Insight

Homa Bay Teaching and Referral Hospital: A Death Trap For Patients

A health committee has revealed that Homa Bay County Teaching and Referral Hospital (HBCTRH) is harmful to patients. Roggkenya takes a look the report which hasn’t been picked up by Kenyan media yet.

The Homa Bay County Health Service Committee (HBCHSC) members are concerned that the hospital is not in a condition where patients would be guaranteed their highest attainable health standards.

According to a report released on April 27, 2021, the hospital is “deplorable, wretched, odious, unfortunate, poor, unsatisfactory, execrable, pitiful, distressing, disgraceful, despicable, disreputable, reprehensible, contemptible, calamitous, dreadful, tragic, sorrowful, lamentable, regrettable, grievous, intolerable, sad, shocking, sickening, terrible, woeful, doleful, mournful, rueful, miserable, condemnable, shameful, pitiable, appalling, abhorrent, atrocious and scandalous.”

The committee was mandated to inquire into the status of Homa Bay County Teaching and Referral Hospital after the matter was raised by a member in consonance with the provisions of Standing Order No.40.

Morice Ogwang, a Member of the County Assembly (MCA) representing Kendu Bay Town Ward raised concerns about the condition of HBCTRH and requested for investigations.

The Committee began its deliberations on April 6, 2021 all through to the culmination of this report on April 27.

Broken laws

Dirty linen pilling up because all washing machines at HBCTRH have broken down. Picture: Homa Bay County Health Service Committee

On April 7, 2021, the committee made an impromptu visit to HBCTRH. From the visit and interviewing key people, they concluded that the status of HBCTRH does not conform to many laws.

For example, section 3[c] of the Homa Bay County Health Services Act, 2020 says that “One of the objectives of the Act is to fulfil the rights of all persons living in Homa Bay County to the progressive realization of their right to the highest attainable standard of health including progressive health care and right to emergency medical treatment.”

Section 3[d] of the same Act, says that “One of the objectives of the Act is to guarantee the people of Homa Bay County an environment that is not harmful to their health.”

Article 43[1][a] of the constitution of Kenya, 2010 also says that “Every person has the right to the highest attainable standard of health, which includes the right to healthcare services, including reproductive health care.”

Children also have their specific rights under Article 53[1][c] of the constitution of Kenya, 2010 which states that… “every child has the right to basic nutrition, shelter and healthcare.”

Miserable state

During its fact-finding mission in the hospital, it was noted by the committee that the admitted children were equally not guaranteed basic nutrition and healthcare given the poor state of the facility.

A dirty kitchen at HBCTRH. Patients are only fed on cabbage and ugali. Picture: Homa Bay County Health Service Committee

They also made the following observations on the status of the hospital:

1.There were no drugs at the pharmacy and all the patients were directed to buy them at the nearest pharmacies outside the facility. This includes very simple and common drugs like the pain killer Panadol.

2.Lack of basic non-pharmaceuticals such as gloves.

3.There were very dirty and old linen as they were last delivered to the facility in 2018.

4.Some patients shared beds which were very dirty and small in size.

5.Lack of good furniture and other hospital equipment to the extent that a patient was made to sit on a very dirty and old stool when put on oxygen.

6.There was no chair in the orthopedic section.

7.Lack of office space to the extent that the facility’s ICT Conference room was converted into a changing room.

8.Very dirty toilets in the wards. Toilets that are supposed to be used by out-patients in the Out Patient Department (OPD) section were closed.

9.Mothers at the maternity who were under the national government program of Linda Mama yet they were compelled to buy all the crucial items outside the facility and were still being billed as having benefitted from the program.

10.The oxygen plant which cost the county millions of shillings broke down and was not operational. This puts many patients at risk especially during this COVID-19 period when oxygen is very essential.

11.Some Personal Protective Equipment (PPE) were stored in the toilet at the ICU block.

12.There were several equipment at the laboratory section which were dysfunctional and no efforts were made to repair them. Five equipment were repossessed by the supplier because they were not paid for after delivery.

13.There was acute shortage of reagents and other consumables such as gauze in the laboratory section.

14.Lack of enough skilled workforce at the facility. For example, there was no Orthopedist yet it is a referral hospital. Ironically, the hospital’s website says that it has ‘Best medical care for all’ and it has 100 specialists. It goes further by saying ‘Top notch experience, our services leave you smiling.’

15.In the pediatric section with a bed capacity of 40, there was only one incubator.

16.Poor record keeping at the central stores creating room for stealing and corruption.

17.Theatre room was not operational yet it is a Level Four referral hospital that serves the whole county. In-patients were charged an exorbitant bed charges of Ksh 1400 per day.

18.Inadequate CCTV cameras within the facility thus compromised the security of the patients and staff.

19.Lack of computerization of the services at the facility taking cognizance of the emerging trend of e-medicine.

20.Existence of several kiosks within the facility thus leading to pilferage of drugs and loss of income.

21.Patients taking up to 48 hours to be attended to due to shortage of personnel.

22.The condition of the kitchen in the facility was wanting due to lack of enough equipment, personnel and foodstuff.

23.The morgue was having bodies beyond its capacity without sufficient supplies and lack of enough personnel (At times having 50 bodies instead of 16).

24.Lack of cleaning services due to strike by the staff employed by the contracted firm which was owed five months payment.

25.Lack of clear chain of command which led to insubordination. A case in point was where the Chief Executive Officer had her instructions not being followed by the Hospital Administrative Officer.

26.There was no screening machine at the blood bank hence there was no screened blood at the facility.

27.Supply of some items at exaggerated prices. A case in point is when one jerrican of jik , a bleach and disinfectant, was supplied at a cost of Ksh 1560, yet it costs only Ksh 400.

28.Some unscrupulous hardware and electronic firms supplied items to the facility contrary to the provisions of the Public Procurement and Assets Disposal Act, 2015.

29.Some staff were demotivated despite playing a huge role of generating a lot of revenue for the facility. For example the mortuary attendants helped in generating up to Ksh 300,000 per month.

30.Lack of uniforms, identification cards and Personal Protective Equipment for the staff.

Failed leadership

leaking roofs in the wards at HBCTRH. Picture: Homa Bay County Health Service Committee

According to the health committee, the County Executive Committee Member (CECM) in charge of County Health Services, Professor Richard Otieno Muga failed in his duties as the chairperson of the Homa Bay County Health Management Team.

The Homa Bay County Health Services Act, 2020 states that “The County Health Management Team shall be responsible for providing supervision and support to the management of all health facilities in the county, providing leadership and stewardship for overall health management in the county, providing strategic and operational planning, monitoring and evaluation of health service delivery in the county; and finally responsible for quality and compliance assurance.”

The report further states that “The CECM exhibited incompetence as he failed to supervise the management of HBCTRH by not providing leadership and stewardship, strategic and operational planning, monitoring and evaluation of health service delivery and ultimately failed to ensure quality and compliance assurance.

CECM Muga contravened the provisions of section 22 of the Homa Bay County Health Services Act, 2020 and section 12[1][b] of the National Health Services Act, 2017 by failing to provide a safe working environment to employees of HBCTRH given its dilapidated buildings and lack of functional toilets at the Out-patient Department (OPD).

Section 22 of the Homa Bay County Health Services Act, 2020 states that “It shall be an offence punishable by a fine, imprisonment or both for any person or employer not to provide a safe working environment.”

Section 12[1][b] of the National Health Services Act, 2017 provides as follows; ‘The rights and duties of healthcare providers shall include the right to a safe working environment that minimizes the risk of disease transmission and injury or damage to the health care personnel or to their clients, families or property.’

The CECM in charge of Health Services contravened the provisions of section 27[3][c] and [d] of the County Assemblies Powers and Privileges Act, 2017 by obstructing or inducing public officers serving at the HBCTRH from giving evidence and produce documents before Committee of the Whole House.

The Administrator, Head of Procurement, Accountant and other Heads of Department of HBCTRH stated categorically that they were instructed by the CECM in charge of Health Services not to ignore the invitation of the committee on April 13, 2021.

They only appeared before the committee after being summoned taking cognizance of the consequences outlined in section 27 of the County Assemblies Powers and Privileges Act, 2017.

The act states that …”every person who is summoned to give evidence or to produce a document before a County Assembly or a committee shall be entitled to the same rights and privileges that are applicable to a witness before a court of law.”

The Administrative Officer of HBCTRH violated the provisions of sections 11 and 12 of the Public Officer Ethics Act, 2003 by having firms she was a shareholder in, to bid for tenders at HBCTRH and thus improperly enriched herself.

Section 11 of the Public Officer Ethics Act, 2003 provides as follows; “A public officer shall not use his office to improperly enrich himself or others, have an interest that may be affected by the carrying out of his/her duties, carry out regulated activities with respect to which the public officer’s organization has a role and has a contractual or similar relationship with the public officer’s organization.’

The Administrative Officer and the Head of Procurement of the HBCTRH violated the provisions of sections 3 and 4 of the Kenya Medical Supplies Authority [Amendment] Act, 2019 by obtaining drugs and medical supplies from other private companies. It is only the Kenya Medical Supplies Authority (KEMSA) that is mandated by law to deliver these items to all county public health facilities.

There are six levels of hospitals in Kenya, Level Six being the highest level and most sophisticated. Most counties have one Level Four Hospital while big counties like Nairobi have two. It is therefore expected that the only Level Four hospital like HBCTRH should be better equipped and provide better services than they do. Mention what level

What journalists should do:

  1. The committee recommends that the CECM in charge of Health Services, Professor Richard Otieno Muga should be removed from office in consonance with the provisions of section 40 of the County Governments Act 2012, for incompetence, abuse of office and gross violation of the constitution of Kenya, 2010 and other laws. Follow how the story unfolds and if this recommendation will be effected.
  1. The committee also recommends that the Administrative Officer of the HBCTRH should be dismissed from public service for violating the provisions of sections 11 and 12 of the Public Officer Ethics Act, 2003. They therefore ask relevant investigative agencies such as the Ethics and Anti-Corruption Commission, Directorate of Criminal Investigations and Director of Public Procecution to conduct thorough investigations on her involvement in corruption, misappropriation of funds and violation of procurement laws. Find out if this will happen.
  1. Visit Level Four Referral Hospitals in your county and compare their state to other counties.
  1. Talk to residents of Homa Bay County to find out how the poor state of the hospital is affecting them.
  1. Talk to top officials at the Homa Bay Teaching and Referral Hospital to get their reaction to the report.
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