County governments are warning of an escalating healthcare crisis, blaming the Social Health Authority (SHA) for holding back billions of shillings meant for county hospitals.

The funds, owed under the now-defunct National Hospital Insurance Fund (NHIF), are said to be crucial for the continued operation of health services in devolved units.

Appearing before the Senate Public Investments and Special Funds Committee, Makueni Governor Mutula Kilonzo Jr outlined the growing pressure counties are facing due to delayed disbursements.

He said the impact is already being felt in drug supply, staff availability, and access to vital medical equipment, undermining progress in achieving Universal Health Coverage.

“The health function has not been properly costed, and that is why we have budgetary challenges,” he told the committee.

In Makueni, healthcare takes up 38 per cent of the total county budget, with 2,200 out of 3,900 workers stationed in the health department. But despite this investment, the workforce is stretched thin.

“I have 242 health facilities in Makueni. Out of that, about 150 have only one nurse, one nurse attending to over 2,000 patients every month,” he said.

Similar shortages are being experienced in other counties, with a lack of nurses, medical officers, and specialist doctors—such as neurosurgeons—reported countrywide.

Governors say the situation is being worsened by Kemsa’s inability to supply essential medicines consistently, forcing counties to seek alternative private suppliers to keep health services running.

The Senate committee, chaired by Vihiga Senator Godfrey Osotsi, has now resolved to summon SHA Chief Executive Officer Dr Mercy Mwangangi to explain the delays.

Amid growing pressure, governors are pushing for a debt swap plan to resolve the impasse.

They want the over DSh9 billion owed by SHA to county health facilities to be used to clear debts that counties owe the Kenya Medical Supplies Authority (Kemsa).

“We are proposing a debt swap. Let the money that NHIF or SHA owes the facilities be given to Kemsa so that services are not interrupted,” said Governor Mutula, who chairs the Council of Governors’ Legal Affairs Committee.

He emphasised that settling the matter would ease pressure on county budgets and allow continued healthcare provision.