,installationofEPIfridges-36
• Cancer centre-Marsabit County teaching andReferral Hospital
• p) OxygenPlant-4(Sololo,Moyale,MCTRH,Kalacha)
• TheCountyconducted9nutritionsurveysfrom2018todate(Thisincludes7smartSurveys,1KABP Surveys,1 SQUAECSurveys and 1NutritionCapacity assessments).Thishashelped inprovidingnew evidences and shapedprogrammingfor thesector
• UpcomingSolololevelivhospital-completion at90%
• Completion and operalizationof North-HorrGokHealthCentre
• t CTScan atMarsabit CountyReferral Hospital and Moyale subcountyReferral Hospital.

3.Key reproductive health indicators:

KDHSRMNCAH2014COMPAREDWITH2022FOR MARSABITCOUNTY

| INDICATOR | 2014 | 2022 | |--------------|---------------|--------------| | SBA | 26% | 69% | | IANC | 73 | 93.8 | | 4hANC | 46 | 67,1 | | FP | 11 | 6 | | MMR | 1127/100000LB | 321/100000LB | | GBV | | 16.4 | | TEENAGEPREG | 18 | 29.6 | | FPUNMET NEED | | 37.6 | | PNC | 9 | 40.6 | | INFANTMR | 42/1000 | 32/1000 | | NEONATALMR | 28/1000 | 21/1000 |

KEY.

SBA-Skilled Birth attendant-Number ofmothers deliveringin ourfacilities

FP-family planning

ANC-Antenatal care-caregiven tomotherduringpregnancy

MMR-maternalmortalityratio

GBV-Genderbasedviolence

PNC-Postnatal care-caregiven to themotherafterdelivery.

NeonatalMR/InfantMR-Mortalityratio

4.OTHERDEVELOPMENTPROJECTS.

| PROJECT | Before 2017 | 2017-2024 | TOTAL | |-----------------------|---------------|-------------|---------| | 1Dispensary | 58 | 23 | 81 | | 2|Health Centres | 20 | 12 | 32 | | 3Hospitals | 4 | 1 | 5 | | 2Maternity | 9 | 14 | 20 | | 3Staff House | 12 | 37 | 49 | | 4Laboratory | 6 | 15 | 21 | | 5Fencing | 15 | 37 | 52 | | 6Pit Latrine | 78 | 44 | 122 | | 7lBurning Chambers | 6 | 14 | 20 | | 7lIncinerator | 4 | 1 | 5 | | 8Solar | 14 | 44 | 58 | | 9Equipment/reagents | 78 | 59 | 137 | | 10/Furniture | 82 | 17 | 66 | | 11lElectricity | 4 | 15 | 19 | | 12/Waterconnection | 0 | 14 | 14 | | 13Renovation | 36 | 57 | 6 | | 14General Ward | 1 | 4 | 5 | | 15LandPurchased | 1 | 1 | 2 |

Other services:

1.BEYONDZEROACHIEVEMENT:

Beyond zero isone of thesuccess storiesin thiscounty.In theyear2014,theFirstLady,H.EMargaretKenyatta donated 2BeyondZerovehiclestoimprovematernal andchildoutcomestationed atMCTRH andMoyale Hospital respectively.H.E Rachel Ruto also donated1extraBeyondzerovehicle stationed atMCTRH to serve Sub-countiesofNorthhorrandLaisamis(Where accessible).

PriortotheexistenceofBeyondZeroservices,reproductivehealth,maternal,childandneonatalindicatorswere performingpoorlyparticularlyin hardtoreach areas.Immunizationcoveragewaslow and therewas highmaternal andneonatalmortalityrate.Thetrend hashoweverchangedpositively.

| Beyond Zero Service | 2017/ 2018 | 2018/ 2019 | 2019/ 2020 | 2020/ 2021 | 2021/ 2022 | 2022/ 2023 | 2023/ 2024 | 2024/ 2025 | Total | |---------------------------------|--------------|--------------|--------------|--------------|--------------|--------------|--------------|--------------|---------| | ANC | 796 | 703 | 347 | 173 | 254 | 452 | 680 | 415 | 3,820 | | CompletedANC4h Visit | 147 | 94 | 49 | 87 | 76 | 234 | 187 | 117 | 991 | | Immunization | 1,028 | 1,130 | 516 | 104 | 189 | 439 | 540 | 248 | 4,194 | | Treatmentof Illnesses | 4,730 | 4,005 | 1,856 | 10,59 | 356 | 2,675 | 2,378 | 1,956 | 28,547 | | Nutritional Screening | 749 | 2,643 | 1,347 | 4,739 | 1,367 | 1,458 | 2,360 | 1,841 | 16,504 | | HIV Testing& Counselling | 946 | 429 | 274 | 1,649 | 345 | 289 | 562 | 287 | 4,781 | | VitA Supplementation& Deworming | 1,314 | 1,364 | 478 | 3,156 | 871 | 1,367 | 1,893 | 1,048 | 11,491 | | | | | | | | | | Total | 70,328 |

2.RMCAHIndicatorsl:

Marsabit Countyisoneof thecountieswithpoorRMNCAHindicatorscomparedto thenational figures especiallyhighmaternal mortalityburden.This ispartlyattributed to inadequate investment across all the domainsof thehealthcaresystemdevelopment aswell aspoor healthseekingbehavior of theresidentsdueto theirnomadic lifestyle.SinceKayo Government tookover leadershipofMarsabit County,greateffortwasshifted to theRMNCAH.The County Government throughimproved HRH numbers,increased number of functional healthfacilities andincreasedfundingfrom partners hasrealizedgreat stridesinRMNCAH indicators.This is particularlyevidentintheimmunizationcoverage,skilleddeliveries,childrenattendingCWC,andpregnant womenattendingANCservicesamongothers.

Belowisthetableshowingthetrendofperformance:

| RMCAH Indicator | 2017 /2018 | 2018/ 2019 | 2019/ 2020 | 2020/ 2021 | 2021/ 2022 | 2022/ 2023 | 2023/ 2024 | 2024/ 2025 | |---------------------------------------------------------------|--------------|--------------|--------------|--------------|--------------|--------------|--------------|--------------| | Proportionofchildren underoneyearFully Immunized | 71.10% | 68.30% | 82.70% | 85.50% | 80.35% | 79.80% | 81.60% | 72.40% | | Proportion of pregnantmothers delivered by skilled attendants | 43.20% | 49.50% | 72.50% | 68.40% | 67.50% | 67.90% | 69.30% | 56% | | Proportion of pregnantmothers attending4ANC visits | 35.70% | 37.70% | 54.50% | 48.80% | 45.60% | 56.25% | 44.56% | 40.78% | | Proportionofchildren underfiveyears attendingCWC | 2.80% | 4.50% | 3.00% | 4.20% | 3.80% | 4.00% | 4.60% | 3.60% |

3.Imaging Services:

Thisisonedepartment thatwasgrosslyunderstaffedwithpoorpower supplymakingitdifficultfor the workers to use the digital x-rayunit.Since2017,the departmenthasrealizedvarious achievements courtesy oftheKayoadministration.Theseinclude:

• Upgradingthepowersupplyto3-phaseMarsabit Countyteachingandreferral Hospital.
• Upgradepowersupply atLaisamissub-countyhospital(OngoingFY2024/2025)
• Recruitmentof8newradiographers.
• Upgradepower supply atMoyale subcountyHospital(OngoingFY2024/2025).
• Establishment of CTScan at the Marsabit County Referral Hospital(64-slice)-With onlinereporting.
• EstablishDigital DentalunitatMCTRH
• Establishment of CT ScanMoyaleSCRH(16-slice)-with online reporting.
• Establish digitalX-rayunit atMCRTH
• X-ray block and equipping at Laisamis sub-countyreferral hospital.

4.Community Health Services (CHS)

• Marsabit County CHS strategy and bill approved.

Numberofcommunityunitsandstaffestablishmentin2006-2016

| SUB-COUNTY | CHU | CHAS | CHVS | |--------------|-------|--------|--------| | NorthHorr | 17 | 10 | 351 | | Laisamis | 12 | 5 | 220 | | Moyale | 19 | 8 | 639 | | Saku | 10 | 6 | 287 | | TOTAL | 58 | 29 | 1,497 |

Numberofcommunity unitsandCHSstaff establishmentfrom2017to2025(ADDITIONAL)

| SUB-COUNTY | CHU | CHAS | CHVs | |--------------|-------|--------|--------| | NorthHorr | 15 | 54 | 160 | | Laisamis | 13 | 54 | 150 | | Moyale | 15 | 45 | 150 | | Saku | 11 | 44 | 120 | | TOTAL | 54 | 197 | 580 |

5.AmbulanceReferralSupportServices;

| Sub County | Total No. | Station | |---------------------|-------------|-------------------------------| | NorthHorrSub-county | 1 | Kalacha SCR Hospital | | NorthHorrSub-county | | NorthHorrH/C | | NorthHorrSub-county | 1 | DukanaH/C | | NorthHorrSub-county | 1 | Turbi/BubisaWard-basedatMCTRH | | NorthHorrSub-county | 1 | Illeret | | Moyale Sub county | 2 | MoyaleSCRHospital | | Moyale Sub county | 1 | Ramata health Centre | | Moyale Sub county | 1 | SolololevelIVHospital |

| Laisamis Sub-county | 2 | LaisamisSCRHospital | |-----------------------|-----|-----------------------| | Laisamis Sub-county | 1 | KorrH/C | | Laisamis Sub-county | | Kargi H/C | | Laisamis Sub-county | 1 | Loiyangalani ward | | Saku sub-county | 3 | Marsabit CRHospital |

| GRANDTOTAL | 17 | |--------------|------|

Ambulance distribution acrossthecounty.

| Financial Year | No. Of Referrals Within the County | No. Of Referrals Outside the County | Total | |------------------|--------------------------------------|---------------------------------------|---------| | 2017-2018 | 207 | 300 | 507 | | 2018-2019 | 510 | 700 | 507 | | 2019-2020 | 480 | 680 | 507 | | 2021-2022 | 357 | 258 | 507 | | 2022-2023 | 449 | 304 | 507 | | 2023-2024 | 389 | 391 | 507 | | 2024-2025 | 201 | 189 | 507 | | GRAND TOTAL | 2593 | 2822 | 3549 |

6.RENAL and DialysisUnits:

Thisunit was establishedon17July2018,through the initiative of H.E the Governorfollowing the signing of theMOUfor theManaged EquipmentServices.Since thengreatmilestones havebeenrealized.This included:

• 6Renal DialysisMachinesinstalled
• Increase ofclients accessingdialysisservicesfrom one inJuly2018to36currently.
• Improvedwatersupplytotheunit
• Increase in the unit staffing from2(2018) to13(2025).The staffingincluded10 trainedrenalnurses, 2nutritionists,1 biomed Engineer).
• Sustainablesupplyofrenalcommodities
• Establishment of afully equipped isolationroomforHepatitisB clients.

7.PhysiotherapyServicesAchievement:

• Increaseinworkloadcommutativelyfrom1,977in theyear2017to5,803intheyear2025.
• RecruitmentoftwoadditionalphysiotherapiststhroughUHCprogram
• ProcurementofElectric shear for Marsabit County Referral HospitalandMoyale Sub-County Hospital

8.ICTInfrastructure and support services:

• NetworkingoftheMotherChild ComplexatMCTRH
• Installation of Medbos system for MCTRH and 3 sub-county hospitals (Laisamis,Moyale and Kalacha).
• Installationof Laboratoryinformationmanagementsystems(LIMS)atRegional Laboratory atMCTRH, andIntegrationofLIMSwithMedbossystem.
• Alternativenetworkconnectivityforthe administrationaspointtopointfromMarsabitCountyReferral Hospital,Additional installationof24portswitchfor administrationblock.
• Installation ofCCT atMoyaleSCR hospital

9.CommunityLedTotal Sanitation(CLTS)Activities

CLTSisaninnovative approachforempowering communities tocompletelyeliminateopendefecation(OD). It focuses on igniting a change in collective sanitation behavior.The process involves triggering the whole communitywhile emphasizing on thecollective benefitof stopping OD.Thisresultsin communityconstructionandutilizationoftoilets andhandwashingfacilities

| County/Su b County | H/H No | Total Pop | Noof Villages | No Trigger ed | Total No Claim ed | Total No Verifie d | Tot Certif ied | ODF Status | |----------------------|----------|-------------|-----------------|-----------------|---------------------|----------------------|------------------|--------------| | Moyale | 24753 | 153771 | 474 | 43 | 12 | 6 | 6 | 10.5% | | Saku | 15658 | 79181 | 176 | 108 | 25 | 24 | 18 | 28.1% | | Laisamis | 19209 | 101089 | 246 | 41 | 4 | 4 | 4 | 75.1% | | NorthHorr | 17069 | 125744 | 218 | 30 | 1 | 1 | 1 | 61.8% | | MARSABIT | 76689 | 459785 | 1114 | 222 | 42 | 35 | 29 | 41.9% |

10.CurativeServices

| Hospital | 2107 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 | |-----------------------------------|--------|--------|--------|--------|--------|--------|--------|--------| | Marsabit County Referral Hospital | 110255 | 175756 | 203806 | 193405 | 201425 | 198673 | 202428 | 205567 |

| Kalacha SC Referral Hospital | 9696 | 10832 | 13371 | 13587 | 14366 | 14458 | 14897 | 15000 | |--------------------------------|--------|---------|---------|---------|---------|---------|---------|---------| | Laisamis SC Referral Hospital | 12018 | 16711 | 14194 | 150067 | 15089 | 15347 | 15875 | 15976 | | Moyale SC Referral Hospital | 46946 | 57648 | 106701 | 109567 | 123670 | 125700 | 130876 | 135786 | | Totalfor County | 178915 | 260947 | 338072 | 466626 | 354550 | 354178 | 364076 | 372329 |

| | 2107 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 | |----------------------|--------|---------|---------|---------|---------|---------|---------|---------| | Saku Sub County | 216509 | 323574 | 349774 | 387890 | 395081 | 397001 | 401342 | 405011 | | Laisamis Sub county | 142654 | 206979 | 146987 | 147891 | 148579 | 150025 | 152347 | 155453 | | NorthHorr Sub County | 126676 | 150172 | 131210 | 147654 | 151047 | 149986 | 151253 | 155067 | | Moyale Sub County | 207464 | 402392 | 397250 | 401023 | 406987 | 410354 | 412654 | 420764 | | Totalfor County | 693303 | 1083117 | 1025221 | 1084458 | 1101694 | 1107366 | 1117596 | 1136295 |