Nairobi, Kenya – A new audit has painted a grim picture of Kenya’s public health system, revealing systemic failures ranging from financial mismanagement and staff shortages to stalled projects and crumbling infrastructure.
The review by Auditor General Nancy Gathungu for the year ending June 30, 2025, shows that despite billions in public investment, most hospitals are struggling to deliver basic care and meet Universal Health Coverage (UHC) benchmarks.
The audit found that Level 4 hospitals were short 12,089 healthcare workers, while 10 Level 5 hospitals reported a shortfall of 1,207 staff. Shockingly, facilities such as Mandera County Referral, Msambweni, and Mtwapa hospitals had no staff at all. Others, such as Garissa and Isiolo Level 5 hospitals, operated with less than half their required workforce.
Dozens of hospitals were unable to provide essential services: 54 lacked surgical units, 51 had no paediatric care, 73 offered no renal dialysis, and 43 could not provide tuberculosis management. Infrastructure was equally strained, with Level 4 hospitals reporting a 12,669-bed deficit, while Level 5 hospitals fell short by 1,638 beds. Samburu Teaching and Referral Hospital faced the most acute shortage.
Critical shortages of ICU beds, theatres, and incubators crippled hospitals’ ability to handle emergencies. Auditors also flagged poor drug management, with 14 hospitals lacking proper storage facilities and 13 failing to implement stock rotation systems, leading to avoidable expiries.
Major hospitals, including Kenyatta National, Jaramogi Oginga Odinga, Mama Lucy, and Mbagathi, had stalled projects such as unfinished theatres and wards, denying the public vital services. Thirty-six hospitals had idle equipment and vehicles lying unused.
Hospitals reported a Sh71.36 billion budget but underspent by Sh3.48 billion, suggesting key services were never implemented. Others overshot budgets, with Embu Level 5 Hospital overspending by 243 P.c. Meanwhile, Sh955 million in collected revenue was never remitted to county accounts, Sh214 million went unaccounted for, and uncollected revenue ballooned to Sh11.35 billion.
The audit revealed weak or absent oversight structures: 75 hospitals lacked updated asset registers, 80 had no title deeds for occupied land, and 13 had no internal audit functions. Several boards were either irregularly composed or completely ineffective, leaving accountability in tatters.
In her foreword, Auditor General Gathungu decried recurring failures and a lack of consequences for responsible officers. She urged structural reforms, tighter governance, and stronger political will to prevent further erosion of healthcare delivery.
“Stalled projects, idle assets, and persistent governance lapses deny Kenyans quality healthcare despite huge public investment,” Gathungu warned.
The report underscores the urgency of reforms if Kenya is to realize its UHC goal, warning that without decisive action, patients will remain trapped in a system where accountability has collapsed and care is compromised.
