By Martin Masai

Tensions are boiling in Machakos over Sh130 million disbursed by the Social Health Authority (SHA) to county hospitals — money that was meant to save lives but is now at the centre of a governance storm.

The funds landed in the accounts of Machakos Level Five Hospital and 11 other Level Four facilities two weeks ago.

Machakos Level Five alone received Sh115 million, while the rest shared Sh15 million. Yet, instead of easing the pain of collapsing services, the money has been trapped in a tug of war between the county treasury and hospitals.

Last week, the rot surfaced when patients at Machakos Level Five missed dialysis sessions for lack of supplies even as staff knew that the county had received millions from the Social Health Authority.

Behind the scenes, sources revealed that the county treasury was pushing to sweep the cash into its Family Bank Account  — leaving hospitals to choke under suffering patients, unpaid bills, empty shelves, and desperate patients.

Only Kes.35 million was left at Level Five after the uproar, a token gesture to calm the chaos.

Governance Breakdown

The crisis exposes a gaping hole in Machakos County’s health governance.

For three years, the facilities have operated without Hospital Boards of Management (HBOMs) — the legal authority required to approve budgets, sanction spending, and paved way for issuance of  an Authority to Incur Expenditure (AIE) by the relevant Chief Officer.

Without HBOMs, medical superintendents and hospital administrators have been reduced to figureheads.

They can not legally touch the Facility Improvement Fund (FIF), which pools revenues generated by hospitals.

In 2023/24 alone, Machakos hospitals raised over Kes. 700 million in Own Source Revenue. Yet not a cent has been ploughed back to improve services, purchase equipment, or pay suppliers.

Instead, the county treasury routinely sweeps the money from hospital accounts and deploys the cash for unaccountable uses.

Suppliers are left unpaid, businesses owing the facilities collapse, and hospital managers make humiliating trips to the Chief Officer’s office to beg for crumbs.

“The problem is not money. It is governance,” said one senior medic. “Even if the hospitals were told to use the SHA millions, none of us would dare touch it. Without boards, it’s illegal.”

Audit Committee: Too Little, Too Late?

Ironically, the absence of critical governance infrastructure in the health sector coincides with Governor Wavinya Ndeti’s inauguration this week of the Pioneer Machakos County Audit Committee — a body mandated under the Public Finance Management Act, 2012.

The committee, chaired by Jones Makau Nzomo, with members Stephen Nzioki Sila, Ann Nduku Maingi, and Boniface Kalinda Mulii, has been tasked with serving as the county’s internal watchdog to strengthen integrity, accountability, and transparency.

Governor Wavinya pledged to safeguard their independence and ensure they have the authority and resources to execute their mandate.

But critics say the move, coming three years into her tenure, underscores the contradictions of her administration: tightening oversight at the treasury while leaving hospitals in limbo without Boards of Management — the very structures needed to stop the haemorrhage of funds and the collapse of health services.

For dialysis patients and struggling suppliers, the launch of an audit committee may be a headline milestone, but the reality on the ground remains bleak.

Hospitals are running on fumes, governance gaps are unaddressed, and the promise of health sector accountability is little more than a ceremonial ribbon-cutting.

Contacted for comment, Health Minister Justus Kasivu denied knowledge about sweeping of SHA funds but said hospitals are running normally and added that the county was consolidating efforts to ensure the health needs of residents are met in an efficient manner. 

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