Report On The County Oversight And Networking Engagements In Laikipia And Meru Counties

DATE

TABLED BY

COMMITTEE

CLERK AT THE TABLE

PAPERS LAID

11-11-25 Chairperson

KIARIE

THIRTEENTHPARLIAMENT

THE SENATE

STANDINGCOMMITTEEONHEALTH

REPORTONTHECOUNTYOVERSIGHTANDNETWORKINGENGAGEMENTS INLAIKIPIAANDMERUCOUNTIES.

Y

Clerks Chambers, Parliament Buildings, NAIROBI.

D5[2025

pgnang

November, 2025

Table of Contents

| LISTOFABBREVIATIONS | LISTOFABBREVIATIONS | LISTOFABBREVIATIONS | 1 | |-----------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------|-------| | PRELIMINARIES | PRELIMINARIES | PRELIMINARIES | | | EstablishmentandMandateofthe Committee | EstablishmentandMandateofthe Committee | EstablishmentandMandateofthe Committee | 2 | | Committee Membership | Committee Membership | Committee Membership | | | CHAIRPERSON'SFOREWORD | CHAIRPERSON'SFOREWORD | CHAIRPERSON'SFOREWORD | | | Acknowledgements | Acknowledgements | Acknowledgements | | | CHAPTERONE | CHAPTERONE | CHAPTERONE | | | 1. | INTRODUCTION | INTRODUCTION | | | 1.1. | COUNTYPROFILES | COUNTYPROFILES | | | | 1.1.1. | Laikipia County | 8 | | 1.1.2. Meru County CHAPTERTWO | 1.1.2. Meru County CHAPTERTWO | 1.1.2. Meru County CHAPTERTWO | 10 | | 2. | | | | | 2.1. | LAIKIPIACOUNTY | LAIKIPIACOUNTY | 10 | | | 2.1.1. Submissionsby the CountyExecutive | 2.1.1. Submissionsby the CountyExecutive | | | 2.1.2. | | OversightVisittoNyahururu CountyReferralHospital | 10 11 | | | 2.1.3. | Oversight Visit to Timau Sub-County Hospital | 15 | | | | OversightVisits toKibirichiaSub-CountyHospital | 21 | | 2.2. | MERUCOUNTY | OversightVisit toNanyuki TeachingandReferral Hospital | 17 | | | | | 17 | | 2.2.1. 2.2.2. 2.2.3. OversightVisit toMeru Teaching and Referral Hospital 2.2.4. Meetingwith the CountyExecutive 3. COMMITTEEOBSERVATIONS Health Sector Funding | 2.2.1. 2.2.2. 2.2.3. OversightVisit toMeru Teaching and Referral Hospital 2.2.4. Meetingwith the CountyExecutive 3. COMMITTEEOBSERVATIONS Health Sector Funding | 2.2.1. 2.2.2. 2.2.3. OversightVisit toMeru Teaching and Referral Hospital 2.2.4. Meetingwith the CountyExecutive 3. COMMITTEEOBSERVATIONS Health Sector Funding | 27 | | 3.1. | 3.1. | 3.1. | 27 | | 3.2. | 3.2. | 3.2. | | | | HumanResourcesforHealth | HumanResourcesforHealth | 27 | | 3.3. | HealthInfrastructure | HealthInfrastructure | 28 | | 3.4. | COMMITTEERECOMMENDATIONS | COMMITTEERECOMMENDATIONS | 29 | | 4. | | | 31 | | 4.1. | The Pharmacy and PoisonsBoard (PPB) | The Pharmacy and PoisonsBoard (PPB) | 31 | | 4.2. | | | 31 | | 4.3. | The Council of Governors- Governor, Laikipia County | The Council of Governors- Governor, Laikipia County | 32 | | 4.4. | Governor, Meru County | Governor, Meru County | 33 |

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LISTOFABBREVIATIONS

A&E

Accident and Emergency

CECM

CountyExecutive CommitteeMember

CHS

Community Health Service

CHW

CommunityHealthWorker

CHP

CommunityHealth Promoter

CPSB

County Public Service Board

CoG

Council of Governors

CS

Cesarean Section

DG

Deputy Governor

EMR

Electronic Management Records

FIF

Facilities Improvement Financing

FY

Financial Year

HDU

High Dependency Unit

HMIS

Health Management Information System

HPTs

Health Products and Technologies

HRH

HumanResourceforHealth

ICT

Information Communication and Technology

ICU

Intensive Care Unit

KEMSA

Kenya Medical Supplies Agency

KMPDU

Kenya Medical Practitioners and Dentist Union

MEDS

Mission for Essential Drugs Supplies

MES

Medical Equipment Service

MoH

Ministry of Health

NG

National Government

NHIF

National HealthInsuranceFund

PSC

Public Service Commission

SHIF

Social HealthInsuranceFund

UHC

Universal Health Coverage

WHO

World Health Organization

NTRH

Nanyuki Teaching and Referral Hospital

NCRH

Nyahururu County Referral Hospital

MTRH

Meru Teaching and Referral Hospital

TSCH

Timau Sub-County Hospital

KSDH

Kibirichia Sub-District Hospital

PRELIMINARIES

EstablishmentandMandateofthe Committee

TheStandingCommittee onHealthis establishedpursuant tostanding order 228 (3) and the Fourth Schedule of the Senate Standing Orders and is mandated to consider allmattersrelatingtomedicalservices,publichealthandsanitation.

Pursuant toStanding Order 228(4), the Committee is specifically mandated to-

• management,activities,administrationandoperationsoftheMinistryof Health anditsdepartments;
• 3)studyandreviewall legislationreferredtoit;
• 2)studytheprogramme andpolicy objectives of theMinistry ofHealth and its departments,and theeffectivenessoftheimplementationthereof;
• 4) study, assess and analyze the success of the Ministry of Health and departmentsassignedtoitasmeasuredbytheresultsobtainedascompared withtheirstatedobjectives;
• 5 considertheBudgetPolicyStatementinlinewiththeCommittee'smandate;
• 6 reportonallappointmentswheretheConstitutionoranylawrequiresthe Senate to approve;
• 8 considerreportsofCommissionsandIndependentOfficessubmittedtothe Senatepursuant totheprovisions ofArticle254of theConstitution;
• make reports and recommendations totheSenateas often aspossible, includingrecommendations forproposedlegislation;
• 9 examineanystatementsraisedbySenatorsonamatterwithinitsmandate;and 10)followupandreportonthestatusofimplementationofresolutionwithinits mandate;and
• 11)follow up and report on the status of commitments made by the Cabinet SecretariesintheirresponsetoquestionsunderStandingOrder51C

Committee Membership

The Committee is comprised of the following members:

1. Sen. Jackson K. Arap Mandago, EGH, MP

Chairperson

2. Sen. Mariam Sheikh Omar, MP

Vice-Chairperson

3. Sen. Justice (Rtd.) Stewart Madzayo, EGH, MP -

Member

• 4.Sen.Ledama Olekina,MP

Member

5. Sen. David Wakoli,MP

Member

• 6.S Sen. Richard Onyonka,MP

Member

• 7.S Sen.TabithaMutinda,MP

Member

• 8.Sen. Hamida Kibwana,MP

Member

9. Sen. Joseph Githuku,MP

• Member

CHAIRPERSON'SFOREWORD

Atits Sitting held onTuesday,27hMay,2025,the CommitteeonHealth deliberated on the state of provision of healthcare services at health facilities country-wide and resolved to conduct oversightvisits to Laikipia and Meru Counties to acquaint itself oversight visits took placefrom 18 to20u June,2025.

This Report contains a record of the outcome of a comprehensive evidence-gathering exercise undertakcn pursuant to the Committce's mandate to oversee the delivery of medical services, public health and sanitation in the counties, countrywide. These oversight visits were designed to gather evidence, provide firsthand insights and augment information receivedwithin theprecincts of Parliament on the state of healthcare infrastructure, service delivery and the challenges faced by healthcare providers and the communities they serve.

The Committee engagements involved site visits to Nyahururu County Referral Hospital and Nanyuki Teaching and Referral Hospital in Laikipia County, Timau SubCounty Hospital, Kibirichia Sub-County Hospital and Meru Teaching and Referral Hospital in Meru County.

Through these interactions,the Committeegathered critical evidence on the adequacy of healthcare personnel, the status of medical equipment and supplies, the effectiveness of emergency and referral systems and the implementation of digital health records. The Committee sought to acquaint itself with the information and understand the operationalization of health financing mechanisms including the Social Health Insurance Fund (SHIF) and the Facility Improvement Fund (FIF). The Committee further sought to assess the county's compliance with relevant health sectorpoliciesandregulations.

The Committee identified several critical and pervasive challenges impacting healthcare delivery in the two counties. Although both counties have increased their health sector budgets, the funding remains insufficient relative to the magnitude of devolved health needs and the populations served.

Laikipia County faces unique funding strains as its health facilities serve residents from several neighboring counties, thereby overstretching both human and financial resources. Conversely, Meru's main referral must cater to a population of 1.4 million, in addition, population to patients from surrounding counties, further compounding budgetary pressures, particularly for critical care, emergency and specialized services.

Both counties face an inadequate number of healthcare workers across nearly all facility departments.This shortfall is primarily due tonatural attrition and expanding scopeof healthservices underdevolvedgovermments.Consequently,the existingstaff are overburdened, resulting in burnout and decline in the quality of care. The distribution of health workers disproportionately favors higher-level hospitals,leaving sub-county and peripheral facilitiesseverely understaffed.

Facility infrastructure in the two countics is in a critical state of disrepair. Significant deficits were observed, including missing window panes, broken tiles, dilapidated roofs, falling ceilings and condemned structures. Several sections remain undercquipped with crucial projects such as mortuary, waste disposal systems and intensive care units (ICU) either stalled or incomplete.Healthcare facilitics in the two counties lack essential cquipment as demonstrated by critical shortage of incubators in newbon units, ICU/HDU beds and equipment, functional dialysis machines and outdated and abscnce of laboratory items.

This report presents a comprehensive analysis of these issues and makes recommendations to the three county governments and other stakeholders. These recommendations are aimed at strengthening ghealthcare systems,enhancing accountability and ensuring that investments in healthcare translate into tangible improvementsinservicedelivery and health outcomes.

Acknowledgements

On behalf of the Committee, I wish to thank Sen. Kathuri Murungi, MGH, MP, Senator for Meru County and Sen. Nderitu John Kinyua, MP, Senator for Laikipia County for their warm welcome and support extended to the Committee by their offices during the oversight visits. Their input and contributions enabled the Committee carry out its oversight mandate and functions effectively in the two counties.

The Committee wishes to extend its appreciation to the Governors of Meru and Laikipia Counties and their respective County Executive Committee Members for their input, submissions and evidence produced during the oversight tours. The Committee is also grateful to the members of staff and other stakeholders in the healthcare facilities visited during the tour for their submissions, which have greatly enhanced the evidence analyzed during processing of this report.

I acknowledge and appreciate the Members of the Committee for their dedication and commitment during gathering of evidence, drafting of this report and setting out conclusions andrecommendations.

Further appreciation goes to the Office of the Speaker of the Senate and the Office of the Clerk of the Senate for their continuous support to the Committee during executionofitsmandate.

It is now my pleasant duty and privilege to present this report of the Standing Committee on Health, for consideration and approval by the House pursuant to Standing Order No. 223 (6) of the Senate Standing Orders.

Sm/

Signed

....Date....

SEN.JACKSONK.ARAPMANDAGO,EGHMP CHAIRPERSON,STANDINGCOMMITTEE ONHEALTH

1.INTRODUCTION

1. The Standing Committee on Health is established pursuant to standing order 228 (3) and the Fourth Schedule of the Senate Standing Orders and is mandated to considerallmattersrelatingtomedicalservices,publichealthandsanitation. 2. 2.To executeitsmandatethe Committeehasadopteddifferentmodesof operation, engagements,theCommitteeis ableto augment theevidencegatheredwithin the precinctsofParliamentwithsitevisits. 3. 3.At its Sitting held on Tuesday,27thMay,2025,the Committee resolved to conduct oversightvisitstoLaikipiaandMeruCountiestoacquaintitselfwiththeprovision of healthcare services aspart of its oversight function.These oversightvisits took placefrom 18th to20thJune,2025.

Purpose and Objectives

4. The specific objective of these engagements was to visit select healthcare facilities in the three counties in order to- 2. a)assess the state and quality of the infrastructure,facilities,hospital equipment and provision ofemergency services;

• b) asses the automation of healthcare provision systems for patients, drugs and commodity management;

4. assess the availability of requisite healthcare personnel, the gaps and C challenges, if any, these counties face in regard to healthcare workers;

• d) assess the availability of training and capacity building programs and avenues for healthcare workers in emergency healthcare, specialized services and referrals;

6. assess the availability of drug and medical supplies in healthcare facilities in the counties; and

• f) obtain information on the Social Health Authority(SHA)reimbursements, facility accreditations and pending bills with the Kenya Medical Supplies Agency (KEMSA).

Scopeof theEngagements

• 5.The Committeeselected thefollowingfacilitiesfor assessment-
• 1) Nyahururu County Referral Hospital and Nanyuki Teaching and Referral Hospital in Laikipia County; and
• and Kibirichia Sub-County Hospital in Meru County.

CHAPTERONE

Methodology

6. Between 18th and 20th June 2025, the Committee undertook site visits to the designated facilities.During these visits,Members engaged with pertinent county government officials,hospital management, and other stakeholders, and gathered oral and written submissions.Additionally,the Committee also conducted thoroughphysical inspections ofpremises,reviewedrelevant documentation and directly observed theworkingconditions and challenges on site. 7. The findings, analysis and recommendations presented in this Report are grounded in evidence gathered throughout these engagements and are intended to facilitate the enhancement of health sector governance, accountability and service delivery within theframework of thedevolved system of governance.

1.1.COUNTYPROFILES

1.1.1. Laikipia County

8. Laikipia County comprises three administrative sub-counties (Constituencies) namely; Laikipia East, Laikipia North and Laikipia West. Laikipia County has a population of approximately518,560. 9. The County has made significant strides in healthcare provision, particularly since the advent of devolution. The County has 3 County Referral Hospitals, 10 SubCounty Hospitals, 21 Health Centers and 141 dispensaries totaling 175 public health facilities. Additionally, 45 of these facilities are accredited by NHIF 10. The Nanyuki Teaching and Referral Hospital has an estimated inpatient bed capacity of 159, 24 maternity beds, 11 cots, 2 emergency casualty beds and 2 ICU bedsservingthepublichealthcareneeds. 11. The total estimated budget for FY 2024/25 amounts to Kshs.8.05 billion.It comprised Kshs.3.15 billion (39 percent) and Kshs.4.89 billion (61.0 percent) allocation for development and recurrent programmes respectively. The budget estimate represents an increase of Kshs.798.58 billion (11 percent) from the FY 2023/24budget. Also,in the first half of the FY 2024/25, the community health promoters were given an annual budget allocation of Kshs.25.23 million that there are no actual receipts or actual receipts percentage as percentage of annual allocation presented in the report of the Office of The Controller of Budget; 12. In the FY 2024/25, the County allocated Kshs.1.03 billion to the health sector of which Kshs.206.48 million is for the recurrent expenditure and Kshs.822.2 million allocated for the development expenditure. Up to the first half of the FY 2024/25, the county had only spent Kshs. 33.70 million of its recurrent budgets and s na s p s OfficeoftheControllerofBudget.

1.1.2.MeruCounty

13. Meru County covers an area of 7,006km2 and has a population of 1.545,714 people. The County has over one hundred government-managed public health facilities.The major health facilities include; Meru Teaching and Referral Hospital, Maua Sub-County Hospital, Nyambene Sub-County Hospital, Mikinduri Sub-County Hospital among others. 14. The Meru Teaching and Referral Hospital servs as the main referral facility and has an estimated inpatient bed capacity of over 300, with specialized wards including maternity, newborn units, intensive care, and isolation units serving the population'shealth needs. 15. Meru Teaching and Referral Hospital is the largest hospital in the county and hence collects the largest amount of money as FIF. The County has enacted regulations to operationalize the Facility Improvement Fund (FIF) Act, 2023. 16. The total estimated budget for FY 2024/25 amounts to Kshs.13.92 billion. It comprised of Kshs.4.97 billion (36 percent) and Kshs.8.95 billion (64 percent) allocation for development and recurrent programmes, respectively. The County's Net Approved Budget is Kshs.13.08 billion, which consists of Kshs.8.53 billion for recurrent and Kshs.4.55 billion for development. 17. In the FY 2024/25, the County allocated Kshs. 3.782 billion to the health sector of which Kshs.2.983 billion is for recurrent expenditure and Kshs. 798.7 million allocated for the development expenditure. Up to the second quarter of FY 2024/25, the county had only spent Kshs.1.486 billion of its recurrent budget and Kshs. 441 million on development spent on development as reported by the office ofthecontrollerofbudget. 6. 18.In the first half of the FY 2024/25, the county had collected Kshs 41.33 million from the FIF that was utilized by the hospitals as reported by the office of the controller of budget though thefacilities did not submit a report on utilization on the funds.In the first half FY 2024/25, the County had spent Kshs. 10.4 million onthepharmaceutical andnon-pharmaceuticalsupplies.

CHAPTERTWO

2.COMMITTEEOBSERVATIONS

2.1.LAIKIPIACOUNTY

2.1.1. Submissions by the CountyExecutive

19. The Committee paid a courtesy call to the Governor at his office in Nyahururu Town prior to the commencement of the visits and subsequently convened a debriefing meeting with at his office in Nanyuki following conclusion of the visits. 20. The Governor was accompanied by the Deputy Governor, the County Secretary, the County Executive Committee Administration, the County Executive Committee Health,the County Executive CommitteeWater and Environment,the County Chief Officer of Health, Chief Officer in the Department of Health Services and othersenior officialsfrom the CountyGovernment. 3. 21.TheGovernorinformed theCommittee that: 4. a)Laikipia County borders the counties of Nyeri, Samburu, Nakuru, Isiolo, Meru and Nyandarua whose residents relied heavily on the Laikipia healthcare facilities hence straining the available resources and overstretching the available human resources for health;

Picture 1: TheGovernor,LaikipiaCounty demonstratingto the Committeethecatchmentareaservedbythehealthcare facilitiesin theCounty

• b)Laikipia County has also been affected by persistent drug supply challenges from the Kenya Medical Supplies Authority (KEMSA), experiencing order fill rates that typically rangebetween50% and 70%;
• c) The County had mooted an idea of establishing its own medical training institutetotrainhealthcarepersonnelandbuildcapacitiesoftheexisting Human Resources for Health;
• d) The County Government had taken major steps to invest in its healthcare personnel with a strong emphasis on converting staff on fixed-term contracts especially those under the Universal Health Coverage (UHC) scheme; and
• e) The County Government is actively upgrading its healthcare facility infrastructure andbroaderservicedeliverycapacitiesandhadprocuredanew laundrymachineforhospital use.

2.1.2.Oversight Visit to Nyahururu County Referral Hospital

22. The Committee conducted an oversight visit at the Nyahururu Referral Hospital on Wednesday,18th June,2025.During thevisit, the Committeewas accompanied by Mr. Albert Taiti, the County Executive Committee Member (CECM) in charge of the Health Department and Dr. Timothy Panga, the Chief Officer, Department of Health. Upon arrival the Committee was received by the Hospital Administrators led by Dr.Lawrence N.Kamande, the Chief Executive Officer, Nyahururu Teaching and Referral Hospital. 23. The Committee was presented with an overview of the facility's operations, including service coverage and was informed that the facility has an emergency department that operates on a 24-Hourbasis,fullyfunctionaloperatingrooms,a functional pharmacy and a laboratory. Further, the Hospital has successfully achieved a significant reductioninpatientwaitingtimes. 24. The Committee was further informed that Nyahururu County Referral Hospital servespatientsfromtheneighboringcountiesfollowing itsproximityto Nyandarua, Nakuru, Samburu and Nyeri counties. The facility has a bed capacity of two hundred and forty-four (244) beds, including fifty-four (54) maternity. Additionally, theNewBornUnit has a total of twenty -six(26) beds and twentynine (29) cots. 4. 25.Additionally, the hospital has ten (10) dialysis) beds/machines, while its mortuary has a capacity of eighteen (18) bodies. However, during the visit the Committee was informed that there were sixty-one (61) bodies preserved at the mortuary, significantly exceedingits storagecapacity.

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Picture2: Mediareportindicating theoverstretchedpatienthandling capacity observed at Nyahururu County Referral Hospital

26. During the visit and engagement with hospital management and staff, the Committee made the following observations:

• a) Overcrowding: The committee observed that the maternity and outpatient departments were extremely overcrowded. The inadequacy of consultation rooms contributed to the prolonged wait times and congestion. In the maternity ward, shortages of beds compelled some mothers to share single beds, raising concerns regarding an increased risk ofinfection and patient discomfort;

11

Picture3: TheCommitteeobservedovercrowdedpost-natalwards theNyahururuCountyReferralHospitalwherepatients weremadetosharebeds

TheSenateHealthCommitteehascalled for urgentinfrastructuralexpansion and increased fundingforNyahururuCountyReferralHospital toaccommodatethegrowingnumberofpatients itreceivesfromLaikipiaandsevenneighbouring counties.

18THJUNE2025

• b)Infrastructure and Maintenance: several infrastructural deficiencies were identified, including missing window panes, broken tiles, deteriorating ceilings, and damaged beds within the wards.These issues were deemed detrimental to infection prevention, patient comfort, and overall quality of care;

Picture4and5: includingbroken tiles,missingwindowpanesand damaged beds attheNyahuturuCountyReferral

deteriorating and infrastructural deficiencies Hospital

• c)Laboratory Licensing and Capability:the hospital's laboratory retained necessary certification and licensing, however the Committee found that the license had expired. It was further reported that persistent shortages of equipment and reagents limited the facility's ability to provide a full range of diagnostic services;

• d) Waste Management; the hospital's incinerator was found to be nonfunctional, resulting in an accumulation of medical and biohazard waste a situation posing substantial health and environmental risks to both staff and the community;

2. e)Neonatal and Critical Care; an acute shortage of infant incubators was evident in the newborn unit. Makeshift incubators, such as cardboard cartons, were reportedlyin use.The hospital lacked operationalIntensive CareUnit (ICU) beds, severely limiting its capacity to provide critical care for severely ill patients; 3. Pharmacy and Drug Management; the hospital experienced significant challenges with the management of pharmaceutical stocks. The Committee noted inconsistencies between physical drug stocks and recorded inventories, incomplete documentation,and notable stockpiles of expired drugsin themain privatepharmacies dueto stockouts;

Picture 6:Showingtheaccumulation ofmedicaland biohazardwaste situationposingsubstantialhealthandenvironmentalriskstoboth 1 staff and thecommunity.

Picture7:TheCommittee observed persistent shortages ofequipment andreagentslimited thefacility'sabilitytoprovidea fullrange of diagnosticservicesPatientWelfare.

• g The Committee observed that some patients, particularly in maternity, were detained in the hospital due to inability to settle medical bills.

2.1.3. Oversight VisittoNanyuki Teaching and Referral Hospital

27. The Committee visited the Nanyuki Teaching and Referral Hospital on Thursday 19th June, 2025 accompanied by Mr. Albert Taiti, the County Executive Committee Member (CECM) in charge of the Health Department, Dr. Timothy Panga, the Chief Officer, Department of Health and Dr. Sammy Kilonzo, the Chief Executive Officer, Nanyuki Teaching and Referral Hospital. 28. The Committee was informed that Nanyuki Teaching and Referral Hospital was established in the 1930s. The provides a comprehensive range of health services, including general outpatient and specialist clinics, emergency care, maternal and child health services, pharmacy, laboratory, radiology, and renal dialysis. Further, the Hospital has seen recent infrastructure improvements, reflective of efforts to meet increasing patient demand and evolving health requirements in the region. 29. During its assessment of the Hospital, the Committee made the following key observations:

• a! Overcrowding and Patient Flow;thehospital's outpatient department, pharmacy,laboratory,and inpatient wards were notably overcrowded,with insufficient waiting areas. Some patients were compelled to share beds due to the overstretched capacity, highlighting a severe mismatch between facility resources and patient volumes;
• b Stock and Supply Management; the Committee observed poor supply chain oversight,withtheprevalenceofexpiredpharmaceuticalsandunusedmedical stock. This indicated inefficiencies in drug and commodity management, undermining the timely and effective provision of essential medicines;
• Critical Care Capacity; the Hospital faces shortages in Intensive Care Unit (ICU) beds, with demand consistently outstripping supply. The Hospital regularly receives critically ill patients from a wide catchment area, intensifying pressure on limited critical care resources;
• Mortuary Capacity and Management; the mortuary was found to be severely overcrowded, accommodating sixty-two (62) bodies despite a design capacity of only twelve (12).Delays in collection,mainly attributed to financial constraints faced byfamilies,had resulted in an accumulation of both unclaimed and uncollected bodies;
• Pharmaceutical Records and Inventory Controls; the Hospital's pharmacy operates with both manual and digital inventory management systems, which are poorly synchronized. This dual approach has led to inconsistencies, making it difficult to accurately monitor drug stock, usageand expiries, impeding timely reordering;

Picture 8:The Committee observed discrepancies between physical stocksandrecordedstocksindicatingpoorinventorycontrol practices.

• f Patient Nutrition and Dietary Needs;although the facility's kitchen was functional and maintained hygienic standards, patient meals lacked customization for specific health or physiological requirements, and all patients were served uniform meals regardless of condition;
• Equipment andAssetManagement;theCommitteeobserved numerous obsolete,non-functional,and outdated medical devices abandoned within hospital premises, underscoring persistentchallengesinequipment management,maintenance,and disposal;

2.2.MERUCOUNTY

2.2.1. OversightVisit to Timau Sub-CountyHospital

30. The Committee conducted an oversight visit to the Timau Sub-County Hospital on Thursday 19th June, 2025 and was received by Dr. Nicholas Kimaita, the Hospital administrator anda host of otherhealthcarepersonnel at thefacility.The Committee was informed that the Facility was established to fill a critical gap in healthcare provision in a region that previously depended on distant hospitals in Nanyuki and Meru Town. 2. 31.The Committee was informed that the Hospital is managed byMeru County Government and is classified as a Level 4 facility. It offers a wide range of services such as outpatient,comprehensive care centre,maternity and child health, pharmacy and laboratory services, antenatal and post-natal care, family planning and immunization, curative and minor surgical outpatient care. 3. 32.The Committeewas informed that the Hospital is managed byMeru County Government and is classified as a Level 4 facility. It provides a comprehensive range of services including outpatient care, comprehensive care Centre, maternity and child health services, pharmacy and laboratory services, antenatal and postnatal care, family planning and immunization as well as curative and minor surgical outpatient care. 33. During its inspection and consultations with staff, the Committee noted the following key findings- 5. a Human Resource Constraints; the facility suffers from a chronic shortage of both medical and support staff.At the time of the visit, there were only two pharmacists, eight clinical officers, and thirteen nurses, which was inadequate for the patient load. The hospital lacks specialist personnel, leading to frequent patient referrals for advanced care; 6. b Infrastructure Deficiencies; the in-patient section is limited and the maternity ward was found deserted, likely due to a combination of poor infrastructure, insufficient staff, and obsolete equipment. The maternity unit lacks a dedicated theatre and a functioning newborn unit.Essential diagnostic services such as xroom notset up according tosafety standards;

Picture9and1o:TheCommitteeobservedinadequatepharmaceutical managementand poor storage ofmedical supplies atTimauSubCounty Hospital

• Stalledand Incomplete Projects;the mortuarywasincomplete and the construction appeared to have stalled despite references to ongoing works in County tender documents. One building on the compound had been condemned for structural instability, and stockpiles of expired drugs were disposed of withintheseunsafestructures.

Picture1land12:TheStalledhospital mortuary(with agreenroof)at themiddleofa trackof landunderwheat andcowpeas.

• d Land and Asset Management; the compound encompassed a substantial tract of land cultivated with wheat and cowpeas. It was unclear whether this land had been leased to external parties or was being directly cultivated by the hospital.
• Essential Supplies and Equipment; the Hospital faces persistent shortages of critical drugs, basic medical supplies, and functioning equipment. Bathroom facilities were in disrepair, and overall maintenance was substandard. There was evidence of procurement of morefurniture than needed,with excess items strewn in corridors and disused rooms;
• Waste and Records Management; The incinerator was found to be without a door and lacked perimeter fencing, raising concerns regarding environmental safety. Health and Pharmacy records were maintained in paper form, which posed a risk of loss and resulted in inefficiencies in information retrieval and tracking of medical commodities. Additionally, Pharmacy bin cards were missing for several medicines;
• a Non-compliance and SafetyRisks;ofparticular concernwas thehospital's use of banned asbestos for roofing, which is a violation of occupational health andsafety standards.

Picture13:Thecommitteeobservedthatthehospitalincineratorlackeda functional door and perimeter fencing,raising significant concerns regarding environmentalsafety.

2.2.2.Oversight Visits to Kibirichia Sub-County Hospital

34. On 19th June 2025, the Committee undertook an oversight visit to Kibirichia SubCounty Hospital. The Committee was informed that Kibirichia Sub-County Hospital serves as a key public health facility in Meru County, providing a range of medical services to thelocalcommunity and its environs.The facilityis intended to operate at Level 4 status but faces several constraints limiting its ability to provide the full spectrum of care expected at this level; 2. 35.The Committeemade thefollowingkey findings: 3. Pharmaceutical and Supply Chain Challenges; there were pronounced a lapses in pharmacy records and drug management. Several records, including those detailing expired and controlled drugs, exhibited discrepancies. Expired medications were found in the facility's only ambulance, indicating unsafe disposal practices and inadequate pharmaceutical oversight; 4. b Infrastructure and Equipment Deficits; the facility lacked critical infrastructure, including a functional mortuary, staff housing and specialized units such as theatres and laundry. Many essential medical devices and equipment were obsolete or non-functional, raising concerns about the reliability and range of services provided. 5. Human Resource Shortages; staffing levels were significantly below requirements, causing work overload and burnout among available healthcare workers..These shortages adversely affected service quality, patient care, and staffmorale.

Picture14:TheCommitteeobserveddiscrepanciesbetweenrecorded drugsstocks and actual stocks on theshelvesatKibirichiaSub County Hospital

• d Stockouts and Patient Impact; chronic shortages of essential drugs, dressings, and laboratory reagents were reported. Patients frequently faced stockouts and, as a result, were compelled to purchase medicines from private pharmacies, increasing out-of-pocket costs and undermining the goal of equitable access to healthcare.
• Ambulance and Emergency Services: the hospital had only one operational ambulance, which was poorly maintained and had been used for storage of expired drug, thereby compromising its availability and usability during emergencies.
• f) Facilities and Waiting Areas; the waiting bays were inadequately furnished, lacking sufficient seating and shelter for patients and visitors. This contributed to discomfort and congestion, particularly during busy periods.

Picture15:The only functional ambulance at Kibirichia Sub County Hospitalwasstockedwith expireddrugs.

2.2.3. OversightVisittoMeruTeachingandReferral Hospital

36. The Committee undertook an oversight visit to the Meru Teaching and Referral Hospital (MTRH) on 19th June, 2025. The delegation was received by senior facility management and county health officials led by Dr. Dennis Mugambi, the CountyExecutiveCommitteeMemberinchargeof theDepartmentofHealth Services and Dr. Bernard Murithi the Chief Executive officer Meru Teaching and Referral Hospital.

37. The Committee was informed that MTRH is a major public referral hospital servingbothMeru Countyand thebroader region,catering toan estimated tii services. The Facility provides a comprehensive range of clinical and specialist services, including general and emergency care, maternity, pediatric, surgical, dental, psychiatric, renal, oncology, ICU, HDU and rehabilitative services. It also hosts specialized clinics such as oncology, dialysis, chemotherapy, maxillofacial surgery, neurology, dermatology, and urology. 2. 38.During its visit and consultations with hospital management and staff, the Committee made the following key findings; 3. a MentalHealthServices;thehospitalhasestablisheda comprehensivemental health unit that offers both inpatient and outpatient psychiatric care, serving patientsfromMeru and distantcountiesincludingMandera andMarsabit.The unit also functions as a training site for health students. Despite the breadth of its services, the unit faces staffing shortages, frequent drug stock-outs, and limitations in infrastructure; 4. b Critical and Specialized Care; the High Dependency Unit (HDU),part of the ICU, is equipped with modern equipment, though it regularly experiences excess demand. Some ICU/HDU equipment provided under the Managed Equipment Services (MES) programme were out of service due to lack of maintenance support after contract expiry. There are no intensivists in the unit following the departure of Cuban specialists; 5. Maternity andRenalServices:Maternitywardswerefound tobe congested, with some patients sharing beds or awaiting bed availability after delivery, largely due to high referral inflows. The renal unit, though fitted with advanced machines,onlyhad five(5)functional hemodialysis machines,with others lying idle for lack of consumables and reagents; 6. (p Oncology and Cancer Care; the hospital operates a cancer treatment center, but its capacity is limited to administering chemotherapy. Patients requiring advanced therapies, such as radiotherapy or brachytherapy, and pediatric cancer cases are referred to national facilities like Kenyatta National Hospital or Kenyatta University Teaching and Referral Hospital; 7. Financial and Supply Chain Challenges; the facility faces severe budgetary strains,particularlydue todelaysin reimbursements from the Social Health Insurance Fund (SHIF), compounded by a sizable annual wage bill. MTRH often relies on internally generated Facility Improvement Financing (FIF) for pharmaceutical and non-pharmaceutical supplies, but this is often insufficient; 8. Pharmacy and Records Management; pharmacy management was found to be problematic, with discrepancies in drug records and the presence of expired and unaccounted-for controlled substances. Overall Records management relied

heavily on manual documentation, hindering efficiency and compromised auditability;

Picture16:The Committee observed expired drugs at theMeru Teaching andReferralHospital.

• Mortuary Service; the hospital's mortuary, designed for sixty (60) bodies, held up to two hundred (200) bodies at the time of the visit, largely due to unclaimed or uncollected remains. This overstretching reflects wider social and infrastructural challenges.

2.2.4. Meetingwith theCountyExecutive

39. The Committee informed the County Executive that, during the visit, the following preliminary observationswere made- 2. The Meru Teaching and Referral Hospital had congested maternity wards,with a evidence indicating an insufficient number of maternity beds and baby cots at the wards. Further, both healthcare and support staff, exhibited signs of complacency, characterized by disinterest, lack of motivation and general disengagement, particularly within the hospital pharmacy

• b) Therewerenotablechallengeswithrecordkeepinginallthehealthcare facilities visited by the Committee. The widespread reliance on manual and compromised dataquality,andhindered concurrentaccesstodata

• In all the healthcare facilities visited, record keeping and control procedures in pharmaceutical supply management were suboptimal, relied on manual, paperbased inventoryinsteadofdigitalandelectronic tracking.TheCommittee observed that this was likely to create inefficiencies in tracking drugs, increased the risks ofloss and misplacement and slowed down audits.
• At Timau Sub-County Hospital,excess furniture was strewn throughout the facilityand it appeared thatmore hadbeen procured than necessary,with surplus items poorly placed in the corridors and disused rooms. The Committee observed that this situation indicated poor prioritization and inadequate institutional oversight.
• The seating areas in healthcare in all the facilities visited were inadequate, failing to provide sufficient comfort, accessibility, or functionality to meet the needs of patients, visitors and staff. The Committee observed that the shortage ofseatingled to overcrowding and congestionwithmanyindividualsforced to stand.
• f The healthcare facilities faced significant challenges regarding the improper disposal of expired drugs, including the dumping of such drugs in unlocked and disused rooms. This practice constitutes a serious breach of both patient safety standards and regulatory requirements for hospital pharmacy management.

Picture 17: During a de-briefing meeting at the Office of the Governor, Meru County

CHAPTERTHREE

3.COMMITTEEOBSERVATIONS

3.1.Health Sector Funding

40. The health sector budgetary allocation has generally increased since the advent of devolution. County governments are expected to prepare clear budgets for healthcare service delivery, drawing funding from equitable share of national revenue, county own-source revenues, user fees, grants and donations. 41. Although both counties have increased their health sector budgets, the funding remains insufficient relative to the magnitude of devolved health needs and the populations served. This funding shortfall undermines both quality and accessibility of care in the two counties and impends efforts to build resilience in the health system. 42. Laikipia County Government reported that the health sector received Kshs. 1.03 billion in Financial Year 2024/2025, while Meru allocated Kshs. 3.782 billion for the same period. Nonetheless, the majority of health budgets in these counties are consumed by staff salaries and drug supplies leaving limited resources for infrastructure development, equipment, ,acquisition and service expansion. Development allocations are frequently under-implemented or reallocated to cover immediate recurrent expenditures, resulting in incomplete projects such as mortuaries and incinerators; 43. Laikipia County faces unique funding strains as its health facilities serve residents from several neighboring counties, thereby overstretching both human and financial resources. Conversely, Meru's main referral must cater to a population of 1.4 million, in addition population to patients from surrounding counties, further compounding budgetary pressures, particularly for critical care, emergency and specialized services. 44. Meru County is heavily dependent reimbursements from Social Health Insurance Fund (SHIF) to cover wage bills; however, delays and inconsistencies in these disbursements severely strain liquidity at facilities. Both counties have increasingly relied onfacility-generated revenues,bututilizationreports remain missing or incomplete,and these funds continue to fall short of meeting actual needs.

3.2.HumanResources for Health

45. There is pronounced shortage of qualified health personnel across facilities, attributed to legislative employment ceilings, poor retention, delayed wage payments, and inconsistencies in distribution of specialists. Overwork, burnout, and skill mismatches are prevalent, particularly in high-demand areas such as maternal health and mental health. Staff morale is further diminished by delays in salarypayments andlackofcontinuousprofessional trainingopportunities.

• 46.Both countiesface aninadequatenumber ofhealthcareworkers acrossnearly all facilitydepartments.Thisshortfallisprimarilyduetonaturalattritionand expandingscopeofhealthservicesunderdevolvedgovernments.Consequently the existing staff are overburdened, resulting in burnout and decline in the quality of care.

47. There is a widespread inability to retain trained and experienced personnel, which underminesservicedeliveryandcontinuity.Further,limited resources have affectedcontinuous sprofessionaldevelopment and in-service training opportunities contributing to stagnation in skills and expertise. Additionally, specialist healthcare workers in critical care, pharmacy, laboratory sciences and mental health remain scarce, particularly in lower-level facilities. This shortage has compelled facilities to implement inappropriate task shifting, whereby lessskilled staff undertake specialized roles, adversely affecting quality of care and patient safety. 48. The distribution of health workers disproportionately favors higher-level hospitals, leaving sub-county and peripheral facilities severely understaffed, with rural areas particularly vulnerable. Additionally,frequent delays in salary payments and non-remittance of statutory deductions have been reported, which significantly demotivating staff and negatively affect morale. These challenges are compounded by poor working conditions, including inadequate infrastructure, lack of essential supplies and overcrowded departments.

3.3.HealthInfrastructure

• 49.Facilityinfrastructureinthetwocountiesisinacriticalstateof disrepair. Significant deficits were observed, including missing window panes, broken tiles, dilapidatedroofs,falling ceilingsandcondemned structures.Severalsections remain under-equipped with crucial projects such as mortuary, waste disposal systems and intensive care units (ICU)either stalled or incomplete. The continued use of banned materials such as asbestos roofing, compromised safety and has left facilities ill-equipped to respond effectively to surges in demand, thereby exposingpatients and staff toincreased risk.

50. Major facilities like Nyahururu County Referral Hospital and Nanyuki Teaching and Referral Hospital operate well beyond their intended capacities. For instance, atNyahururu,maternity and outpatient departments experiencedsevere overcrowdingwith,mothers forced to share beds,increasing the risk of infections andcontributing tosignificantdiscomfort.Overcrowdingisalsoacuteinthe mortuary,which routinelyholdsfar morebodies than designedto accommodate. There was a marked shortage of essential medical infrastructure, including a lack of incubators in newborn units and non-operational Intensive Care Units (ICUs). 51. Inadequate waste management systems, exemplified by non-working incinerators, haveresultedinthehazardousaccumulationofbiohazardouswaste.Despite recent upgrades in some facilities,maintenance remains insufficient,leading to rapid deterioration of equipment. Additionally, obsolete and damaged medical equipment oftenremain on thefacilitygroundswithoutproper disposal.

52. The Nyahururu County Referral Hospital has an acute shortage of incubators in its newborn unit compelling Mothers to opt to improvised incubators made from old cartons, thereby compromising the quality of neonatal care; Facilities such as Kibirichia Sub-County Hospital lack a functional mortuary, adequate staff housing, and specialized units. Furthermore, much of the equipment at the facility is obsolete or non-functional, significantly limiting its capacity to deliver quality healthcareservices. 53. Timau Sub-County Hospital faces condemned key buildings and an unsafe, incomplete incinerator. The lack of investment has resulted in deserted maternity wards, at Timau, due to poor infrastructure and inadequate staffing, nonfunctional x-ray units and theatres, and poor furnished waiting bays, all of which significantly diminish patient experience and care outcomes. 54. Meru Teaching and Referral Hospital, despite having advanced departments such as the ICU/HDU, mental health, renal, oncology units, suffers severe congestion, dilapidated wards, and overstretched mortuary services, which at the time of the visits were holding over 200 bodies well above the designed capacity of 60.

3.4.Provision and Management of Health Products and Technologies

55. Healthcare facilities in the two counties lack essential equipment as demonstrated by critical shortage of incubators in newborn units, ICU/HDU beds and equipment, functional dialysis machines and outdated and absence of laboratory items. 2. 56.BothNyahururu and Nanyuki Teaching andReferral Hospitalslack operational ICU beds and the equipment necessary for critical care. As a result, the hospitals areunable to provideintensivecare services for severelyill patients,often requiring risky and delayed referrals elsewhere. Dialysis capacity is limited; Nyahururu has 10 dialysis beds/machines, which are insufficient for the high demand, given the hospital's role as a regional referral facility. Furthermore, the Laboratories face a recurrent shortage of reagents and lack adequate, up-to-date diagnostic equipment, hindering their capacity to conduct essential tests. At the time of the oversight, the laboratory license at Nyahururu had expired. 57. The hospitals in Laikipia County have significant stockpiles of expired drugs, citing poor pharmaceutical waste management and oversight. Some of these drugs were found to be stored unsafely, raising the risk of accidental dispensing. Further, Nanyuki's facility is littered with non-functional and outdated medical equipment, especially outside the theatre, highlighting severe gaps in medical equipment management and disposal. 58. Facility morgues are significantly overstretched. For example, Nyahururu morgue, designed to accommodate 18 bodies, has held as many as 61, while Nanyuki morguehad 62bodies against acapacity of only12 during the oversightvisits. The mortuary in Meru Teaching and Referral Hospital is designed for 60 bodies

but has held about 200, amplifying risks and reflecting chronic under-capacity in storage and handling of remains.

59. Healthcare facilities in the two counties lack basic diagnostic and lifesaving equipment. Facilities like Timau and Kibirichia are critically underequipped. For instance, Timau's x-ray is non-functional, the new wing meant for radiology lacks equipment, and the maternity ward has neither a newborn unit nor a dedicated theatre.Major units, including the renal unit at the Meru Teaching and Referral Hospital, often operate with only a fraction of their machines for instance five out of ten dialysis machines,due to chronic shortages of consumables and reagents. Kibirichia and Timau facilities in Meru County have many old, obsolete, or broken-down machines. 60. All visited Meru facilities report frequent shortages of essential supplies, including basic medications, dressings, and laboratory reagents, regularly forcing patients to procure these items from private pharmacies. The absence of digital inventory and supply chain management systems in both counties has led in frequent discrepanciesbetweenrecords and actual stocklevels,therebyimpending efficient restocking and contributing to losses and wastage.Moreover, much of the advanced equipment supplied under the now-defunct Managed Equipment Services (MES) program remains idle owing to insufficient maintenance capacity, unavailability of spare parts, and lack of necessary consumables following the expirationofthecontracts. 61. The accumulation of expired drugs was a common occurrence in the two counties, frequently stored in unlocked or inappropriate locations, with minimal evidence of structured pharmaceutical waste management protocols.Dysfunctional incinerators and lack of proper equipment have exacerbated the risks of hazardous waste exposurefor staff, patients,and surrounding communities.

CHAPTERFOUR

4.COMMITTEERECOMMENDATIONS

62. With the foregoing, the Committee makes the following recommendations-

4.1.The Pharmacy and Poisons Board (PPB)

The Committee recommends that the Pharmacy and Poisons Board should -

• a)Establish and enforce robust protocols for pharmaceutical waste management and proper disposal of expired drugs;
• b)Undertake regular audits and supervision of drug stores in all healthcare facilities, ensuring expired drugs are promptly withdrawn and securely locked and safely destroyed and table its audit reports to the Senate after every six (6) months;
• Develop and implement digital inventory management systems across all facilities to ensure traceability, minimize stock discrepancies and improve restocking efficiency;
• d) Enforces stricter renewal timelines, periodic licensing reviews, and public transparency of license validity for pharmaceutical-related operations in healthcare facilities; and
• e) Partner with county governments to design and enforce professional development programs for pharmacists and pharmaceutical technologists.

4.2.TheCouncilof Governors-

63.The Committeerecommends that the Council of Governorsshould-

• a) Direct that all county governments expeditiously operationalize the Facilities Improvement Financing Act, 2023 including the rapid enactment of supporting legislationasrequiredbySection29of theAct,toenableretentionand transparentuseoffacility-generatedrevenuesforinfrastructureandservice upgrades;

2. b)Direct each county to initiate individual procurement and maintenance plans for essential health equipment, including filling gaps left by the defunct Managed Equipment Services (MES) Program, to prevent lapses in service delivery and avoid reliance on obsolete technology; 3. Ensure establishment of coordinated county frameworks for strengthening pharmaceutical and non-pharmaceutical supply chains, including; automating inventory management systems, instituting robust pharmaceutical waste disposal and expired drug management protocols and diversifying suppliers beyond KEMSA to mitigate frequent shortages and stockouts;

• d)Makeitmandatoryforcountiestocommitabalancedportionof annualhealth budgets for capital development and preventive maintenance of healthcare infrastructure, addressing overcrowding, safety hazards and completion of stalled projects in all public facilities; and
• Ensure deploymentof certified pharmacy staff in rural and sub-county facilities, reducing inappropriate task-shifting and improving supervision standards.

4.3. Governor, Laikipia County

64. The Committee recommends that the Governor, Laikipia County should-

• a) Increase health sector allocation to balance recurrent and development expenditures, and fast-track the establishment of the proposed medical training institute to strengthen Human Resources for Health (HRH);

2. b Explore sustainable financing mechanisms such as Facilities Improvement Fund (FIF)legislationtor ringfence facility-generated 1revenuesfor infrastructure, staff recruitment, and essential medical supplies; 3. Convert healthcare workers under short-term contracts into permanent and pensionable terms, invest in continuous professional development to build specialist capacity in critical areas such as critical care, pharmacy, and laboratory sciences, and ensure timely payment of salaries and statutory remittances to improve motivation, retention, and staff morale. 4. (p Upgrade Nyahururu County Referral Hospital and Nanyuki Teaching and Referral Hospital by expanding maternity, outpatient, and newborn units, operationalizing the ICU, and completing stalled projects such as the mortuaries and incinerators. 5. Digitize inventory management and implement fully digital systems for trackingdrugs and commodities across allfacilities to eliminate discrepancies between physical stock and records. 6. Establish strict pharmaceutical waste management protocols, including safe storage and disposal of expired drugs, while negotiating with KEMSA and diversifying suppliers to ensure a consistent supply of essential medicines.

4.4. Governor, Meru County

65. The Committee recommends that the Governor, Meru County should- 2. a)Expand specialized services by upgrading the oncology center including radiotherapy and pediatric oncology, ensuring functional dialysis machines, and strengthening the mental health unit through recruitment of psychiatric specialists, counsellors, and support staff;

• b) Digitize and integrate drug and commodity inventory systems across all facilities, institute proper pharmaceutical waste management including safe disposal of expired drugs and strengthen supply chain oversight to prevent stockouts while ensuring consistent availability of critical supplies such as dialysis consumables, oncology reagents, and ICU essentials;

4. C Provide resources to rehabilitation of dilapidated hospitals, complete and operationalize stalled hospital projects such as mortuaries, radiology, maternity, specialized care wings, replace unsafe asbestos roofing, rehabilitate condemned structures, and establish preventive maintenance schedules for both infrastructure and medical equipment; 5. S(P Strengthen county health financing by enacting legislation for the Facilities Improvement Fund (FIF) to retain facility-generated revenue, allocate dedicated funds to complete stalled projects such as mortuaries, maternity units and incinerators, and engage Social Health Authority (SHA) to address delays in SHIF reimbursements to prevent liquidity crises. 6. e)Recruitadditionalhealthcareworkersandspecialistsandensureequitable distribution across sub-counties, and boost staff motivation through prompt payment of salaries, statutory deductions, and incentives for rural postings. 66. The Committee, further, recommends that the Cabinet Secretary, Ministry of Health, Council of Governors, the Governor Laikipia County Government and the Governor,Meru County Government shouldprovide animplementation status to the aforementioned recommendations within sixty (60) days from the date of adoption of this report by the Senate.

Annex 1:

Minutes of the Committee sittings

MEMBERSPRESENT

13THPARLIAMENT I4THSESSION

MINUTES OF THE FORTY EIGHTH(48TH)SITTING OF THE STANDING 11.00AMINCOMMITTEEROOM3,BUNGETOWER

1. Sen. Jackson K. Arap Mandago, EGH, MP 3. Sen. Justice (Rtd) Stewart Madzayo, EGH, MP 3. 2.Sen. Mariam Sheikh Omar, MP 4. Sen. David Wakoli, MP 5. Sen. Richard Onyonka, MP

ABSENTWITHAPOLOGY

1. Sen. Ledama Olekina, MP 2. 3.S Sen. Joseph Githuku Kamau, MP 3. 2.Sen. Tabitha Mutinda, MP 4. 4.Sen.Hamida Kibwana, MP

SENATESECRETARIAT

1. Mr. David Ngamate 3. Mr. David Munene 2. Ms. Lilian Onyari 4. Mr. Ian Otieno 5. 5.Mr. Ibrahim Odindo

MIN/SEN/SCH/248/2025

• Chairperson
• -Member
• Vice-Chairperson
• Member
• Member
• Member
• Member
• -Member
• Member
• Clerk Assistant
• Research Officer
• Fiscal Analyst
• Audio Assistant
• Serjeant at Arms

PRELIMINARIES

The meeting was called to order at twenty-eight minutes past eleven o'clock and the proceedings commenced with a word of prayer and brief introductions of those present.

MIN/SEN/SCH/249/2025

The agenda of the meeting was adopted with amendments after being proposed by Sen. Mariam Sheikh Omar, MP, and seconded by Sen. David Wakoli, as listed below-

1. Preliminaries;

• a) Prayer

3. b)Introductions 4. Adoption of theAgenda; 2. 5. Confirmation of Minutes of the Previous Committee Meetings3.

• a) Minutes of the 30th & 31st Committee Sittings held on Wednesday, 18th June, 2025;

7. and b) Minutes of the 32nd and 33rd Committee Sitting held on Thursday, 19th June, 2025; 4. Matters arising from the Minutes of the Previous Meeting; Consideration and adoption of the Committee Report on the County oversight 5. visits to Laikipia and Meru Counties (Committee Paper No. 144); 6. Any other Business; and 11. Adjournment/Date of the Next Meeting. 7.

MIN/SEN/SCH/250/2025

CONFIRMATIONOFTHEMINUTESOF THEPREVIOUSCOMMITTEESITTINGS

• . The Confirmation of the Minutes of the previous Committee meetings was deferred following reorganization of the agenda.

1. The Committee Secretariat presented the Committee Report on the County Oversight and Networking visits to Laikipia and Meru Counties which was conducted between Tuesday, 17th June, 2025 and Friday, 20th June, 2025 for consideration and adoption; 2. The Committee noted that in all the counties visited there was a recurrent and widespread presence of expired drugs across various points in the healthcare system. These included medical facilities where patients are treated, pharmacies where drugs are dispensed, hospital and county medical stores that manage bulk supplies, and even ambulances that are expected to provide emergency care. 3. During deliberations, the Committee observed that inclusion of the photos had greatly enriched its report on oversight visits by providing clear visual evidence of the issues encountered on the ground. The photos not only complemented the written narratives but also offered compelling illustrations of facility conditions, equipment status, drug storage practices, and overall infrastructure;

| MIN/SEN/SCH/251/2025 | CONSIDERATIONANDADOPTIONOF THE COMMITTEE REPORT ON THE COUNTY OVERSIGHT VISITS TO COUNTIES LAIKIPIA ANDMERU | |------------------------|----------------------------------------------------------------------------------------------------------------|

ADOPTIONOFTHEAGENDA

4. The Committee observed that consideration and adoption in Plenary of its previous reports on similar oversight visits was taking inordinately long time. This delay was noted to undermine the timeliness and effectiveness of its recommendations, particularly those intended to address urgent challenges within the health sector. The Committee further noted that the prolonged timelines limited the impact and weakened the accountability framework envisaged in parliamentary oversight; and 5. Following its consideration, the Report on the County Oversight and Networking Visits to Laikipia and Meru Counties was adopted unanimously after being proposed by Sen. Justice (Rtd.) Stewart Madzayo, EGH, MP and seconded by Sen. Richard Onyonka, MP.

MIIN/SEN/SCH/252/2025 ANYOTHERBUSINESS

The Committee resolved to invite the Cabinet Secretary, Ministry of Health to a meeting of the Committee to address the recurrent presence of expired drugs in healthcare facilities and the delayed Social Health Insurance Fund (SHIF) reimbursements.

MIN/SEN/SCH/253/2025 ADJOURNMENT

There being no other business, the meeting ended at four minutes past one o'clock. The nextmeetingshall beheld onnotice

SIGNED

.DATE..

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

MEMBERSPRESENT

13THPARLIAMENTI4THSESSION

MINUTESOFTHETHIRTYTHIRD COMMITTEEONHEALTHHELDONTHURSDAY,19THJUNE,2025AT6.00PMIN (33RD) SITTINGOFTHESTANDING THEGOVERNOR'SBOARDROOM,MERUCOUNTY

• 1.Sen Mariam Omar, MP

ABSENTWITHAPOLOGY

2. Sen. Richard Onyonka, MP

• Vice Chairperson

3. Sen. Joseph Githuku Kamau, MP

• -Member

4. Sen.Hamida Kibwana, MP

• -Member

• 5.Sen. Tabitha Mutinda, MP

• -Member

1. Sen. Jackson K.Arap Mandago, EGH, MP 4. Sen. David Wakoli, MP 2. Sen. Justice (Rtd.) Stewart Madzayo, EGH MP 4. 3.Sen. Ledama Olekina, MP

SENATESECRETARIAT

2. Mr. David Ngamate 1. Mr. Humphrey Ringera 3. Mr. Gilbert Juma 4. 5.Ms. Juliet Masinde 4. Mr. Ryan Injendi 6. Mr. Ian Otieno

IN ATTENDANCE

7. Mr. Ibrahim Odindo

• Member

• Chairperson

• -Member
• -Member
• -Member
• Senior Research Officer
• Legal Counsel
• Clerk Assistant
• Research Officer
• Audio Assistant
• -Media Relations Officer
• Serjeant-At-Arms

• 1.Hon. (Rev) Isaac Mutuma M'Ethingia

2. Hon. Lindah Kiome

• Governor

3. Mr. Darius Maranya

• The Deputy Governor

4. Dr. Dennis Mugambi

• Ag. County Secretary

• County Executive Committee Member Health Department

5. Dr. Wahome Mukundi

• Chief Officer,Health Services

MERUCOUNTYEXECUTIVE

• 6.Dr. Bernard Murithi

7. Dr. Nicholas Kimaita 8. Dr. Evelyn Kawira Majau 9. Ms. Rosaline Gakii

MIN/SEN/SCH/171/2025

• 1) The Committee held a meeting with the Governor, Meru County and informed him that during the oversight visit, it made thefollowing observations amongst others that would be contained in the Committeereport on theoversightvisit.These arethat-
• b. There were notable challenges with record keeping in all the healthcare facilities visited by the Committee. Manual and paper records were widely used causing inefficiencies in information retrieval, data quality and hampered concurrent data access;
• a. The Meru Teaching and Referral Hospital had congested maternity wards and there was some evidence of insufficient number of maternity beds and baby cots at the wards. Further, the staff both healthcare and support staff, demonstrated some aspects of complacency characterized by signs of disinterest, lack of motivation and general disengagement especially at the hospital pharmacy.
• c. In all the healthcare facilities visited, record keeping and control procedures in pharmaceutical supply management were suboptimal, relied on manual, paper-based inventoryinsteadof digital and electronictracking.The Committeeobserved that thismost likely to create inefficiencies in tracking drugs, increased the risks of loss and misplacement and slowed down audits;
• e. The seating areas in healthcare in all the facilities visited are not convenient and do not adequately support patient, visitors and staff needs in terms of comfort, accessibility or function. The Committee observed that there was no enough seating in the healthcare facilities leading to standing crowds and congestion;
• d. At Timau Sub-County Hospital, furniture there was excess was strewn all over the facility and there appeared to have been procurement of more than needed furniture at the facility with excess furniture poorly placed on the corridors and disused rooms at the facility. The Committee observed that this signaled poor prioritization and institutional oversight;
• Chief Executive Officer Meru Teaching and Referral Hospital - Administrator, Timau Sub-County Hospital

8. -Medical Superintendent -Assistant Director Communication

PRELIMINARIES

MIN/SEN/SCH/170/2025 The meeting was called to order at Six o'clock and proceedings commenced with a word of prayer

followed by introductions from those present.

MEETINGWITHTHEGOVERNOR,MERU COUNTYGOVERNMENT.

• f.The Committeehadobserved thathealthcarefacilitiesfacedchallenges ofimproperdisposal of expired drugs, such as dumping them in unlocked and disused rooms. The Committee observed that this was a serious breach of both patient safety standards and regulatory requirements for hospital pharmacy management.
• 2)TheGovernorinformedtheCommitteethat-
• a.Meru Countyhad beenfacingtransition challenges and that thecurrentgovernor was streamlining the County health facilities to improve on service delivery of medical service;
• 1.That the above factor overstretched the services especially the mental health wing as this served patients from counties as far as Embu, Mandera, Isiolo and Marsabit Counties

2. That the county faced unprecedented cases of cancer, mainly esophagus cancer that was linked to the miraa chewing; 4. The County was facing challenges in the handling of employees under the Global Fund for health due to the recurring industrial strikes. 3. That in an attempt to avoid detaining patients without Social Health Authority membership, the county was piloting an initiative of using own funds to register the affected patients to avoid detaining them after treatment.The Governor assured the Committee ofhispersonal interventionfor the release of thepatientdetained in thematernityward; 5. That the national Management Equipment Services posed a huge challenge to the county. That the supplied dialysis machines lay idle and the county was forced to buy new dialysismachines 6. The County had greatly invested in uplifting ofthe health care services across all the wards in the entireMeru County;and

MIN/SEN/SCH/172/2025 ADJOURNMENT/ANYOTHERBUSINESS

There being no other business, the meeting was adjourned at eight o' clock. The next meeting would beheld onnotice.

SIGNED

....DATE...

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

13THPARLIAMENT I4THSESSION

MINUTESOF THETHIRTY SECOND(32D)SITTINGOF THESTANDING COMMITTEE ON HEALTHHELD ON THURSDAY, 19TH JUNE,2025AT 11.00 AMINHEALTHFACILITIESINMERUCOUNTY

MEMBERSPRESENT

1. Sen Mariam Omar, MP

• -Vice Chairperson

2. Sen. Richard Onyonka, MP

• -Member

3. Sen. Joseph Githuku Kamau, MP

• Member

• 4.S Sen. Hamida Kibwana, MP

• Member

• 5.Sen. Tabitha Mutinda, MP

• -Member

ABSENTWITHAPOLOGY

1. Sen. Jackson K. Arap Mandago, EGH, MP 3. Sen. Ledama Olekina, MP 3. 2.S Sen.Justice(Rtd.)StewartMadzayo,EGH MP 4. Sen. David Wakoli, MP

SENATESECRETARIAT

1. Mr. Humphrey Ringera 3. Mr. Gilbert Juma 2. Mr. David Ngamate 4. Mr. Ryan Injendi 5. 5.Ms. Juliet Masinde 6. Mr. Ian Otieno 7. Mr. Ibrahim Odindo

INATTENDANCE

• Chairperson
• -Member
• Member
• -Member
• Senior Research Officer
• Clerk Assistant
• Legal Counsel
• Research Officer
• Media Relations Officer
• Audio Assistant
• Serjeant-At-Arms

MERUCOUNTYEXECUTIVE

| 1. Dr. Dennis Mugambi | - County Executive Committee Member DepartmentofHealthServices | |--------------------------|------------------------------------------------------------------| | 2. Dr. Joseph W. Mukundi | - Chief Officer, Department of Health Services | | 3.Dr. Bernard Murithi | - Chief Executive officer Meru Teaching and Referral Hospital | | 4. Dr. Nicholas Kimaita | - Administrator Timau Sub-County Hospital |

• 5.Dr.Evelyn Kawira Majau

6. Ms. Rosaline Gakii

MIN/SEN/SCH/166/2025

• -Medical Superintendent
• -AssistantDirector Communications

PRELIMINARIES

The Committee commenced the tour of the Meru County healthcare facilities at eleven o'clock by visiting Timau Sub-County Hospital, Kibirichia Sub-County Hospital and thereafter proceeded to theMeru Teaching and Referral Hospital.

MIN/SEN/SCH/167/2025

OVERSIGHTVISIT TOTIMAUSUBCOUNTY HOSPITAL

1. The Committee conducted an oversight visit to the Timau Sub-County Hospital on Thursday 19th June, 2025 and was accompanied by Dr. Nicholas Kimaita, the Hospital administrator and a host of other healthcare personnel at the facility; 2. The Committee was informed that the Timau Sub-County Hospital is located in Buuri Sub-County, off Meru-Nanyuki Highway. The Facility was established to fill a critical gap in healthcare provision in a region that previously depended on distant hospitals in Nanyuki and Meru Town; 3. The Hospital is managed by Meru County Government and is classified as a Level 4 facility. It offers a wide range of services such as outpatient, comprehensive care centre, maternity and child health, pharmacy and laboratory services, antenatal and post-natal care, family planning and immunization, curative and minor surgical outpatient care; 4. During the visit, the Committee made the following observations-

• a. There is a chronic shortage of medical personnel and support staff at the facility. The Committee was informed that there are only two (2) pharmacists,eight (8) clinical officers, and thirteen (13) nurses for the whole hospital, which is insufficient for the patient load and service requirements. The hospital lacks key specialists and experienced healthcare personnel leading to frequent referrals;
• b. The hospital has inadequate healthcare infrastructure and facilities; there is limited in-patient section and the maternity ward was deserted probably due to poor infrastructure, lack of adequate care, insufficient staff and obsolete equipment;
• C. The Maternity Ward did not have a functioning new born unit and a theatre dedicated for maternity related operations. Critical facilities like the x-ray services, which are important for obstetric care were non-functional and the xray room had not been purposed properly for such functions. At the time of the Committee visit it was reported that only one delivery per day was taking place;

• d.Severe shortage of professional medical attention during labour and delivery basic maternity supplies. This neglect was also observed in the bathrooms where therewere broken cisterns;
• e. Thewaslargetrackofhospitalland thatwasunderwheatandcowpeas and it wasnotclear if theland hadbeenleased toprivate entities orit was thefacility thathad decided to cultivate on its idle land;
• f.There was an incomplete and/or stalled mortuary which was nearing completion and whose construction had begun during the previous county government The Committee observed that tenders and procurement records from the County Government of Meru reference planned or ongoing works for the mortuary an indicator and confirmation of its existence and ongoing incomplete status;
• g. The incinerator at the facility was missing a door, a critical component for safe and efficient operation. There was no fencing around its compound which exposed the structure to unauthorized access and posed significant health and safety risks;
• h. There was one building within the hospital compound that had been condemned due to safety concerns and structural instability;
• i. There were some expired drug stockpiles disposed at the condemned and abandoned buildings within the hospital. There was no dedicated secure and compliantstoragespaceforexpiredmedicationandtheCommitteewas informed that the facility had notified the Department of Health to come and pick them for quite some time;
• j. The health records were maintained on paper exposing them to vulnerability of loss and making it difficult to quickly retrieve patient information, manage appointments and/or track clinical outcomes effectively. The Committee observed gaps in accuracy and completeness of records at the pharmacy and there were no bin cards for some medication;
• The hospital had constructed a 'new wing' ostensibly to host radiology, eyecare and other specialized department.However,the Committee observed that the x-ray room did not have essential equipment and capability. Indeed, there wasaflashdoorinsteadoftherecommendedlayerofleadsheetingtoshield staff, patients and public from ionizing radiation leaks;

1. The hospital roofing was predominantly made of banned asbestos which is a violation of occupational and community safety

MIN/SEN/SCH/168/2025

OVERSIGHTVISIT TOKIBIRICIA SUBCOUNTY HOSPITAL

5. The Committee conducted an oversight visit to Kibirichia Sub-County Hospital on Thursday, 19th June, 2025 and was taken through different departments to acquaint itself with the service provision at the facility. 2. 6.During the oversight visit the Committee observed that- 3. a.The facility faces challenges related to the management of drug issuance and pharmacy records, several records including a record of expired drugs and controlled substances contained discrepancies. There were even expired drugs at the facility's ambulance;

• b. The hospital required a massive infrastructural development; there was no functional mortuary, no staff houses and there were no specialized units such as the theatres and laundry units and many existing medical equipment were old, obsolete and appeared expensive to maintain;
• C. The facility faces severe staffing shortages which was likely causing burnouts to the existing human resources for health due to overworking and poor working conditions of the existing staff;
• d. The hospital faced shortage of medical supplies and there were reports of frequent stockouts of essential drugs, dressings and lab reagents. Some patients reported that they were forced to buy medications from private pharmacies;

7. There was only one functional ambulance at the facility. However, the e. Committee observed that it had held expired drugs;

• f. The hospital had insufficient medical equipment and technologies required for a level-four facility; there were no essential machines for basic tests and laboratory equipment were outdated, obsolete and non-functional;

9. The waiting bays at the facility were not properly furnished and lacked adequate g. seating areas for patients and visitors which was likely to affect patients' comfort.

MIN/SEN/SCH/169/2025

OVERSIGHT VISIT TO MERU TEACHINGANDREFERRALHOSPITAL

• 7.The Committee conducted an oversight visit to the Meru Teaching and Referral Hospital on Thursday, 19th June, 2025 and was received by Dr. Bernard Murithi, the Chief Executive Officer and a host of other senior medical personnel at the facility. The Committee was accompanied by Dr. Dennis Mugambi, the County Executive CommitteeMember in charge of Health Department.

8. The Committee was informed that the Meru Teaching and Referral Hospital is a major public healthcare facility in Meru County which also acts as a regional referral facility for neighboring counties and covers a population of about 1.4 million people. It is recognized for its role in specialized, innovative and affordable healthcare provision.

9. The hospital offers routine and specialized care in departments such as outpatient, inpatient, accident and emergency, maternity, pediatric, medical laboratory, dental, pharmacy, rehabilitative, imaging, surgical, orthopedic and psychiatric care. The hospital further provides specialized clinics such as oncology, chemotherapy, dialysis, maxillofacial surgery, neurology, dermatology, urology, ICU/HDU and renal unit. 10. During the oversight tour, the Committee made the following observations- 3. a.The facility had a well-established and comprehensive mental health unit which treatsawiderangeofmentalhealthconditions andservespatientsfromother neighboring and asfar asMandera andMarsabit Counties.Theunitprovides

• b. The mental health unit is a teaching hospital, training students in health fields and its staff includes psychiatric nurses, counsellor, clinical psychologist, social workers and occupational therapists. However, the unit faced issues such as staff shortage, drug stock-outs and infrastructure limitation;
• C. The High Dependency Unit (HDU) which is part of the Intensive Care Unit (ICU) is well equipped with modern, state-of-the-art medical equipment and specialized machines. However, the unit often faces high demand and patient overload which strains available resources and staff capacity;

6. d.The Committee observed that when the contract ended for the equipment donated through the Managed Equipment Services (MES) the unit is unable to service some of its equipment. During the visit, the Committee was informed that at least six (6) ICU/HDU equipment were out of service or unmaintained. The Committeewasfurtherinformed that therewerenointensivists at theunit since the departure of the Cuban doctors;

• e. The maternity wards were congested and some patients were sharing beds and others had to wait to receive a bed after delivery as a result of pressure from referral and continuoushighpatientvolumes;
• f. The renal unit is equipped with modern and advanced machines. However, the unit had only five (5) working hemodialysis machines although in total there were ten (1o) machines at the unit. The Committee was informed that the newer machines were not working for lack of consumables and reagents and plans were underway to procure two (2) more dialysis machines;

9. The cancer treatment center located within the hospital was only able to offer g. minimal services such as administration of chemotherapy. Patients requiring facilities such as the Kenyatta National Hospital (KNH) and the Kenyatta University Teaching Research and Referral Hospital (KUTRRH);

• h. The hospital experiences challenges in SHIF reimbursements which puts tremendous pressure on the hospital whose annual wage bill is estimated at Kshs. 224 million. It was further observed that the facility procures its own pharmaceutical and non-pharmaceutical supplies mainly from the resources raised through Facility Improvement Financing (FIF);

2. The facility faces challenges related to the management of drug issuance and pharmacy records, several records including a record of expired drugs and controlled substances contained discrepancies the pharmacies and drug stores; 3. Committee was informed that there were about two hundred (200) bodies held at the mortuary during the visit. The healthcare personnel reported that the backlog was caused by uncollected and unclaimed bodies.

MIN/SEN/SCH/170/2025 ADJOURNMENT/ANYOTHERBUSINESS

There being no other business, the tour ended at five o' clock in the evening. The next meeting shall be by notice.

LS

69

SIGNED.

.DATE..

SEN.JACKSONK.ARAPMANDAGO,EGH,'MP (CHAIRPERSON, COMMITTEE ON HEALTH)

13THPARLIAMENTI4THSESSION

MINUTES OF THE THIRTY FIRST (31SI)SITTING OF THE STANDING COMMITTEEONHEALTHHELDONWEDNESDAY,18THJUNE,2025AT4:00 P.M.ATTHEOFFICEOFTHEGOVERNOR,LAIKIPIACOUNTY

MEMBERSPRESENT

2. Sen. Richard Onyonka, MP

• -Vice Chairperson

3. Sen. Joseph Githuku Kamau, MP

• -Member

• Member

• 4.S Sen.Hamida Kibwana,MP

• Member

• 5.Sen. Tabitha Mutinda, MP

1. Sen Mariam Omar, MP

ABSENTWITHAPOLOGY

• Member

1. Sen. Jackson K. Arap Mandago, EGH, MP

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

• Chairperson

• 3.Sen.Ledama Olekina, MP

-Member

• 4.Sen. David Wakoli, MP

• -Member

SENATESECRETARIAT

2. Mr. David Ngamate 1. Mr. Humphrey Ringera 3. Mr. Gilbert Juma 4. 5.Ms. Juliet Masinde 4. Mr. Ryan Injendi 6. Mr. Ian Otieno 7. Mr. Ibrahim Odindo

INATTENDANCE

• Member
• Senior Research Officer
• Legal Counsel
• Clerk Assistant
• Research Officer
• Audio Assistant
• -Media Relations Officer
• Serjeant-At-Arms

LAIKIPIACOUNTYEXECUTIVE

1. Hon. Joshua Irungu, EGH

-'- Governor

• 2.Hon.Rueben Kamuri

• Deputy Governor

3. Mr.Albert Taiti

• County Executive Committee Member (CECM)

Health Services

4. Ms. Purity Kendi Gitonga

• County Executive Committee Member (CECM)

County Administration, Coordination & Public Service

5. Mr. Samwel Wachira

• County Executive Committee Member(CECM)

6. Ms. Leah Njeri 7. Mr., Koinange Wahome 8. Mr. Timothy K. Panga

MIN/SEN/SCH/164/2025

The meeting was called to order at four o'clock and the proceedings commenced with a word of prayer followed by a round of introductions from those present.

MIN/SEN/SCH/165/2025

MEETINGWITH THE GOVERNOR, LAIKIPIACOUNTYGOVERNMENT

1. The Committee held a de-briefing meeting with the Governor, Laikipia County to present its preliminary report and informed the Governor that during the oversight visit to the healthcare facilities in the County, the following observations had been made- 2. The Nyahururu Referral Hospital appeared to be extremely congested in virtually a all the departments and units visited by the Committee such as the outpatient, laboratory, pharmacy and maternity wards; 3. b congested possiblydue to insufficient consultation rooms at the outpatient department and because of many detained patients at the maternity wards; 4. C Nyahururu County Referral Hospital experiences a significant shortage of incubators for pre-term babies. This shortage has led to overcrowding and improvisation of solutions or sharing of incubators; 5. (p 'The hospital keeps-and-relies heavily and solely on physical and manual records efficient retrieval of medical records difficult; 6. There is no elaborate and comprehensive record system at the pharmacy and the unit relies on manual record keeping resulting in difficulties in tracking medication, 7. f There was presence and accumulation of expired and unused medical stocks piled up at the main pharmacy without clear process of disposal. The Committee observed that this increased the risk of accidental dispensing and jeopardized patient safety; 8. The Nyahururu Referral Hospital did not have a functional incinerator and medical g waste especially infectious and hazardous materialshad piled and accumulated exposing staff, patients and members of the public;

Finance and County Planning Development

• County Executive Committee Member (CECM)
• Water,EnvironmentandNaturalResources
• The County Secretary
• County Chief Officer of Health

PRELIMINARIES

• h) There were complaints from the patients during the visit that they had been advised privately-owned pharmacies because they were lacking at the Nyahururu Referral Hospital;

2. i Nyahururu CountyReferral Hospital hasexperienced notable challenges in the maintenance of its physical facilities, which has directly impacted the hospital environment and patient care. These include, broken and missing floor tiles, leaking roofs and falling ceilings, and broken hospital beds; 3. j) The laboratory at Nyahururu Referral Hospital holds an expired operating license from the Kenya Medical Laboratory Technicians and Technologist Board (KMLTTB) which was observed to be a serious regulatory violation;

• k) Nanyuki Referral Hospital was equally congested with a high influx of patients witnessed which was attributed to the high-quality maternity services, specialized and comprehensive care and referral patterns;

5. D Nanyuki Referral Hospital faces challenges with limited patient waiting areas, particularly in the outpatient department and significant overcrowding was witnessed with groups of patients and their relatives found cramped up; 6. m)Despite significant investments in infrastructure at Nanyuki Referral Hospital, including modern maternity wing designed to decongest the previous maternity facilities, the hospital experiences severe overcrowding and congestion at the maternity wards with several women found sharing beds;

• n) Nanyuki Referral Hospital faces significant shortage of ICU beds relative to probable demand.

2. The Governor informed the Committee that-

• Laikipia County borders the counties of Nyeri, Samburu, Nakuru, Isiolo, Meru and Nyandarua whose residents relied heavily on the Laikipia healthcare facilities hence straining the availableresourcesand overstretchingthe availablehumanresources for health;
• b) Laikipia County has been affected by persistent drug supply challenges from the Kenya Medical Supplies Authority (KEMSA), experiencing order fill rates that typically range between 50% and 70%;
• The County had mooted an idea of establishing its own medical training institute to train healthcare personnel and build capacities of the existing Human Resources for Health;
• d The County Government had taken major steps to invest in its healthcarepersonnel with a strong emphasis on converting staff on fixed-term contracts especially those under the Universal Health Coverage (UHC) scheme;

• The County Government is actively upgrading its healthcare facility infrastructure and broader service delivery capacities and had procured a new laundry machine for hospital use.

MIN/SEN/SCH/166/2025 ADJOURNMENT/ANY OTHERBUSINESS

There being no other business, the meeting ended at seven o'clock.

CSS

SIGNED....

.DATE.

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

13THPARLIAMENTI4THSESSION

MINUTES OF THE THIRTIETH (3OTH)SITTING OF THE STANDING COMMITTEEONHEALTHHELDONWEDNESDAY,18THJUNE,2025AT11.00 PMATNYAHURURUTEACHING ANDREFERALHOSPITAL,LAIKIPIA COUNTY

MEMBERSPRESENT

1. Sen Mariam Omar, MP

• -Vice Chairperson

2. Sen. Richard Onyonka, MP

• Member

• 3.S Sen. Joseph Githuku Kamau, MP

• Member

• 4.S Sen. Hamida Kibwana, MP

• Member

5. Sen. Tabitha Mutinda, MP

• Member

ABSENTWITHAPOLOGY

1. Sen. Jackson K. Arap Mandago, EGH, MP 2. Sen. Justice (Rtd.) Stewart Madzayo, EGH MP 3. 3. 4. Sen.Ledama Olekina,MP 4. Sen. David Wakoli, MP

SENATESECRETARIAT

1. Mr. Humphrey Ringera 2. Mr. David Ngamate 3. Mr. Gilbert Juma 4. Mr. Ryan Injendi 5. 5.Ms.Juliet Masinde 6. Mr. Ian Otieno 7. Mr. Ibrahim Odindo

INATTENDANDANCE

• Chairperson

• -Member
• -Member
• Member
• -Senior Research Officer
• Clerk Assistant
• Legal Counsel
• Research Officer
• -Media Relations Officer
• Audio Assistant
• Serjeant-At-Arms

LAIKIPIACOUNTYEXECUTIVE

• 1.Mr.Albert Taiti

• County Executive CommitteeMember(CECM) Department of Health

2. Mr. Timothy K. Panga

• Chief Officer, Department of Health

3. Dr. Waihenya Mwangi

• County Director of Health

4. Dr. Lawrence N. Kamande

• Chief Executive Officer (CEO) Nyahururu Teaching and Referral Hospital

MIN/SEN/SCH/160/2025

PRELIMINARIES

The Committee commenced the tour ofLaikipia County Healthcarefacilities at ten o'clock with a courtesy call at the Office of the Governor, Laikipia County in Nyahururu Town. Thereafter,the Committeeproceeded to undertake oversightvisits atNyahururu County Referral Hospital in Nyahururu Town and Nanyuki Teaching and Referral Hospital in Nanyuki.

MIN/SEN/SCH/161/2025

OVERSIGHTVISITTONYAHURURU COUNTY REFERRAL HOSPITAL, NYAHURURUTOWN

• 1.The Committeeconducted an oversightvisit at the Nyahururu Referral Hospital on Wednesday, 18th June, 2025 and was accompanied by Mr. Albert Taiti, the County Executive Committee Member (CECM) in charge of the Health Department, Dr. Timothy Panga, the Chief Officer, Department of Health and Dr. Lawrence N. Kamande the Chief Executive Officer, Nyahururu Teaching and Referral Hospital;
• The Committee was taken through a presentation on the operations of the facility including service coverage and was informed that the facility has an emergency department that functions round the clock, operating rooms, a functional pharmacy and a laboratory. Further, the Hospital has been able to significantly reduce waiting times for patients.

3. The Committee was informed that the facility serves patients from the neighboring counties following its proximity to Nyandarua, Nakuru, Samburu and Nyeri counties. It has a bed capacity of two hundred and forty-four (244) beds including fifty-four (54) maternity. Additionally, the New Born Unit held a total of twenty -six (26) beds and twenty-nine (29) cots. The hospital has ten (10) dialysis) beds/machines; while its mortuary has a capacity of eighteen (18) bodies. However, during the visit the Committee was informed that there were sixty-one (6l) bodies preserved at the mortuary overstretching its storage capacity;

• 4.During the tour of the facility, the Committee observed that-
• (1)The maternity and out patient departments are extremely overcrowded and there wereinsufficient consultation rooms at the out-patient departmentwhich could havecontributed toslowpace and hugepile up of patients;
• 2 The maternity wards were filled beyond capacity with some mothers sharing single beds which is likely to increase the risk of infections and lead to increased physical and mental discomfort;
• (3) The Hospital faces significant challenges regarding proper drugs records management in its pharmacy. There were inconsistencies between physical stock and recorded inventory as well as inadequate or incomplete documentation of drug stock;

• (4) There were expired drugs stockpiled at the facilities' main pharmacy with no clear indication of pharmaceutical waste management protocols. Nevertheless, there were patients who informed the Committee that they had been advised to purchase essential drugs such as painkillers and supplements from the private pharmacies in town;

2. 5 There were challenges related to poor infrastructural maintenance including missing window panes, broken tiles, falling ceiling in the wards and broken beds which affected patient comfort, infection control and overall quality of care at the facility;

• (6) While the Laboratory hold necessary certification and license from the Kenya Medical Laboratory Technicians and Technologists Board, the Committee observed that the license had expired;

4. 7 The Hospital Laboratory faces persistent and significant challenges in providing full range of diagnostic tests, primarily due to a lack of adequate equipment and recurrent shortage of reagents;

• (8) The Hospital incinerator was dysfunctional leading to the accumulation of piled medical and biohazard wastes at the facility. This poses serious health and environmental risks and could expose patients, staff and the community to infections;
• (9) The new born unit faces a shortage of incubators, a critical piece of equipment to care for premature and low birth weight infants. The Committee observed that some mothers have resorted to improvising makeshift incubators using old

7. cartons; (10) The hospital does not currently have an operational Intensive Care Unit (ICU) bed for patient care and the Hospital does not have capacity to offer critical care for severely ill;

• (11) The hospitals' counseling unit was not aware of any in-patient that were undergoing mental challenges and were in need of the counselling services; and

9. wards especially in the maternity wing for prolonged period due to inability to pay medical bills. OVERSIGHTVISITTO

MIN/SEN/SCH/162/2025

NANYUKI TEACHINGANDREFERRALHOSPITAL

1. The Committee visited the Nanyuki Teaching and Referral Hospital on Thursday 19th June, 2025 accompanied by accompanied by Mr. Albert Taiti, the County Executive Committee Member (CECM) in charge of the Health Department, Dr. Timothy Panga, the Chief Officer, Department of Health and Dr. Sammy Kilonzo, the Chief Executive Officer, Nanyuki Teaching and Referral Hospital;

• 2.The Committee was informed that Nanyuki Teaching and Referral Hospital was established in the 1930s and provides comprehensive services including general outpatient care, maternal and child health clinics, emergency services, pharmacy, laboratory, radiology and renal dialysis. The Hospital operates several specialist outpatient clinics throughout the week covering high risk antenatal care, pediatrics, gynecology, diabetes, medical and surgical clinics;
• (1) There has been some recent infrastructural development at the hospital reflecting efforts to enhance healthcare infrastructure and respond to the growing patient demands;

3. During the tour of the facility the Committee observed the following-

• (2) The Hospital serves a large catchment area with a high patient workload drawing from the neighboring counties owing to its location. It also serves as a critical referral and primary healthcare provider accommodating population that relies on its comprehensive services;
• (4) Prevalence of expired drugs and unused medical stocks at the Hospital signaling poor supply chain oversight and suggesting that some medicines either expire unused or are frequently unavailable when needed;
• (3) There was overcrowding and limited waiting areas at the Hospital leading to overcrowding of the outpatient department, the pharmacy the laboratory and inpatient wards where some patients were sharing beds;
• (5) The Hospital faces shortage of ICU bed capacity with demand outstripping availability especially considering the vast catchment area.The Committee was informed that the facility often receives critically ill patients from neighbouring counties which rapidly fills the available beds;
• (6) The Hospital faces challenges with proper drug records management at its pharmacy and relies on both manual and digital inventory leading to inconsistencies between physical drug stocks and recorded inventory making it difficult to accurately track drug movements usage, expiration and restocking needs;
• (7) The Hospital mortuary is experiencing severe overcrowding and was holding sixty-two (62) bodies during the visit despite its designed capacity being for twelve (12) bodies. The Committee was informed that families sometimes delay collecting bodies because of financial constraints and there were about sixteen (16) unclaimed bodies lying at the mortuary;
• (8) While there was a functional kitchen providing nutritious and hygienic meals, the Committee observed that all patient meals were typically uniform and there was no evidence of individualization of dietary needs to cater for
• specific health conditions and distinct nutritional requirements related to different physiological demands of the patients;
• Obsolete, non-functional and outdated medical equipment were strewn outside the theater highlighting significant challenge in medical equipment management and disposal.

ADJOURNMENT/ANYOTHERBUSINESS MIN/SEN/SCH/163/2025

There being no other business, the Hospital tour was concluded and the Committee proceeded to the meeting with the Governor.

SmM

..DATE.

SIGNED..

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