The donors have put the national government on spot over rampant corruption which they says could frustrate the rollout of Universal Health Coverage (UHC) in the country.
At the same time, the World Bank has suggested that the national and county government will need to increase budgetary funding for health programmes by 20 percent for UHC to succeed.
Donors attending the third national Universal Health Coverage conference in Kisumu warned that if corruption is not tamed, then it will be difficult to realise the goals of providing affordable and accessible healthcare in Kenya as envisaged in the UHC plan.
At the same time, health managers in counties asked the national government to form a nurses service commission to address the understaffing experienced in public hospitals.
They argued that like the Teachers Service Commission which is in charge of employing teachers, the national government should set up a commission to recruit nursing staff.
The county health managers are among stakeholders attending the three day third UHC conference in Kisumu to review progress made in provision of affordable and accessible healthcare to Kenyans.
Human resource gaps and pressure on available health facilities are some teething problems that the sector is still grappling with, the conference heard.
Speaking on the first day of the forum at the Grand Royal Swiss Hotel in Kisumu, USAID Mission Director Mark Meassick said the systems in Kenya are frustrating transparency, hence affecting service delivery in the health sector.
"The US government spends USD500 million per year on health support in Kenya. Most Kenyan people want integrity while the system is against that. There is need to bring more transparency in the health system," said Mr Meassick.
He said the Kenyan allocation for health is way below the expected targets, despite the huge support from the US government.
"The health support is a gift from US citizens to Kenyans but we can tell you having worked in the platform for year. My country feels fatigued to support the health system," Mr Meassick said.
He said the national government needs to review incentives to health workers.
"The issue of incentives of labour needs to be looked into very seriously from a wider perspective. There are thousands of Kenyan trained health workers in the US. We need to see how to solve this crisis because we train nursing staff who end up working in South Africa or Rwanda," he said.
Mr Meassick pointed out that the US government funds more than 33,000 health workers at a cost USD8 million annually.
Kenya Healthcare Federation's Amit Thakker said the national government needs to weed out ghost workers in the health sector.
"If we don't turn the issue of inefficiency around, then I am sorry we will not move from the pilot phase to finally rolling out in the 47 counties. If the government does not put the perpetrators behind bars then we will have a long way to deal with inefficiency in the health sector," said Dr Thakker.
He added, "The human resource and supplies are biggest costing factors in the health sector. We have heard cases of the Kenya Medical Supplies Agency supplies meant for public hospitals ending up in private chemists.
World Bank Programme leader Paolo Belli said the UHC is a real opportunity for reforms in the health sector.
"The approach to UHC has to be a partnership between the county governments, national government and private sector.
"It can't be just government trying to figure out problems in the whole sector. We need a partnership and also learn some new technologies in dealing with challenges in the health sector," said Mr Belli.
This is the third conference after Machakos and Nyeri conferences.
Kisumu, Isiolo, Nyeri and Machakos counties have been piloting UHC since April last year.
Speaking on behalf of the Lake Region Economic Bloc (LREB), Nyamira County Health Executive Douglas Bosire said the human resource crisis facing public hospitals in counties can be curbed if they share nursing human resources.
"In the previous meeting we held in Bomet, we proposed that counties in the LREB can share the available nurses amongst themselves," said Dr Bosire.
The head of the Health Sector Coordination and Inter-Governmental Affairs Osman Warfa said there is need to employ more nursing staff and at the same time improve skills for the existing staff.
"For universal health coverage to work, we will need to rationalise the existing nursing staff and improve the staffing skills," said Dr Warfa.
Nyeri Deputy Governor Caroline Karugu said apart from understaffing, the lack of health data poses another challenge.
She said in Nyeri County, which has a high prevalence of diabetes, many health facilities have no tangible data.
Kisumu County acting Health Executive Nerry Achar said there is serious shortage of nurses and other medical staff to attend to overwhelming number of patients flocking public hospitals.
"With the launch of the UHC in Kisumu, we are giving free health services, which has drawn more people to the facilities. The facilities are just the same, therefore straining the nurses and other staff," said Mr Achar.
"Unfortunately we are told we cannot recruit more nurses because of budget. There is need for legislation to be passed to give leeway for funding that can allow counties to employ more nursing staff," he added.
Kisumu's UHC progress report released in March reveals that health workers are providing care to a tripled number of patients, which compromises the quality of services provided and satisfaction.
For the universal health care to be effective, the county needs 7,476 staff against the current 1,803 employed health workers.
Kisumu County has 194 doctors and 827 nurses in public hospitals.
The county requires 250 doctors and 4,269 nurses according to the UHC progress report.
Mr Achar said for UHC to succeed the Ministry of Health needs to partner with that of Finance.
"Being the Finance CEC and now the acting CEC for Health, I have come to realise that the health docket needs to be given more attention when doing budgets," he said.
The Kisumu County Health department has also accused the county assembly of frustrating the implementation of the UHC programme.
Former Health CEC Rosemary Obara claimed the county is yet to access Sh127.5 million that was allocated for the first quarter of the project.
Dr Obara said even after holding talks with County Assembly Speaker Onyango Oloo and the assembly Health committee, MCAs are yet to approve the expenditure, seriously hampering health operations in the county.
While Isiolo, Nyeri and Machakos are concluding the first quarter of UHC and preparing reports on expenditure, Kisumu is yet to access the money.