How patients suffer under the charade that is NMS hospitals

When the national government in late 2020 tasked the Nairobi Metropolitan Services (NMS) to build at least 19 new hospitals across different informal settlements, the mission was clear: enhancing access to affordable health services.

At least Sh2 billion was sunk into setting up Level 2 and 3 facilities and in February last year, the first four were commissioned by President Uhuru Kenyatta.

The deadline given by the President to the Lt-Gen Mohamed Badi-led administration had been met, so it seemed.

The public would be treated to images of the “high” numbers of patients attended to at the new health facilities and even the first delivery.

All was well. The NMS Director-General was basking in glory and spared no chance to assert how in the disciplined forces, there is no such thing as failure and they work with timelines.

But that is where the superlatives, if any, end. What would follow would be one false start after the other.

It would take months to launch the next facilities despite the pledge to have all of them open within two months. Close to a year later, some of the facilities are yet to be commissioned. However, that is a story for another day.

No doubt part of President Kenyatta’s legacy projects and by extension worn by NMS as a badge of honour since taking over the running of four key Nairobi County functions, health services included, in March 2020, the hospitals have flattered to deceive.

When the Nation visited six of the 14 commissioned hospitals, we were met with a grim picture of the state of the facilities tottering on the brink of being declared brick and mortar installations devoid of the very services they were to offer to the catchment population.

Most of the healthcare workers would only speak about the positives while steering away from talking about the challenges for fear of reprisals.

The hospitals are supposed to offer all primary health services, including laboratory services, at no cost but behind that smokescreen of nice buildings and communication fed to the public, lies untold suffering by patients.

The new hospitals suffer from an inadequate supply of medical supplies, non-consumables and laboratory testing kits and reagents.

Lack of medicine

The heightened hope that met the opening of the new hospitals has now been dashed as the reality of haphazard planning, hurried commissioning and lack of pharmaceuticals and other items begins to bite.

“The hospital is like a skeleton with no flesh. It is like opening a kiosk with nice shelves but no groceries. Do you think customers will keep coming to such a shop?” poses a visibly frustrated Vincent Onsongo, the nurse in charge at Ngomongo Level 2 Hospital.

“NMS did things in a hurry with no proper planning and budgeting. For it to be a hospital, patients must get full medical care. But now they are just partial hospitals,” he adds.

The dispensary, he said, used to attend to more than 100 outpatients daily but the number has drastically reduced to half because of lack of medicine and poor services.

“We used to attend to more than 100 patients when the facility opened before things began to deteriorate. Patient numbers began reducing because of a lack of medicine as despair set in. We are now attending to between 50 and 70 patients a day.”

The facility operates between 8am and 5pm from Monday to Friday but on the day we visited, it looked more like a ghost town. We counted three patients.

“Most of the patients tell others not to go there because there is no medicine. We are missing most drugs. We don’t have antibiotics, we only have cough syrup. We did some orders last year but we are still waiting. The requisitions go to the sub-county MoH officer then we wait,” he explains.

He pointed out that the hospital could only offer full-package treatment for malaria right from testing to issuing medicine.

Interestingly, the most common diseases in the area are respiratory maladies such as chest infections, coughing and ailments associated with poor sanitation in the area like diarrhoea.

“Most of the items we need in the lab are missing and we can only carry out malaria and salmonella tests. After the pomp of the launch, they disappeared,” he averred.

Healthcare workers have had to put up with abuses from frustrated patients, who spend time queuing only to be told they cannot get lab tests or drugs.

“They get annoyed asking, ‘Why make me line up then tell me there are no drugs?’ Some even abuse us when they come to the pharmacy and we tell them there are no drugs,” he said.

With frustration palpable, Mr Onsongo observed that most of the residents do not have the wherewithal to even get three meals a day, let alone go to private hospitals or chemists, and the new hospital was their hope.

New health facilities

“When you are forced to tell them to go somewhere else to get drugs yet you know they cannot, it traumatises them. You look at them and see someone who most probably has not eaten for days,” he said.

The nurse in charge of another facility, who sought anonymity, also laid bare how workers have resorted to begging from nearby health facilities to get consumables, with the problem cutting across all the new health facilities.

The nurse explains that an ideal situation is that when a patient visits a hospital, they should consult with a doctor, who can then send them for testing and the results are used to diagnose the disease before they are sent to a pharmacy with a prescription.

But that is lacking at the level 3 facility the nurse is in charge of. Level 3 facilities offer 24-hour services.

“The hardware part, which is the building, human resources, and equipment, is there but the software part, which is the consumables, is not there. We don’t have reagents, medicine and kits,” the nurse revealed.

“So what services are being offered for free? Is it talking to her and telling her to go and buy (the medicines)?”

Testing is limited to typhoid cases. Only slow-moving drugs are on the shelves. The theatre has never operated ever since the facility opened in July last year. No adequate supply of brooms, cleaning agents, gloves and even mops.

“Patients get so frustrated that they even start abusing us. They ask us what is free at the hospital if they are supposed to buy virtually everything. Is it only consultation? Most patients here need the fast-moving drugs yet they are not there,” said the healthcare worker.

But that is not all. There is a shortage of staff, an erratic supply of electricity and no security, with the hospital lacking any kind of fence.

Unpredictable power supply forced the hospital to stop offering Covid-19 vaccines as there is no backup generator to ensure proper storage of the vials. It is the same problem across the other facilities, and some have chosen to send back the vaccines lest they go bad.

“We have no perimeter wall and the security officers here are volunteers. They were employed by the contractor and chose to remain behind to help. If not for them, we would be recording statements over stolen items, this being a high-risk area,” the nurse said

Another nurse in charge revealed that workers deliver babies without even the bare minimum equipment, putting mothers and even themselves at risk of contracting diseases like hepatitis B or HIV because working areas are not properly sterilised or patients are handled with bare hands.

Dangerous environment

“We are being asked why the mothers are not coming to deliver in our facilities yet we lack the required commodities. We are putting everyone at risk,” said the medic, who also did not want her identity revealed for fear of victimisation.

The facility, just like the others, lacks proper security despite being in the middle of a dangerous environment right in the middle of an informal settlement.

At Zimmerman-Pickens Level 2 Hospital, the problem of lack of medicines is not alien to them, with a healthcare worker informing us that most of their clients are only mothers bringing their children for immunisation.

She revealed that their pharmacy is not well-stocked and so when there are no drugs, patients also stop coming. When they are out of medicine, they request supplies from Kahawa West Health Centre.

“The problem is in outpatient because of lack of medicines. When medicines are not available, we only do consultations and tell them to go and buy but when we tell them to buy medicine they disappear,” she said.

At Kiamaiko Dispensary, our attempts to get information from the nurse in charge was unsuccessful as she told us to first get authorisation from NMS, which would then inform the sub-county MoH officer to give her the go-ahead to talk to the media.

“There is protocol. Nobody will give you information without such authorisation. I have to get authorisation from my boss, which is NMS. Even commodities coming from Kemsa have to pass through the sub-county pharmaceutical officer, who then distributes them to the periphery facilities,” she said.

But she admitted that the number of patients visiting the facility had dropped due to Covid-19 and the lack of drugs.

“There was a time we used to serve 200 outpatients daily to an extent we could even break for lunch past 1pm but the numbers have dropped,” the nurse said.

She also said the facility had not been officially handed over to NMS as there were still some works being done by the contractor though it was commissioned in February last year.

“Most of the facilities were being launched in a rush because of the deadline (given by the President to NMS). Badi has never come back since it was commissioned.”

In the current financial year ending June 30, NMS was allocated Sh21.18 billion for the four transferred functions of health, transport; public works, utilities and ancillary services; and county planning and development services.

The previous financial year, the national government entity received Sh27.1 billion.

Hospitals built by NMS

“We still believe there (was money) appropriated under the national government for NMS and now we have the Sh20 billion that we have appropriated for NMS under the County Assembly budget. That makes it Sh46 billion,” said Nairobi County Assembly Budget and Appropriations Committee chairman Robert Mbatia (Kariobangi MCA) in December during debate on the second supplementary budget, which was passed.

“That is enough money and if (provided) I know and believe that NMS can do a lot of work."

Reached for comment, Kenya Medical Supplies Authority (Kemsa) acting CEO John Kabuchi said NMS owes it more than Sh367 million for supplied medicines.

“The Nairobi Metropolitan Services currently has an outstanding bill of Sh367,659,727.10 with (Kemsa). They last serviced their account on May 17, 2021,” Mr Kabuchi said in a statement.

He explained that the last supply went to Nairobi County health facilities on January 28, 2021, adding that the situation is similar in more than 10 new levels 2 and 3 hospitals built by NMS.

Worryingly, Kemsa has also not received any medical supplies order from NMS this financial year.

“Kemsa has not received any order for the new hospitals from NMS. Currently, we have no valid Local Purchase Order from NMS. The one which came in the last financial year was not supplied due to the huge outstanding debt,” he said.

But what is the problem? Mr Onsongo, the nurse in charge at one of the hospitals, pointed to protocol and attendant bureaucracy as some of the challenges they have to contend with.

The nurses in charge only correspond with the Ministry of Health sub-county officer, who then escalates any communication to the county office.

The officer does monthly reports and delivers them to the sub-county human resources manager in Mathare North, with the reports supposed to be forwarded to the county health records office, where NMS can access them.

“There is protocol. You report to your immediate boss, like the sub-county MoH officer, and your work ends there. What you can do is just follow up. After the launch, no one has come back,” he explained.

The nurse added that the data is just a façade as it does not reveal whether the patients received full medical services or were just offered consultation services.

“We give the data in numbers and when he sees we have attended to like 2,000 outpatients then he thinks all is good, but most of the numbers are just consultations,” the nurse said.

But the problem is deeper, with the nurse unsure whether even the President or NMS boss is aware of what is happening, as they are only told the positives with the challenges hidden from them.

For instance, one nurse said that they are not allowed to speak to anyone except with direct authorisation from NMS and even when that permission is granted, they are supposed to only talk about the positives.

Relying on donations

When the bosses visit, the nurse said, Kemsa will be called to supply medicines and everything will be done to put on the best show. But the commodities would not last even a week before the hospital is back to the usual shortages.

“We are treated to movies. If big people in the government come, we are told not to talk about the negatives but only the positive,” the medic revealed.

“Maybe even Badi or the President do not know what we are going through. Imagine you are told not to talk about the challenges, who will then tell him about them? He is only being told that everything is alright.”

The nurse observed that bureaucracy and protocol are a problem as they are all about phone calls and reports without feedback on the requests they make even though the reports contain the challenges the facilities face.

“I tell you, it is so frustrating that if I start talking about it, I feel so bad. It makes me feel sick, frustrated and not feeling like being here,” the nurse added.

For the nurse, there is no respite in sight as Kenya is in an election year and most of the attention will be focused on campaigns and elections.

“There is not any hope. People will be busy campaigning and all the money will be channelled there.”

When reached for comment, NMS admitted to the new hospitals lacking drugs and have been relying on donations but said the situation cuts across the entire county. 

Further, the agency said that currently the hospitals do not have any standby generators in case of a blackout but the same has been budgeted for in the next financial year.

On lack of commodities, NMS said the workforce still do not have adequate PPEs and has been relying on donations mostly by the Ministry of Health. 

In regards to security, the national government agency stated that they have initiated a procurement process for outsourcing security services in all its health centres with the Directorate of Enforcement, in the meantime, requested to temporarily post officers to the health facilities as the completion of the procurement process is awaited.     

“Nairobi Regional Commissioner has been requested to enhance patrol in areas where the new facilities are located,” reads in part a statement from NMS.  

On the issue of lack of perimeter walls at the facilities, NMS said they have already requested for documentation and preparation of designs and bills of quantities (BQs) for construction of perimeter walls with the BQs already prepared and tender documents requested for. 

“These are new health facilities that have recently been constructed under the Presidential Directives. However, NMS, through the Directorate of Service Delivery and Compliance has started the construction of perimeter walls using internal mechanisms for instance at Ngundu-Kamulu Health Centre.”