Report On The County Oversight And Networking Engagements In Kilifi County-1

REPUBLICOFKENYA

THIRTEENTHPARLIAMENT

THE SENATE

THESTANDINGCOMMITTEEONHEALTH

REPORTONTHECOUNTYOVERSIGHTANDNETWORKING ENGAGEMENTSTOKILIFICOUNTY

Clerks Chambers, Parliament Buildings, NAIROBI.

en

October,2025

(orapprolalartabip

0511225

TABLEOFCONTENTS

| LISTOFABBREVIATIONS | LISTOFABBREVIATIONS | | |---------------------------------------------------|---------------------------------------------------------|----| | PRELIMINARIES | PRELIMINARIES | | | EstablishmentandMandateoftheCommittee | EstablishmentandMandateoftheCommittee | | | Committee Membership | Committee Membership | | | CHAIRPERSON'SFOREWORD | CHAIRPERSON'SFOREWORD | | | CHAPTER ONE | CHAPTER ONE | | | Introduction | Introduction | | | 1.1. | Purpose and Objectives | | | 1.2. | Scope of the Engagements | 7 | | 1.3. | Methodology | 8 | | 1.4. | The County Profile | 8 | | CHAPTER TWO | CHAPTER TWO | 11 | | 2. COMMITTEEOBSERVATIONSANDSTAKEHOLDERSUBMISSIONS | 2. COMMITTEEOBSERVATIONSANDSTAKEHOLDERSUBMISSIONS | 11 | | 2.1. | Mtwapa Sub- County Hospital | 11 | | 2.2. | Kilifi County Referral Hospital (KCRH) | 14 | | CHAPTER THREE | CHAPTER THREE | 19 | | 3. COMMITTEEOBSERVATIONS | 3. COMMITTEEOBSERVATIONS | 19 | | 3.1. | Infrastructure and Facility Challenges | 19 | | 3.2. | Human Resource Management Issues | 19 | | 3.3. | Supply Chain andPharmaceutical Management Issues | 19 | | 3.4. | Operational Failures and Emergency Service Deficiencies | 20 | | 3.5. | Overwhelmed Facilities | 20 | | CHAPTERFOUR | CHAPTERFOUR | 21 | | 4. COMMITTEERECOMMENDATIONS | 4. COMMITTEERECOMMENDATIONS | |

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LISTOFABBREVIATIONS

A&E

Accident and Emergency

CECM

CountyExecutive CommitteeMember

KCRH

Kilifi County Referral Hospital

CHS

Community Health Service

CHP

Community Health Promoter

CPSB

County Public Service Board

CONE

County Oversight and Networking Engagements

CoG

Council of Governors

MoH

Ministry of Health

EMR

Electronic Management Records

FIF

Facilities Improvement Financing

FY

Financial Year

PMS

Personnel Management System

HMIS

Health Management Information System

HRH

Human Resource for Health

ICU

Intensive Care Unit

KEMSA

KenyaMedical SuppliesAgency

KMPDU

Kenya Medical Practitioners and Dentist Union

PPB

Pharmacy and Poisons Board

NG

National Government

SHIF

Social HealthInsuranceFund

PPE

Personal Protective Equipment

NHIF

National Health Insurance Fund

PSC

Public Service Commission

SHA

Social Health Authority

SHIF

Social Health Insurance Fund

UHC

Universal Health Coverage

OSR

Own-Source Revenue

WHO

World Health Organization

PRELIMINARIES

Establishment and Mandate of the Committee

TheStandingCommittee onHealthis establishedpursuant tostandingorder 228(3) and theFourthScheduleoftheSenateStandingOrdersand ismandatedtoconsider allmattersrelatingtomedicalservices,publichealthandsanitation.

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

• 1)investigate,inquireinto,andreportonallmattersrelatingtothemandate, management,activities,administrationandoperationsoftheMinistryof Healthanditsdepartments;
• 3)studyandreviewalllegislationreferredtoit;
• 2)study the programme and policy objectives of the Ministry of Health and its departments,and theeffectivenessoftheimplementationthereof;
• 4)study, assess and analyze the success of the Ministry of Health and departmentsassignedtoit asmeasuredbytheresultsobtainedascompared with theirstatedobjectives;
• 5 considertheBudgetPolicyStatementinlinewiththeCommittee'smandate;
• 6 Senatetoapprove;
• 7 makereportsandrecommendationstotheSenateasoftenaspossible, includingrecommendationsforproposedlegislation;
• 8 considerreportsofCommissionsandIndependentOfficessubmittedtothe Senatepursuant totheprovisionsofArticle254oftheConstitution;
• 9)examine any statements raised by Senators on a matter within its mandate; and 10)followupandreportonthestatusofimplementationofresolutionwithin its mandate;and
• 11)follow up and report on the status of commitments made by the Cabinet SecretariesintheirresponsetoquestionsunderStandingOrder51C

CommitteeMembership

The Committeeis comprised of thefollowingmembers-

1. Sen. Jackson K. 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.Sen. Richard Onyonka, MP

Member

• 7.Sen.TabithaMutinda,MP

Member

• 8.Sen.Hamida Kibwana, MP

Member

9. Sen. Joseph Githuku, MP

• Member

At its Sitting held on 22nd July,2025, the Standing Committee on Health resolved to undertake an oversight visit to Kilifi County to acquaint itself with the healthcare provision in the County as part of its ovcrsight function. This oversight visit took place on 2nd August, 2025. This report contains a rccord of this visit which was designed to provide first hand insights into the state of healthcare infrastructure, service delivery and the challenges faced by healthcare providers and the communities they serve.

The engagements involved site visits to key healthcare facilities,direct interactions with Countyleadership,healthcareworkers and members of the public.Through these interactions, the Committee gathered critical evidence on the adequacy of healthcare personnel, the status of medical equipment and supplies, the effectiveness of emergency andreferralsystems andtheimplementationofdigital healthrecords.

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 sector policies and regulations.

The Committee noted systematic failures across infrastructure, human resource management and supplychainintegritydespite someevidenceofrecentefforts towards healthcare improvement.Healthcare facilities in Kilifi County suffer from significant infrastructural deterioration, including worn out floors, walls and pathways, dilapidated kitchens and inadequate space resulting in severe overcrowding, particularly in maternity wards where mothers were compelled to share beds.

The facilities in the County face severe understaffing particularly in specialized areas likematernity andpediatrics,exacerbated bylackofsupervisionfromseniormedical professionals, high staff demoralization due to stalled promotions and poor compensation, including casual cleaning staff who were often unpaid for over two months and lacked necessary protective equipment. There were lapses in pharmaceutical management andsafety,indicated bylackofrequiredPharmacy and PoisonsBoard accreditation license,thepresence of expired drugs mixedwith current stocksinpharmacies and found in ambulances anddiscrepanciesbetweenrecorded and physical drug inventories.

This report presents a comprehensive analysis of these issues and makes actionable recommendations to the Kilifi County government and other stakeholders. These recommendationsareaimedatstrengthening g healthcare systems, enhancing accountability and ensuring that investments in healthcare translate into tangible improvementsin service delivery and health outcomes.

Acknowledgements

On bchalf of the Committec, I wish to thank Sen. Justice (Rtd.) Stewart Madzayo, EGH, MP, Senator for Kilifi County, for the warm welcome and the support extended to the Committee by his officc during the oversight visit. The input and contributions of his officc enabled the Committcc carryout its ovcrsight mandate and functions effectively during its visit.

The Committce wishcs to extend its appreciation to Hon.GideonMung'aro, OGW, Governor,Kilifi County Government and hisExecutive CommitteeMembersfor their input, submissions and evidence produced during the oversight tour. The Committee is also grateful to themembers of staff and other stakeholders in thehealthcare facilitics visited during the tour for their submissions, which have greatly enhanced the evidence analyzcd during processing of this report.

Further, the Committee extends the appreciation to the Speakers of the County AssemblyinKilifiCountyandMembersof theCountyAssemblycounterpart committees on health for their facilitation and participation.

Finally, I acknowledge and appreciate the Members of the Committee for their dedication and commitment during gathering of evidence, drafting of this report and settingout conclusions and recommendations.

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.

Signed.

Date...Y

SEN.JACKSON K.ARAP MANDAGO,EGH,MP CHAIRPERSON,STANDINGCOMMITTEEONHEALTH

ADOPTIONOFTHEREPORTOFTHESTANDINGCOMMITTEEON HEALTHONTHECOUNTYOVERSIGHTANDNETWORKING ENGAGEMENTSINKILIFICOUNTY.

Wc, the undersigned Members of the Standing Committee on Health of the Senate, do hereby append our signatures to adopt the Report of the Standing Committee on Health on the County Oversight and Networking Engagements in Kilifi County

• 1.Sen.JacksonK.Mandago,EGH,MP

• 2.Sen.MariamSheikh Omar,MP

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

4. Sen. Ledama Olekina, MP

5. Sen. David Wakoli, MP

6. Sen. Richard Onyonka,MP

• 7.Sen.Tabitha Mutinda,MP

8. Sen. Hamida Kibwana, MP

9. Sen. Joseph Githuku, MP

Introduction

• 1.Article96(1)of the Constitution mandates theSenate to represent the counties and serve to protect the interests of the counties and their governments. Article 124 (1) on the other hand provides that each House of Parliament may establish committees,and shall make Standing Orders for the orderly conduct of its
• 2.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 consider allmattersrelatingtomedicalservices,publichealth andsanitation and to undertake investigations, inquiries and reports on relevant issues under its purview as prescribed by the Constitution and theStanding Orders.

3. In fulfilment of the Senate's constitutional responsibility to represent and protect the interests of counties and their government, at its Sitting held on 22nd July, 2025, the Committee resolved to undertake an oversight visit inKilifi County to acquaint itselfwith theprovisionof healthcareservicesin the County aspart of its oversight function. This visit took place on 1st and 2nd August, 2025.

1.1. Purpose and Objectives

4. The specific objective of these engagements was to visit select healthcare facilities inthethreecountiesinorderto-

• a) Assess the state and quality of the infrastructure, facilities, hospital equipment andprovision ofemergencyservices;

3. ? Assess the availability of requisite healthcare personnel, the gaps and challenges, if any, these counties face in regard to healthcare workers;

• b) Asses the automation of healthcare provision systems for patient, drugs and commodity management;
• d) Assess the availability of training and capacity building programs and avenues for healthcare workers in emergency healthcare, specialized services and referrals;

6. e)Assess the availability of drug and medical supplies in healthcare facilities in the counties; and 7. f Obtain information on the Social Health Authority(SHA)reimbursements, facility accreditations and pending bills with Kenya Medical Supplies Agency (KEMSA).

1.2.Scope of the Engagements

• 5.The Committee selected thefollowing facilities for assessment-
• 1)Mtwapa Sub-CountyHospital; and
• 2) Kilifi County Referral Hospital

CHAPTERONE

1.3.Methodology

• 6.On 2nd August,2025,the Committee undertook site visits to the designated facilities. During these visits, Members engaged with relevant county government officials, hospital management, and other stakeholders, and gathered oral and written submissions.Additionally,the Committee alsoconductedthorough physical inspections of premises, reviewed relevant documentation and directly observed theworkingconditionsandchallengesonsite.

7. The findings, analyses, 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,andservice delivery within theframework of the devolved system of governance.

1.4.TheCountyProfile

• 8.Kilifi County is located north and northeast of Mombasa along the Indian Ocean coast,featuring sandybeaches and significanthistorical sites such as the Ruins of Gedi and Mnarani ruins, which date back to the 11th to 17th centuries. Kilifi County covers an area of approximately 12,245.90 square kilometers (4,728.17 square miles)and has a population of about 1,453,787 according to the 2019census.
• 9.The County depends heavily on tourism and fishing due to its coastal location. Agriculture is also a major livelihood source, contributing about 52.7% of household income, mostly from rain-fed small-scale farming, including crops like cassava and cashew nuts,as well as livestock such as dairy cattle and poultry. However, the County faces high poverty(about 71.7%)and food insecurity challenges.

10. The County projected several health sector development projects for the Financial Year 2024/2025 as outlined in its budget and development plans.Key health sector projects including construction of Kilifi County Referral Hospital (KCRH) Complex Phase I1. This major project had a contract sum of about Kshs. 389 million.It is intended to expand specialized facilities,including improved emergency and intensive care units, surgical theatres,and diagnostic services and expansion of maternal and childhealthservices. 11. The County established three mental health and maternal health clinics at Malindi Sub-County Hospital, Mariakani Sub-County Hospital, and Kilifi County Referral Hospital. Additionally, newer rural centers have been opened in Ganze, Kaloleni, and Gongoni tobring services closer to underserved communities.These clinics runweeklyandhavebeeneffectiveinincreasingcommunityawareness and reducingstigma about mental illness as a treatable condition.

• 12.The County is also involved in strengthening rural health facilities and outreach projects include upgrading dispensaries and health centers to improve access in

remote areas, including the rollout of grassroots primary health campaigns to bring specialistcarecloserto communities.

13. In the FY 2024/25, the County allocated Kshs. 18.74 billion, with 43.4% allocated for development programs and 56.6% for recurrent expenditures. By the end of the first nine months,the Countyhad received Kshs.7.02 billion as the equitable share of national revenue, Kshs. 897.6 million from conditional grants, and raised Kshs. 842.37 million as Own-Source Revenue (OSR), including Kshs. 287.46 million from the Facility Improvement Fund (FIF).1 2. 14.In addition, for the FY 2024/25, the County has planned to undertake several major development projects dedicated to the health sector. Table 1 below outlines the key health sector projects scheduled for implementation during FY 2024/25.

| Project Name | Location | Description | Contract Sum | status | |-------------------------------------------------------------------------------------------|-----------------------|-------------------------------------------------------------------------------------------|------------------------|-----------------| | Procurements and Installation of Medical Equipment | Countywide | Installation of advanced radiology equipment such as CT scanners | Not specified | Ongoing | | Mental Health Clinic Establishment and Expansion | Various Sub- Counties | Establishment of mental health clinics in rural areas to improve access and reduce stigma | Not specified | Ongoing/Planned | | Construction of 112BedMale andFemale Wards atSt. Lukes Hospital | Kaloleni Ward | Construction of newwards for inpatient services | Tender process ongoing | Planned | | Constructionand Completionof30 Bed Maternity with Operating Theatre at St. Lukes Hospital | Kaloleni Ward | New maternity ward with operating theatre | Tender process ongoing | Planned |

Source:Kilifi CountyBudgetImplementationReport

1CountyGovernment of Kilifi.(2024).Kilifi CountyBudget ImplementationReport,FirstQuarterFY2024/25. Directorate ofBudget and EconomicPlanning.Retrieved from https://kilifi.go.ke/wpcontent/uploads/2025/02/budget-implementation-report-quarter-1.pdf

• 15.TheExecutive and theAssembly submitted apendingbillspaymentplan at the commencement of FY 2024/25, committing to pay Kshs 1.5 billion and Kshs. 66.68 million, respectively, in the first nine months of FY 2024/25. However, the County did not adhere to this payment plan, as it cleared Kshs.1.12 billion for the Executive andKshs.37.75million for the Assembly.As of 31st March 2025, the outstanding bills amounted to Kshs. 790.12 million, comprising Kshs. 721.94 million for the County Executive and Kshs. 68.18 million for the County Assembly.

CHAPTERTWO

2.COMMITTEEOBSERVATIONS

2.1. Mtwapa Sub-County Hospital

• 16.MtwapaSub-CountyHospital in Kilifi County is a level 4 health facility located about one kilometer off Mombasa-Malindi road. The hospital was recently upgraded by the Kilifi County government to significantly improve service delivery and better serve the growing population of the Mtwapa area and Kilifi South sub-county. The Committee conducted an oversight visit to the Mtwapa Sub- County Hospital, a level 4 public health facility on 2nd August, 2025.

17. The Committee was informed that Mtwapa Sub County Hospital features a 80-bed capacity, surgical operating theatre services, a resource center and a drug store with a constant supply of medicines and medical equipment as part of the county's efforttobringmodernhealthservicescloser toresidentsandreducetheneedto travel to Mombasa or Kilifi town. The Committee was further informed that plans for further expansion included constructing an emergency wing, adding radiology and X-ray services to enhance emergency and diagnostic care.

• 18.The Committee was further informed that the Hospital provides services to about four hundred (400) patients daily. However, it faces significant challenges related to understaffing.
• 19.During the visit and engagement with the facility administration and staff, the Committeemadethefollowingobservations-
• 1)MtwapaSub-CountyHospitalgenerallylacksadequateinfrastructure and space for medical and support services, with essential areas like waiting bays, pharmacies, and stores forced into small, congested spaces. There was no clear and proper infrastructure andfacilities to store essential equipment which is likely to compromise patient comfort and health care quality;
• 2)Thereissevereunderstaffingleadingtoextendedworkingshifts,someupto twelve hours, which negatively affects quality of patient care. Indeed, there was only onelaboratory technologist on dutyduring thevisit.Further,senior medical staff such as doctors and pharmacists were not listed on the duty rosters availed to the Committee;
• 3) The facility's pharmacy lacked an accreditation license from the Pharmacy and PoisonsBoard (PPB),which is likely to jeopardizepatient safety and regulatory compliance;

• 4) The hospital laboratory faces persistent shortages of equipment and reagents, limiting the range of diagnostic tests available;
• 5) The hospital incinerator was dysfunctional, leading to the accumulation of medical and biohazard waste at the facility;

3. 6)Thecontractedcleaningstaffreported thattheyhadnotreceivedtheir salaries for over two months and had not been provided with the necessary equipment like gloves and masks. The cleaning staff reported that they were initiallycontractedbythehospitalbuthadbeentransitioned toaprivate company, resulting in salary reductions and non-remittance of statutory deductions;

Picture1:TheCommitteeobservedthatthedrugstockswere limited and thepharmacy staff faced humanresource challenges and expireddrugsandmedicationwerepresentinthehospitalshelves whichlackedproperdruginventorycontrol

Picture 2:The Committee observed discrepancies between physical stocks andrecordedstocks.

Picture 3:Someofthe expired drugs andmedication which were foundinthehospitalambulanceandpharmacy

2.2. Kilifi County Referral Hospital (KCRH)

20. The Committee undertook a visit to Kilifi County Referral Hospital on 2nd August, 2025 and was accompanied by Mr.Peter Mwarogo,the County Executive Committee Member (CECM) in charge of the Health and Sanitation Services,Dr. David Mulewa, the Chief Officer, Department of Health and Dr. MatanoKibwana, the Medical Superintendent at the facility. The Committee was accompanied by Members of theKilifi CountyAssembly Committee onHealthServices. 21. The Committee was informed that the Kilifi County Referral Hospital (KCRH) is a Level 4 primary care hospital located in Kilifi Town Centre and serves a population of about 1.5 million people annually. The Hospital serves as the main public referral hospital for Kilifi County, providing a wide range of services including pediatric care, emergency services, inpatient care, and modern diagnostic capabilities such as advanced radiology equipment including 64-slice CT scanners. 3. 22.During the visit and engagement with the administrators and staff at the Kilifi Referral Hospital,the Committeemade thefollowing observations- 4. (1)Staffingshortagesweresevere,withonlyonegynecologistinthebusy maternityward,absenceofapediatrician,andheavyrelianceonnursesand interns, while senior medical professionals and Heads of Departments were often missing atworkstations;

• (2) The hospital pharmacy operated without a valid Pharmacy and Poisons Board (PPB)licenseforbothfacilityandpharmacists.Therewere drugstock discrepancies: some medications were listed as having zero records while physically present on shelves. Further, expired drugs,including injectables, were mixed with other drugs in the pharmacy, and unused medical stocks were prevalent, signaling poor pharmaceutical management and oversight;
• (3) Despite some recent infrastructural development, there was widespread deterioration with worn-out floors, walls, pathways and especially a dilapidated hospital kitchen, raising hygiene and safety concerns. Several hospital wardswerefound tobeinpoorcondition,underminingpatientsafety and comfort. Further the oxygen plant was non-functional and essential amenities such as water taps and bathroom doors were missing, straining emergencyandcritical careservices;

Picture 4:The Committee observed widespread infrastructural deterioration with worn-out floors, walls and peeling paints witnessed in majority of the hospitalwardsvisited.

Picture 5:The Committee observed that the hospital kitchen was also greatly dilapidatedwhichraised hygiene andsafety concerns.

• (4) The maternity wards were severely overcrowded, with mothers compelled to share beds and endure poor sanitation; most bathrooms lacked doors and cleaning staff lacked essential tools. Patients and staff endured significant indignities due to capacity gaps and poor working conditions;

Picture6:The bathroom doors weremissing and wherepresent they werewornoutand unabletolockproperly.

Picture7:Therewaswidespreaddeteriorationandwearingoutofthe facilitiesatthewardsespeciallyinthebathrooms

• (5) There was no functional incinerator at the hospital, resulting 1n accumulation and unsafe dumping of medical and biohazard wastes.

2. progression, leading to demoralization and poor service quality. Further, Staff citedfrustration due to stalled d promotionsandlack of career progression, leading to demoralization and poor service quality. There were systemic issues in staff supervision, with ineffective oversight and a breakdown of reporting structures.

• (7) Casual cleaners had been transitioned to a private company without formal contracts and had not received salaries for two months; and many lacked basic protective equipment. The laundry services were inadequate: no linen ironing machine, and most linen was dusty, indicating neglect.
• (8) Out of seven hospital ambulances, only two were operational and most grounded vehicles had been vandalized, losing essential parts such as wheels and mirrors. Expired drugs were found in ambulances, which poses risks for patient safety and contributes to antimicrobial resistance.

Picture 8:The Committeeobserved thattherewere only two operational ambulancesinKilifi CountyReferalHospital

Picture9:TheCommitteeobservedthatmostgroundedvehiclesthathad beenpreviouslyused asambulanceshadalsobeenyandalized

Picture1l:TheCommitteeobservedastalledmobileclinicrepurposedfor storageofmedicalsuppliesand expireddrugs.

CHAPTERTHREE

3.COMMITTEEOBSERVATIONS

3.1.Infrastructure and Facility Challenges

• 23.Both hospitals suffer from significant infrastructural deterioration,including wornout floors, damaged ceilings, inadequate bed capacity, and poor sanitation facilities. The lack of functional ambulances, absence of incinerators, and stalled mobile clinic further compromise emergency response and safe waste disposal. Such infrastructural deficits hinder effective patient care, infection control, and overall hospital operations.
• 24.Mtwapa Sub-County Hospital lacked adequate infrastructure and space, forcing essential services like pharmacies and waiting bays into small, congested areas. The Kilifi County Referral Hospital maternity ward was severely overcrowded, compellingmotherstosharebeds.
• 25.Further, the hygiene concerns were raised due to greatly dilapidated kitchen at Kilifi County Referral Hospital. Additionally, many bathrooms were missing doors and exhibited poor sanitation.

3.2.HumanResourceManagementIssues

26. The two facilities visited exhibited critical shortcomings in personnel management, staffing levels and morale. Both facilities faced severe understaffing, particularly in critical areas like the maternity ward and the laboratory. This resulted in extended working shifts some up to twelve hours negatively affecting patient care. 2. 27.There was conspicuous absence of senior medical professionals and heads of departments at workstations, signaling lack of effective leadership and oversight. Staff reported frustration due to stalled promotions and lack of career progression with some of them reporting that they received promotion letters but did not receive corresponding salary adjustments. 28. The contracted cleaning staff reported not receiving salaries and remuneration for inordinate long periods some spanning over two (2) months and they also lacked necessary protective equipment and working gear. These casual workers, who were transitioned to private cleaning companies after being recruited by their respectivefacilities,often lacked formal contracts.

3.3.Supply Chain and Pharmaceutical ManagementIssues

29. The oversight visit revealed poor oversight and non-compliance in the handling of medication and supplies in the healthcare facilities in Kilifi County. Expired drugs and medication, including injectables were found mixed with current stock in pharmacies, shelves, stores and functional ambulances, posing serious risks to patient safety.

• 30.Discrepancies existed between physical drug stocks and recorded stocks. For instance,somemedicationslisted as zerorecordson thebincardswerefound tobe physically present on the shelves. Further, the pharmacies at the two facilities lackedvalid accreditationlicensesfrom thePharmacy andPoisonsBoard (PPB). The hospital laboratory at Mtwapa faced persistent shortage of equipment and reagents.

3.4.OperationalFailures andEmergencyServiceDeficiencies

31. The Committee observed significant operational gaps which compromise provision of essential healthcare services, especially emergency response and infection control in the County. The incinerators at both Mtwapa Sub-County Hospital and KCRH were non-functional,leading to the accumulation and unsafe dumping of medical and biohazard waste in open areas. KCRH's installed incinerator was reportedlystalledduetopowerconnectionchallenges. 2. 32.TheCommitteeobservedthattheambulanceserviceswereinadequateinthe healthcare facilities in the County; at KCRH, only two out of seven ambulances were operational, and most grounded vehicles had been vandalized, missing essential parts like wheels and mirrors. Further, the oxygen plant at KCRH was non-functional, posing serious risks to emergency and critical care services

3.5.OverwhelmedFacilities

• 33.TheCommitteeobservesthattheMalindiReferralHospitalmortuaryservesas the central facility for storing over fourhundred(4oo)bodies exhumedfrom the Shakahola massacre, including many remains of children. These are preserved in the main morgue and additional refrigerated containers provided by the Kenya Red Cross.
• 34.Thehuge numberofbodiesoverwhelms themortuaryandthecoldstorage is causing a backlog that severely disrupts hospital operations. This congestion also blocks ambulance access. The backlog poses significant public health and financial challenges due to the high electricity costs associated with preserving thelargevolumeofremains.

CHAPTER FOUR

4.COMMITTEERECOMMENDATIONS

35. With the foregoing, the Committee recommends that the Governor, Kilifi County Government should- 2. a)Provideresourcesandprioritizerenovationandmaintenanceof thehospital infrastructure including floors, ceilings, walls, bathrooms and kitchen facilities to ensure compliance with Health Infrastructure Norms and Standards;

• b) Allocate sufficient resources to Kilifi County Referral Hospital to expand current bed capacity, equip critical units, including the ICU and expand maternity and pediatric wards;
• c) Prioritize repair and maintenance of the ambulance fleets to ensure operational readiness. Additionally, mobile clinics should be restored and equipped for emergency transport and servicefunctions;

5. d)Installfullyfunctionalincineratorstoensuresafe and compliantmedicalwaste disposal and promptly resolve the existing power connection issues with the Kenya Power to guarantee uninterrupted operation;

• e) Implement routine maintenance and repair programs, establishing scheduled maintenance plans for hospital buildings, equipment and utilities;
• f) Allocate adequate resources to upgrade hospital kitchens to ensure the provision of quality and nutritious meals while adhering to established hygiene, safety and dietary standards;

8. g)Conductacomprehensivestaffingassessmenttoidentifyvacancies and address understaffing, particularly in critical areas like maternity, pediatrics and pharmacy;

• h) Develop and implement a comprehensive strategy to resolve systemic stalled promotion and salary stagnation for the majority of employees in order to combat the resultant low morale and diminished productivity;
• i) Resolve delayed salary payments for casual workers by ensuring timely remuneration and appropriate salary increments and foster positive employee relations through regular feedback, supportive supervision and participatory decision-making processes;
• j) Enhance collaboration with the Kenya Medical Supplies Authority (KEMSA) to ensure prompt and complete delivery of pharmaceuticals by improving order processing, payment and communication to reduce supply delays and stock-outs;
• k) Enhance pharmaceutical management practices, including proper storage, regular disposal of expired drugs, and adherence to professional standards with pharmacist oversight;

• 1) Enforce strict inventory audits to remove expired drugs and reconcile recorded stocks with actual inventory;

2. m)Repair andmaintainlaundryequipment toensure efficientcleaningprocesses and provide sufficient quantities of clean linen to uphold hygiene standards and reduce the risk of healthcare-associated infections; 3. management systems to improve efficiency, accuracy, and timely access to patient information

• o) ensure close monitoring, regular visits, and consultations with facility management, and ensure that the responsible personnel properly account for cash collections from the Facility Improvement Fund (FIF) and Social Health InsuranceFund (SHIF)

5. 36.TheCommitteerecommendsthattheCountyPublicServiceBoardshouldensure that anyformal promotion is immediately accompanied by corresponding salary adjustment and assumptions ofincreased responsibilities. 6. 37.The Committee,further,recommendsthat the GovernorKilifi County Government shouldprovideanimplementationstatustothe aforementionedrecommendations within sixty (60) days from the date of adoption of this report by the Senate.

Annex 1:

Minutes of the Committee sittings

13THPARLIAMENT4THSESSION

MINUTESOFTHE FIFTIETH (50TH) SITTING OFTHESTANDING COMMITTEE ONHEALTHHELD ONTUESDAY,30THSEPTEMBR,2025AT 11.00AMINCOMMITTEEROOM4,BUNGETOWER

MEMBERSPRESENT

• 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. David Wakoli, MP

• -Member

5. Sen. Joseph Githuku Kamau, MP

• -Member

ABSENTWITHAPOLOGY

• 1.Sen.Ledama Olekina,MP

2. Sen. Tabitha Mutinda, MP 3. Sen. Hamida Kibwana, MP

• 4.Sen. Richard Onyonka, MP

SENATESECRETARIAT

1. Mr. Humphrey Riingera 2. Mr. David Ngamate 3. Mr. Gilbert Juma 4. Ms. Lilian Onyari 5. Mr. David Munene 6. Mr. Ian Otieno 7. 7.Mr. Jack Lemeteki 8. 8.Mr.Ibrahim Odindo

MIN/SEN/SCH/258/2025

• -Member
• -Member
• -Member
• -Member
• -Senior Research Officer
• Clerk Assistant
• Legal Counsel
• Research Officer
• Fiscal Analyst
• -Audio Assistant
• -Media Relations Officer
• Serjeant at Arms

PRELIMINARIES

The meeting was called to order at twenty-seven past eleven o'clock and the proceedings commencedwith awordofprayer andbrief introductionsofthosepresent.

MIN/SEN/SCH/259/2025

ADOPTIONOFTHEAGENDA

Theagendaof themeetingwasadoptedwithamendments afterbeingproposedbySen. Joseph Githuku Kamau,MP,and seconded by Sen.David Wakoli,MP,as listed below-

1. Preliminaries;

• a) Prayer
• b) Introductions

2. Adoption of the Agenda; 4. Matters arising from the Minutes of the Previous Meeting; 3. Confirmation of Minutes of the Previous Meetings; 5. Consideration and Adoption of the Committee Report on the County oversight visit to Kilifi County (Committee Paper No.146); 6. Consideration of the Kenya Health Products and Technologies Regulatory Authority Bill, 2022 (National Assembly Bills No.54 of 2022) (Committee Paper No.148); 7. Any other Business; and 8. Adjournment/Date of the Next Meeting.

MIN/SEN/SCH/260/2025

CONFIRMATIONOFTHEMINUTESOF THEPREVIOUS MEETINGS

1. The Minutes of the 42nd meeting held on Saturday 2nd August, 2025 were confirmed as a true record of the proceedings having been proposed by Sen. David Wakoli, MP and seconded bySen.Joseph GithukuKamau,MP; 2. TheMinutesofthe43rdmeetingheldonSaturday2ndAugust,2025wereconfirmed Kamau, MP and seconded by Sen. David Wakoli, MP

MIN/SEN/SCH/261/2025

MATTERSARISINGFROMTHEABOVE MINUTES

There were no matters arising from Minutes of the previous meeting..

MIN/SEN/SCH/262/2025

CONSIDERATION ANDADOPTION OF THE COMMITTEEREPORTONTHECOUNTY OVERSIGHTVISITTOKILIFICOUNTY

1. The Committee Secretariat presented the Committee Report on the County Oversight and Networkingvisit toKilifi County which was conducted on 2ndAugust, 2025for consideration and adoption; 2. The Committee observed that despite the pressing need for safe medical waste disposal,thehealthcare facilitiesvisited,they did not have functionalincinerators for handling biomedical waste. The Committee observed that this was dangerous and the unhygienicdumpingofmedicalwasteinopenareaswasduetonon-functional incinerators.

3. Following its consideration, the Report on the County Oversight and Networking Engagement in. Kilifi was unanimously adopted after being proposed by Sen. David Wakoli, MP, and seconded by Sen. Joseph Githuku Kamau, MP;

MIN/SEN/SCH/263/2025

| CONSIDERATIONOFTHEKENYAHEALTH | CONSIDERATIONOFTHEKENYAHEALTH | |------------------------------------|------------------------------------| | | AND TECHNOLOGIES | | REGULATORY AUTHORITY BILL,2022 | REGULATORY AUTHORITY BILL,2022 | | (NATIONALASSEMBLYBILLSNO.54OF2022) | (NATIONALASSEMBLYBILLSNO.54OF2022) |

The Committee resolved to prioritize and fast track consideration of the Kenya Health Products and Technologies Authority Bill,2022(National Assembly BillsNo.54 of 2022)thatwaspendingbeforetheCommitteeasitwassubjecttotimelinesprovided under the Standing Order.

MIN/SEN/SCH/264/2025

ANYOTHERBUSINESS

The Members and Committee were informed that there would be a press briefing by the media on Thursday, 2nd October, 2025 at 11:00 a.m.They were urged to keep time for the briefing,whichwill inform thepublic on the state of hospitals in thevarious counties visited so far.

MIN/SEN/SCH/265/2025 ADJOURNMENT

Therebeing no other business, the meeting ended at twenty-two minutes past one clock. The next meeting shall be held on notice.

SIGNED...

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

13THPARLIAMENT|4THSESSION

MEMBERSPRESENT

MINUTESOFTHEFORTY THIRD COMMITTEEONHEALTHHELDONSATURDAY,2NPAUGUST,2025AT5.00 0(43RD)SITTING OF THE STANDING PMATGOVERNORSOFFICE,KILIFICOUNTY

1. Sen. Justice (Rtd) Stewart Madzayo, EGH, MP 2. Sen. David Wakoli, MP 4. Sen. Joseph Githuku Kamau, MP 3. Sen. Tabitha Mutinda, MP

ABSENTWITHAPOLOGY

• 2.Sen.Mariam Sheikh Omar, MP
• 1.Sen.Jackson K.Arap Mandago,EGH, MP

4. Sen. Richard Onyonka, MP 3. Sen. Ledama Olekina, MP 5. Sen. Hamida Kibwana, MP 1. Mr. Humphrey Ringera

SENATESECRETARIAT

2. Mr. David Ngamate 4. Mr. David Munene 3. Mr. Gilbert Juma 5. Mr. Ian Otieno

INATTENDANCE

6. Mr. Ibrahim Odindo

• Member
• Member

4. -Member

• Member
• Chairperson

7. -Member 8. -Vice-Chairperson 9. -Member

• Member

11. -Senior Research Officer

• Legal Counsel
• Clerk Assistant
• Research Officer
• Serjeant at Arms
• Audio Assistant

KILIFICOUNTY ASSEMBLY,HEALTHSERVICESCOMMITTEE 1. Mr. Edward Kazungu

• 3.Mr.Hassan Mohammed Said

2. Ms. Mary Maneno

• 4.Mr. Mwambire Mohamed

6. Mr. Edward Kazungu 5. Mr. Thomas Mumba Chengo 7. Mr. Stephen Baya 8. Ms. Patrice Sikuku

• Vice-Chairperson
• Chairperson
• Member
• -Member
• -Member
• -Member
• -Member
• -Member

KILIFICOUNTYEXECUTIVE

• Governor

1. Hon. Gideon Mung'aro, OGW

• Ag. County Secretary - County Executive Committee Member -Finance

2. Mr. Philip Chanzo

3. Mr. Yaye Shosi

• County Executive CommitteeMember -Health

4. Mr. Peter Mwarogo

• Chief Officer, Department of Health

5. Dr. David Mulewa

• Ag. County Director of Health

6. Dr. Hassan Leli

• Sub -County Medical Officer of Health,

7. Dr. Sultan Hubess

Kilifi South

• -Medical Superintendent Kilifi County Referral Hospital

8. Dr. Matano Kibwana

• Medical Superintendent

9. Dr. Samiya Mabruk Abeid

• Mtwapa Sub-County Hospital

PRELIMINARIES

MIN/SEN/SCH/224/2025

The meeting was called to order at half past five o'clock and the proceedings commenced with a word of prayer and brief introductions of those present. OVERSIGHTEXIT REPORTONTHE

• HOSPITAL 1. The Committee held a de-briefing meeting with the Governor, Kilifi County to present its preliminary observations and report on 2nd August, 2025. The Committee informed the Governor that during the oversight visits the following observations had been made-
• (1) There was some evidence of remarkable efforts towards improving healthcare provision in the County with tangible projects, investments and reforms implemented in several areas and facilities. The Committee noted the Kilifi County Referral Hospital Complex featuring state-of-the-art facilities including an Emergency and Accidents section, an ICU, and surgical theaters;
• (2) Despite the notable improvements, there was also widespread neglect of existing health infrastructure and persistent unsanitary conditions in the two facilities visited. The Kilifi County Referral Hospital appeared overwhelmed, poorly equipped and understaffed leading to low quality of care especially in the maternity
• and new born units; (3)The healthcarepersonnel were demoralized and some employees reported that they had waited for inordinate log periods for their promotions and even those who received promotion letters did not receive corresponding salary adjustments. There had been cases wherepromoted staff informed the Committee that they received formal letters without any increase n pay or responsibilities frustrating aspirations for career progression;

| MIN/SEN/SCH/225/2025 | MTWAPASUB-COUNTYHOSPITALAND REFERRAL COUNTY THE CKILIFI | |------------------------|-----------------------------------------------------------|

• (4) The Committee was concerned about lack of supervision by Heads of Departments significantly undermined service quality and staff discipline. The Committee observed that there was no effective staff oversight and or established supervisory lines, resulting in confusion, breakdown of reporting and possible discipline issues;
• (5) Expired drugs and medication were found in pharmacies, stores and ambulances highlighting serious lapses in pharmaceutical management and drug disposal practices. Further, there was variance in the drugs record at the pharmacy with some medication having been indicated has having zero records while there were physical stocksinthe shelves;
• (6) The ambulance services in the County appeared to be inadequate; for instance, at the Kilifi Referral Hospital there were only two (2) out of seven (7) ambulances in operation during thevisit.It alsoappearedlikemostof thegrounded ambulances had been vandalized and were missing parts such as wheels, side mirrors and headlights implying that someone might have deliberately decided to vandalize and or sell spare parts from the grounded ambulances;

4. (7)There is strong evidence that casuals recruited and/or transitioned to private cleaning companies such as Ms. Kulty Cleaning Service Limited, to provide cleaning services inbothfacilitiesvisited did not haveformal contracts.Further, thecasuallaborershadnotbeenpaidfortwomonthsduringthevisits and their employers were not remitting statutory deductions such as those remitted to Social Health Insurance Fund;

• (8) Despite the pressing need for safe medical waste disposal, the healthcare facilities visitedbytheCommitteedidnothavefunctionalincineratorstohandlebiomedical waste and there was dangerous, unhygienic dumping of medical waste in open areas.

Remarks by the Governor

• 2.The Governorinformed the Committee that-
• (1) Kilifi County had made significant strides in improving the provision of healthcare services focusing on accessibility, quality and infrastructure development to meet the needs of its constituents. The County had equipped and upgraded the Malindi County Referral Hospital to enhance its capacity to provide specialized and referral services including in maternal and child health, renal analysis and emergency care;
• (2)The Countyhad increasedhealthcareworkers includingmedical officers and there areplanstohiremorenurses.Furthertherearecontinuouseffortstotrainand deploy more healthcare personnel in critical areas;

• (3) Whereas an incinerator had been installed at the Kilifi Referral Hospital, it was currently facing power connection challenges with the Kenya Power Company. Consequently, the County was seeking assistance from relevant stakeholders to resolvetheissues;
• (4) The County Government of Kilifi had signed a contract worthy Kshs 45 million with Ms. Kulty Cleaning Service to provide cleaning services in the healthcare facilities and the county governments would follow up on the implementation of the provision of contracts;
• (5) The County Government had observed that many doctors had been operating from their private clinics for lack of adequate supervision at the public facilities. Consequently, the Executive had advertised vacancies in the positions of facility andheadsofdepartmentsin thehealthcaresectorandsuitablecandidateswould be recruited.

3. The Committee was further informed that the Malindi Referral Hospital mortuary, has served as the central facility for storing over four hundred (4oo) bodies exhumed from the Shakahola massacre. These bodies many of them being children, were preserved in both the main hospital morgue and additional refrigerated containers provided by the Kenya Red Cross. 4. The Committee was informed that the mortuary was overwhelmed by the huge number of bodies.Further, the cold storage at the facility is causing a backlog that severely disrupts hospital operations, blocks ambulance access, and poses both public health and financial challenges due to the high electricity costs of preserving so many remains. Consequently, there is need for a long-term solution.

MIN/SEN/SCH/226/2025 ADJOURNMENT/ANYOTHERBUSINESS

There being no other business, the meeting ended at half past eight o'clock. The next meeting shall be held on notice.

LUS

SIGNED

.DATE...

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

13THPARLIAMENT|4THSESSION

MINUTES OF THE FORTY SECOND(42ND)SITTING OF THE STANDING COMMITTEEONHEALTHHELDONSATURDAY,2NPAUGUST,2025AT 9.00 AMHELDINKILIFICOUNTY

MEMBERSPRESENT

1. Sen. Mariam Sheikh Omar, MP

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

• Vice-Chairperson

• -Member

3. Sen. David Wakoli, MP

• -Member

4. Sen. Tabitha Mutinda, MP

• Member

5. Sen. Joseph Githuku Kamau, MP

ABSENTWITHAPOLOGY

2. Sen. Ledama Olekina, MP 2. 1.Sen. Jackson K. Arap Mandago, EGH, MP 3. Sen. Richard Onyonka, MP 4. Sen. Hamida Kibwana, MP

SENATESECRETARIAT

• 2.Mr. David Ngamate

1. Mr. Humphrey Ringera 3. Mr. Gilbert Juma 5. Mr. Ian Otieno 4. Mr. David Munene 6. Mr. Ibrahim Odindo

• Member

• Chairperson

• -Member
• -Member
• Member
• Senior Research Officer
• Legal Counsel
• Clerk Assistant
• Research Officer
• Serjeant at Arms
• Audio Assistant

INATTENDANCE:KILIFICOUNTYHEALTHSERVICESCOMMITTEE

• -Member

1. Mr. Edward Kazungu

• Chairperson

2. Ms. Mary Maneno

• Vice-Chairperson

• 3.Mr.Hassan Mohammed Said

-Member

• 4.Mr.MwambireMohamed

• Member

5. Mr. Thomas Mumba Chengo

-Member

6. Mr. Edward Kazungu

-Member

7. Mr. Stephen Baya

• Member

8. Ms. Patrice Sikuku

KILIFICOUNTYEXECUTIVE

• County Executive Committee Member (CECM)

1. Mr. Peter Mwarogo

Department of Health and Sanitation Services

• Chief Officer DepartmentofHealth andSanitationServices

2. Dr. David Mulewa

• Ag. County Director of Health

3. Dr. Hassan Leli

• Sub - County Medical Officer of Health, Kilifi South

4. Dr. Sultan Hubess

• -Medical Superintendent, Kilifi County Referral Hospital

5. Dr. Matano Kibwana

6. Dr. Samiya Mabruk Abeid - Medical Superintendent,

Mtwapa Sub-County Hospital

PRELIMINARIES

MIN/SEN/SCH/220/2025

The Committee commenced the tour of Kilifi County Healthcare facilities at nine o'clock by undertaking an oversight visit at Mtwapa Sub - County Hospital in Mtwapa, Kilifi South and later the Kilifi County Referral Hospital in Kilifi.

MIN/SEN/SCH/221/2025

OVERSIGHTVISITTOMTWAPA-SUB COUNTYHOSPITAL,MTWAPATOWN

• The Commitee was received at Mtwapa Sub-County Hospital on Saturday, 2nd September, 2025 and was received by Dr. Samiya Mabruk Abeid, the Medical Superintendent.
• The Committee was informed that the facility has recently been upgraded to level-4 2. and provides services to between four hundred (400) and six hundred (600) patients daily. The hospital features an 80-bed capacity, surgical operating theatre services, a resource center, and a drug store with a constant supply of medicines and medical equipment as part of the county's effort to bring modern health services closer to residents and reduce the need to travel to Mombasa or Kilifi towns;

3. The Committee was further informed that the facility faces challenges related to understaffing resulting to extended working shifts some lasting up to twelve (12) hours which may affect the quality of patient care. The specialized clinics operated during weekdays and were closed over the weekends. Further, during the visit, there was only one laboratory technologist on duty who was supposed to run the laboratory for a twelve (12) hour shift.

Committees Observations 4. During the tour of the facility, the Committee observed the following-

• (1) The facility generally lacks adequate infrastructure and space for different medical and support services such as waiting bays, pharmacies, stores, cash offices among more which were forced to occupy small spaces;

• (2) The pharmacies lacked an accreditation license from the Pharmacy and Poisons Board (PPB), which is a regulatory requirement to ensure patient safety and professional standards are met. It was also congested since it occupied a small space but the drug stocks were limited. It further faced human resources challenges; there were only two (2) pharmacists and three (3) pharmaceutical technologists at the facility;
• (3) The senior medical staff members including the medical doctors and pharmacists, were not listed on the duty roster availed to the Committee. Further, the facility relied on manual registers;
• (4) There were expired medication and drugs at the facility ambulance which the Committee was informed was being operated independently through the County Emergency Medical Services (EMS) Program. Further, there was no inventory of the drugs available in the ambulance;
• (5) The contracted cleaning staff reported that they had not received their salaries for over two months and had not been facilitate with the requisite equipment and tools such as gloves and masks to undertake their functions. The Committee was further informed that the casuals were contracted by the facility and were consequently remunerated through Facilities ImprovementFund(FIF).However,they had been transitioned to a private company following a directive from the Executive and theirsalarieshad alsobeen reduced;
• (6) 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;
• (7) The Hospital incinerator was dysfunctional leading to the accumulation of piled medical and biohazard wastes at the facility.

MIN/SEN/SCH/222/2025

OVERSIGHTVISITTOKILIFICOUNTY REFERRALHOSPITAL

Member (CECM) in charge of the Health and Sanitation Services, Dr. David Mulewa,

5. The Committee undertook a visit to Kilifi County Referral Hospital on 2"d August, 2025 and was accompanied by Mr. Peter Mwarogo, the County Executive Committee the Chief Officer, Department of Health and Dr. Matano Kibwana, the Medical Superintendent at the facility. The Committee was accompanied by Members of the Kilifi County Assembly Committee on Health Services. 6. The Conmittee was informed that The Kilifi County Referral Hospital (KCRH) is a Level 4 primary care hospital located in Kilifi Town Centre and serves a population of about 1.5 million people annually;

7. The Committee was further informed that KCRH operates 24 hours a day and has a capacity of 172 in-patient beds. The hospital serves as the main public referral hospital for Kilifi County, providing a wide range of services including pediatric care, emergency services, inpatient care, and modern diagnostic capabilities such as advanced radiology equipment including 64-slice CT scanners. The facility handles a population about 1.5 million people in the county and handles around 4,000 pediatric admissions annually;

CommitteeObservations

• (1) There has been some recent infrastructural development at the Hospital reflecting efforts to enhance healthcare infrastructure and respond to the growing patient demands;

8. During the tour of the facility the Committee observed the following- 3. 2 The Hospital is facing general infrastructural deterioration, including worn-out floors, pathways, working services and walls in general which is exacerbated by delays in renovations. The hospital kitchen was in a dilapidated state, with peeling paint and missing tiles that posed both hygiene and safety concerns;

• (3) recruited, however, there was no evidence was observed. For instance, the maternity ward, despite being very busy was only served by one gynecologist. In the absence of adequate specialist support, some nurses especially at the maternity and new born units reported that they were forced to rely on consultations conducted over mobile phones, underscoring systemic gaps in staffing and service quality;

5. 4 The Committee observed that majority of the Heads of Different Departments at the Hospital were missing at their respective work stations; the majority of healthcare personnel at the hospital were nurses and interns, with a conspicuous absence of senior medical professionals to provide oversight and specialized care. The lack of effective leadership and professional presence left frontline staff unsupported, contributing to gaps in service delivery and weakening the overall quality of patient care at the hospital 6. 5 Whereas the Committee was informed about availability of at least fifteen (15) pharmacists at the facility, the Hospital pharmacy was being operated by pharmaceutical technologist who was not being supervised by anyone. Further, there was no PPB license for both the pharmacy and the pharmacists; 7. 6 There was variance in the drugs record at the pharmacy. Indeed, one medication was indicated has having zero record while there were physical stocks in the shelves. Further, expired drugs including injectables were found mixed up in the shelfswithotherdrugs; 8. 7 The Committee noted that the ambulance services are inadequate; the Committee was informed that out of twenty-two (22) ambulances owned by the County, only twelve (12) were functional. At theKilifi Hospital there were only two (2) out of seven (7) ambulances in operation during the visit. It also appeared like most of the grounded ambulances had been vandalized and were missing parts such as wheels, side mirrors and headlights implying that someone might have deliberately decided to vandalize and or sell spare parts from the grounded ambulances. Nonetheless, expired drugs were found in the two functional ambulances, which significantly contribute to increased antimicrobial resistance;

• (8) The laundry department did not have a linen ironing machine. Most of the linen were dusty an indication of non-use of thelaundry services.Further,the staff at the department lacked proper working equipment and protective clothing;
• 9) Prevalence of expired drugs and unused medical stocks at the Hospital signaling unused or arefrequently unavailablewhen needed;
• (10) The maternity wards at Kilifi County Referral Hospital were severely congested, withwomencompelled tosharebedsdue toinadequatecapacity.Personnel shortages were pronounced, as the facility lacked a pediatrician and nurses appeared disoriented, citing frustrations over stalled career progression and pendingpromotions. Thewards presented indignities to mothers and their new born, with majority of the bathrooms missing doors and poor sanitation conditions attributed to casual workers operating without essential tools and cleaning materials;
• (11) The hospital lacked essential equipment required for specialized procedures, severelylimitingthescopeofservices availabletopatients.Severalwardswere found to be dilapidated, with compromised infrastructure that undermines patient safety and comfort. The oxygen plant was non-functional, posing serious risks to missing, further straining service delivery in the facility.

MIN/SEN/SCH/223/2025 ADJOURNMENT/ANYOTHERBUSINESS

There being no other business, the oversight visits to the facilities were concluded at five o'clock in the evening and the Committee proceeded to a meeting with the Governor.

Ym

SIGNED...

..DATE..

SEN. JACKSON K. ARAP MANDAGO, EGH, MP (CHAIRPERSON,COMMITTEEONHEALTH)