By KPC Reporter

Fresh investigative findings from Nyamira County Referral Hospital have exposed a deepening crisis in the county’s healthcare system particularly within the renal unit.

Information obtained in confidence from multiple patients battling kidney complications, as well as after accessing the renal unit, has raised questions about official assurances that services remain fully functional and stable.

These revelations come amid a heated dispute between Health Cabinet Secretary Aden Duale and Nyamira Governor Amos Nyaribo, who are presenting sharply contrasting accounts of the state of healthcare delivery in the county.

Duale, speaking in the Senate, had claimed that Nyamira’s health system was effectively in collapse, citing systemic failures in service delivery.

The remarks sparked immediate pushback from Governor Nyaribo, who dismissed the allegations as baseless and insisted that key services—including CT scans, X-rays, and dialysis—were fully operational.

“I challenge Duale to come to Nyamira County Referral Hospital to witness that we have the alleged missing machines and they are operational,” Nyaribo said during a press briefing held at the facility on Thursday.

He further maintained that diagnostic and treatment services were functioning without interruption, pointing to continued staffing and service delivery as evidence of stability.

However, client-centered investigations at the hospital’s renal department present a far more strained picture—one that partially confirms concerns about system pressure while complicating the narrative of full functionality.

The unit is equipped with eight dialysis machines, but a few are consistently operational, with the rest frequently breaking down due to age, lack of spare parts, and limited maintenance capacity.

Some machines are described as outdated, with repairs delayed or impossible due to unavailable components.

Despite this, the unit continues to operate under extreme pressure, running almost continuously to meet demand.

It handles an average of 15 patients daily and approximately 56 dialysis sessions per week, with nurses reportedly working extended hours to keep services running.

Nurses are said to arrive as early as 3 a.m. to prepare patients and manage the heavy treatment schedule, as the few functional machines are pushed to their limits, operating day and night.

The unit itself is described as cramped and overstretched, with some patients forced to seek dialysis services in private hospitals within Kisii Town due to delays and limited capacity.

Nyaribo indicated during his press briefing that plans were underway to expand space and capacity of the unit.

KPC also established that cost remains a growing burden for patients, with each dialysis session costing about Sh10,500.

The Social Health Authority (SHA) system—formerly NHIF—covers only two sessions per week, although some patients need as many as three.

Further, it emerged that coverage gaps are widening, with essential supportive medication such as blood boosters reportedly not covered for the past three months.

Also, some laboratory tests previously included in insurance packages are now being paid for out of pocket.

Further, the county reportedly has no resident nephrologist, leaving complex renal cases largely managed by surgical nurses.

Patients who have undergone kidney transplants also face additional financial strain, with immunosuppressive drugs costing at least Sh2,500 out of pocket monthly, while follow-up care remains inconsistent.

These revelations sit in tension with the county government’s defence of its health system.

Governor Nyaribo accused the Ministry of Health of failing to reimburse Nyamira Sh454 million under the SHA scheme, despite what he described as strong compliance levels.

“We are committed to service delivery even with arrears of Sh454 million. Nyamira is sixth in compliance but last in reimbursement, and this injustice must be addressed,” he said.

County Executive Committee Member for Health Dr Donald Mogoi reinforced the county’s position, arguing that service delivery remains active despite financial constraints.

He pointed to SHA registration figures, stating that Nyamira ranks 16th nationally with 56.9 percent coverage.

“How come SHA has reimbursed us Sh400 million if health services have collapsed in this county?” he posed.

He also cited performance data, noting that the county handled 5,939 CT scan and X-ray cases in 2025, and maintained that dialysis services continue despite equipment pressure.

As noted above, dialysis, transplant and nephrology services face additional strain since absence of a specialist nephrologist means that cases are managed without dedicated expertise.

A source argued that this was worrying since “kidney disease cases—including among younger patients—are increasingly presenting late, worsening outcomes and complicating treatment.”

Tracing back to the origin of specialist services in Nyamira, it is a fact that dialysis was never offered within the county before the advent of devolution.

Investigations now trace back to longer-term structural challenges tied to earlier national health investments during the tenure of former President Uhuru Kenyatta.

Under the Managed Equipment Services (MES) programme, counties received high-cost medical equipment such as dialysis machines and CT scanners.

This was a major relieve for patients in the county, who, previously, sought dialysis in major towns including Eldoret and Nairobi.

While the MES initiative expanded access at the time, many facilities now face ageing machines, breakdowns, expired service contracts, and shortages of spare parts—leaving counties struggling to maintain functionality years after installation.

So far, only the Nyamira County Referral Hospital handles patients, who come in from the five sub-counties, including the extreme ends of Borabu.

This further drains patients who have to spend more on private transport to get to the hospital on time, a situation that would be arrested for all if the services were taken to the sub-county hospitals.

“The dialysis unit is one of the busiest in the hospital and should offer the best services,” a patient who sought anonymity due to the sensitivity of the matter said.