NANDI COUNTY ASSEMBLY OFFICIAL...

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ASSEMBLY DEBATES 04 July, 2018

NANDI COUNTY ASSEMBLY

OFFICIAL REPORT

Wednesday, 4th July 2018

The House met at 9:30 am

[The Temporary Speaker (Hon. Chepkemei Clarah) in the Chair]

PRAYER

QUORUM

Temporary Speaker (Hon. Chepkemei): Clerk, confirm if we have sufficient quorum.

(The Clerk confirmed that quorum was insufficient)

Temporary Speaker (Hon. Chepkemei): I now direct the Sergeant-at-arms to ring the bell for

ten minutes.

(The bell was rung)

(Several Hon. Members entered the Chambers)

(The Clerk confirmed that quorum was sufficient)

MOTION

ADOPTION OF HEALTH AND SANITATION COMMITTEE REPORT ON INSPECTION

VISITS TO HEALTH FACILITIES IN THE COUNTY

Hon. Sanga: I beg to move a Motion on the adoption of Health and Sanitation Committee report

on inspection visits to health facilities in the County that was done between January and April

2018. Hon. Members you had been given this report and all of you have gone through the report.

We will not go page by page, I will just go to the recommendations---

Hon. Maiyo Teresa: Thank you, the report is big, the Members might not have gone through like

me, instead of going straight to the recommendations. I request that the mover highlights other

areas. Thank you.

Temporary Speaker (Hon. Chepkemei): I will urge you to consider going through some parts

of the report, the Members will be up to speed with the report.

Hon. Sanga: Thank you. In this report we visited some of our health centers, referral hospitals and

dispensaries. One of the places we visited are Kapsabet, Nandi Hills, Chepterwai Sub-County



hospital, Potopoto dispensary, Cheptilil dispensary, Taito dispensary, Kabutie dispensary and

Kabirirbei dispensary. In my presentation we met some terms and abbreviations, I want to bring

them to your attention.

M.C.H – Maternal and Child Health, O.P.D – Out Patient Department, KEMSA – Kenya Medical

Supplies Authority, MEDS – Medicines and Essential Drugs Supply, CECM – County Executive,

Committee Member, MO –Medical Officer, CO—Clinical Officer, MCA—Member of County

Assembly, AIDS-Acquired Immunodeficiency Syndrome, HAO-Hospital Administration Officer,

HMB-Hospital Management Board, HMT-Hospital Management Team, NO I/C--Nursing Officer

In Charge.

I will start with Kapsabet County referral hospital. Kapsabet County Referral Hospital is currently

a level 3 hospital offering both in and outpatient health care services. It is the proposed Nandi

County Referral Hospital and yet to be upgraded to a level 4. It has a bed capacity of 200 and bed

occupancy rate of 75%-80%. The number of technical staff are 250, 53 staff on contract terms who

were deployed and there are 38 non-technical staff, totaling 341 staff. The hospital received

modern equipment under MES project from National Government for renal, X-ray & theatre for

level 5 Hospitals. These were the statistics by then, some things might have changed since we

visited. We have seen in brief we have the number of medical consultants, we have a deficit of

three, nine are required, General medical officers are 13, we need 18, we have a deficit in all areas,

the worst deficit is Kenya National Registered nurses, we need 90, we have 63, some have been

employed. In the summary, those are some of the highlighted issues. The issue highlighted above

can be categorized as most urgent that needs to be dealt with immediately, urgent to be addressed

in the midterm and less urgent to be addressed in the future. Urgent issues preparation of hospital

master plan, acquisition of title deed and fencing, supply of essential medical products e.g. drugs,

non-pharm, laboratory reagents and X-ray films among others. They said they take too long to

receive reagents, the procedure is too long, X-ray films take too long once they request for it.

Completion of power upgrade project to enable the use of general X-ray machine and improve

power supply reliability, they need a generator. There is also need for construction of waiting bays

for outpatient department and maternity (to include washrooms) lab. The bay is too small, there is

need for more lavatories, procurement of dental chair and establishment of a framework and fund

for outsourcing professional services e.g. surgery and orthopedic services. This means we will

have a reversal from MTRH to come and offer services. Procurement of medical equipment (list

to be provided) and equip and commission renal unit. We have a unit that is not working because

they need it. Installation of HMIS, CCTV and procurement of computers, promotion, re-

designation and retention of staff, they had complaints of staff that have not been promoted, the

contracts are ending soon and we need to retain them, relocate the dumping site, completion of

ongoing structures (2nd theatre, MCH toilets walkway) ablution block for administration and

outpatient, construct more rooms for service delivery to accommodate ENT, oncology and 2 more

examination rooms.

Mid-term issues include employment of more staff, procurement and installation of CT scan,

installation of oxygen plant including piping, construction of staff rest rooms, changing the

entrance of the hospital, construction of store, for holding before they are dispersed, expansion of

dispensing area for the drugs, long term issues, construction of modern casualty and outpatient

complex, construction of modern maternity with theatre, construction of amenity wing,

construction of isolation ward and upgrade of existing mortuary, that is clear.

Nandi Hills County hospital is a level four facility situated in Nandi Hills town 17kms to the east

of Kapsabet town along the Eldoret –Kericho road. The catchment population stands at 50,384 for



basic health services but also receives referrals from the three Sub Counties (Tinderet, Aldai &

Nandi hills) for specialized services. The facility has the medical superintendent in charge and

supported by health management team (HMT) and hospital management board (HMB). It is 150

bed capacity facility with a coverage occupational of approximately 89 beds on a daily basis. The

hospital sits on 5.3 acres hectares of land and has services provided in the following areas:

outpatient department, ward 1(female ward) – medical ,surgical and gynecological, ward 2

(pediatric), ward 4 (male) surgical and medical, maternity unit (labor ward/antenatal ward/post

natal), radiology department, HIV/AIDS comprehensive care center, operating theatres,

physiotherapy, occupational therapy, biomedical engineering, nutrition, health records information

technology, dental unit, ophthalmology (eye unit), ear ,nose and throat. Administration (Medical

Superintendent, Nursing Officer in charge, Health Administrative Officer) they have a lot of

challenges. Hon. Speaker, the challenges experienced in Nandi Hills Sub-County hospital are; all

the departments and cadres are grappling with serious staff shortage. The worst hit cadres are the

nursing department, medical officers, clinical officer, anesthetists and radiographers. The table

shows staff establishment against the expected human records norms. We have one specialist in

Nandi Hills and we need 5, a shortage of four. We had a case in Nandi Hills where a patient died

because we needed anesthetist, they work 24 hours without motivation. Motivational aspects

should be considered, cleaning and security services are contracted to private companies. They

stopped cleaning a long time ago and we have heard the same complaints both in Kapsabet and

Nandi Hills.

On drugs and non-pharmaceuticals, the hospital gets bulk essential drugs and non-pharms from

KEMSA procured by the County. Currently the hospital records sufficient supplies. A few

emergency and specialized drugs are procured locally from the local suppliers. We can see some

other items that I don’t have to go through. I will mention medical beds, bed side lockers, trolleys

stretchers, resuscitators, fluid stands, inspection lambs, wheel chairs and screens. These are very

old, rusty, not mobile and in most cases broken. All these need to be purchased, linen, gowns,

aprons and boots, the hospital has very old and torn linen supplies. A major procurement of these

essential supplies needs to be done immediately. Most patients have to do with blankets from

home. The hospital has an old manual washer which mostly is not functional. There is urgent need

to procure a modern washer, dryer and ironing machine. This will also cut on wear and tear of

linen. There is need for open air drying and improve availability of clean and iron linen even in

rainy weather. On information technology, most of the few computers in the hospital are obsolete

and expensive to maintain, they result in delay in serving patients. Modern practice of medicine

recommends paperless patient care. The hospital therefore be given priorities in inventory in

modern computers, networking and installation of prosper software. On CCTV and intercom

services, the hospital has no communication coverage. This results in time wastage in unnecessary

movement that could otherwise have been used to save patient. Remember there is a woman we

lost, she was from the ward represented by Hon. Magdalene, she died due to delays, and we need

more space and staff.

The hospital has no specific ambulance attached to the facility. The delay in mobilization of a

centralized managed ambulance with bureaucracies result in delay, confusion and loss of lives.

The hospital has no vehicle to aid in day to day running of hospital needs. These two requirements

need to be addressed urgently. Maintenance and servicing of the same should be decentralized to

the hospital once the vehicles are provided.

Completion of maternity theatre. The project was abandoned by contractor halfway therefore

patients (mothers) are wheeled 50 meters away instead of being operated under the same roof.



There is a building near the theatre that is almost complete, they should be completed because the

women are suffering a lot. They are supposed to be resuscitated near the theatre. Most buildings

are old and dilapidated, there is need for face lift, do electrical works, plumbing, drainage work,

and general renovation of the building. Casualty construction and OPD expansion. There are small

rooms and the patients there come in large numbers. The hospital doesn’t have an emergency unit

with the small OPD serving as the casualty, clinics examinations officers and nursing officers.

Fencing and security gate house. The hospital compound is porous and can be accessed from any

direction. It is therefore difficult to safe guard patients, staff and hospital property including

supplies. Power upgrading. There is need for fast tracking of the construction of generator and

transformer houses to allow for optimal utilization of equipment including X-ray and sterilization

equipment. Laundry machine. The hospital needs to procure a new washing, drying and ironing

machine. The very old machine keeps breaking making its maintenance expensive. It also damages

the linen. Mortuary. Being a level 4 hospital the hospital requires a fully operational mortuary that

can preserve a minimum of 30 bodies, including complete prayer room. The facility has currently

a small holding room. It is a cold room instead of the mortuary, Hon. Koech Gideon will confirm

the work has started.

The hospital kitchen is poorly designed in smoke passage. This results in all the smoke emitted

remaining in the hall. The smoke emission channel and roof need restructuring. From this, the

staff will develop chronic obstructive airway disease (COPD), the welfare of the staff there is not

well taken care of.

Chepterwai Sub-County hospital requires additional staff in a number of departments, a stand by

generator for power back up, renovation including painting of the walls and ceilings and even

improving patient-doctor privacy in the observation rooms by providing curtains. The doctor

attends to patients without privacy. There is need for procuring of facilities such as X-ray

machines, lab equipment and setting of the theatre that is already in place. Procuring of computers

for effective and efficient service delivery by the team, payment of casuals who have been working

for almost 18 months without pay and even confirming some volunteers who are qualified and

equal to the task. Reclaiming of the land title deed for the facility, there is a bad story in that, the

man who had transferred land to the hospital was moved to the forest without a title deed, he has

been chased back, the man wants to reclaim his land, and the title deed is still in his name.

The challenges facing the facility are that more rooms are required for observations as some of the

units are shared, for instance there is a single room acting as an immunization room/maternal care

unit /nutrition. There is a small room that serves as a minor theatre/stitching/dressing room that is

not equipped. Renovations need to be done in the rooms as some rooms have leaking roofs, even

where drugs are stored. A stand by generator is needed to step in during power outage.

A fridge is required to store immunization drugs which are currently stored at Chemase health

center which is quite a distance away. Additional staff especially MO, nurse, lab technologist,

pharmacist and casuals are needed.

OPD requires window curtains for doctor-patient privacy. There is examination table and no

thermometers for taking vitals. Laboratory requires a cupboard, fridge and essential machines such

as HB machine for malaria tests as malaria is a common disease in the area. Consumable drugs

such as anti-malaria and anti-rabies were missing in the pharmacy. The dispensary does not have

a pharmacist.

The dispensary does not have water. Water piping was done but not to completion and therefore

this should be taken with urgency as a hospital cannot function without water. Delivery room

requires a delivery bed, curtains, proper lighting in the room, proper protective gear for the nurses,



oxygen concentrator and resuscitation tools. Shelves are required in the drug store. There is need

for a modern incinerator for proper waste disposal. Casuals need to be paid as they have been

working without pay for close to 10 months. The dispensary needs to be fenced.

We went to Kapsimotwo Ward and visited Cheptilil dispensary challenges are that casuals have

been working without pay for close to 10 months and therefore the County Government should

work on their pay as soon as possible. The facility has essential drugs but sometimes the drugs are

not supplied on time. No laboratory services in the dispensary due to lack of personnel, lack of a

room as well as lab equipment. The dispensary does not have electricity and therefore the County

Government should install electricity, procure computers for effective and proper service to the

community. The rooms need to be renovated as the walls, roofs and floors need repairs and

painting. Staff quarters are incomplete. The facility needs to be fenced. The dispensary does not

have staff toilets and so the staff are left sharing with the patients. There is no septic tank at the

dispensary. Drug store requires shelves. Maternity wing is incomplete though foundation has

already been laid. The dispensary should receive an additional nurse, CO/MO, lab technician and

pharmacist.

Taito Community dispensary; this dispensary is located in Chepkunyuk Ward. On the the

challenges the County Government should consider paying casuals who have been working

without pay for close to 10 months. Renovations need to be done in the entire dispensary. Proper

drainage needs to be put in place as water flows in to the building during rainy season. There no

shelves in the drug store. There is need for additional staff especially a nurse, a lab technologist,

and a pharmacist. This dispensary does not have a title deed as well. The dispensary needs to be

properly fenced.

Kabutie dispensary; the Committee headed to Kabutie dispensary. This dispensary has challenges.

It has been 11 years since the opening of the dispensary but implementation has been a problem. I

think this must have been implemented. The two finished buildings, one being the laboratory and

the other staff quarters need to be operationalized. Water pipes need to be installed. Sewage is

already connected to the sceptic tank therefore the County Government will work on modernizing.

Proper fencing is needed. I think this dispensary was commissioned and it has been opened. When

we wrote this report, it was not yet but it has been commissioned. It is similar to Kabirirbei

dispensary and maternity wing.

Challenge with those dispensaries including that in Chemundu is that, there is no adequate land to

construct the dispensary as planned by the Committee together with the members of the

community. Dispensary committee does not have enough funds to purchase extra piece of land.

The dispensary committee in consultation with Members of County Assembly opted to begin with

the maternity wing as they plan to expand into dispensary as time goes.

Even after beginning the maternity wing, the building is incomplete due to contractor not being

paid by the County Government. I think this is a problem of pending bills. They need to be included

in the pending bills so that it can help continue the task. The County Government should procure

drilling machines that will serve community and dispensary as water is a major necessity.

Finally on recommendations, the Committee recommends the following;

The department should put in place a plan to recruit medical personnel for all understaffed health

facilities for operations and service delivery.

Medical service department should develop proper guidelines on maintenance and allocation of

ambulances for Sub-county hospitals that have no standby ambulance in order to curb referral

complications.



Supply of drugs should be facilitated to major health facilities to avoid delays. The department

should move with speed to pay the dues of casual workers in health facilities. Water tracking

should be done on health facilities. It should be done through drilling of boreholes especially in

Potopoto, Kabutie, Kabirirbei dispensaries water tanks with big capacities should be provided in

those facilities for water storage. Health facilities without an existing connection should be

considered for the sake of refrigeration of vaccines. Laboratory services especially Chepterwai

hospital MCH unit through the office of the CECM for Health and Sanitation, department should

do renovation to various infrastructures in different health facilities in the County including staff

quarters and wards. Ex-ray machines should be provided especially at Chepterwai sub-county

hospital and radiologist hired as this was recorded as an issue of concern by the people of

Chepterwai. The department should ensure that enough beddings are procured and delivered in the

dispensaries. Problem of power outage in our referral hospital and dispensary should be addressed.

Department should fast-track operationalization of dispensaries which are non-functional. New

dispensaries need to be constructed in areas which have got nurses to help.

In conclusion Hon. Speaker, the Committee is grateful to the office of the Speaker and that of the

Clerk of the County Assembly for support accorded during Committee sittings and visitations. I

wish to express my appreciation to Hon. Members of the Committee who sacrificed their time to

participate in activities of the Committee and in preparation of this report. It is therefore my

privilege on behalf of the Committee to table this report and recommend it to be discussed in this

Hon. House and adopted. I ask Hon. Gideon Koech to second. Thank you.

(Hon. Gideon Koech bowed to second)

(Question proposed)

Hon. Murrey: Thank you very much Hon. Speaker. I admit that this Committee has done

commendable job. I want to thank this Committee because it took a sample of medical facilities of

all the levels in the County starting from the referral and then Sub-County hospitals. Some of them

at even village level. This department is very crucial for any County. Health sector is supposed to

be working very well but from what we are getting from this report, this department needs very

urgent attention because there are challenges all over the County. You realize that starting from

the referral hospital, a lot of facilities are lacking and there is need for additional staff for the

hospital to run efficiently. We have been informed that patients are being referred to Moi Teaching

and Referral Hospital in Eldoret. This is a pointer that a lot needs to be done in this County. I know

things are improving and the Chair of the Committee has told us that there are certain changes that

have taken place in between the time they were collecting data for this report and today some

changes have taken place. I also hope that the Cuban doctors have arrived. I don’t know neither

do I have any information. I hope this report is going to be of essence in making a basis for the

follow up of those challenges because there are numerous and this Committee has a lot of

responsibilities to ensure that those challenges are catered for the same within which my

Committee, being chaired by Hon. Gideon Koech, Committee on Implementation. You realize that

this is a very important department but has a lot of problems.



One thing I want to congratulate this Government is on the issue of drugs. I got an opportunity

some few months ago to go round two dispensaries that are operational in my Ward. The staff and

even the patients were actually very happy that for the first time, the dispensary was having a lot

of drugs and we want to congratulate the CECM for health and the team because they have done

a lot for this County; despite the fact that a lot needs to be done. I urge the Committee to continue

going round. I know this is only a sample out of the so many medical facilities in this County. The

Committee should go round and it will discover that even the others which were not covered have

almost the same problems. Lastly, we have certain facilities which already are 100% complete.

Some are 50% complete like in my Ward. There is a dispensary which was completed several

years ago. It was started two years ago and up to this time, it is not operational. So, I urge this

Committee to work towards that to ensure that such dispensaries are opened for operations so that

our people can access medical services within their vicinity. I really support this Motion. Thank

you.

Hon. Kipkemboi: Asante sana. Kwanza nashukuru kamati kwa kufanya utafiti na kuleta ripoti

hii kwenye Bunge. Hii inaonyesha changamoto zilizopo kwemye hospitali zetu ndogo ndogo na

pia zile za rufaa. Wamefanya kazi nzuri ingawa wamechelewa maanake juzi tumefanya bajeti na

pesa zote zimefanyiwa mipango. Wangeleta ripoti hii hapo awali ili tuweke kwenye ratiba ya

bajeti. Sasa hii haitatusaidia labda hadi mwaka ujao. Tulishagawa pesa kwa minajili ya kujenga

zahanati. Ni vyema washughulikie kwa haraka ripoti yao ya hapo mbeleni. Walizuru ssehemu

mbalimbali wakapata changamoto lakini sasa hakuna pesa itakayotumika kwenye mapendekezo

yao. Itabidi iwekwe kwenye bajeti ya ziada. Kwa wadi ninayo wakilisha nafikiri walizuru hospitali

ya rufaa pekee maanake tuna hospitali ya Cheindoi, Kiropkeet na Ndeebokuruiot. Haikuandikwa

na silalamiki maanake haitasaidia.

Sehemu ya Terik wagonjwa wanaenda kutibiwa huko Kisumu na haijatajwa hapa. Nilitembea kwa

hiyo wadi na kushangazwa na jambo hilo na halikuangaziwa kwa bajeti. Yafaa tusaidiane maanake

naweza kuzuru Kisumu na katika shughuli zangu nikaugua malaria na yafaa nikirudi nyumbani

nitibiwe njiani katika hospitali ya huko Terik.

Pesa ya kujenga hospitali haitoshi. Tayari wamechukua pesa nyingi. Bajeti ya juzi ilichukua bilioni

mia moja na nukta sita. Hii karibu imalize pesa ya kaunti. Tujenge hospitali ya rufaa na tukubaliane

kuwa zile ndogo ndogo zingoje kwanza. Hapa Kapsabet, pesa nyingi zimetengewa hospitali na

wale wanatibiwa hapa si wakaaji wa wadi ya Kapsabet pekee. Hata watu wa Kaunti yetu ya Nandi

wanakataa hospitali yao na kuenda Eldoret. Kama kwenye mahitaji ya mashine ya CT scan, watu

hupeleka pesa nyingi Eldoret. Hata mashine ya kuosha figo watu huacha hapa Kapsabet kwa elfu

ishirini na kuenda Eldoret.

Twafaa kuelewana kama tunaanza na Kapsabet ama Nandi Hills maanake tuna shida kubwa.

Mgonjwa hupelekwa Eldoret, mtu akipata ajali ni Eldoret ilhali tuko na hospitali ya rufaa.

Mawaziri wanatenga pesa na sisi tunaunga mkono tu. Lazima tuchunguze kama pesa hizo inasaidia

ama haisaidii kama mifano iliyo kwa wadi ya Kapsabet kule Meswo. Katika serikali ya awali, kuna

mambo mengi tulifanya bila kumaliza. Kwa mfano, mambo ya maji, barabara ikatengenezwa na

hakuna kalvati. Kwa sababu ya tamaa ya kupata kura hapa na pale, hatukumaliza miradi. Lakini

sasa hivi nafurahi kuna zahanati pale Kabutie ambayo naibu wa Gavana alienda kufungua na

ilikuwa imekaa kwa zaidi ya miaka kumi.



Vile Mheshimiwa Murrey amesema, tuone zile zinafanya kazi ili tumalize. Tusiongeze gharama

zaidi kwa kujenga zahanati zaidi ilhali hatuna pesa za kuajiri wahudumu wa afya.

Nikimalizia, ningependa mheshimiwa Mwenyekiti wakutane na waziri, wahakikishe kama kuna

pesa imetengwa, ifanye kazi. Hapo awali Mwenyekiti wa Kamati ya afya alitembelea Kaunti

ingine na tunahitaji maarifa kutoka kule itusaidie. Zile michango huwa tunafanya kwa ajili ya

matibabu nchi za nje ni pesa mingi sana na tunaumia. Mtu akipelekwa eldoret hata kama wanajua

hawezi kupona wanadai elfu mia nane au zaidi. Hii ingetusaidia hapa Nandi.

Hon. Sing’oei: Ahsante kwa nafasi hii. Nashukuru sana Kamati ya afya kwa udadisi waliofanya.

Ijapokuwa naona walijipenda na kuenda kwa wadi wanaowakilisha na kuacha zingine. Wakati

mwingine wawe wanaulize wawakilishi kuhusu mazahanati kwenye wadi zote. Hata hivyo,

siwapingi.

Tumesikia matatizo ni mengi katika mazahanati na hata kwa hospitali ya rufaa. Nasikia wikendi

wagonjwa hawapati blanketi na sijui shida iko wapi. Tena madaktari hawapatikani wikendi. Wale

wauguzi pia hawajalipwa na kila mahali wanalalamika. Hatujui shida iko wapi? Kweli, mambo ya

matibabu ni magumu lakini twafaa kujaribu vile serikali yetu ya Kaunti hujaribu. Wakati

mwingine dawa pia huchelewa lakini uzuri hufika.

Kuna zahanati kule Kombe ina madawa, daktari wa zahanati ya Kapchepkog aligongwa na

pikipiki. Wamama huja zahanati ya Kombe na hufukuzwa ilhali ni mtaa moja. Inafaa Kamati izuru

zahanati hii kuchunguza zaidi na kung’amua shida ilioko. Sitanena mengi ijapokuwa naona kazi

ni ngumu lakini lazima tufanye ili watu wapate matibabu. Kuna zahanati ya Kamkoya iko tayari

lakini hakuna dawa na vitu vingine. Ni hayo tu toka kwangu. Asante.

Hon. Rono Magdalene: Thank you Madam Speaker. I rise to support the report by the Committee

on Health and Sanitation. You have given us the report and I support that the report is good having

visited some hospitals although it seems you went to one direction. I don’t know if it is because

the Chairman comes from there or what? All the same, that’s a good report having sampled the

rest of the dispensaries. As I am speaking, at the other end, we have dispensaries fully constructed.

Hon. Koech David my neighbor will agree that we have dispensaries constructed previously. Like

in my Ward, we have three complete dispensaries with utilities inside. The inspection has been

done by the CO for health and the director and they found out that the facility is viable for use. It

only needs medics and the medicine. I wish you had gone before the budget was done, this report

would have carried more weight during budgeting. Next time you should visit others so that you

can have a conclusive recommendation.

You touched on the issue I had complained about; that is negligence. It was not about ambulance

delay but negligence of a medic in Nandi Hills but something has been done there. There was

another incident but when I called the doctor he acted and life was saved. It happened immediately

after the other one. The medics have improved. I wish that next time you will visit the areas around

Aldai. Most of those dispensaries I am talking about are in the escarpment where most of us live

and are known as hardship areas since they are places where we have a lot of dispensaries to help

the community. There is need for more dispensaries there. Health is a necessity but should

concentrate in it since without health we cannot do all these other things. I urge the Chairman and

the Committee to make a visit to other areas. I support this report. Thank you.

Hon. Koech Gideon: I was almost tempted to think that you have deliberately tried to deny me

chance to contribute but now that you have given me, that temptation has gone. Allow me to say



that I stand to support this report being a Member of this Committee. First, the decision on where

to visit was not based on selfishness. Coming to Nandi Hills, it is automatic that if you visit referral

hospital you must go to Nandi Hills and then we identified based on certain areas close to this

place and some that are far from this place. We had to choose between Potopoto and Kapsengere

and we ended up in Potopoto. Hon. Serem is not a members of Health and Sanitation Committee,

if we were to go as per the membership.

Secondly, as it has been mentioned by Hon. Kipkemboi that this report should have come earlier

so that it can be factored in in the budget. I must say, although the report is coming in at this time,

we as a Committee have gone ahead to engage the department even before the visits. I am sure

among these recommendation, there are several that have been captured in the budget. For

instance, when you talk of the issue of computers and making sure that we have automated system

in our health facilities, in fact it was captured under supplementary budget 2. I think the issues are

at advanced stages and that hopefully in due course we shall be having somebody to make sure

that our County referral hospitals are fully automated.

When we talk of power outages and fluctuations, Kapsabet referral hospital and Nandi Hills as

captured by this report benefitted in supplementary budget 2 for power upgrade, generator house

and generator. For instance, Nandi Hills and Kapsabet I think are set to have standby generator big

enough to accommodate ICU bed and machines that were brought by the National Government

through the MES programme. I am sure as a matter of fact that even the issues of ambulances as

captured in the budget, we can say out of what we have recommended in this report, seventy to

eighty percent have already been captured in the budget. The 20% now is our responsibility to

make sure that as we move forward, we engage and see when we have a supplementary budget

coming as of course we shall have it, we might factor in those.

Having said that, I want to add that as I have just highlighted in the budget, facelift of Kapsabet

and Nandi Hills. As we speak, construction of state of the art mortuary in Nandi Hills is ongoing

though most of us don’t want to hear of such but it’s a fact and in the next one or two months we

shall be going there to officially commission it.

In the budget, we also captured the oxygen plant in Kapsabet and Meteitei. Thus, all these are

things that have been brought about because of our engagement as a Committee and after visiting

the health centers. The purpose of this visit was to make sure we get what is happening in the

ground. I am sure though we never visited a dispensary in every ward, what was captured as the

challenge ailing Potopoto dispensary and Cheptilil dispensary is what is ailing Kosoiywo

dispensary and Kaptien dispensary in my Ward that were not visited. What is ailing Nandi Hills

Sub County hospital is what is ailing Kobujoi, Kaptumo or Mosoriot. We did a sample and we

should focus on recommendations.

(Hon. Kipkemboi on a point of inquiry)

Hon. Kipkemboi: Ningependa kufahamishwa na Mheshimiwa Koech Gideon kwa yale amesema

kwamba miradi ya wadi anayowakilisha imetengewa pesa, kwa nini zetu hazijatengewa?

Hon. Koech Gideon: Hon. Speaker, my statement was based on the fact that Hon. Member for

Kapsabet contributed and said that this is a good report, but it should have come before the budget

for FY2018/2019. I was highlighting the things that are in this report that I felt and I remember are



also captured in the budget. I might not be aware of all what is in the budget as at this point in

time. Of course individually, Hon. Members know for instance that this was captured in this

particular budget. Thus, I cannot shade light on whether Kapsabet ward dispensaries are captured

in the budget or not but I was laying bare what is in this report and what is captured as per the best

of my knowledge what we passed in the budget.

(Hon. Kipkemboi on a point of information)

Hon. Kipkemboi: Sasa ilikuwa na maana gani hii ripoti ipitishwe ilhali tayari imezingatiwa katika

bajeti 2018/2019. Hivyo ndivyo alivyokiri kwamba kuna moja inajengwa Nandi Hills na pia ingine

kazi inaendelea ndipo nikauliza, kama hangeweka pesa kazi ingeendelezwa na nini? Sasa haina

maana!

Hon. Koech Gideon: I refuse to be informed in that manner. I refuse to take that point of

information because saying that passing this report has no meaning in itself is not a very logical

statement. We have indicated in this report Hon. Speaker, with due respect to Hon. Kipkemboi the

challenges facing our dispensaries. We have brought this report so that all of us can share, learn

from what is the best practices that we have so that we can improve. I wish to proceed and conclude

my contribution to this debate.

On our recommendation, we have highlighted and we did not make a specific recommendation

basing on the number of dispensaries or referral hospitals visited. For example, the

recommendation that the department should fast track operationalization of dispensaries which are

not functioning, that one captures one in Nandi Hills ward, Kosoiywo dispensary which is almost

complete but it is not functional, that also captures some dispensaries we once visited with Hon.

Chemutai in Kobujoi Ward. We visited a number of dispensaries around six or seven that were

almost complete and needed shelves and drugs only. I am saying that this report is not specific to

the Wards we visited it is general and it is a prayer, let us pass and adopt this report, and we as the

Members of Implementation Committee we will make a follow up on the same, if need be we can

engage and see where we can assist in case there are problems.

The same captures new dispensaries that should be constructed in areas that have no access to

health facilities. If we adopt this, the budget was passed and I am sure as per the ruling of the

Speaker, we are supposed within the 21 days have to pass a schedule of itemization of the projects.

I am sure we passed around hundred million for health facilities across Nandi County. If we pass

this report, it will inform a discussion of saying, can we have this allocation being in this particular

ward and given to this facility? Madam Speaker, I must say that this is a comprehensive report. It

has laid bare the challenges that we are experiencing in our health facilities. It has also shed light

on where we can move as a County to make sure that the health of our people is improved as it is

said that a health nation is a wealthy nation.

A few concerns that I felt should have been highlighted in all our facilities is that we have a

challenge in terms of cleaning services especially in Kapsabet, Nandi Hills, Kaptumo, Meteitei,

Mosoriot and the rest of the facilities. We have contractors who have been given work to clean our

facilities but have continually abdicated their responsibility of paying the workers thus rendering

our facilities in bad shape occasionally when the workers down their tools. I would have imagined



that we still have to relook into this issue, it is my prayer and this is something that we will take

up as a Committee going forward, that we terminate the contract of all cleaning services agents so

that the County Government of Nandi hires those to clean and make sure that our facilities are

clean.

Secondly, we have suppliers of foodstuffs in all the facilities, some are subject to the pending bills,

some are irregularly being paid after supplying goods and services to our facilities, this is

something we also need to look at.

Lastly, I happen to have been in Kapsabet referral hospital the other day, the condition of the beds

in matters cleanliness is bad. We have the stretchers, I saw a stretcher used to move around patients

with rust! A patient had some cuts, can you imagine that particular cut coming in contact with rust

in the stretcher? Did that patient go to the hospital for treatment or further injuries? That is

something that we need to look at, it is a situation that we must improve and we must talk facts as

they are so that we can improve. Otherwise I must say that I fully support this report for its

comprehensive nature and wish all of us to support so that we can use as a benchmark to move

forward. Thank you.

Hon. Chumba Milka: Thank you Hon. Speaker for giving me this chance. Since this is my third

time I have stood in my place but I have not caught your eye, I must thank you for this chance. I

stand to support the work of this Committee. This is a wonderful job done even though you went

to the same direction. I am in support, why did you not pass through Kurgung and Ndalat on your

way to Chepterwai? Chepterwai is so far than Kipkaren and Kurgung why didn’t you bypass?

You would informed us when you visited these areas so that we could suggest dispensaries to visit.

Probably the ones that you visited are the good ones. Health is something that is important to us in

Nandi. We know the Deputy President, when he came to Mosoriot, promised that he was going to

give us 20 million to buy a machine for the referral hospital and we are grateful for that but what

we want to do is that every Member in every ward should have one big dispensary that is equipped

so that people cannot travel all the way to Kapsabet referral hospital or to Eldoret. We must have

one, even though we know that the ambulances are in the process of being acquired we better have

one big hospital in every Ward. We know that Nandi Hills and Kapsabet are our big hospitals but

most of our people go to private hospitals. We want to ensure that people use services in our own

hospitals and not private hospitals.

As a matter of urgency, we know most of people who go to the dispensaries are young children

and mothers. I urge the Committee Members of Health and Sanitation that when they have

activities to conduct in the wards to kindly consult us. We are there representing mothers in the

wards and entire Nandi County, we know a lot, thank you very much. I stand to support.

Hon. Komen: Thank you so much Hon. Speaker. Let me take this opportunity to really thank the

Members of Health and Sanitation Committee for the good report from the areas that they covered.

Mine is to take you to Terik Ward, if you see from the screen that is Kapsengere health center, that

picture speaks a thousand words. I have been telling this House that Terik is marginalized and that

is the facility that we have at the moment and the facility that is under construction needs about

fifteen million which has not been allocated.



I would have wished the Committee visited Kapsengere health center to see for themselves so that

they can give recommendations and make allocations for this financial year. So in this regard, I

am requesting that out of the hundred million that has been allocated for the health facilities kindly

allow Kapsengere health center get 15 million so that we can do something and help the people of

Terik ward. You can see a picture of someone who was injured and I took him to hospital on 30th

to Kisumu at Jaramogi referral hospital and he was not able to be treated in Kisumu just because

he is Kimutai.

I can sense from the mood of the House that you are seeing the sense of what we have been talking

about. Kindly let us be our brothers’ keepers and let us allocate resources to this facility. Thank

you.

Hon. Koech David: Thank you Hon. Speaker. First of all let me thank the Committee of Health

and Sanitation for the comprehensive report and for making the visits. You have captured so many

things which are very critical in the health sector. Hon. Komen, I realize that the dispensary in

Terik Ward is in a sorry state but it is only that we have not taken photos of the hospitals in the

Wards we are representing, they are also worse but we will try to as much as possible ensure we

balance allocations so that when we get the 100 million it should be equally distributed.

I would like to remind the Chair of Health and Sanitation that there is a day the Governor said that

we shall have a health center of excellence in every Ward, please make a follow up just as a Hon.

Member mentioned. We should have at least one which will serve as a referral of a Ward before

further referrals can be done.

As Hon. Koech Gideon has said, most of the issues which are captured in this report are in the

budget and I am happy to hear that mortuary construction is going on in Nandi Hills. It will ease

the congestion we have in Kapsabet. I went to Kapsabet hospital some days back at night and for

sure those Wards are very filthy. I went round and I asked one of the patient how the services were

in the hospital, the patient said that the services were good but the challenge is water. So I think

the water issue is addressed. Cleanliness is very important, at times it is the environment that makes

us sick. When one is treated in a clean environment, it is not the same as the patient that has been

treated in filthy environment. So the Chair and the Members of the Committee of Health and

Sanitation, let us take that as a matter of urgency so that we ensure that the environment in which

our patients are staying in is clean.

I realize that there is a major problem on staffing in terms of doctors especially for the critical

areas. You can imagine a hospital like Nandi Hills is understaffed by over ten Clinical Officers

and you know the work Clinical officers do. I believe through the Chairman you can make requests

so that we can have enough staff as possible. You realize that the reason most of the dispensaries

that were constructed have not been opened is because there are no nurses. Like Hon. Rono

Magdalene was talking about, we have a lot dispensaries that have been constructed. Even in the

ward I represent, there is a big dispensary that has a big maternity, that was constructed with over

10 million but there is no staff. We have everything including the shelves. So, it is a major

challenge that we have in our County that should be addressed because before we start new

dispensaries let the ones that have been constructed be operationalized first.



Otherwise in future ensure that you visit other areas. In fact if it is possible you can start with Terik

ward, we have heard Hon. Komen complain before and when there is a complain somewhere---

(Hon. Koech Gideon on a point of information)

Hon. Koech Gideon: Thank you Hon. Speaker, I wish to inform the Leader of Majority that he is

a Member of Health and Sanitation Committee so he should be saying ensure we visit and not you

visit.

(Laughter)

Temporary Speaker (Hon. Chepkemei): Leader of Majority I believe you stand guided.

Hon. Koech David: Thank you Hon. Speaker, I am surely a Member of the Committee and as one

of them I recommend that we visit Terik Ward. Hon. Komen has been complaining and we cannot

neglect it. For me in the ward I represent, I am not badly off but for Hon. Komen we shall visit

Terik ward. Otherwise as Hon. Chumba Milka mentioned we appreciate the MRI machine that the

Deputy President promised---

(Hon. Chumba Milka on a point of information)

Hon. Chumba Milka: Thank you Hon. Speaker. I would like to inform the Leader of Majority

that it is not Terik ward alone that is in a pathetic situation, it is in all the wards!

(Hon. Kipkemboi on a point of order)

Hon. Kipkemboi: Mhe. Spika, kulingana na Kanuni ya Bunge 82 inasema wazi kuwa ukisimama

katika hoja ya nidhamu ni lazima utaje hiyo sheria.

Hon. Koech David: Thank you Hon. Kipkemboi, you have saved me from this---

Temporary Speaker (Hon. Chepkemei): Leader of Majority, I think Hon. Milka should have

said she was standing on a point of enquiry and not point of information.

Hon. Koech David: Thank you. I was just recommending Terik ward because all of you have

always heard Hon. Komen complaining. We are only saying that it is a concern and maybe in our

next visit we can start from Kapsengere then we go to another ward as we progress. Otherwise

thank you very much. I support this Motion fully.

Temporary Speaker (Hon. Chepkemei): Hon. Terry!

Hon. Maiyo Teresa: Thank you Hon. Speaker for giving me this opportunity to make my

contributions. I realize that health is a major concern---

(Hon. Kipkemboi on a point of information)



Hon. Kipkemboi: Mhe. Spika, hatuna Mheshimiwa anayeitwa Terry---

Temporary Speaker (Hon. Chepkemei): Hon. Kipkemboi, time and again, we have talked about

this and I think we have come to an agreement that instead of Teresa we say Terry and I think we

have said it so many times allow us to refer to Hon. Teresa as Terry.

Hon. Maiyo Teresa: Thank you, and I have a legal document to that effect, may I make my

contributions on the same. May I thank Health and Sanitation Committee for the expansive report

they have done and thank the Committee for having kept our hospitals running. From the time we

came to office you realize that the “Tuga Tai” Government took over when the hospitals had been

grounded for like six months and to date it has run continuously well. I cannot avoid saying thank

you to the Government for what it has done so far.

On the report that is on the floor, I only got a bit confused when Kapsabet hospital was indicated

to be level three and that it needs upgrading to level four and Nandi Hills is in level four and I was

wondering which is the referral hospital in this case?

I also noted that so many workers in these hospitals especially the casuals both at the health centers

and referral hospitals have not been paid for like ten months and you realize that the health

department takes a lion’s share of our budget both from the first and second supplementary and

the entire budget that we recently passed. How comes they have not been paid. If it is about the

contracted cleaning services then you can imagine someone handling patients going without salary

for like ten months, these are people who are expected to be handled carefully by motivating them.

I am sure they cannot be handled well by hungry people who do not know when their salary will

be paid, it is unfortunate.

The same report has given maternity expansion. The ones that are to be done after the crucial ones

are done when you get there they are pathetic. We recently went to a maternity ward with Hon.

Kiplagat MCA for Kabiyet ward, the congestion that is there is wanting. Three mothers are sharing

a single bed and are either in labor or have delivered their babies. I realized women are doing very

good work of bearing children and we are doing it without complaining nor charging---

(Applause)

We only need a better place to labor in peace

(Laughter)

Honestly three women sharing a bed isn’t good! We should prioritize maternity section.

In our budget, health sector takes a lion share and the wage bill takes so much considering the

development aspect and we have come to understand that more staff are still needed in the hospitals

so possibly the entire County should look at priority areas if it is health sector let it be staffed well

comparing to the other departments so that the wage bill is managed and the same time the public

is comfortable with the health issues.



We also talked about rest rooms for nurses and waiting bays for those taking care of patients. I

have been to the maternity like three times this year at night and you find women who are waiting

for the mothers in labor outside even up to midnight and when they are allowed to go in, they are

going to stand in the pavement. If the mothers are sharing the bed in threes, the ones who are taking

care will have to stand waiting for the rest, it is really pathetic and I urge the Health and Sanitation

Committee to look into that.

Considering that large share of the money was allocated to the health sector, we really expect so

much in a short time possible. We should be seeing what the first and the second supplementary

budgets that we passed has done especially from the Implementation Committee so that, as we

pass more budgets we are seeing the health sector improving. I am happy you already mentioned

the ones that were budgeted for. We hope soon enough we are going to see work being done.

Otherwise I want to support this report that it is going to guide on the way forward and we want

to see the Committee possibly going to the areas which were not visited, which includes the rest

of the wards like Kilibwoni and the others. Thank you very much.

Temporary Speaker (Hon. Chepkemei): Thank you Hon. Teresa for acknowledging that men

and women in Mosop are taking their work seriously and all the other Members should encourage

their residents to follow suit.

Hon. Maru: Thank you Hon. Speaker. I stand to support this Motion now that there were a lot of

complains about the visits made by the Committee and I have been squeezing the Chairman of the

Committee and he has informed me that this was just the first phase. So let us relax, they will be

coming in the next phase.

Now that---

(Hon. Koech Gideon on a point of enquiry)

Hon. Koech Gideon: I just got slightly distracted I did not clearly get the term you used did you

say you were squeezing the Chairman?

Hon. Maru: No, I withdraw that word we were communicating. I wanted to inform the Chair of

Health and Sanitation Committee that in Sang’alo/Kebulonik Ward, there is a marginalized area

that is bordering western along Kamwega to the forest of Nandi and between Kakamega forest.

There are around seven thousand habitats there, having seen the images from Terik ward, I will

even say that if I can get what they have and take it to them in a container I think the people in that

marginalized point will be happy.

Similarly, we have a problem with the toilets in our referral hospital here in Kapsabet. If there will

be any renovation that should be considered first, it should be in this area. It has to have a basin

toilet that you sit on, it is a challenge say for someone like me or the Leader of Majority considering

our weight; it’s a challenge to use the toilets that do not have seats. The Committee should

prioritize the toilets. When a patient is sick, they need conducive environment, the Chairman

should take that up.



What Hon. Teresa was saying about the maternity makes it so absurd to see three mothers sharing

one bed, so I think the best thing is for every ward we open up a maternity to decongest the

maternity in the referral, because labor is not a disease you do not need to come to the referral.

They can get the babies in the maternity in the wards and take the babies home. Thank you, I

support this.

Hon. Chepkwony Philip: Thank you Hon. Speaker for giving me this chance to contribute on this

report by the Health and Sanitation Committee. First of all, I would like to thank the Committee

for bringing this report. We still have financial years ahead of us and I think if this report is not

catered for adequately in this financial year, it will inform the budget in the subsequent financial

years.

I do not want to waste time because Kapsabet and Nandi Hill have been mentioned. Let me talk

on the area that I come from Cheptilil, let me thank the Committee for visiting there, that is where

I come from. Let me thank the Members for acknowledging that there is no electricity in Cheptilil

dispensary and therefore the County Government should work on it. I am grateful that that was

highlighted because it has been a problem because the drugs that need to be stored in a fridge are

kept 10 kilometers away in Kibwari because of lack of power.

The other thing I am grateful about is that the Committee captured a facility that is being used by

around twenty thousand people because it covers a large area, and the other thing I want the

Members to note is that having to attend to that large number of people I think the Members of the

Committee should have recommended for that dispensary to be upgraded to a health center because

of the huge population it serves. The Committee should consider in future to recommend that we

upgrade the facility, it covers the lower side of Kapsimotwo which is a huge area.

The other thing mentioned is the staff quarters that is incomplete. I agree with Hon. Koech David

that we have some facilities that were constructed by the CDF before the projects were abandoned.

The same case is with Cheptilil, one staff quarter was constructed by CDF but it is incomplete and

I wish the Committee should have said that the CDF should hand over the project to the County

Government. I think it needs a little financing for it to be complete.There is also a foundation that

was started for maternity wing but it is incomplete but as Hon. Maiyo Teresa has clearly put it that

they are not complaining but they only need a good environment, that also applies to people of

Cheptilil, we only need a conducive environment for the mothers.

Let me talk about Nandi Hills, I would like to thank the Committee for highlighting Nandi Hills

Sub County hospital because three Sub Counties are using the hospital, we should upgrade it to

the standard of Kapsabet because as you know we are at the boarder of Nandi County and

thankfully after the handshake, we have peace at the boarders, so if we can improve our facility at

Nandi Hills then it will help us. Otherwise I stand to support the report.

Temporary Speaker (Hon. Chepkemei): Hon. Members, judging from the mood of the House,

I will proceed to put the question.

(Question put and agreed to)



COMMUNICATION FROM THE CHAIR

Temporary Speaker (Hon. Chepkemei): Hon. Members, today with us are teachers and pupils

from Kimong Primary school in Kipkaren Ward. They have come here to learn and we welcome

them and I request the House to give them a round of applause.

(Applause)

It is good that we have the Member from Kipkaren ward Hon. Chumba Milka, please say a word

to welcome them.

Hon. Chumba Milka: Thank you Hon. Speaker, I was seated and I did not know what was going

on in the public gallery. Wow! I am shocked, you know the Chief Whip sits in the last seat and the

gallery is not visible well. I would like to thank them and welcome Kimong upper primary school.

This is Nandi County Assembly, it is a Hon. House and I am grateful that you chose to come today.

I know the head teacher is there, staff and the school committee members, feel welcomed. Hon.

Members, let us give them another applause.

(Applause)

You are welcome again another day. I am happy to see you, thank you.

ADJOURNMENT

Temporary Speaker (Hon. Chepkemei): There being no other business the House stands

adjourned to the next session.

(The House rose at 11:25 am)

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