Ahmed Dagane RN, BA, BSN, MBA-Healthcare Management is a veteran nursing leader, healthcare administrator, and clinician with over a decade of frontline experience in Kenya’ public health sector. /HANDOUT
In August 2026, a massive public uproar ignited across Kenya when details emerged regarding a specialised paediatrician on the Turkana County payroll. Allegations surfaced indicating that the specialist, who also lectures at a university, was spending the vast majority of their time in Nairobi, travelling to Turkana to fulfill duties for as little as four days a month.
While the Turkana case shocked the nation, a closer look into peripheral and frontier counties reveals that this is not an isolated incident. It is a quiet, systemic crisis. In counties like Garissa, a similar pattern has weaponised the health sector: specialised medical consultants, surgeons, pediatricians, and physicians reportedly split the month, working only fortnights and vanishing for the remainder of the period to manage lucrative private clinics in major metropolitan hubs like Nairobi or even working in their own clinics in Garissa.
This rampant culture of "time theft" by public officials presents a devastating ethical, financial, and humanitarian crisis for the citizens who rely most heavily on the devolved healthcare system. Public consultants’ pocket full-time county salaries, complete with hardship and retention allowances, while treating their public deployment as a part-time, secondary gig or side hustle. The consequences of a consultant working a few days a month are measured in human lives. When a specialised consultant is absent from stations like Lodwar or Garissa County Referral Hospital, complex cases stall. Pregnant women requiring emergency specialised obstetric care, neonates with severe complications, and patients requiring advanced surgical interventions face two choices: wait for the consultant’s monthly return, or raise exorbitant fees to travel to Nairobi. For many poor families in frontier regions, the latter is impossible. Delayed care directly translates to preventable mortality.
This crisis is deeply personal. As a former Chief Executive Officer at the Garissa County Referral Hospital (formerly Garissa Provincial General Hospital), our administration inherited an institutional culture gripped by rampant absenteeism. To instill accountability, we introduced a strict attendance register and later a biometric clock-in, clock-out system. The results were immediate and shocking. Through rigorous oversight, our collective efforts uncovered and stopped the salaries of 16 staff members who were drawing full-time county paychecks while covertly working for humanitarian agencies in the Dadaab refugee camps. We proved that monitoring attendance saves public funds and rescues patient lives. Regrettably, because institutional governance in our counties is fragile, the biometric tracking system faced intense internal resistance and was quietly abandoned. The old guard crept back, and with it, the empty wards.
This decay is not restricted to hospital wings; it is an endemic rot cutting across the entire public service. Only a few months ago, in May 2026, Kenyans watched in collective disgust as Public Service Cabinet Secretary Geoffrey Ruku staged a surprise dawn spot-check at the North Eastern regional offices in Garissa, discovering a ghost town of locked doors, empty workstations, and stranded citizens. While CS Ruku's findings exposed a broader, systematic breakdown of public sector work ethic nationwide, this articles focus remains unapologetically fixed on healthcare professionals. When a standard civil servant absconds from their desk, files gather dust and corporate bureaucracies’ stall; when a medical specialist commits time theft, the consequence is measured instantly in body bags.
However, accountability cannot be purely local; it must be systemic. Having proven the impact of digital governance at the county level, these lessons came in handy into national leadership. Serving later as the C.E.O of the Kenyatta University Teaching, Referral and Research Hospital (KUTRRH), our administration successfully introduced attendance monitoring system and spearheaded the rollout of a Hospital Management Information System. An advanced Biometric Health ID system was conceptualized that geo-fenced doctor verification and patient authentication directly into the Level 6 facility operations. These proved that technology can effectively dismantle fraud, eliminate fake claims, and mandate physician presence.
Crucially, our team proved that technological surveillance is only half the battle; it must be paired with operational dignity. During my tenure leading KUTRRH, our administration made it an unyielding law that all employees were paid strictly by the 30th of every month. We eliminated the bureaucratic delays that plague public service. By honoring our structural, financial commitment to our medical teams on time, we earned the moral and managerial authority to demand total professional compliance, absolute punctuality, and uninterrupted service delivery.
The structural realities of county payrolls
Yet, across the wider landscape, to view this crisis purely as a failure of professional ethics is to ignore a harsher structural reality: the broken promise of county payrolls. We cannot talk about the accountability of medical staff without addressing the failure of county governments to protect the dignity of labor. It is an open secret that several counties significantly delay salaries for three to four months at a time. Expecting a doctor, nurse, or allied health worker to provide flawless, high-stakes care while facing eviction, unable to pay school fees, or struggling to buy basic groceries is an exercise in systemic delusion. Delayed salaries are a direct assault on staff morale. Deprived of regular income, even the most dedicated professionals are forced into survival mode. For specialists, this manifests as fleeing to private clinics during official working hours to generate the immediate cash flow required to sustain their families. The county's delay breeds the consultant’s absence. If the state expects public servants to honour official hours, it must first honour its contractual obligation to pay them on time.
Modernising human resources: The empanelment model and hourly shifts
To build a sustainable future, Kenya's public healthcare architecture must evolve beyond archaic workforce frameworks. We must introduce a structured specialist empanelment model that allows hospitals to hire consultants on a part-time basis and compensate them on a strict pro rata framework, paying them explicitly for the exact number of cases handled and quantifiable work performed. Absent consultants should never draw full-time public funding; they must be compensated strictly for the verified hours they serve within the facility. This model is built on transparency and absolute alignment of expectations from day one.
At KUTRRH, we institutionalized this strict vetting process. During specialist interviews, a standard and mandatory question was posed to every candidate: will you commit to a full-time institutional basis? The final decision to hire was fundamentally grounded in their answer. Candidates who fully committed to full-time availability were brought onto the standard payroll, whereas those who could not make that full-time pledge were formally offered structured parttime agreements. As such, we hired about 100 specialists through the empanelment model. This eliminated ambiguous dual-practice arrangements right from the doorstep of employment.
Concurrently, accountability must be matched with global labor standards. Like the rest of the developed world, Kenya needs to institute formal overtime structures where nurses, doctors, and allied healthcare workers are justly and transparently compensated for every hour worked over and beyond their standard contractual limits. Furthermore, we must completely overhaul the traditional culture surrounding "on-call" versus "on-duty" status. The current status quo allows a doctor to claim "on-call" status for emergencies while physically remaining nowhere near the hospital premises, causing catastrophic treatment bottlenecks. We must phase out these ambiguous off-site on-call frameworks and completely scrap them in favor of scheduled, active on-duty shifts. Just like the rest of the world, medical professionals must be physically present on-site during their entire assigned shift hours to guarantee maximum patient safety.
The sub-specialist paradox
Nuance, however, must be applied. We must carefully differentiate between general consultants and ultra-scarce sub-specialists. Kenya has a critical deficit of sub-specialists, such as pediatric nephrologists, cardiothoracic surgeons, neurosurgeons, and gynecological oncologists. These individuals are desperately needed by patients across both the public and private divides nationwide, and it is impossible for them to be physically stationed in a single frontier county 24/7. In these highly exceptional cases, it is acceptable for private patients to access their rare expertise. However, to prevent a conflict of interest, a strict policy framework must dictate that these complex cases are formally referred to major national teaching and referral hospitals like KUTRRH, KNH, MTRH and the newly designated JOOTRH rather than allowing subspecialists to moonlight casually in private clinics/ dispensaries down the street from their public duty stations.
The amenity ward debate: revenue vs. equity
This intersection of public duties and private patients brings us to a polarising debate within healthcare governance: the introduction of "amenity" or private wards within public institutions. On the surface, amenity wards offer clear merits. They serve as a critical internal revenue generation engine for cash-strapped public hospitals, allowing facilities to subsidise free or lowcost care in general wards using profits gathered from affluent patients. More importantly, they act as an institutional compromise to curb the "brain drain" and time theft of medical consultants. By allowing doctors to see private patients within the public facility itself, the hospital retains its top-tier specialists on-site, ensuring they are immediately available if an emergency arises in the public ward.
Conversely, the demerits of amenity wards often overshadow their promises, fundamentally shifting the hospital's priority from equity to profit. When a public facility introduces private wings, an internal caste system is invariably created. Doctors naturally prioritise their private, high-paying amenity patients, spending disproportionate time in luxury wings while abandoning the overcongested, understaffed public wards. Furthermore, it creates a perverse ethical incentive where public resources such as diagnostic machines, theatre space, and pharmaceutical stocks are diverted to amenity patients who pay out-of-pocket or use private insurance, leaving public patients to face engineered shortages.
Lessons from the African continent
For the core public medical cadre, the time has come for Kenya to adopt a radical, uncompromising policy shift: a total statutory ban on public hospital doctors owning or operating standalone private healthcare facilities. Allowing a public doctor to own a private hospital creates a predatory, irreconcilable conflict of interest. It financially incentivizes the public hospital to fail whether through engineered drug shortages or artificial equipment downtime so that desperate patients can be directed to the doctor's private facility down the road. No High Court Judge is permitted to run a private law firm on the side; no Cabinet Secretary, PS, or CEO runs a parallel corporate consultancy. Medicine must no longer be the exception to public service integrity.
This is not an unproven theory. We can look to Turkey's historic Health Transformation Program. In 2010, Turkey introduced its landmark "Full-Time Law," completely outlawing dual practice and banning public doctors from operating private clinics or moonlighting in private hospitals. The ban was highly successful, radically improving public hospital attendance and reducing institutional corruption. Critically, Turkey succeeded because the state paired the ban with a massive financial trade-off: they aggressively increased public sector salaries and introduced a robust pay-for-performance scheme.
We need not look only to Europe. Bold reforms are taking root across our own continent. In March 2026, the government of Malawi executed a groundbreaking policy directive aimed precisely at halting time theft and conflict of interest. The state banned all public health workers from owning or operating private clinics, providing a strict 30-day window to fully divest from private assets or face immediate termination. Similarly, South Africa has enforced strict boundaries under its Remunerative Work Outside the Public Service (RWOPS) framework, legally mandating that public specialists meet strict core hours and performance quotas before conditional private work is authorized, with immediate salary clawbacks for violations. The lesson for Kenya is clear. A total ban on private practice is only moral, sustainable, and enforceable if counties guarantee timely salary disbursements and competitive retention packages.
A new ethical contract
True healthcare reform requires a binding, two-way ethical contract. First, counties must ensure that salaries and allowances are paid reliably by the 30th of every month, establishing the moral authority to demand absolute compliance. Second, the Ministry of Health and the Social Health Authority (SHA) must enforce strict, legally mandated biometric tracking for all public clinicians. You either serve the public full-time or exit to the private sector completely. The devolution of health was meant to bridge the gap between the privileged and the marginalised. When public consultants double-dip while public facilities lie abandoned, they steal the right to health from Kenya’s most vulnerable populations. But when counties withhold salaries for months on end, they drive a knife into the heart of public service morale. We must eradicate both the theft of time by clinicians and the theft of dignity by the state.
The writer is a healthcare management veteran, a veteran nursing leader, healthcare administrator, and a clinician with over a decade of frontline experience in Kenya’ public health sector. He focuses on strategic health workforce advocacy, labour relations, and healthcare legislation; he is a former Chief Executive Officer of the Kenyatta University Teaching, Referral and Research Hospital (KUTRRH). Currently, he offers senior healthcare consultancies across various firms and serves as a Board of Director for Takween Africa.
