A new audit by the Auditor General has exposed severe weaknesses in Kenya’s public hospitals, highlighting a system struggling with poor financial management, staffing gaps, and critical shortages of medical equipment and services.
The review, covering up to June 30, 2025, reveals hospitals failing to meet their mandates despite substantial government funding.
Staffing shortages top the list of challenges. Level 4 hospitals, which require 101 health workers each, reported a combined shortfall of 12,089 staff across 176 facilities. Level 5 hospitals also faced deficits, with 10 hospitals falling short of 1,207 staffers against a requirement of 3,230.
Mandera County Referral, Kayole II, Msambweni, and Mtwapa subcounty hospitals had no staff at all, while most facilities operated with only three to 50 workers. Only Lodwar, Wajir, Longisa, Kapsabet, Kapenguria, Vihiga, Siaya, Makueni, Lamu, Webuye, and Iten hospitals had more than 90 staff members.
Service delivery is also critically compromised. The audit found that 54 hospitals did not offer surgical services, 51 lacked paediatrics, 51 had no gynaecology units, 54 lacked radiology, 73 had no renal dialysis services, and 43 could not provide tuberculosis treatment.
Infrastructure deficits were glaring, with Level 4 hospitals having only 6,231 beds against a required 18,900, leaving a shortfall of 12,669 beds. Level 5 hospitals also reported shortages, with Samburu Teaching and Referral Hospital among the worst affected.
Medical equipment gaps further limit service delivery. Level 4 hospitals, expected to have at least five incubators and five cots per newborn unit, had only 278 units against a requirement of 1,360.
Level 5 hospitals lacked ICU and HDU beds, operational theatres, and newborn incubators. Storage for pharmaceuticals was inadequate in 14 hospitals, and 13 failed to implement basic inventory practices, resulting in drug wastage.
Stalled projects and idle assets were also common. Twelve hospitals had incomplete theatres and wards, denying the public expected benefits. Thirty-six hospitals had unused equipment and vehicles despite urgent needs.
Financial management was weak. While hospitals reported a combined budget of Sh71.36 billion, only Sh67.88 billion was spent, leaving Sh3.48 billion unutilised.
Seven hospitals overspent by more than 50 per cent, with Embu Level 5 Hospital exceeding its budget by 243 per cent. Revenue collection was poorly managed, with Sh955 million not remitted to county revenue funds, Sh214 million unaccounted for, and Sh11.35 billion uncollected.
Internal controls and governance were nearly absent in many facilities. Seventy-five hospitals lacked updated fixed asset registers, 80 did not have title deeds for occupied land, nine had no approved procurement plans, and eight exceeded procurement budgets.
Seven hospitals had no audit committees, 13 lacked internal audit functions, 31 had ineffective boards, and 26 had irregularly composed boards.
In her foreword, Auditor General Nancy Gathungu noted the recurring nature of these problems and the lack of consequences for accounting officers.
She acknowledged funding limitations and tight audit timelines but stressed the need for stronger oversight.
The report recommends improving governance and accountability, enhancing hospital management capacity, ensuring adequate staffing and equipment, and enforcing compliance with health service standards.