A new audit has flagged systemic failures across the country’s public hospitals, revealing a healthcare system plagued by financial mismanagement, inadequate staffing and severe shortages of essential equipment and services.
The review by Auditor General Nancy Gathungu for the period covering June 30, 2025, paints a troubling picture of institutions struggling to fulfil their mandates despite massive public investment.
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Beyond financial mismanagement, the audit revealed severe deficiencies in service delivery, particularly in relation to Universal Health Coverage (UHC) benchmarks.
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Top of the list is staffing shortages.
Level 4 hospitals require 101 staff members each, including 16 medical officers and specialists such as surgeons, paediatricians and radiologists.
However, 176 hospitals reported a collective shortage of 12,089 healthcare workers.
Level 5 hospitals fared no better, with 10 hospitals reporting a shortage of 1,207 staff against a requirement of 3,230.
The report says Mandera County Referral, Kayole II, Msambweni and Mtwapa subcounty hospitals had no staff at all. A majority had three staffers to 50 staffers.
Lodwar, Wajir, Longisa, Kapsabet, Kapenguria, Vihiga, Siaya, Makueni, Lamu, Webuye and Iten county referral hospitals were the only ones that had more than 90 staff members.
For Level 5s, the optimum number is 323, but some, like Garissa county referral, had only 67 staffers in place, 130 in Samburu, 150 in Isiolo and 171 at Bungoma county referral hospital. The facilities had a total shortfall of 1,207 workers.
The report further revealed that many hospitals are unable to provide basic services, including to children seeking treatment at the facilities.
It emerged that 54 did not offer surgical services, 51 lacked paediatric services, 51 had no gynaecology services, 54 did not provide radiology, 73 lacked renal dialysis services, while 43 did not offer tuberculosis management.
The audit further lifted the lid on the inadequate infrastructure in county hospitals, with bed capacity falling far short of requirements across the board.
Level 4 hospitals should have 150 beds each, but 126 hospitals had only 6,231 beds against a required 18,900, leaving a deficit of 12,669 beds.
Level 5 hospitals, which should have 500 beds each, reported a shortage of 1,638 beds across seven facilities.
The most serious shortage was reported at Samburu Teaching and Referral Hospital.
Pumwani Maternity, Nyeri, Meru, Mbagathi, Isiolo and Garissa Level 5 hospitals also reported severe shortages ranging from 171 beds to 357 beds.
The auditor further flagged inadequacies in medical equipment, with some hospitals emerging as having critically short supplies.
Level 4 hospitals should have at least five incubators and five cots in newborn units, but 147 hospitals had only 278 against a required 1,360.
Level 5 hospitals lacked sufficient ICU and HDU beds, operational theatres and newborn incubators, severely limiting their ability to handle emergencies and specialised care.
Auditors also established that 14 hospitals lacked adequate storage for pharmaceuticals, compromising drug quality and safety.
Some 13 hospitals failed to implement First Expiry, First Out or First In, First Out systems, leading to avoidable drug expiries and wastage.
STALLED PROJECTS
Twelve hospitals had stalled projects, including unfinished theatres and hospital wards, denying the public the intended benefits and wasting invested funds.
Kenyatta National Hospital, Kenyatta University Teaching, Referral and Research Hospital, Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisii Referral Hospital, Mama Lucy, Mbagathi, Keringet and Siaya county hospitals have been cited.
“Stalled projects are an indication that the public has been denied benefits that would have accrued from the completed projects and that value for money invested in the projects has not been realised,” Gathungu said.
Some 36 hospitals had idle assets, including medical equipment and vehicles, lying unused despite pressing needs.
The audit uncovered many layers of financial irregularities. While hospitals reported a combined budget of Sh71.36 billion, they spent only Sh67.88 billion, resulting in an under-expenditure of Sh3.48 billion.
Gathungu argued that the situation suggests that planned activities, potentially including critical service delivery and maintenance, were not carried out, directly impacting public health services.
At the same time, seven hospitals overspent their budgets by more than 50 per cent, with Embu Level 5 Hospital exceeding its budget by a shocking 243 per cent.
“Such over-expenditure without approval violates public finance laws and points to poor budgetary control,” the auditor general said.
Revenue management was another area of failure. It emerged that Sh955 million collected by 19 hospitals was never transferred to the County Revenue Fund, as required by law.
Another Sh214 million remained unaccounted for, while uncollected revenue stood at Sh11.35 billion.
“These gaps not only reflect weak internal controls but also deprive the health system of much-needed funds.”
Gathungu further highlighted a near-total breakdown in internal controls and governance structures.
The audit established that 75 hospitals failed to maintain updated fixed asset registers, making it impossible to track public investments in land, buildings and medical equipment.
Another 80 hospitals lacked title deeds for the land they occupy, exposing them to legal and ownership disputes.
Procurement irregularities were widespread, with the audit revealing that nine hospitals operated without approved procurement plans, while eight others exceeded their approved budgets in purchasing goods and services.
“These violations of the Public Procurement and Asset Disposal Act, 2015, raise serious concerns about value for money and the risk of corruption.”
Perhaps most alarming is the absence of basic oversight mechanisms, where it emerged that seven hospitals had no audit committees and 13 lacked effective internal audit functions.
Some 31 hospitals had ineffective Boards of Management, and 26 had irregularly composed boards, with the auditor saying that without the structures, accountability is nearly impossible to enforce.
In her foreword, the auditor highlighted the recurring nature of these issues and the lack of consequences for accounting officers.
She pointed to inadequate funding and tight audit timelines as constraints on the office’s effectiveness, but also emphasised the need for stronger oversight and enforcement.
The report recommends strengthening financial governance and accountability mechanisms, enhancing capacity building for hospital management, ensuring hospitals are adequately staffed and equipped, improving procurement and inventory management and enforcing compliance with health service standards.
INSTANT ANALYSIS
Audit of Level 4, Level 5 and Level 6 hospitals for the year under review paints a mixed picture, one of progress in some areas and persistent weaknesses in others. The findings are an indictment of a healthcare system failing at multiple levels. From missing title deeds and expired drugs to empty incubators and unpaid bills, the evidence points to a system where accountability has broken down and patient care is compromised. As the country strives toward UHC, these findings underscore an urgent need for structural reforms, political will and sustained investment in both infrastructure and governance. Without decisive action, the promise of quality healthcare for all Kenyans will remain out of reach.
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