Kenyans face a drug shortage as counties owe the Kenya Medical Supplies Agency Sh2.3 billion.
In an April 11 report featuring defaulters, Nairobi County tops the list with a debt of Sh284 million dating as far back as 2014.
Kemsa has a deal with counties, which pay within 45 days after delivery.
The drug shortage looms despite the county governments setting aside Sh747 million for health in the current financial year.
Of this money, only Sh70 million has been used to offset the debt.
"We have used Sh70 million from the amount we had set aside to pay Kemsa. The remaining Sh677m has not been spent," said Dr Irene Muchoki, the Deputy Director of Medical Services.
Dr Muchoki said on March 27 that Nairobi residents may soon be forced to seek medical care in private facilities.
"The situation is tricky because so far our county hospitals only received drugs once in this financial year and that was last August. The issue is dire and the public has been crying," said Dr Muchoki. Health Cabinet Secretary Sicily Kariuki gave the city's public health facilities a lifeline last August when she ordered Kemsa to resume supplying drugs to the devolved units despite a Sh235 million debt.
The counties have, however, accumulated more debt since then, leading to shortages caused by the refusal of Kemsa to supply them with more drugs.
In Nairobi, the drug shortage has persisted as Governor Mike Sonko continues to make headlines with acts of charity, including last week's release of patients detained in public hospitals over unpaid bills.
Other counties that owe Kemsa huge amounts of money include Homa Bay, which owes the agency Sh138 million, Makueni (Sh163 million), Narok (Sh105 million), Turkana (Sh96 million), Kiambu (Sh95 million), Kitui (Sh94 million), Nakuru (Sh89 million), Meru (Sh88 million), Vihiga (Sh71 million) and Wajir (Sh68 million).
Of the counties where the pilot of the universal health coverage programme has been rolled out, Kisumu tops the list with a debt of Sh77 million, followed by Machakos with Sh34 million, Nyeri (Sh9 million) and Isiolo (Sh2.3 million).
Only Elgeyo Marakwet has cleared its debt, with an overpayment of Sh400,000.
At a Monday media briefing over the report Dr Jonah Manjari, the Kemsa chief executive, said the agency was holding talks with county governments over clearance of outstanding debts.
"We are still in negotiations over the need to clear the debts as soon as possible, so far their response has been positive. It is our hope that the debts will soon be cleared," he said.
"Counties are normally allocated funds for expenses such as purchasing drugs and non-pharmaceutical supplies. We still do not know why they have not yet remitted these monies to Kemsa so as to clear their debts," said Mr Manjari.
He said there was need for counties to priorities payments to ensure that the ongoing universal health coverage programme, which is expected to be rolled out countrywide by May, is successful.