9 January 2019

Kenya: For Better Services, Make Mathari Hospital Autonomous, Says Ouko

Mathari Teaching and Referral Hospital in Nairobi should be made semi-autonomous to ensure effective specialised mental health services, Auditor-General Edward Ouko has recommended.

Mr Ouko said this will enhance the hospital's capacity to mobilise resources and serve the public effectively.

In his performance audit report on provision of mental health services, Mr Ouko said the hospital lacks resources to acquire and maintain equipment, drugs and personnel.

"Services at the hospital are affected by lack of critical equipment such as computerised tomography scan and magnetic resonance imaging machines," the report says.

The audit established that wards are not enough and the hospital has an average bed occupancy rate of 115 per cent.

Further, it experiences stock-outs on critical drugs and does not have adequate skilled and qualified personnel.


"The effect is that patients get poor services, diagnosis is delayed and their condition could become worse. Patients and their families continue suffering," Mr Ouko says.

The audit team examined the operations of Mathari Hospital and its 19 psychiatric units for five financial years, covering 2011/12 to 2015/16.

This was the period when provision of healthcare services was devolved.

The team also examined the extent to which standards and guidelines for provision of mental healthcare services have been developed and communicated, carried out inspection of the adequacy and state of the available infrastructure, reviewed the treatment process, assessed availability of psychotic drugs and evaluated the adequacy of skilled personnel.

According to the report, the measures put in place by the Ministry of Health and devolved governments have not been effective in providing mental healthcare services at national and county levels.

It cites failure to implement and update provisions of the Mental Health Act and the challenges in hospitals providing mental healthcare services.

The audit established that while the government has put some effort in managing the provision of services through the passage of the Kenya Mental Health Policy 2015-30, it faults the ministry for not effectively delivering on its mandate of enforcing the health policy and standards management.


Mr Ouko wants the ministry to ensure the 2014 Mental Health Bill is finalised for enactment so as to incorporate the devolved governments, the rights to be accorded to the patients with mental illnesses, as well as incorporating the county mental health councils.

He also called on the ministry and county governments to prioritise mental healthcare services, ensure there are adequate and relevant qualified personnel and provide critical equipment and drugs.

"In addition, the Ministry should effectively communicate the already developed standards and guidelines to enhance efficient mental healthcare services."

The hospital management, through the Health Ministry, should liaise with the Ministry of Interior and the Department of Correctional Services on how to cater for the patients in maximum security unit wards to avoid overstretching the available resources, the Auditor-General added in his report.

"The hospital, through the ministry's legal department, should enact a policy on initiating binding memoranda of association with public and private institutions that train their students at the institution," he said.

"This will ensure the resources for training and the training facilities are appropriately provided without overstretching the other services."


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