Report Of The Health County Oversight And Networking Engagements In Bungoma And Kakamega Counties

A report of Health (Senate)

Published: April 2026 · 13th

Read the report (OCR extract)

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| LISTOFABBREVIATIONS | LISTOFABBREVIATIONS | LISTOFABBREVIATIONS | |----------------------------------------|------------------------------------------------------|----------------------------------------| | PRELIMINARIES. 3 | PRELIMINARIES. 3 | PRELIMINARIES. 3 | | ESTABLISHMENTANDMANDATEOFTHECOMMITTEE. | ESTABLISHMENTANDMANDATEOFTHECOMMITTEE. | ESTABLISHMENTANDMANDATEOFTHECOMMITTEE. | | CHAIRPERSON'SFOREWORD 4 | CHAIRPERSON'SFOREWORD 4 | CHAIRPERSON'SFOREWORD 4 | | CHAPTERONE | CHAPTERONE | CHAPTERONE | | INTRODUCTION | INTRODUCTION | INTRODUCTION | | 1.1. | COUNTYPROFILES. | 8 | | 1.1.1 | BUNGOMACOUNTY | 8 | | 1.1.2 | KAKAMEGACOUNTY. | 9 | | CHAPTERTWO | CHAPTERTWO | CHAPTERTWO | | 2. | COMMITTEEOBSERVATIONSANDSTAKEHOLDERSUBMISSIONS | 10 | | 2.1. | MEETINGWITHTHECOUNTYASSEMBLY | 10 | | 2.2. | MEETINGWITHTHEGOVERNOR,BUNGOMACOUNTY | 11 | | 2.3. | OVERSIGHTVISITTOBUNGOMACOUNTYREFERRALHOSPITAL(BCRH). | | | 2.4. | COUNTYOVERSIGHTVISITTOKIMAETIHEALTHCENTRE | | | | OVERSIGHTVISITTOKAKAMEGACOUNTYREFERRALHOSPITAL | .31 | | 2.5. CHAPTERTHREE | 2.5. CHAPTERTHREE | | | 3. | COMMITTEEOBSERVATIONS | 46 | | 3.1. | INFRASTRUCTUREANDPHYSICALFACILITIES | 46 | | 3.2. | HUMANRESOURCESFORHEALTH | 47 | | 3.3. | MEDICALEQUIPMENTANDTECHNOLOGY | 48 | | 3.4. | HEALTHINFORMATIONSYSTEMSANDDATAMANAGEMENT | 49 | | 3.5. | PHARMACEUTICALSERVICESANDSUPPLYCHAINMANAGEMENT | 49 | | 3.6. | INFECTIONPREVENTIONANDCONTROL | 50 | | 3.7. | FINANCIALMANAGEMENTANDSUSTAINABILITY | 51 | | 3.8. | SPECIALIZEDSERVICESANDEMERGENCYCARE | | | 3.9. | QUALITYASSURANCEANDSERVICEDELIVERY | 52 | | CHAPTERFOUR | CHAPTERFOUR | | | 4. COMMITTEERECOMMENDATIONS | 4. COMMITTEERECOMMENDATIONS | .53 | | 4.1. | CABINETSECRETARY,MINISTRYOFHEALTH | | | 4.2. | CHIEFEXECUTIVEOFSOCIALHEALTHAUTHORITY(SHA | ..53 | | 4.3. | GOVERNOR,BUNGOMACOUNTYGOVERNMENT. | 54 | | 4.4. | GOVERNOR,KAKAMEGACOUNTYGOVERNMENT | .55 | | 4.5. | COUNTYPUBLICSERVICEBOARDSOFBUNGOMAANDKAKAMEGA | 56 |

LISTOFABBREVIATIONS

AIA

AnnualInvestmentAllowance

CECM

CountyExecutiveCommitteeMember

CHP

Community Health Promoter

CPSB

CountyPublic ServiceBoard

EMR

ElectronicManagement Records

FIF

Facilities Improvement Financing

Financial Year

HMIS

Health Management Information System

HPTs

Health Products and Technologies

HRH

Human Resource for Health

SHIF

Social HealthInsuranceFund

SHA

Social Health Authority

OSR

OwnSourceRevenues

ICU

Intensive CareUnit

KEMSA

Kenya Medical Supplies Agency

KMPDU

Kenya Medical Practitioners and Dentist Union

MEDS

Mission for Essential Drugs Supplies

MoH

Ministry of Health

National Government

NHIF

National HealthInsuranceFund

PSC

Public Service Commission

UHC

Universal Health Coverage

WHO

World Health Organization

MAT

Medically Assisted-Therapy

PRELIMINARIES

EstablishmentandMandateoftheCommittee

TheStandingCommittee onHealth isestablishedpursuant tostanding order 228(3) and theFourthScheduleoftheSenateStandingOrders andismandated toconsider all mattersrelatingtomedicalservices,publichealthandsanitation.

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

2)studytheprogrammeandpolicyobjectivesof theMinistryofHealthand its departments,and the effectivenessoftheimplementation thereof;
1)investigate,inquire into,and report on all matters relating tothe mandate, management,activities,administrationandoperationsoftheMinistryofHealth anditsdepartments;
3)studyandreviewalllegislationreferredtoit;
4)study,assess and analyzethesuccess oftheMinistry of Health and departments assigned toit asmeasuredbytheresultsobtained ascomparedwith theirstated objectives;
5) considertheBudgetPolicyStatementinlinewiththeCommittee'smandate;
6 reportonall appointmentswheretheConstitutionoranylawrequirestheSenate to approve;
makereports andrecommendations totheSenateasoften aspossible,including recommendationsforproposedlegislation;
8 considerreportsofCommissionsandIndependentOfficessubmittedtothe SenatepursuanttotheprovisionsofArticle254oftheConstitution;
9)examine any statementsraised by Senators on a matterwithinits mandate; and 10)followupandreportonthestatusofimplementationofresolutionwithinits mandate;and
11)follow up and report on the status of commitments madeby the Cabinet Secretariesin theirresponseto questions underStandingOrder51C.

CommitteeMembership

The Committee is comprised of the following members-

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, CBS, MP

-Member

5. Sen. Richard Onyonka, MP

-Member

6.Sen.Tabitha Mutinda,CBS, MP

-Member

7.Sen. Hamida Kibwana, MP

-Member

8. Sen. Joseph Githuku, MP

-Member

9. Sen. Vincent Kiprono Chemitei Cheburet, MP

-Member

CHAIRPERSON'SFOREWORD

At itsSittingheldon4thNovember,2025 theStandingCommittee onHealthdeliberated onthe state of provision of healthcare services athealthfacilities country-wide and resolved to conduct an oversight visit toBungoma and Kakamega Counties to acquaint itself with the provision of healthcare services as part of its oversight function.

The oversight visits which took place on 14th and 15th November, 2025 were designed toprovide crucialfirsthand insights into the state of health infrastructure,service delivery quality and the urgent challenges affecting medical staff and local communities theyserve.

The Committee engagements involved site visits and direct interactions with healthcare workers andmembersofthepublicatBungoma CountyReferral Hospital andKimaeti Health Centre in Bungoma County and Kakamega County Referral Hospital in Kakamega County. Through these interactions, the Committee gathered critical evidenceandnotedwidespreaddeteriorationofhealthinfrastructureandsafety standards across the two counties,including cracked floors, leaking roofs, damaged ceilings, broken doors and windows, exposed electrical wiring and dilapidated furniture.

The Committee noted widespread overcrowding in wards and maternity units, stalled orpoorlyexecutedcapitalprojectsand obsoleteornon-functionalmedical,diagnostic and ambulance equipment whichfurther undermine service delivery andpatientsafety in these healthcare facilities.In several facilities,kitchens,laundries,sanitation facilities and waste-management areas were found to be substandard with inadequate laundry capacity, firewood-based cooking, poor food-handling surfaces and open burning of mixed biomedical waste posing serious infection-prevention, environmental and occupationalhealthrisks.

The Committee also observed persistent human resource and service-delivery challenges, including understaffing of critical cadres such as nurses, clinical officers, radiographers and morticians, heavy workloads in emergency and maternity units and reliance on long-serving casual and contract staff without regularization.Weaknesses inpatient-centred carewere evident in the detention of patients over unpaidbills, congestion and lack of privacy in maternity and newborn units, inadequate sanitary facilities and insufficient waiting areas for clients and caregivers.

At the same time, the facilities struggled with delayed Social HealthAuthority (SHA) reimbursements and dependence on internally generated funds, which constrained their ability to maintain infrastructure, recruit staff, procure supplies and sustain essential services. The persistent delays in SHA reimbursements should be treated as a systemic risk to the implementation of Universal Health Coverage (UHC) implementation and thatSHA and National Treasury should be compelled to submit biannual status reports.

Further, the Committee identified significant governance, health information and pharmaceutical management gaps, including malfunctioning or absent electronic health information systems,inconsistencies inpatient data between admissions andward recordsandinadequatedeploymentofSHAverificationdevicesthatforcedpatient movement for biometric authentication.Pharmacyandsupply-chain weaknesses manifested through near-expiry and expired medicines on shelves,poor stock control andreportsofpatientsbeingdirected topurchasemedicines externallydespiteevidence ofavailablestock.

TheCommitteerecommendsthattheCountyGovernmentsofBungomaand Kakamega,in collaboration with the relevant regulatory agencies,urgently prioritize the rehabilitation and upgrading of health infrastructure, safety systems and critical equipment in the visited facilities. This should include comprehensive structural repairs, completion and rational planning of capital projects, restoration or replacement of non-functional diagnostic and treatment equipment, and modernization of kitchens, laundries, sanitation and waste-management systems in line with national infection-prevention,occupationalhealth and environmental standards.

TheCommitteefurtherurges thedevelopmentandimplementation offacilitymaster plans aligned to county development plans, with ring-fenced budgetary allocations and clear timelinesfor addressing identified gaps.

Tostrengthen servicedelivery and safeguard patient welfare,the Committee recommendsacceleratedrecruitmentandrationaldeploymentofessentialhealth workers,including nurses, clinical officers,radiographers,morticians and support staff, guided by Ministry of Health staffing norms.County Public Service Boards should regularize long-serving contract and casual staff and ensure adequate staffing of high-volume emergency and maternity units to reduce unsafe workloads and improve quality of care. At the same time, hospital managements should enhance patient-centred care by eliminating the detention of patients over unpaid bills, improving privacy and sanitation in wards,expanding waiting and sanitary facilities,and enforcing professional accountabilitythroughvisiblestaffidentification andfunctionalfeedback mechanisms.

The Committeefurther calls upon the Social Health Authority, the Ministry of Health and County Governments to address systemic financing, health-information and pharmaceutical-managementweaknessesthatundermineservicedelivery.This includesclearingoutstanding greimbursementarrearsandinstitutingpredictable payment cycles, fully deploying functional electronic health information systems and adequateSHAverification devices,andtighteningpharmaceutical andsupply-chain controls to prevent wastage,stock-outs and misuse of medicines.The Committee recommendsthattheCountyAssembliesintensifystructuredoversightof these interventions, require regular progress reporting from duty bearers and ensure sustained compliance with legal, regulatory and policyframeworks governing thehealth sector.

Acknowledgements

The Committee sincerely thanks Sen.David Wafula Wakoli, CBS,MP,Senator for Bungoma County and Sen. Dr. Boni Khalwale, CBS, MP, Senator for Kakamega Countyfor theirwarm welcome and theinvaluable support extended to the Committee by their offices during our oversight visits.The contributions and input from their teams greatly facilitated the effective discharge of the Committee's oversight mandate and functionsinthetwocounties.

The Committee further wishes to extend its appreciation to Hon.Kenneth M. Lusaka, EGH, Governor of Bungoma County; and Hon. (FCPA.) Fernandes Barasa, OGW, Governor of Kakamega Countyand therespectiveExecutive CommitteeMembersfor theirinput and submissions during the oversight tours.

Further,the Committee extends its sincere gratitude and appreciation to theSpeakers of BungomaCountyAssemblyandKakamegaCountyAssemblyand theCounty Assembly Members of the respective County Assembly Committees on Health for their facilitation.

TheCommitteeis alsograteful tothemembersofstaff andotherstakeholdersinthe healthcare facilities visited during the tour for their submissions,which have greatly enhanced the evidence analyzed during processing of this report.

Finally, I acknowledge and appreciate the Members of the Committee for their dedication and commitment throughout the process of 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 execution ofits mandate.

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

SIGNED

.....DATE.....

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

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 execute its mandate, the Committee has adopted different modes of operation which include County Oversight and Networking Engagements. Through these engagements, the Committee is able to augment the evidence gathered within the precincts of Parliamentwith sitevisits. 3. 3.At its Siting held on Tuesday,4thNovember 2025, the Committee deliberate on the healthcareprovision in the counties andresolved to undertake a County Oversight and Networking Engagements (CONE) in Bungoma and Kakamega Counties to acquaint itselfwith theprovision of Healthcare Services in the Counties as part of its oversight function.

Purpose and Objectives

4.The specific objective of the visit was to-
a) assess the state and quality of the infrastructure, facilities, hospital equipment and provision of emergency services;
b) asses the automation of healthcare provision systems for patients, drugs and commodity management;
C) assess the availability of requisite healthcare personnel, the gaps and challenges, if any, these counties face in regard to healthcare workers;
d)assess the availability of training and capacity building programs and avenues referrals;
e) 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 andpendingbillswith theKenyaMedical Supplies Agency (KEMSA).

ScopeoftheEngagements

5. The Committee selected the following facilities Counties for assessment- 1. Bungoma County Referral Hospital (BCRH), and Kimaeti Health Centre in Bungoma County, and 2. Kakamega County Referral Hospital (KCRH) in Kakamega County.

CHAPTERONE

Methodology

6. On 14th and 15th November, 2025, the Committee conducted site visits to the identified facilities.During these visits, Members engaged with pertinent county government officials,hospital management and other stakeholders in order to gather submissions and evidence. The Committee also conducted physical inspections of the premises, reviewed documentation and observed working conditions and challenges affectinghealthcareprovision and deliveryfirsthand. 2. 7.The findings, analyses and recommendations set out in this Report are based on evidence collected during these engagements and aim to support the improvement of health sector governance, accountability and service delivery within the context ofdevolvedgovernanceframework.

1.1.COUNTYPROFILES

1.1.1BUNGOMACOUNTY

8.Bungoma County is located in Western Kenya within the Lake Victoria Basin, coveringanareaofapproximately3,032.2squarekilometers.Accordingtothe 2019 Kenya Population and Housing Census, it has a population of about 1,670,570 people, making it a relatively densely populated County. This relatively dense population places significant demand on health services in the county.
9.According to the Ministry of Health, Bungoma County has a total of approximately 275 Health facilities distributed across its nine sub-counties. Of these,154 are government-operated health centers, making up the majority of public healthcare provision in the County, the remainder includes faith-based facilities (around 22), private facilities (approximately 95), and a small number under NGOs (about 4).
10.According to the Office of the Controller of Budget Kenya, The County Gross ApprovedFY2024/25Budget wasKshs.15.59billion.It comprisedKshs.4.97 billion (32 percent) and Kshs.10.62 billion (68 per cent) allocation for development and recurrent programmes, respectively. The budget estimates represented an increase of Kshs.1.56 billion (11 per cent) from the FY 2023/24.The increase was attributed to a rise in its own-source revenue projection and equitable share of revenue raised Nationally.

11. Further, Bungoma County's Gross Approved Budget for the financial year 2024/25 was Kshs. 15.59 billion. The budget comprised Kshs. 4.97 billion (32 percent) allocated to development programs and Kshs. 10.62 billion (68 percent) allocated to recurrent programs. The budget estimate represented an increase of Kshs. 1.56 billion (11 percent) from the FY 2023/24 budget. The increase was attributed to a rise in the county's own-source revenue projections alongside its equitable share revenue raised Nationally.

12. During the period under review, the County reported a collection of Kshs.441.40 million asFacilitiesImprovement Financing(FIF),whichwas42percent of the annual targetofKshs.1.06billion.Thecollected amountwasretained and utilized at sourcein linewith theFacilityImprovementFinancingAct,2023.

1.1.2KAKAMEGACOUNTY

13.Kakamega County is located inWesternKenya and bordersVihiga County to the South, Siaya County to theWest, Bungoma and Trans Nzoia Counties to the North, and Nandi and Uasin Gishu. The County covers an area of approximately 3,033.8 km2.The county has an estimated population of about 1,867,579 people according to the 2019 census, with a population density of 618 people per square kilometer, projecting considerable Healthcare provision needs linked to its population size, density, and geographic spread.
14.The County has at least 374 Health facilities including Public Hospitals, FaithBasedInstitutions,PrivateClinics,andNGO-runcenters.PublicFacilitiesaccount for over half of the county's Health centers, with the rest divided between private providers (approximately 40%), faith-based groups (7.2%), and NGOs (1.3%) representing about 2.6% of all Health facilities in Kenya.
15.Kakamega County Gross Approved Supplementary I Budget for FY 2024/25 was Kshs.17.93 billion. The Budget comprised Kshs.5.93 billion (33 per cent) and Kshs.12 billion (67 per cent) allocation for development and recurrent programmes, respectively. The budget estimates represented an increase of Kshs.1.38 billion (8.4 per cent) from the FY 2023/24 budget, which comprised a development budget of Kshs.5.24 billion and a recurrent budget of Kshs.11.31 billion. The increase in the budget was attributed to the rise in conditional grants and balances brought forward.
16.During the review period, the County received Kshs.11.35 billion in revenues to fund its development and recurrent activities.The total revenue consisted of Kshs.8.56 billion from the equitable share of revenue raised Nationally, additional allocations from the Government and DevelopmentPartners of Kshs.22.93billion, and its Own-Source Revenue (OSR) collection of Kshs.1.23 billion including Facilities Improvement Financing (FIF) of Kshs.593.75 million and Kshs.640.55 millionfrom other OSR sources such asAnnualInvestmentAllowance(AIA).

CHAPTERTWO

2.COMMITTEEOBSERVATIONSANDSTAKEHOLDERSUBMISSIONS

2.1. MeetingwiththeCountyAssembly

17. The Commitee paid a courtesy call to the County Assembly of Bungoma on 14th November, 2025 where it was received by the Speaker, Hon.Emmanuel Situma. The Speaker was accompanied by Hon. George Makari, Chairperson Committee onHealthServices alongside othermembers of the Committee on HealthServices. TheChairpersonbriefed theSpeaker and theMembers of theCountyAssembly present about the objectives of the oversightvisit. 18. On his part, the Speaker thanked the Committee on its role in mentoring the County Assembly and Committee Members with an aim to improving oversight. The Speaker assured theCommittee thattheMembersof theCountyAssemblywill work closelywith theSenate during and after the oversightvisit andfollow-up on theimplementationstatus oftheSenateresolutions.

Picture 1: TheCommitteeonHealthduringacourtesycall on theSpeaker of the County Assembly of Bungoma.

2.2.1 Meeting with the Governor, Bungoma County

19.The Committee paid a courtesy call on the Governor, Bungoma County Government onFriday,14thNovember,2025andbriefedhim about theobjective oftheoversightvisit.
20.During the courtesy call, the Committeewas informed that-
a) Bungoma County operates approximately two hundred and seventy-five (275) healthcare facilities distributed across its nine sub-counties.Of these,one hundred and fifty-four (154) are government-operated health centres, which constitute the majority of public healthcare provision in the County.The remainder comprises around twenty-two (22)faith-based facilities, approximately ninety-five (95) private facilities and four (4) facilities operated by Non-Governmental Organizations (NGOs);
b) The County's Gross Approved budget for FY 2024/25 totaled Kshs 15.59 billion, 10.62 billion (68%) for recurrent programmes. These estimates represented an increase of Kshs 1.56 billion (11%) from FY 2023/24, attributed to higher projected own-source revenue and an increased equitable share of nationally raised revenue;
c) The County reported a collection of Kshs.441.40 million as FIF, which was 42 percent of the annual target of Kshs.1.06 billion. The collected amount was retained and utilized at source in line with the Facility Improvement Financing Act, 2023; and
d) The conversion and confirmation ofthe Universal Health Coverage (UHC) staff, totaling up to two hundred and forty-five (245) across all cadres, was still pending due to financial constraints. Further the list of the affected members of staffwasbeingvalidated.

2.3.OversightVisittoBungoma CountyReferral Hospital(BCRH)

21.The Committeeconducted anoversightvisit to theBungoma Level 5 Hospital in Bungoma County on Friday 14th November, 2025 accompanied Mr. Chrispinus Barasa, the County Executive Committee Member for Health and Sanitation; Dr. Magrina Mayama, the County Chief Officer for Health and Sanitation;Dr.Simon Kisaka, the Bungoma County Hospital Superintendent; Mr. Humphrey Silungi, the County Director of Public Works and Mr. Robert Mose, Bungoma County Health AdministrativeOfficer.
22.During theCommitteewasinformed that:
a)The hospital had a bed capacity of three hundred and eleven (31l) beds including thirty-one (31) maternity beds.Additionally,the Newborn Unit accommodated atotalof thirty-one(31)cots and ten(10)KangarooMother Care (KMC) beds;

b)The facility employed a total of twenty-two (22) consultants, including eleven (11) medical officers nine (9) on Permanent and Pensionable (PNP) terms and two (2) on contract terms. Additionally, the facility employed thirty-six (36) registered clinical officers, comprising twenty-six (26) on PNP terms, seven (7(on Bungoma County Government contracts, and 3 on Universal Health Coverage (UHC) terms. These included twenty (20) general clinical officers and sixteen (16) specialists;
c) Nursing staff totaled to one hundred and eight one (181), made up of one hundred and thirty-five (135) on PNP, thirty-five (35) on Bungoma County Contract, nine (9) on UHC.one (1) Dumisha and one (1) on MOH COVID 19 Fund contract. These includes one hundred and forty-three (143) general
d)The pharmacy department had two (2) General pharmacists employed on PNP terms with one (1) on Bungoma county contract, pharmaceutical technologist was seven (7) on PNP, Seven (7) on Bungoma County contract and two (2) on UHC. Further the Radiography services were supported by nine (9) radiographers,of whom four (4) were on PNP terms and one (1) on Bungoma county Government contract and four (4) on Universal Health Coverage (UHC);
e)The Nutrition staff included 9 nutritionists three (3) on PNP terms and six (6) officers on Bungoma county Government contract.However,the facility did not have a psychologist on permanent and pensionable terms and therefore relied onlocum psychologist;
officer anesthetists on permanent and pensionable (PNP) terms, two (2) on locum terms, and two (2) nurse anesthetists. The facility also employed nine (9) physiotherapy staff (6 on PNP terms and 3 on contract); 7 occupational therapists (5 on PNP terms, 2 on locum terms, and 1 on Bungoma County Government contract); and 5 orthopedic trauma staff (2 on PNP terms, 2 on machines that were operational and three(3) that were defective;
23.The Committee was further informed that the hospital faced challenges related to delayedSHAreimbursements amountingtotwohundred andfourteenmillioneight hundred and ninety-four thousand, four hundred and seventeen shillings (214,894,417)whichhadadverselyaffected thedeliveryof effectiveservices. Further, in the FY 2023/2024, the facility collected - 284,017,917 Facility Improvement Fund (FIF) revenues.

24.During the visit at the Bungoma County Referral Hospital, the Committee made thefollowingobservations-
a) That the health management system deployed by JumboSoft System was not providing the intended services to the hospital and experienced frequent downtime, despite the substantial investment made in its acquisition;
b) The Hospital faced significant challenges stemming from deteriorating infrastructure and overcrowding. The physical environment was in poor condition, with broken furniture in consultation rooms, cracked floors, faded and peeling wall paint and damaged ceilings. Wards were congested, forcing some in-patients to occupy verandahs improvised as wards furnished with old, rustybeds,unclean linen,and inadequate working surfaces and equipment, conditions that collectively compromised patient comfort and quality of care;
c)There were loose electrical sockets and exposed wiring in thelaboratory, alongside a shortage of essential reagents, while the hospital kitchen was old, poorly maintained, inadequately equipped and lacked modern equipment and essentialtoolsnecessaryforefficientoperation;

Picture2: Thecrackedflooratthemaincorridorsandcommonareasofthe BungomaCountyReferralHospital.

Damaged roof at Bungoma County Referral Hospital with

Picture3&4 damagedceilingsandlooseelectricalwires.

Picture5&6: Severely damp and mould-infested corridor ceiling with corroded exposed pipework,highlighting chronic waterleakage andpoormaintenanceandsmoke-stainedkitchenwallwith extensivetilelossandexposed,deterioratedplaster demonstratinglongstandingneglect ofbasicmaintenancein the kitchen.

Picture7: Piles of obsolete desktop computers, printers and other ICT equipment heapedinahospital room,underscoringpoore-wastemanagement and theneedforstructureddisposal ofcondemnedassets.

Picture8: Severelywornkitchenworktopwithpotholes,stagnantwastewaterand cracked surfacewherevegetables arebeingprepared,illustratingpoor food-handling and infection-preventionstandards.

Picture9: Oldfirewood-fueled hospital kitchenwith large,soot-stained cooking pots andwet, slippery floor,highlighting outdated equipment and significantoccupational andfood-hygienerisks.

Picture 10:Poorly ventilated and cramped dry-store with cooking oil jerrycans and bulkfoodsacksstackedondustywoodenshelvesandfloor,fallingshort ofrecommendedfood-safetyandhospitalnutritionstandards.

Picturell: The Committee Membersinspectingthecongested fresh-produce store,notingpoorventilation and crampedstorageconditionsfor vegetablesandotherfooditems.

d)There was variance in patient data between the admissions office and the wards,particularly between the admission office and the NewMother and Child Wing, where the recorded number of births also differed from the main hospital, raising concerns about data accuracy. The New Mother and Child Facility was well set out and efficiently run; however, it required re-design to facilitate easy access for stretchers and wheelchairs. During the visit to the New Mother and Child Unit, the Committee was also alarmed by the high numberofteenagemothers;

Picture12: TheMotherandBabyHospitalmainentranceblock, showingthenewlyconstructedmaternitywingwherethe oversightteamnotedimprovedinfrastructurecomparedto

theoldhospitalbuildings.

Therewas only onelaundrymachine serving theHospital out of fourobserved at the laundry unit, with the other machines appearing to have been nonfunctional for an inordinate long period, resulting in a large pile of dirty linen from the medical wards. The Committee observed piles of surgically soiled linen being washed alongside other hospital garments and linen, contrary to the normal practice of separate cleaning and further noted that electronicwaste was being dumped in thelaundry store.In addition,there were only three laundry staff members who were serving as casual labourers at the unit since2019;

Congestedhospitallaundryroomwithageingindustrial machinesandaheapofsoiledlinenonthefloorand an abandonedwashingmachinelyingoutsidethe laundry section,symbolizingreflectinginadequateworkflow,poor hygiene and limitedcapacityforsafelinenmanagement.

Picture13&14:

Picture 15: Cluttered hospital store room filled with bulging gunny bags, scrap metal and old records,reflecting poorwaste segregation, fireriskandinadequatespacemanagementatBungomaCounty ReferralHospital.

f)Some patientsinformed theMembers that theywereasked topurchase prescribed medicines from outside the hospital, yet the Committee's inspection of thepharmacyconfirmed thatthesamemedicineswereinstockand itwas further noted that there was no record for controlled opioid (narcotic) analgesic and regulated medicine and drugs such as morphine;
g)That thewaste disposal point waswell maintained but it was located adjacent to staff quarters and lacked proper segregation,while the mortuary, though well maintained, was overcrowded and did not have adequate arrangements for managing bereaved families collecting bodies;

Picture16:IncineratorattheHospital,wheretheCommitteenotedwithconcern thatitissituatedadjacenttostaffquartersandlackspropersegregation ofwaste.

Picture17:ServiceDeliveryCharterat theMortuary ofBungomaCounty Referral Hospital.

h)The Committee noted that the Emergency Department, staffed by two medical officers, six clinical officers and twelve nurses, manages a heavy workload from neighbouring counties such as Kakamega and Trans Nzoia,as well as patients from neighbouring Uganda, resulting in significant strain on the already limited resources. It was reported that in some shifts,only one nurse was on duty, further exacerbating the heavy workload and potentially compromising the quality and timeliness of emergency care;
The Committee noted that a Radiography Complex was under construction but expressed concern over the poor workmanship, and further emphasized the need for a comprehensivehospital master plan to consolidate thefacility layout and adequately provide for future expansion; and
The Committee observed that thefacilityhad onlyeight radiographers against an estimated requirement of 16 to 20,resulting in understaffing in the Radiology Department. Moreover, the MES equipment were non-functional, s s per day, and there was no functional CT scan available at the facility.

Picture18: CommitteebeingtakenthroughademonstrationofX-ray equipmentatBungomaCountyReferralHospital.

Picture19: Internal view of theRadiography Complex under construction at Bungoma County Referral Hospital, where the Committee expressed concern over the poor

workmanship.

Picture20: ExternalviewoftheRadiographyComplexwheretheCommittee underscoredtheimportanceofacomprehensivehospital masterplantoconsolidatethefacilitylayoutandmakeadequate provisionforfutureexpansion

2.4. County OversightVisittoKimaeti Health Centre

25.The Committee conducted an oversight visit to Kimaeti Health Centre on 14th November, 2025.The Committee was received by Mr.Paul Wamalwa, Clinical Officer in Charge of the Kimaeti Health Centre, a level II health facility.

26. During the oversight visit, the Committee was informed that the Hospital operated on a 24-hour basis,with the Health Records Unit managed by four contracted employees, two engaged directly by the Hospital and two under a partnership arrangement, who were further supported by students on attachment. 27. The Committee was informed that the facility experienced persistent understaffing, which adversely affected service delivery and compromised the quality ofcare, with a total of twenty-two (22) casual employees on the staff establishment drawing a combined monthly wage bill of Kshs. 266,000.

28.The Committee was further informed that the facility experiences challenges arising from delayed Social Health Authority (SHA) reimbursements, which have led to arrears in the payment of wages to casual employees. The Committee noted that Kimaeti Health Centre increasingly relies on internally generated resources to sustain operations.

Picture 21: Signage atthe entranceofKimaetiHealthCentreinBungoma County,undertheDepartmentofHealthandSanitation.

29.The Committee was further informed that the facilitycomprises a laboratory, pharmacy, Maternal and Child Health (MCH) unit, records office, administration block, male and female wards and a maternity ward, and has a bed capacity ofthirtyfive (35). At the time of the visit, the Committee also observed a long-stalled building project within the facility. The maternity ward had no curtains or mosquito nets, was not clean and appeared unusually deserted, with some rooms being used tostoreobsoletematerials and documents;
30.The Committee observed that thefacility had a total of fourteenstaff posted by the County Government, comprising clinical officers, a Health Administrative Officer, two laboratory technologists, one nutritionist, one clerical officer and eight nurses. Against theMinistry of Health staffingnormsfor a Level 3Afacility,thenumber of clinical officers and nurses was below the recommended minimum, limiting the laboratory and nutrition services barely met the minimum staffing requirements;
31.The Committee observed that the health centre infrastructure was in a poor state; the kitchen was a semi-permanent, poorly maintained structure that relied on firewood; the facility depended on inadequate manual sterilization of medical kits; the male wards were poorly maintained, with curtains falling; and there was a stalled building that required completion to decongest the already limited facility space.

Picture22:

TheCommitteeChairpersoninspects apatientward atKimaeti Health Centre inBungoma County,highlighting concerns about

thestateoftheinfrastructureandgeneralwardconditions.

Picture23:ObsoletematerialsstoredinoneoftheroomsatKimaetiHealth Centre.

Picture 24:TheLaboratory workspace atKimaeti Health Centre,Bungoma County.

Picture25: Ceiling damage at Kimaeti Health Centre with visiblewater stains, cracksandstructuraldeterioration.

Picture26:Patientward atKimaetiHealthCentre,showinginadequate maintenance,withdamagedwall structures andwornbeddings,

Picture27:Sanitationfacilitiesandwashroomareashowingvisible structuraldeterioration,peelingwalls,andinadequate maintenanceatKimaetiHealthCentre.

Picture28:KitchenfacilitiesatKimaetiHealthCentre;modestinfrastructure withvisiblewear and limited amenities,underscoring theneed for investmentinimprovedfoodpreparationandstorageareas.

2.5. OversightVisittoKakamegaCountyReferralHospital

32.The Committee conducted an oversight visit to the Kakamega County Referral Hospital on Saturday 15th November, 2025 accompanied Mr. Livingstone Imbayi, the County Executive Committee Member for Health Services; Dr. David Alilah, the County Chief Officer for Medical Services; Dr. Dixon Mchana, the Kakamega CountyHospital ActingMedicalSuperintendent.TheCommittee was also accompaniedbytheMembersoftheCountyAssemblyCommitteeonHealth
33.During the oversightvisit, the Committee was informed that the facility maintains a total bed capacity of 384. This capacity is distributed across various general and specializedwardsto accommodatediversepatientneeds.Thegeneralwardsinclude Ward 1 with 20 beds, Ward 2 with 19 beds, Ward 3 with 22 beds,Ward 4 with 21 beds,and thelargest section,Wards5A& 5B,which provides 51beds.Additional general inpatient space is found in Ward 6A (21 beds), Ward 7A (18 beds), Ward 7B (8 beds), Ward 8 (13 beds), and Ward 9 (22 beds).
34.The Committee was informed that specialized care units at the hospital are comprised of a 14-bed Oncology unit, a 10-bed Burns Unit and an Intensive Care Unit (ICU) equipped with 6 beds. Maternal and neonatal care are significant components of thehospital's infrastructure,featuring a NewbornUnit (NBU)with 38beds,a Post-Natal Ward (PNW) with 45 beds, an Ante-Natal Ward (ANW) with 14 beds and a Labour Ward (LW) with 7 beds. The facility also provides 6 beds for Kangaroo Mother Care (KMC) and 6 beds for the High Dependency Unit (HDU), alongside an Amenity ward containing 23 beds.Beyond active patient care, the hospital's mortuary is noted tohave a capacityof 112 bodies.
35.The Committeewasfurtherinformed that theHospital'shumanresourcesare divided into three primary categories; Permanent and Pensionable (P&P), Locum, and Universal Health Coverage (UHC). The Medical and Clinical Staff consists of 35 consultants,all of whom are onPermanent and Pensionable terms and51 medical officersconsistingof33P&Pstaff and18 Locumstaff.Thereis atotalof62Clinical Officers, including 35 P&P, 26 Locum, and 1 UHC. There are 9 specialized clinical officers, all on P&P terms. The nursing staff constitute the largest segment of the workforce. There are 347 general nurses (231 P&P, 112 Locum, and 4 UHC) and 38 specialized nurses (37 P&P and 1 Locum).

36. During the visit at the Kakamega County Referral Hospital, the Committee made the following observations-

a)The National Health Information Management System (NHIMS) had not been deployed at the Hospital. The existing reporting system was observed to be userunfriendly,with patient information not easily retrievable.Furthermore,the facility had an inadequate number of Social Health Authority (SHA) verification machines, compelling patients to be transferred from hospital wards to the admissions area to access SHA services;

b) The Outpatient Department (OPD) operated only during daytime hours, attending to approximately 120 patients per day and about 45 patients over the weekend.It wasfurther observed that there was no duty rota in place,resulting in delays in service delivery.Additionally,staff members did not wear name tags or uniforms bearing their names, hindering ease of identification and accountability;

2. c)The Committee observed that some patients were being detained at the facility due to unsettled hospital bills. The Labour Ward was found to be congested, with 65 mothers occupying only 45 available beds, thereby compromising patient privacy.Similarly,eightincubatorswerebeingused to accommodate 15 infants, raising concerns about neonatal safety and the quality of care provided; 3. d)The Committeefurther noted thelackofwaitingbays orbenchesfor patients visitors and the absence of curtains or blinders in some wards,particularly within the maternity section, which affected patient privacy and comfort. Additionally,onlytwotoiletswere availablefor useby over 20patients and caregivers,highlighting inadequate sanitation facilities in the wards;

e) The hospital received medical supplies from KEMSA and MEDS; however, a significant portion of the stock had short expiry periods, raising concerns about inventory control and wastage. Further, The Committee observed inconsistencies in thepharmaceutical records,with expired drugsfound stocked on the shelves. Patients were further required to obtain prescribed medicines directly from the central drug store due to stock management challenges;

5. The Emergency Unit lacked essential protective equipment, including hand gloves, which health personnel reported that there were instances where patients were required to purchase medical supplies such as gloves and syringes prior to receiving medical attention. It was further noted that the hospital did not have a functional ambulance, despite substantial budgetary provisions by the County Assembly for the same. Additionally, the designated ambulance driver had not undergone the requisite training. The Committee also noted with concern the dilapidated condition of seats and thedeteriorating ceilingwithin theAccident andEmergencyDepartment;

g) The Hospital infrastructure was in a dilapidated state. Several window panes exposed, posing safety risks, while seats and stretchers were extensively worn out, reflecting poor maintenance of the facility;

Picture 27:

Thedilapidatedinterioroftheambulanceat Kakamega County Referral Hospital, including wornseating,rustedsurfaces,andinadequate emergency equipment,reflects systemic neglect of criticalemergencyservices.

Picture 28:Thedeteriorated state ofinfrastructure atKakamega County Referral Hospital, exemplified by weathered and damaged entry doors.

Picture 28:A Committee Member points out a damaged signage at the Outpatient Department,highlighting systemic gaps in facility maintenance at KakamegaCountyReferral Hospital.

Picture29: ThewornanddamagedfurnitureatKakamegaCountyReferral Hospitalinapatientservicearea.

Picture 30: Improvised coverings affixed to clinical areas at Kakamega County Referral Hospital.

Picture31: Exposed andpoorlysecuredelectrical wiringatKakamegaCounty ReferralHospital.

Picture32:Thewater-damaged and deterioratingceiling atKakamega County ReferralHospital.

Picture 33:A section of dilapidated infrastructure at Kakamega County Referral Hospital.

Picture 33:A patient being wheeled from the wards to the main admissions section toauthenticateSHAbiometrics.

Picture 34:Kakamega County Referral Hospital Pharmacy Store.

Picture 35: MembersoftheCommitteeinspectthepharmacystoreatKakamegaCounty ReferralHospital,wheretheynotedasignificantportionofthestockhad shortexpiryperiods,raisingconcernsoverinventory control andpotential wastage.

h) The Radiology Unit lacked essential consumables required for its efficient operation. The mammogram and MRI machines had been non-functional for thepast five months,while the ultrasound equipment was not operating optimally.Additionally,thelaboratorywasfoundtobeequippedwithobsolete andagingmachines,whichadverselyaffected the qualityandtimeliness of diagnosticservices;

2. i The hospital waste was being poorly managed, with waste from the dumpsite burntin anopenfield.Staff assigned tohandle and burnthewastewerenot provided with appropriate protective clothing, thereby exposing them to health and safety risks; 3. 1 The facility's roofing structure was made of asbestos, in contravention of the EnvironmentalManagementandCoordination (WasteManagement) Regulations,2006.Although theHospitalhad a secured plotdesignatedfor the disposalofreplaced asbestosroofing,piecesofasbestoswere stillvisible on the grounds, and some asbestos materials had been buried in an open area used as an incinerator,posingserious environmental and occupational health hazards;

Picture34:AccumulatedbiomedicalwasteatKakamegaCountyReferralHospital wheretheCommitteeobservedpoorwastemanagementpractices, includingtheburningofrefuseincludingmedicalwastesinanopen field.

Picture 35:Accumulated mixed waste at Kakamega County Referral Hospital.

Picture36:MembersoftheCommitteeinspect theopenhospital dumpsiteat Kakamega CountyReferral Hospital,where they observed thatwaste from the facility was being burnt in the open exposing patients, staff and thesurroundingcommunitytoserioushealthandsafetyrisks.

Picture37&38: TheCommitteevisittotheareadesignatedforthedisposalof replaced asbestos roofingwherepiecesof asbestoswere still visibleon thehospitalgrounds,andsome asbestosmaterialshad beenburiedin anopen area usedasanincinerator.

k) The mortuary was well maintained and efficiently managed. It had a private wing that generated own-source revenue for the hospital. The unit had nine morticians—threepermanent and six on contract-one ofwhom had servedfor nine years without confirmation. The Committee further noted concerns regarding staff who had served for extended periods without being confirmed as permanent and pensionable employees.

Picture 40:The Kakamega County Referral Hospital Mortuary which was observed tobewellmaintainedandefficientlymanaged.

Picture 41: The 'private wing' of the Kakamega County Referral Hospital.

CHAPTERTHREE

3.COMMITTEEOBSERVATIONS

37.The Committeemadethefollowing observationsfrom thevisit to thehealthcare facilitiesinthetwocounties.

3.1.Infrastructure and Physical Facilities

a)Structuraldeteriorationandmaintenancedeficits

38.The Committee observedwidespread infrastructure deterioration across thevisited facilities. At Bungoma County Referral Hospital (BCRH), the physical environment was in poor condition with broken furniture in consultation rooms, cracked floors, faded and peeling wall paint and damaged ceilings. Wards were congested forcing some in-patients to occupy verandahs improvised as wards furnished with old, rusty beds, unclean linen and inadequate working surfaces and equipment.
39.At Kimaeti Health Centre,the infrastructure was similarly in a poor state.The facility depended on a semi-permanent, poorly maintained kitchen structure that relied on firewood.Male wards were poorly maintained with curtains falling and there was visible ceiling damage with water stains, cracks and structural deterioration. Sanitation facilities showed visible structural deterioration, peeling walls and inadequatemaintenance.
40.Kakamega County Referral Hospital (KCRH) exhibited equally concerning conditions.Thehospital infrastructurewas in a dilapidated statewithseveralbroken windowpanes temporarilyblockedwith cartons.Electricalcableswereexposed, posing safety risks,while seats and stretchers were extensively worn out.The Committee observed water-damaged and deteriorating ceilings,damaged entry doors and worn furniture in patient service areas.

b)OccupationalHealthandSafetyHazards

41.Another critical cross-cutting deficiency is the lack of safe disposal mechanisms, particularly functional incinerators across the counties.At BCRH, the Committee noted loose electrical sockets and exposed wiring in the laboratory. The hospital kitchen was old, poorly maintained, inadequately equipped and lacked modern equipment and essential tools necessary for efficient operation.
42.At KCRH exposed electrical cables posed immediate safetyrisks.Most alarmingly, the facility's roofing structure was made of asbestos, in contravention of the Environmental Management and Coordination (Waste Management) Regulations, 2006. Although the Hospital had a secured plot designated for disposal of replaced asbestos roofing, pieces of asbestos were still visible on the grounds, and some asbestos materials had been buried in an open area used as an incinerator, posing seriousenvironmentalandoccupationalhealthhazards.

c)InadequateCapacity andOvercrowding

43.Bothreferralhospitalsdemonstratedsevere overcrowding.At BCRH,wardswere congested with patients occupying verandahs as improvised wards. The Emergency Department, staffed by two medical officers, six clinical officers and twelve nurses, managesaheavyworkload fromneighbouring countiessuch asKakamega and Trans Nzoia, as well as patients from neighbouring Uganda,resulting in significant strain on already limited resources. It was reported that in some shifts, only one nurse was on duty.
44.At KCRH,theLabourWard wasfound tobe congestedwith65mothers occupying only 45 available beds, thereby compromising patient privacy. Similarly, eight incubators were being used to accommodate 15 infants,raising concerns about neonatal safety and the quality of care provided. The Committee further noted the lack of waiting bays or benches for patients'visitors and the absence of curtains or blinders in some wards, particularly within the maternity section.

d)IncompleteandStalledDevelopmentProjects

45.The Committee observed evidence of stalled constructionprojects.At BCRH,a RadiographyComplexwasunderconstructionbuttheCommitteeexpressed concern over thepoor workmanship and emphasized theneedfor a comprehensive hospital master plan to consolidate thefacilitylayout and adequately provide for future expansion.
46.At Kimaeti Health Centre, the Committee observed a long-stalled building project within thefacility that required completion to decongest the alreadylimitedfacility space. The maternity ward appeared unusually deserted with some rooms being used to store obsoletematerials and documents.

3.2. HumanResourcesforHealth

a)ChronicUnderstaffing

47. Understaffing emerged as a critical challenge across all visited facilities. At Kimaeti Health Centre,the Committeewasinformed that thefacility experiencedpersistent understaffing which adversely affected service delivery and compromised the quality of care. The facility had a total of fourteen staff posted by the County Government.Against theMinistryof Healthstaffingnormsfor a Level3Afacility. The number of clinical officers and nurseswasbelow the recommended minimum, limiting the facility's capacity to provide continuous inpatient and maternity services. 2. 48.At BCRH, the facilityhad only eight radiographers against an estimated requirement of 16 to 20, resulting in understaffing in the Radiology Department. The hospital did not have a psychologist on permanent and pensionable terms and therefore relied on locumpsychologists.

b)EmploymentTermsandJobSecurityIssues

49.The Committee observed concerning patterns regarding employment terms. At Bungoma County Referral Hospital, the conversion and confirmation of Universal Health Coverage (UHC) staff totaling up to 245 across all cadres was still pending due to financial constraints, with the list of affected staff said to be undergoing validation.
50.At Kimaeti Health Centre,the facility had a total of 22 casual employees on the staff establishment drawing a combined monthly wage bill of Kshs 266,000. The facility experienced challenges arising fromdelayedSocial Health Authority(SHA) reimbursements,which hadled toarrears in the payment of wages tocasual employees. Three laundry staff members at BCRH had been serving as casual labourers since 2019.
51.At Kakamega County Referral Hospital, the Committee noted with concern staff who had served for extended periods without being confirmed as permanent and pensionable employees. One mortician had served for nine years without confirmation.

c)StaffIdentificationandAccountability

52. At Kakamega County Referral Hospital, the Committee observed that staff members did not wear name tags or uniforms bearing their names, hindering ease of identification and accountability. Additionally, there was no duty rota in place in the Outpatient Department, resulting in delays in service delivery.

3.3. Medical Equipment and Technology

a)Non-FunctionalandInadequateTechnology

53.TheCommitteefound numerousinstances of non-functional criticalmedical equipment.TheBCRHwasequippedwithtwodialysismachines thatwere operational and three that were defective. The MES equipment were non-functional, with only one X-ray machine operational serving approximately 60 patients per day, and therewasnofunctional CT scan available at thefacility.At Kimaeti Health Centre, the facility depended on inadequate manual sterilization of medical kits, indicating lack of modern sterilization equipment.
54.At Kakamega County Referral Hospital, the mammogram and MRI machines had been non-functional for thepast five months,while theultrasound equipment was not operating optimally. The laboratory was found to be equipped with obsolete and aging machines which adversely affected the quality and timeliness of diagnostic services.Thehospital did nothave a functionalambulance despite substantial budgetaryprovisionfor the same.Further the designated ambulance driver had not undergone therequisite training.

b)LaundryandSanitationEquipment

55. At Bungoma County Referral Hospital, there was only one laundry machine serving theHospital out of four observed at the laundryunit,with the other machines appearing to have been nonfunctional for an inordinate long period, resulting in a large pile of dirty linen from the medical wards.

c)ElectronicWasteManagement

56. The Committee observed poor management of obsolete equipment. At Bungoma County Referral Hospital, piles of obsolete desktop computers, printers and other ICT equipment were heaped in a hospital room underscoring poor e-waste management and the need for structured disposal of condemned assets.Electronic waste was also being dumped in the laundry store.

3.4.HealthInformationSystemsandDataManagement

a)SystemPerformanceandDowntime

57.At Bungoma County Referral Hospital, the Committee observed that the health management system deployed byJumboSoft System wasnot providing theintended services to the hospital and experienced frequent downtime, despite the substantial investment made in its acquisition.

b)DataAccuracy and Consistency

58.TheCommitteeidentified significant dataintegrityissues.AtBungoma County Referral Hospital, therewasvariance inpatient databetween the admissions office and thewards,particularlybetween the admission office and theNewMother and Child Wing where the recorded number of births also differed from the main

c)SystemDeploymentGaps

59.At Kakamega County Referral Hospital, the National Health Information Management System(NHIMS)had not beendeployed.The existing reporting system was observed tobe user-unfriendly,withpatient information not easily retrievable. Furthermore, the facility had an inadequate number of Social Health Authority (SHA) verification machines compelling patients to be transferred from hospitalwardstotheadmissions areatoaccessSHAservices.

3.5. Pharmaceutical Services and Supply ChainManagement

a)StockManagementDeficiencies

60.KakamegaCountyReferral Hospitalhadreceivedmedical suppliesfromKEMSA and MEDS; however, a significant portion of the stock had short expiry periods, raising concernsaboutinventorycontrol andwastage.TheCommitteeobserved inconsistencies in the pharmaceutical records, with expired drugs found stocked on theshelves.Patientswererequired toobtainprescribedmedicinesdirectlyfrom the central drugstoreduetostockmanagement challenges.

b)PatientAccesstoMedicines

61.AtBungoma CountyReferral Hospital,patients informed Members that theywere asked to purchase prescribed medicines from outside the hospital,yet the Committee's inspection of the pharmacy confirmed that the same medicines were in stock.

ControlledSubstancesManagement

62.At Bungoma County Referral Hospital, it was noted that there was no record for controlled opioid (narcotic) analgesic and regulated medicine and drugs such as morphine.

d)ShortageofEssentialSupplies

63.At Kakamega County Referral Hospital, the Emergency Unit lacked essential protective equipment, including hand gloves.Health personnel reported instances wherepatientswererequiredtopurchasemedicalsuppliessuch asgloves and syringes prior to receiving medical attention. The Radiology Unit lacked essential consumables required for its efficient operation.

3.6. InfectionPrevention and Control

a)LaundryandLinenManagement

64.At BCRH the Committee observed piles of surgically soiled linen being washed alongside other hospital garments and linen, contrary to the normal practice of separate cleaning. There was a large pile of dirty linen from the medical wards due toinsufficientfunctionallaundrymachines.

b)KitchenandFoodSafety

65.The Committee identified serious food safety concerns.At BCRH, the hospital kitchenexhibitedsmoke-stainedwalls withextensivetilelossandexposed, deteriorated plaster demonstrating longstanding neglect of basic maintenance. The Committee observed aseverelywornkitchen worktop withpotholes,stagnant wastewater and cracked surface where vegetables were being prepared, illustrating poor food-handling and infection-prevention standards.The old firewood-fueled hospital kitchen had large, soot-stained cooking pots and wet, slippery floors. The dry-store was poorly ventilated and cramped with cooking oil jerrycans and bulk food sacksstacked on dustywoodenshelves andfloor.
66.At Kimaeti Health Centre, the kitchen was a semi-permanent, poorly maintained structurethatreliedonfirewoodwithvisiblewearandlimitedamenities.

c)SanitationFacilities

67.AtKakamega CountyReferralHospital,only two toiletswere availablefor use by over 20 patients and caregivers, highlighting inadequate sanitation facilities in the wards.At Kimaeti Health Centre,sanitation facilities and washroom areas showed visible structural deterioration, peeling walls, and inadequate maintenance.

d)WasteManagementPractices

68.Critical wastemanagement failures were also observed.At BCRH,the waste disposalpointwaswellmaintainedbutwaslocated adjacenttostaffquartersand lacked proper segregation.AtKCRH waste was beingpoorly managed,with waste from the dumpsite burnt in an open field. Staff assigned to handle and burn the waste were not provided with appropriate protective clothing,thereby exposing them to health and safety risks.The Committee observed accumulated biomedical waste and mixed waste being burnt in the open, exposing patients, staff and the surrounding community to serioushealth and safety risks.

3.7.Financial Management and Sustainability

a)SocialHealthAuthority(SHA)ReimbursementChallenges

69. Both referral hospitals reported significant challenges with SHA reimbursements. At Bungoma County Referral Hospital, the hospital faced challenges related to delayed Social HealthAuthority(SHA)reimbursements amounting toKshs 214,894,417whichhadadversely affected thedeliveryof effective services.At Kakamega CountyReferral Hospital, the Committee observed that some patients werebeing detained at thefacility due to unsettled hospital bills. 70. At Kimaeti Health Centre, the facility experienced challenges arising from delayed Social Health Authority(SHA) reimbursements,which had led to arrears in the payment of wages to casual employees.The Committee was informed that Kimaeti Health Centreincreasingly relies on internallygeneratedresources tosustain operations.

b)FacilityImprovementFinancing

71. In Financial Year 2023/2024, the Bungoma County Referral Hospital collected Kshs 284,017,917 in Facility Improvement Fund (FIF) revenues. During the visit, the County reported a collection of Kshs 441.40 million as FIF in FY 2024 2025, which was 42 percent of the annual target of Kshs 1.06billion,retained and utilized at source in line with the Facility Improvement Financing Act, 2023.

3.8. Specialized Services and Emergency Care

a)EmergencyDepartmentOperations

72.At Kakamega County Referral Hospital, the Outpatient Department operated only during daytime hours, attending to approximately 120 patients per day and about 45 patients over theweekend.At Bungoma CountyReferral Hospital,theEmergency Department manages a heavy workload from neighbouring counties and neighbouring Uganda, with reports that in some shifts only one nurse was on duty, further exacerbating the heavy workload and potentially compromising the quality and timeliness ofemergencycare.

b)MortuaryServices

73.At Bungoma County Referral Hospital, the mortuary, though well maintained, was overcrowded and did not have adequate arrangements for managing bereaved families collecting bodies.In contrast, the Kakamega County Referral Hospital mortuary was well maintained and efficiently managed with a private wing that generated own-sourcerevenueforthehospital.

c)Maternity and Neonatal Care

74.At Bungoma County Referral Hospital, the New Mother and Child Facility was well set out andefficientlyrun;however,it requiredre-designtofacilitate easy access for stretchers and wheelchairs.During the visit to the NewMother and Child Unit, the Committee was alarmed by the high number of teenage mothers. At Kimaeti Health Centre, the maternity ward had no curtains or mosquito nets,was not clean and appeared unusually deserted.

3.9.Quality Assurance and Service Delivery

a)PatientPrivacy andDignity

75.Patient privacy concerns were noted at multiple facilities. At KCRH the lack of curtains or blinders in some wards particularly within the maternity section affected patient privacy and comfort. The Labour Ward congestion with 65 mothers occupying only 45 beds compromised patient privacy. At Kimaeti Health Centre, thematernitywardlacked curtains ormosquitonets.

b)PatientExperience and Access

76. At Kakamega County Referral Hospital, patients were required to obtain prescribed medicines directly from the central drug store due to stock management challenges, andwere compelled tobe transferredfromhospitalwardstothe admissions areato access SHA services due to inadequate verification machines. At Bungoma County Referral Hospital, patients reported being asked to purchase prescribed medicines from outside thehospital despite the samemedicinesbeingin stock.

CHAPTERFOUR

4.COMMITTEERECOMMENDATIONS

77.With theforegoing,the Committee makes thefollowing recommendations -

4.1. CabinetSecretary,MinistryofHealth

78.The Committee makes the following recommendations to the Cabinet Secretary, Ministry of Health-
1)Tofast-track the conclusion and financing of the conversion of UHC staff to permanent and pensionable terms with clear timelines and present an implementation report to theSenatewithinsixty(60)daysfrom the date of adoptionofthisreport;and
2)Toprioritize deployment and integration of theNational HealthInformation Management System at all county referral hospitals and ensurefull functionality of these digital systems, accompanied by user training and change-management.

4.2. ChiefExecutive ofSocial HealthAuthority(SHA

79.The Committee makes the following recommendations to the Chief Executive Officer ofSocialHealthAuthority-
1) To ensure that the National Health Information Management System and SHA verification infrastructure, including biometric and claims-processing equipment, are fully deployed and functional at all public healthcare facilities so thatpatients arenotmovedfromwards toadmissions areasmerely toaccess SHA services;
2)Todevelopandimplementatime-boundplantoclearoutstanding reimbursementbacklogstoallpublichealthcarefacilitiesandensurepredictable disbursement cycles to prevent service disruption and wage arrears;
3)Toestablishclearturnaroundtimestandardsforclaimprocessingand reimbursementtocountyhealthcarefacilitiesandfilewiththeSenate anannual performance report comparing actual reimbursement times against the approved standardsforeachLevel3,Level4and Level5healthcarefacilities
4)Toprovideanimplementationstatustotheaforementionedrecommendations within sixty (60) days from the date of adoption of this report.

4.3. Governor,BungomaCountyGovernment

80.TheCommitteemakes thefollowingrecommendationsto the Governor,Bungoma County Government-
1)To provide adequate budgetary provision in the Financial Year 2026/2027 for phasedabsorption,harmonizationofremunerationandsettlementofrelated healthcare staff obligations;
2)To undertake a comprehensive structural audit and phased rehabilitation of cracked floors, leaking roofs, broken ceilings, damaged doors and windows and unsafe electrical installations prioritizing high-risk clinical areas;
3)To ring-fence and programme part of the development budgets and FIF collections to complete stalled buildings,including the Kimaeti Health Centre block and Bungoma radiography complex and decongest overcrowded wards and maternity units;
4)Toreview the contract and performance oftheJumboSoft Hospital Information System and either enforce service-level agreements to ensure uptime, functionality and user support or competitively procure an alternative interoperablesystemwithin a defined timeline;
5 To allocate dedicated funds to repair or replace non-functional dialysis, MES radiology equipment, mammogram, MRI and obsolete laboratory machines and ensurepreventivemaintenanceschedulesareimplementedandreported quarterly to the County Assembly and the Senate;
6 To enforce strict pharmacy accountability measures, including daily stock reconciliations,prohibition of directing patients to purchase medicines externally where stock exists in-house and proper controlled-drug registers for opioids and otherregulatedmedicines;
7 To urgently procure additional functional laundry machines, employ adequate laundry staff onformal terms and enforce segregation and separateprocessing of surgically soiled linen, in line with the National Infection Prevention and Control (IPC) Guidelines;
8 To provide sufficient resources to upgrade kitchen infrastructure from firewood-based, poorly ventilated units to safer, energy-efficient systems, replace damaged worktops, and enforce food-handling standards, including
9 To strengthen financial management of FIF by ensuring timely remittance and transparent utilization at facility level, with public disclosure of collections and expenditures;

10) To allocate sufficient resources to provide curtains, blinders and adequate toilets and visitor waiting areas in all wards, particularly maternity units, to guarantee patient privacy, dignity and comfort; and

2. 11)To establish and enforce a transparent human resourcemanagementframework in the health sector,including clear duty rosters,staffidentification,promotion guidelines, grievance redress mechanisms, and periodic review of staffing levels against Ministry of Health norms, so as to reduce staff demotivation, improve accountability and support continuity of care. 3. 81.The Governor, Bungoma County submits an implementation status to the aforementioned recommendations within sixty (60) daysfrom the date of adoption of this report.

4.4. Governor,KakamegaCountyGovernment

82.The Committeemakes thefollowing recommendations to the Governor,Kakamega CountyGovernment-
1) To ensure that long serving officers who meet the applicable legal and administrativerequirements are consideredfor confirmation topermanent and pensionable terms,promotion,or placement into equivalent secure terms of service in accordance with Article 41 of the Constitution, the County Governments Act and the principles of fair labour practices in public service;
medicines,ensure timelyredistribution of short-dated stock and eliminate storage of expired medicines on dispensing shelves;
3) To immediately cease open-field burning of mixed and biomedical waste, operationalize or upgrade compliant incineration and waste-segregation systems and provide appropriate PPE to all waste-handling staff;
4) To increase staffing and on-call coverage in Emergency Departments and maternityunits and enforce dutyrotas thatguaranteeminimumnurse and clinician numbers per shift, especially in high-volume facilities;
5) To expeditiously procure and operationalize a fully equipped ambulance for KakamegaCountyReferral Hospitalandensurethatdriversreceive accredited Emergency Driving & Basic Life Support (BLS) Training;
6)Toimmediatelystop thedetention ofpatients over unpaidbills and develop social-protection and indigent-care protocols in line with national policy for handling financially constrained patients;

7) To develop and implement a compliant plan for safe removal, handling, transport and disposal of asbestos roofingmaterialsfromKakamega CRH, including remediation of areas where asbestoshas been buried or exposed;

2. 8)To conduct regular occupational safety audits in hospitals,focusing on exposed electrical wiring, unsafe floors, lack of PPE and unsafe waste-handling practices and implement corrective measures with clear timelines; 3. 9)Toundertake acomprehensivestructural audit andphasedrehabilitationof cracked floors,leakingroofs,broken ceilings,damaged doors and windows and unsafe electrical installationsprioritizinghigh-risk clinical areas; 4. 10)To develop and implement disposal plans for obsolete ICT and medical equipment, in line with e-waste and hazardous waste regulations, and report compliance to National Environment and Management Authority (NEMA) and the Senate within sixty days (60) of adoption of this report; 5. 11)To enforce strict pharmacy accountability measures, including daily stock reconciliations,prohibition of directing patients to purchase medicines externally where stock exists in-house, and proper controlled-drug registers for opioids and other regulated medicines; and 6. 12)To enforce staff identification and accountability by requiring visible name tags and uniforms for all frontline health workers and establishing functional complaints andfeedbackmechanismsforpatients. 7. 83.The Committeefurther recommends that the Governor,Kakamega County submits animplementation statustothe aforementioned recommendationswithin sixty(60) days from the date of adoption of this report.

4.5.County Public Service Boards of Bungoma and Kakamega

84. The Committee makes the following recommendations to the County Public Service Boards of Bungoma and Kakamega Counties- 2. 1)To undertake a comprehensive audit of all long serving staff in the county health departments and county referral hospitals, indicating cadre, date of first appointment,current terms of service,station,sourceofemoluments and whether the officer serves against an approved establishment; 3. 2)Todevelop and implement a time-bound regularization planfor healthcare worker who have served for prolonged periods on locum,casual, contract or other insecure terms while discharging continuous and core health functions, with priority accorded to critical cadres in referral hospitals and high-volume primarycarefacilities.

3) To submit progress reports on the status of validation, confirmation, deployment, promotion and retention of long serving staff, including officers who have served for extended periods without confirmation within sixty (60) days from the date of tabling this report.

Annex 1:

Minutes of the Committee Sittings

13THPARLIAMENT5THSESSION

MINUTESOFTHESIXTEENTH(16TH)SITTINGOFTHESTANDINGCOMMITTEE ON HEALTH HELD ON, THURDAY 26TH MARCH,2026 AT 11.00 PM AT GLEE HOTEL,KIAMBUCOUNTY

MEMBERSPRESENT

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

Chairperson

2.Sen.MariamSheikh Omar,MP

-Vice-Chairperson

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

-Member

4. Sen. Richard Onyonka, MP

Member

5. Sen. Tabitha Mutinda, CBS, MP

-Member

Sen. Hamida Kibwana, MP -Member

7.Sen.Vincent Kiprono Chemitei Cheburet, MP

-Member

ABSENTWITHAPOLOGY

1. Sen. Ledama Olekina, CBS, MP

-Member

2. Sen. Joseph Githuku Kamau, MP

Member

SENATESECRETARIAT

1. Mr. Humphrey Ringera

-Senior Research Officer

2. Mr. Amos Kiangwe

Senior Clerk Assistant

3. Mr. David Ngamate

Clerk Assistant

4. Mr. Gilbert Juma

Legal Counsel

5. Mr. Ian Otieno

-Audio Recording Officer

6. Mr. Stanley Gekore

-Media Relations Officer

7. Ms. Yvonne Momanyi

Legal Intern (DLS)

8.1 Mr. Ham Juma

Legal Intern (DLS)

MIN/SEN/SCH/077/2026

PRELIMINARIES

The Chairperson called the meeting to order at twenty-six minutes past eleven o'clock and the proceedings commenced with a word of prayer followed by brief introduction of those present.

MIN/SEN/SCH/078/2026

ADOPTIONOFTHEAGENDA

The agenda of the meeting was adopted as listed below upon being proposed by Sen. Tabitha Mutinda, CBS, MP and seconded by Sen.Richard Onyonka, MP.

1. Preliminaries; 2. a)Prayer 3. b)Introductions 4. 2.Adoption of the Agenda; 5. 3.Confirmation of the Minutes; 4. Matters arising; 7. 5.Consideration and Adoption of Committee Report on Oversight Visit to Bungoma and Kakamega Counties (Committee Paper No.169); 8. 6.Any otherBusiness;and 9. 7.Adjournment/Date of the Next Meeting

MIN/SEN/SCH/079/2026

CONFIRMATIONOFTHEMINUTES

1. The Minutes of the 64th meeting held on Friday, 14th November, 2025 were confirmed as a true record of the proceedings having been proposed by Sen. Mariam Omar, MP and seconded by Sen. Richard Onyonka, MP; 2. The Minutes of the 65th meeting held on Friday, 14th November, 2025 were confirmed as a true record of the proceedings having been proposed by Sen. Mariam Omar, MP and seconded by Sen. Richard Onyonka, MP; 3. The Minutes of the 66th meeting held on Saturday, 15th November, 2025 were confirmed as a true record of the proceedings having been proposed by Sen. Richard Onyonka, MP and seconded by Sen. Mariam Omar, MP; 4. The Minutes of the 67th meeting held on Saturday, 15th November, 2025 were confirmed as a true record of the proceedings having been proposed by Sen. Mariam Omar, MP and seconded by Sen.Richard Onyonka,MP; 5. The Minutes of the 6th meeting held on Thursday, 12th March, 2026 were confirmed as a true record of the proceedings having been proposed by Sen. Tabitha Mutinda, CBS, MP and seconded by Sen. Justice (Rtd) Stewart Madzayo, EGH, MP; 6. The Minutes of the 11th meeting held on Monday, 16th March, 2026 were confirmed as a true record of the proceedings having been proposed by Sen. Tabitha Mutinda, CBS, MP and seconded bySen.HamidaKibwana,MP; 7. The Minutes of the 12th meeting held on Monday, 16th March, 2026 were confirmed as a true record of the proceedings having been proposed by Sen. Tabitha Mutinda, CBS, MP and seconded bySen.HamidaKibwana,MP; 8. The Minutes of the 14th meeting held on Monday, 23rd March, 2026 were confirmed as a true record of the proceedings having been proposed by Sen. Hamida Kibwana, MP and seconded by Sen.Richard Onyonka,MP; and

9. The Minutes of the 15th meeting held on Monday 23rd March, 2026 were confirmed as a true record of the proceedings having been proposed by, Sen. Tabitha Mutinda, CBS, MP and seconded by Sen. Justice (Rtd) Stewart Madzayo, EGH, MP;

MIN/SEN/SCH/080/2026

Therewerenomatters arising.

MIN/SEN/SCH/081/2026

MATTERSARISINGFROMPREVIOUSMINUTES

CONSIDERATIONANDADOPTIONOFCOMMITTEE REPORTONOVERSIGHTVISITTOBUNGOMAAND KAKAMEGACOUNTIES(COMMITTEEPAPER NO.169);

1. The Secretariat presented the Committee Report on the oversight visits to Bungoma and Kakamega counties as contained in Committee Paper No. 169 for consideration and adoption. 2. Following deliberations, the Committee adopted the report with amendments after being proposed by Sen. Mariam Sheikh Omar, MP and seconded by Sen. Tabitha Mutinda, CBS, MP.

MIN/SEN/SCH/082/2026 ANYOTHERBUSINESS

1.The Committee resolved to invite the Chief Executive Officer of the Social Health Authority tothemeetingof theCommitteescheduled totakeplaceonThursday23rdApril,2026to present the operational report on SHA and respond to issues raised in Statements pending before the Committee.The Committeefurther resolved that at thesaid meeting,all Members of theSenate should beinvited;and

2. Members were informed that an approval had been granted to undertake oversight visits to Nakuru, Baringo, Elgeyo Marakwet, Uasin Gishu and Nandi Counties from Sunday 13th April to Saturday, 18th April, 2026. Consequently, Members were requested to confirm their attendance for logistical planning.

MIN/SEN/SCH/083/2026 ADJOURNMENT

There being no other business, the meeting ended at thirty minutes past ten minutes past one o'clock. The next meeting shall be held twelve noon at the same venue.

SIGNED

. DATE....

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

13THPARLIAMENT4THSESSION

MINUTESOFTHESIXTY-SEVENTH(67TH)SITTINGOFTHESTANDING COMMITTEEONHEALTHHELDONSATURDAY,15THNOVEMBER,2025AT KAKAMEGACOUNTYREFERRALHOSPITALAT11.00AM

MEMBERSPRESENT

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

Chairperson

Sen. Mariam Sheikh Omar, MP

Vice-Chairperson

3. Sen. David Wakoli,CBS, MP

-Member

4. Sen. Richard Onyonka, MP

-Member

5. Sen. Joseph Githuku Kamau, MP

-Member

ABSENTWITHAPOLOGY

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

-Member

2. Sen. Ledama Olekina,CBS, MP

Member

3. Sen. Tabitha Mutinda,CBS, MP

Member

4. Sen. Hamida Kibwana, MP

Member

SENATESECRETARIAT

1. Mr. Humphrey Ringera

Senior Research Officer

2. Mr. David Ngamate

Clerk Assistant

3. Mr. Gilbert Juma

Legal Counsel

4. Mr. Ian Otieno

-Audio Assistant

5.Mr. Jack Lemeteki

-Media Relations Officer

6.Mr.Ibrahim Odindo

Serjeant -- at- Arms

INATTENDANCE

1) Dr. Livingstone Imbayi

-CountyExecutiveCommitteeMember, Health Services

2) Dr. David Alilah

Chief Officer,Medical Services

3)Ms.Rose Muhanda

Chief Officer, Public Health

4)Dr.Dixon Mchana

Ag. Medical Superintendent.

MIN/SEN/SCH/338/2025

PRELIMINARIES

The meeting was called to order at eleven o'clock and the proceedings commenced with a word of prayer and brief introductions of thosepresent.

MIN/SEN/SCH/339/2025

OVERSIGHTVISITATKAKAMEGACOUNTY REFERRALHOSPITAL

1. The Committee conducted an oversight visit to the Kakamega County Referral Hospital on Saturday 15th November, 2025 accompanied Mr. Livingstone Imbayi, the County Executive Committee Member for Health Services, Dr.David Alilah,the County Chief Officer for Medical Services, Dr. Dixon Mchana, the Kakamega County Hospital Acting Medical Superintendent. The Committee was accompanied by the Members of the County Assembly counterpart committee onhealth led by theVice ChairpersonMr.BonfaceMabuka 2. During the oversight visit, the Committee was informed that Kakamega County Referral Hospital thefacility maintains a total bed capacity of 384.This capacity is distributed across various general and specialized wards to accommodate diverse patient needs. The general wards include Ward 1 with 20 beds, Ward 2 with 19 beds, Ward 3 with 22 beds, Ward 4 with 21 beds, and the largest section, Wards 5A & 5B, which provides 51 beds. Additional general inpatient space is found in Ward 6A (21 beds), Ward 7A (18 beds), Ward 7B (8 beds), Ward 8 (13 beds), and Ward 9 (22 beds); 3. Specialized care units at thehospital are comprised of a 14-bed Oncology unit, a 10bed Burns Unit, and an Intensive Care Unit (ICU) equipped with 6 beds. Maternal and neonatal care are significant components of the hospital's infrastructure, featuring a Newborn Unit (NBU) with 38 beds, a Post-Natal Ward (PNW) with 45 beds, an AnteNatal Ward (ANW) with 14 beds, and a Labour Ward (L W)with 7 beds. The facility also provides 6 beds for Kangaroo Mother Care (KMC) and 6 beds for the High Dependency Unit (HDU), alongside an Amenity ward containing 23 beds. Beyond active patient care, the hospital's mortuary is noted to have a capacity of 112 4. The Committeewasfurtherinformed that theHospital'shumanresources aredivided into three primary categories; Permanent and Pensionable (P&P), Locum, and Universal Health Coverage (UHC). The Medical and Clinical Staff consists of 35 consultants,allofwhom are onPermanent andPensionable termsand51 medical officersconsistingof33P&Pstaffand18Locumstaff.Thereisatotalof62Clinical Officers, including 35 P&P, 26 Locum, and 1 UHC. There are 9 specialized clinical officers, all on P&P terms; 5. The Committee was informed that the nursing staff constitute the largest segment of the workforce. There are 347 general nurses (231 P&P, 112 Locum, and 4 UHC) and 38 specialized nurses (37 P&P and 1 Locum).

6. During the visit the Committee made the following observations at the Kakamega CountyReferral Hospital-

a) The Emergency Unit lacked essential protective equipment, including hand gloves,whichhealthpersonnelreported thattherewereinstanceswherepatients wererequired topurchasemedical supplies such as gloves and syringesprior to receivingmedical attention.It wasfurther noted that thehospital did not have a functional ambulance, despite substantial budgetary provisions by the County Assembly for the same.Additionally, the designated ambulance driver had not undergone the requisite training. The Committee also noted with concern the dilapidated condition of seats and the deteriorating ceiling within the Accident and Emergency Department;
b) The National Health Information Management System (NHIMS) had not been deployed at the Hospital. The existing reporting system was observed to be userunfriendly,with patient information not easily retrievable.Furthermore, the facilityhad aninadequatenumber of SocialHealthAuthority(SHA)verification machines, compelling patients to be transferred from hospital wards to the admissions areato accessSHAservices;

4. The Hospital infrastructure was in a dilapidated state. Several window panes were posing safety risks, while seats and stretchers were extensively worn out, reflecting poor maintenance of the facility; 5. (p The Outpatient Department (OPD) operated only during daytime hours, attending to approximately 120 patients per day and about 45 patients over the weekend. It was further observed that there was no duty rota in place, resulting in delays in service delivery.Additionally,staff members did not wear name tags oruniforms bearing their names, hindering ease of identification and accountability; 6. e The hospital received medical supplies fromKEMSA and MEDS;however,a significant portion of the stock had short expiry periods, raising concerns about inventory control and wastage. Further, The Committee observed inconsistencies in the pharmaceutical records, with expired drugs found stocked on the shelves. Patientswerefurtherrequired to obtainprescribedmedicinesdirectlyfrom the central drug store due to stock management challenges; 7. f The hospital waste was being poorly managed, with waste from the dumpsite burnt in an open field.Staff assigned tohandle and burn the waste were not provided with appropriate protective clothing, thereby exposing them to health and safety risks;

g The facility's roofing structure was made of asbestos, in contravention o EnvironmentalManagement andCoordination (WasteManagen Regulations, 2006. Although the Hospital had a secured plot designated fo
disposal of replaced asbestos roofing, pieces of asbestos were still visible o1 grounds, and some asbestos materials had been buried in an open area used ≥ incinerator, posing serious environmental and occupational health hazards;
h The Radiology Unit lacked essential consumables required for its effi operation. The mammogram and MRI machines had been non-functional fo past five months, while the ultrasound equipment was not operating optim Additionally, the laboratory was found to be equipped with obsolete and a machines, which adversely affected the quality and timeliness of diagnO services;
The Committee observed that some patients were being detained at the faci i) due to unsettled hospital bills. The Labour Ward was found to be congested, 65 mothers occupying only 45 available beds, thereby compromising pati privacy. Similarly, eight incubators were being used to accommodate 15 infan
j)
The Committee further noted the lack of waiting bays or benches for patient visitors and the absence of curtains or blinders in some wards, particularly with the maternity section, which affected patient privacy and comfort. Additional1 B sd q e highlighting inadequate sanitation facilities in the wards;
The mortuary was well maintained and efficiently managed. It had a private win k regarding staff who had served for extended periods without being confirmed permanent and pensionable employees.

MIN/SEN/SCH/340/2025 ADJOURNMENT

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

SIGNED...

..DATE....

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

13THPARLIAMENT|4THSESSION

MINUTESOFTHESIXTY-FIFTH(65TH)SITTINGOFTHESTANDINGCOMMITTEE BUNGOMACOUNTYREFERRALHOSPITALANDKIMAETIHEALTHCENTER

MEMBERSPRESENT

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

-Chairperson

2. Sen. Mariam Sheikh Omar, MP

Vice-Chairperson

Sen.David Wakoli,MP

-Member

Sen.Richard Onyonka, MP

-Member

5. Sen. Joseph Githuku Kamau, MP

Member

ABSENTWITHAPOLOGY

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

-Member

Sen.Ledama Olekina, CBS,MP

-Member

3. Sen. Tabitha Mutinda, CBS, MP

Member

4.Sen.Hamida Kibwana, MP

Member

SENATESECRETARIAT

1. Mr. Humphrey Ringera

Senior Research Officer

2. Mr. David Ngamate

-Clerk Assistant

3. Mr. Gilbert Juma

Legal Counsel

4. Mr. Ian Otieno

Audio Assistant

5.Mr.Jack Lemeteki

-MediaRelations Officer

6.Mr.Ibrahim Odindo

Serjeant-At-Arms

INATTENDANCE

1. Mr. Chrispinus Barasa

County Executive CommitteeMember Health andSanitationDepartment

2. Dr. Magrina Mayama

Chief Officer,Health and Sanitation

3.Dr.Caleb Watta

County Director, Health and Sanitation

4. Dr. Simon Kisaka

Medical Superintendent

5. Dr. Emma Nyaboke 6. Ms. Phoebe Wanjala

MIN/SEN/SCH/329/2025

Deputy Director -Health and Sanitation
Senior Nursing Officer

PRELIMINARIES

The Committee commenced the tour of the Bungoma County Referral Hospital at five minutes past one o'clock with brief introductions of the Members present, the accompanying members of the County Assembly and the Executive and the host hospital management.

MIN/SEN/SCH/330/2025

OVERSIGHTVISITTOBUNGOMACOUNTY REFERRALHOSPITAL

1. The Committeeconducted an oversight visit to the Bungoma Level 5 Hospital in Bungoma County on Friday 14th November, 2025 accompanied Mr. Chrispinus Barasa, the County Executive Committee Member in charge of Health and Sanitation Department, Dr. Magrina Mayama, the County Chief Officer for Health and Sanitation, Dr. Simon Kisaka, the Bungoma County Hospital Superintendent alongside Mr. Humphrey Silungi, the County Director of Public Works; 2. During the oversight visit, the Committee was informed that: 3. a)Bungoma County Referral Hospital has a bed capacity of 311 beds, including 31 maternity beds. Additionally, the Newborn Unit accommodated a total of 31 cots and 10 Kangaroo Mother Care (KMC) beds; 4. b)The facility had employed a total of twenty-two (22) consultants; with Eleven (11) medical officers comprising nine (9) PNP and two (2) Bungoma County contract. In addition, there are thirty-six (36) registered clinical officers, twenty-six (26) on PNP, seven (7) on Bungoma county Government contract and Three (3) on UHC, including twenty 20 general clinical officers and sixteen (16) specialists; 5. C1 Nursing staff totaled to one hundred and eighty-one (181), made up of one hundred and thirty-five (135) nurses employed on Permanent basis, thirty-five (35) nurses contracted by the County Public Service Board, nine (9) on UHC staff, one (1) nurse from Dumisha Program and one (1) nurse on MOH COVID 19 Fund contract. Consequently, there are one hundred and forty-three (143) general nurses and thirty-eight (38) specialist nurses; 6. d)The pharmacy department had two (2) pharmacists employed on permanent basis and one (1) contracted by the County Public Service Board. There were seven (7), pharmaceutical technologist on permanent basis, seven on contracts and a further two (2) from the UHC Staff compliment;

e) Radiography services were supported by nine (9) radiographers, of whom four (4) were employed onpermanent basis,one(1)was contracted by the CountyPublicServiceBoard and theotherfourwereUHCStaff.

3. During thevisittheCommitteemadethefollowingobservationsat theBungoma County ReferralHospital: 9. a)The Hospital faced significant challenges stemming from deteriorating infrastructure and overcrowding. The physical environment was in poor condition, with broken furniture in consultation rooms, cracked floors, faded and peeling wall paint, and damaged ceilings. wards furnished with old, rusty beds, unclean linen, and inadequate working surfaces and equipment, conditions that collectively compromised patient comfort and quality of care;

b) There were loose electrical sockets and exposed wiring in the laboratory, alongside a shortage of essential reagents, while the hospital kitchen was old, poorly maintained, inadequately equipped and lacked modern equipment and essential tools necessary for efficient operation;

11. C There was variance in patient data between the admissions office and the wards, particularly between the admission office and the New Mother and Child Wing, where the recorded number of births also differed from the main hospital, raising concerns about data accuracy. The New Mother and Child Facility was well set out and efficiently run; however, it required re-design to facilitate easy access for stretchers and wheelchairs. During thevisit to theNewMother and Child Unit, the Committeewas also alarmed by thehighnumber ofteenagemothers; 12. d)There was only one laundry machine serving the Hospital out of four observed at the laundry unit, with the other machines appearing to have been nonfunctional for an inordinate long period, resulting in a large pile of dirty linen from the medical wards. The Committee observed piles of surgically soiled linen being washed alongside other hospital garments and linen, contrary to the normal practice of separate cleaning and further noted that electronic waste was being dumped in the laundry store.In addition, therewereonlythreelaundrystaffmemberswhowereserving ascasual labourers atthe unit since 2019; 13. e The Committee observed that the health management system deployed by JumboSoft System was not providing the intended services to the hospital and experienced frequent downtime, despite the substantial investment made in its acquisition; 14. f)Patientsinformed Members that they were asked to purchaseprescribed medicinesfrom outside thehospital,yet the Committee's inspection of the pharmacy confirmed that the same medicines were in stock, and it was further noted that there was no record for controlled opioid (narcotic) analgesic and regulated medicine and drugs such as morphine;

g) The Committee observed that the waste disposal point was well maintained, but noted that it was located adjacent to staff quarters and lacked proper segregation, while the mortuary, though well maintained, was overcrowded and did not have adequate arrangements for managing bereaved families collecting bodies;

h)The Committee noted that a Radiography Complex was under construction but expressed concern over the poor workmanship, and further emphasized the need for a comprehensive hospital master plan to consolidate the facility layout and adequately provide for future expansion;
The Committee observed that the facility had only eight radiographers against an estimated requirement of 16 to 20, resulting in understaffing in the Radiology Department. Moreover, the MES equipment were non-functional, with only one X-ray machine operational, serving approximately 60 patients per day, and there was no functional CT scan available at the facility;
1 The Committee noted that the Emergency Department, staffed by two medical officers, six clinical officers and twelve nurses, manages a heavy workload from neighbouring counties such asKakamega and Trans Nzoia,aswell as patients from neighbouring Uganda, resulting in significant strain on the already limited resources. It was reported that in some shifts, only one nurse was on duty, further exacerbating the heavy workload and potentially compromising the quality and timeliness of emergency care.

MIIN/SEN/SCH/331/2025

OVERSIGHTVISITTOKIMAETI HEALTHCENTER

1.The Committee was received by Mr. Paul Wamalwa, Clinical Officer in Charge of the Kimaeti Health Centre, a level II health facility. During the oversight visit, the Committee was informed that the Hospital operated on a 24-hour basis, with the Health Records Unit managed by four contracted employees, two engaged directly by the Hospital and two under a partnership arrangement, who were further supported by students on attachment;

2. The Committee was informed that the facility experienced persistent understaffing, which adversely affected service delivery and compromised the quality of care, with a total of twenty-two (22) casual employees on the staff establishment drawing a combined monthly wage bill of Kshs 266,000;

3.TheCommittee was further informed that the facility experiences challenges arising from delayed Social Health Authority (SHA) reimbursements, which have led to arrears in the payment of wages to casual employees. The Committee was informed that Kimaeti Health Centre increasingly relies on internally generated resources to sustain operations;
4.The Committee was further informed that the facility comprises a laboratory, pharmacy, Maternal and Child Health (MCH) unit, records office, administration block, male and female wards and a maternity ward, and has a bed capacity of thirty-five (35). At the time of the visit, the Committee also observed a long-stalled building project within the facility. The maternity ward had no curtains or mosquito nets, was not clean and appeared unusually deserted, with some rooms being used to store obsolete materials and documents;

5.The Committee observed that the facility had a total of fourteen staff posted by the County Government, comprising clinical officers, a Health Administrative Officer, two laboratory technologists, one nutritionist, one clerical officer and eight nurses. Against the Ministry of Healthstaffingnormsfor a Level 3A facility,thenumber of clinical officers and nurses was below the recommended minimum,limiting the facility's capacity to provide continuous inpatient and maternity services, while laboratory and nutrition services barely met theminimumstaffingrequirements;

6. The Committee observed that the health centre infrastructure was in a poor state; the kitchen was a semi-permanent, poorly maintained structure that relied on firewood; the facility depended on inadequate manual sterilization of medical kits; the male wards were poorly maintained, with curtains falling; and there was a stalled building that required completion to decongest the already limited facility space.

MIN/SEN/SCH/332/2025

THEEXITMEETINGWITHTHEEXECUTIVE

1. The Committee held an exit meeting with the Governor, County Government of Bungoma County to present its preliminary report and informed the Governor that during the oversight visit to the healthcare facilities in the County; 2. The Committee recommended that the County Executive urgently reviews and addresses the challenges associated with the hospital information management system, with a view to ensuring its full functionality, reliability and integration across all service delivery points. In this regard, the Committee advised the Executive to consider benchmarking in other counties to learn best practices in the design, deployment and management of a robust hospital information system, with particular emphasis on strengthening the pharmacy module to enhance medicines management, accountability and service efficiency; 3. 3.The Committee underscored the need toliaisewith theNational PoliceServiceto establish a police mortuary for the preservation of bodies that are either unidentified or subject to ongoing court disputes; 4. 4.The Committee observed that thevisited healthcarefacilitieswerein direneed of general repairs and therefore recommended the establishment of functional maintenance units to undertake day-to-day repair works. The Committee further recommended that the County Government urgently address the status of laundry machines, particularly at Bungoma Level V Hospital, where the existing machines required replacement. Additionally, the Committee underscored the need to install incinerators at sub-county Level 4 hospitals to ensure proper medical waste management; 5. 5.The Committee observed that the healthcarefacilitiesfaced significant challenges in record keeping and health information management, with notable discrepancies and inconsistencies identified at the sub-county hospitals, thereby undermining the accuracy and reliability of health data for decision-making and service delivery;

6. The Committee recommended that the County Government give due consideration to longserving contract staff, particularly those in the laundry and kitchen units,with a view to improving their terms of engagement in order to enhance motivation and retention. 2. 7.The Committee recommended that the County Government liaise with the Kenya Power Company to install a functional transformer to facilitate effective water pumping at Kimaeti Health Centre. 3. 8.TheGovernor informed theCommittee that theCountyhad intended the information managementsystemtointegrateallcountyhealthfacilitiestofacilitateefficient management reporting. He regretted the system's downtime and assured the Committee that the County Government would address the matter. 4. 9.The Committee was further informed that the County Government accepted the Committee's overall recommendations and committed to initiating reforms on the basis of the exit report, pending the final report to facilitate comprehensive implementation of all the Committee'srecommendations.

MIN/SEN/SCH/333/2025 ADJOURNMENT

There being no other business, the meeting ended at forty minutes past seven o'clock. The next meetingshall beheld onnotice.

L326

SIGNED...

DATE..L

SEN.JACKSONK.ARAP MANDAGO,EGH,MP (CHAIRPERSON, COMMITTEE ONHEALTH)

13THPARLIAMENT |4THSESSION

MINUTES OF THE SIXTY-FOURTH (64TH) SITTING OF THE STANDING COMMITTEE ON HEALTH HELD ON FRIDAY,14TH NOVEMBER, 2025 AT THEOFFICEOFTHEGOVERNOR,BUNGOMACOUNTYANDCOUNTY ASSEMBLYOFBUNGOMA

MEMBERSPRESENT

1.Sen.JacksonK.Arap Mandago,EGH, MP

ABSENTWITHAPOLOGY

2. Sen. Mariam Sheikh.Omar, MP

Chairperson

3. Sen. David Wakoli, MP

Vice-Chairperson

4. Sen. Richard Onyonka, MP

-Member

5. Sen. Joseph Githuku Kamau, MP

-Member

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

3. Sen. Tabitha Mutinda, CBS, MP 2. Sen. Ledama Olekina, CBS, MP

4.Sen. Hamida Kibwana, MP

SENATESECRETARIAT

1. Mr. Humphrey Ringera 3. Mr. Gilbert Juma 2. Mr. David Ngamate 4. Mr. Ian Otieno 6. Mr. Ibrahim Odindo 6. 5.Mr. Jack Lemeteki

INATTENDANCE

Member

Member

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

BUNGOMACOUNTYEXECUTIVE

1. Mr. Kenneth Lusaka

Governor

2. Mr. Chrispinus Barasa

County Executive Committee Member, Health and SanitationDepartment

3. Dr. Magrina Mayama

Chief Officer Health and Sanitation

County Director -

4. Dr. Caleb Watta

Health and Sanitation

Medical Superintendent, Bungoma Referral Hospital

5. Dr. Simon Kisaka

Deputy Director -Health

6. Dr. Emma Nyaboke

Director Public Works

7. Mr. Humphrey Silungi

COUNTYASSEMBLYOFBUNGOMA

-Speaker

1.Mr. Emmanuel Situma

Chairperson, Committee on Health Services

2. Mr. George Makari

Member, Committee on Health Services

3. Mr. Tony Barasa

-Member, Committee on Health Services

4. Mr. Jacob Psero

-Member,Committee onHealth Services

5. Ms. Dorcas Nandasaba

Member Committee Health Services

6. Mr. Orize Kundu

PRELIMINARIES

MIN/SEN/SCH/324/2025

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

ADOPTIONOFTHEAGENDA

MIN/SEN/SCH/325/2025

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

1. Preliminaries;

i. Prayer
ii. Introductions

2. Adoption of the Agenda; 5. 3.Courtesy call to the Speaker, Bungoma County Assembly; 4. Courtesy call to the Governor, Bungoma County Government; 5. Any other Business; and 6. Adjournment/Date of the Next Meeting

MIN/SEN/SCH/326/2025

BUNGOMA CALLVISITTO COURTESY COUNTYASSEMBLY

1. The Committee paid a courtesy call on the Speaker and briefed him about the objective of the oversight visit. 2. The Committee outlined the specific objective of this engagement was to visit select Healthcare facilities in the County in order to-

a) assess the state and quality of the infrastructure, facilities, hospital equipment and provision of emergency services;
b) assess the automation of healthcare provision systems for patient, drugs and commodity management;

5. for healthcare workers in emergency Healthcare and specialized services; e assess the availability of drug and medical supplies in Health-care facilities in 6. assess the availability of requisite healthcare personnel, the gaps and challenges, if any, Healthcare workers face in the county; assess the availability of training and capacity building programs and avenues 3. On his part the Speaker thanked the Committee in its role in mentoring the County Assembly and Committee Members with an aim to improve on oversight. The Speaker assured the Committee that the Members of the County Assembly will work closely with the Senate during and after the oversight visit and follow-up on the implementation status of the Senate resolutions. 8. the Counties and pending bills with the Kenya Medical Supplies Agency; and seek information on the Social Health Authority (SHA) reimbursements claimed and accreditationfor CountyHealthfacilitieswithSHA.

MIN/SEN/SCH/327/2025

4. The Committee paid a courtesy call on the Governor, Bungoma County Government on Friday, 14th November, 2025 and briefed him about the objective of the oversight visit.

COURTESYCALLVISITTOTHEGOVERNOR

5.The Governor informed the Committee that-
a Bungoma County has a total of approximately 275 Health facilities distributed across its nine sub-counties. Of these, including 154 government-operated Health Centers, making up the majority of public healthcare provision in the County, the remainder includes faith-based facilities (around 22), private facilities (approximately 95), and a small number under NGOs (about 4);
C the County reported a collection of Kshs.441.40 million as FIF, which was 42 percent of the annual target of Kshs.1.06 billion. The collected amount was retained and utilized at source in line with the Facility Improvement Financing Act, 2023.
b the County Gross Approved FY 2024/25 Budget was Kshs.15.59 billion. It comprised Kshs.4.97 billion (32 percent) and Kshs.10.62 billion (68 per cent) allocation for development and recurrent programmes, respectively. The budget estimates represented an increase of Kshs.1.56 billion (11 per cent) from the FY 2023/24. The increase was attributed to a rise in its own-source revenue projection and equitable share of revenue raised Nationally;

6.The-Committee was further informed that conversion and confirmation of the Universal Health Coverage (UHC) staff, totaling-up-to 245 across all cadres, was still pending due to financial constraints. Further the list of the affected members of staff was being validated.

ADJOURNMENT

MIN/SEN/SCH/328/2025

There being no other business, the meeting ended at forty minutes past eleven o'clock and the Committee proceeded to undertake oversight visits in the healthcare facilities.

..DATE....

SIGNED. SEN.JACKSONK.ARAPMANDAGO,EGH,MP

(CHAIRPERSON,COMMITTEEONHEALTH)

During the visit the Committee made the following observations at the Kakamega County Referral Hospital-
a) The Emergency Unit lacked essential protective equipment, including hand gloves, which health personnel reported that there were instances where patients were required topurchase medical supplies such as gloves and syringesprior to receivingmedical attention.It wasfurther noted that the hospital did not have a functional ambulance, despite substantial budgetary provisions by the County Assemblyfor thesame.Additionally,thedesignated ambulancedriverhad not undergone the requisite training. The Committee also noted with concern the dilapidatedconditionof seatsand thedeterioratingceilingwithintheAccident and EmergencyDepartment;
b) The National Health Information Management System (NHIMS) had not been deployed at the Hospital. The existing reporting system was observed to be userunfriendly,with patient information not easily retrievable.Furthermore,the facilityhad aninadequate number of Social HealthAuthority (SHA)verification machines,compelling patients tobe transferredfrom hospital wards to the admissions area to access SHA services;
TheHospital infrastructure was in a dilapidated state.Several windowpaneswere posing safety risks, while seats and stretchers were extensively worn out, reflecting poor maintenance of the facility;
d The Outpatient Department (OPD) operated only during daytime hours, attending to approximately 120 patients per day and about 45 patients over the weekend. It wasfurther observed that there was no duty rota inplace,resulting in delays in service delivery.Additionally,staff members did not wear name tags oruniforms bearing their names, hindering ease of identification and accountability;
e The hospital received medical supplies from KEMSA and MEDS; however, a significant portion of the stock had short expiry periods, raising concerns about inventory control and wastage.Further,The Committee observed inconsistencies in the pharmaceutical records, with expired drugs found stocked on the shelves. Patients were further required to obtain prescribed medicines directly from the central drug store due to stock management challenges;
f) The hospital waste was being poorly managed, with waste from the dumpsite burnt in an openfield.Staff assigned tohandle and burn thewastewere not providedwithappropriateprotectiveclothing,therebyexposingthemtohealth and safety risks;

g The facility's roofing structure was made of asbestos, in contravention of the EnvironmentalManagement and Coordination (Waste Management) Regulations,2006.Although theHospitalhad a secured plotdesignated for the disposal of replaced asbestos roofing, pieces of asbestos were still visible on the grounds, and some asbestos materials had been buried in an open area used as an incinerator, posing serious environmental and occupational health hazards;
h) The Radiology Unit lacked essential consumables required for its efficient operation. The mammogram and MRI machines had been non-functional for the past five months, while the ultrasound equipment was not operating optimally. Additionally, the laboratory was found to be equipped with obsolete and aging machines, which adversely affected the quality and timeliness of diagnostic services;
i) The Committee observed that some patients were being detained at thefacility due to unsettled hospital bills. The Labour Ward was found to be congested, with 65 mothers occupying only 45 available beds, thereby compromising patient privacy. Similarly, eight incubators were being used to accommodate 15 infants, raising concerns about neonatal safety and the quality of care provided;
j) The Committee further noted the lack of waiting bays or benches for patients' visitors and the absence of curtains or blinders in some wards, particularly within the maternity section, which affected patient privacy and comfort. Additionally, only two toilets were available for use by over 20 patients and caregivers, highlighting inadequate sanitation facilities in the wards;
k The mortuary was well maintained and efficiently managed. It had a private wing that generated own-source revenue for the hospital. The unit had nine morticiansthreepermanentandsixon contractone ofwhomhad served for nine years without confirmation. The Committee further noted concerns regarding staff who had served for extended periods without being confirmed as permanent and pensionable employees.

MIN/SEN/SCH/340/2025 ADJOURNMENT

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

SIGNED...

....DATE..

SEN.JACKSONK.ARAPMANDAGO,EGH,MP (CHAIRPERSON,COMMITTEE ONHEALTH)

Machine-extracted text (docling) from a scanned document — may contain recognition errors. Original PDF — parliament.go.ke.

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Topics

Healthcare & Public Health Universal Health Coverage Healthcare — SHIF / NHIF

Members mentioned 9

← Back to Health

Report Of The Health County Oversight And Networking Engagements In Bungoma And Kakamega Counties

TABLEOFCONTENTS

LISTOFABBREVIATIONS

PRELIMINARIES

EstablishmentandMandateoftheCommittee

CommitteeMembership

CHAIRPERSON'SFOREWORD

Acknowledgements

1.INTRODUCTION

Purpose and Objectives

ScopeoftheEngagements

CHAPTERONE

Methodology

1.1.COUNTYPROFILES

1.1.1BUNGOMACOUNTY

1.1.2KAKAMEGACOUNTY

CHAPTERTWO

2.COMMITTEEOBSERVATIONSANDSTAKEHOLDERSUBMISSIONS

2.1. MeetingwiththeCountyAssembly

2.2.1 Meeting with the Governor, Bungoma County

2.3.OversightVisittoBungoma CountyReferral Hospital(BCRH)

2.4. County OversightVisittoKimaeti Health Centre

2.5. OversightVisittoKakamegaCountyReferralHospital

CHAPTERTHREE

3.COMMITTEEOBSERVATIONS

3.1.Infrastructure and Physical Facilities

a)Structuraldeteriorationandmaintenancedeficits

b)OccupationalHealthandSafetyHazards

c)InadequateCapacity andOvercrowding

d)IncompleteandStalledDevelopmentProjects

3.2. HumanResourcesforHealth

a)ChronicUnderstaffing

b)EmploymentTermsandJobSecurityIssues

c)StaffIdentificationandAccountability

3.3. Medical Equipment and Technology

a)Non-FunctionalandInadequateTechnology

b)LaundryandSanitationEquipment

c)ElectronicWasteManagement

3.4.HealthInformationSystemsandDataManagement

a)SystemPerformanceandDowntime

b)DataAccuracy and Consistency

c)SystemDeploymentGaps

3.5. Pharmaceutical Services and Supply ChainManagement

a)StockManagementDeficiencies

b)PatientAccesstoMedicines

ControlledSubstancesManagement

d)ShortageofEssentialSupplies

3.6. InfectionPrevention and Control

a)LaundryandLinenManagement

b)KitchenandFoodSafety

c)SanitationFacilities

d)WasteManagementPractices

3.7.Financial Management and Sustainability

a)SocialHealthAuthority(SHA)ReimbursementChallenges

b)FacilityImprovementFinancing

3.8. Specialized Services and Emergency Care

a)EmergencyDepartmentOperations

b)MortuaryServices

c)Maternity and Neonatal Care

3.9.Quality Assurance and Service Delivery

a)PatientPrivacy andDignity

b)PatientExperience and Access

CHAPTERFOUR

4.COMMITTEERECOMMENDATIONS

4.1. CabinetSecretary,MinistryofHealth

4.2. ChiefExecutive ofSocial HealthAuthority(SHA

4.3. Governor,BungomaCountyGovernment

4.4. Governor,KakamegaCountyGovernment

4.5.County Public Service Boards of Bungoma and Kakamega

Annex 1:

Minutes of the Committee Sittings

13THPARLIAMENT5THSESSION

MEMBERSPRESENT

ABSENTWITHAPOLOGY

SENATESECRETARIAT

MIN/SEN/SCH/077/2026

PRELIMINARIES

MIN/SEN/SCH/078/2026

ADOPTIONOFTHEAGENDA

MIN/SEN/SCH/079/2026