The Kiambu County Assembly has raised fresh concerns over critical staff shortages in public hospitals, warning that understaffing and absenteeism are undermining healthcare delivery even as the county makes progress in controlling its wage bill.
The Assembly’s Departmental Committee on Public Service and Administration said some health facilities were operating with inadequate personnel, while others had yet to become fully operational because of a lack of staff.
The committee, chaired by Riabai MCA Hezron Gachui, raised the concerns during a meeting with officials from the County Executive Department of Public Service to scrutinise staffing levels, personnel management and the county’s wage bill.
Members also demanded assurances that the county payroll was being regularly audited to eliminate ghost workers and ensure that public funds were not being spent on employees who do not report to their assigned workplaces.
“We have several concerns, one being the wage bill and staffing levels in the departments, particularly in the Health Department, where some hospitals remain understaffed or have no staff at all,” Mr Gachui said.
The concerns came as County Public Service Board chief executive officer Martin Njeri told the committee that Kiambu had made significant progress in reducing the proportion of its revenue consumed by salaries.
Mr Njeri said the county’s wage bill had fallen from 51 per cent of total revenue in 2023 to about 40 per cent, largely as a result of improved own-source revenue collection.
He said the county was now within reach of the recommended 35 per cent wage bill threshold, provided it sustains efforts to expand its revenue base and improve collection.
“We have significantly improved our own-source revenue, and that has enabled us to reduce the wage bill burden. If we continue increasing revenue collection, we are confident we will achieve and even go below the 35 per cent threshold,” Mr Njeri said.
The county recently collected Sh6.5 billion in own-source revenue, contributing to a total budget of approximately Sh19.5 billion. About Sh8 billion of the budget is allocated to personnel costs.
But while the reduction in the wage bill was welcomed, MCAs said the savings should translate into better public services, particularly in the health sector, where residents continue to face challenges accessing medical care.
Mr Njeri said the county executive was exploring a legal framework that would allow health facilities to engage medical personnel on a locum basis and pay them according to the hours worked.
The proposed arrangement, he said, was modelled on a similar system adopted by Nyandarua County and could help address staffing gaps without placing additional pressure on the county’s permanent wage bill.
The proposal received backing from Health Services Committee chairman Joseph Muhinja, who said absenteeism among medical workers had become a major impediment to effective service delivery.
Mr Muhinja said the problem was particularly pronounced during night shifts, when some facilities reportedly lacked adequate personnel to attend to patients.
“The issue of absenteeism among medical personnel has hampered service delivery, particularly during night shifts. Introducing locum engagements will help ensure hospitals have adequate staffing and improve service delivery,” he said.
The committee also expressed concern over cases in which public health workers allegedly fail to report to their assigned stations despite being on the county payroll.
Mr Njeri said a recent government staff integration audit had uncovered cases of permanently employed medical personnel who were simultaneously working in other institutions, raising questions about accountability and the quality of services offered in county hospitals.
The revelations have renewed calls for tighter monitoring of public employees and stronger enforcement of attendance regulations.
Mr Gachui urged the County Executive to deploy available health workers to facilities that have been completed or are operational but are yet to provide services at full capacity because of staffing shortages.
He also called for the introduction of a biometric attendance management system to track employees’ working hours and shifts, arguing that technology would help curb absenteeism and improve accountability.
The committee cited reports of staff absenteeism, including at Kiambu Level 5 Hospital, and said the county needed to strengthen supervision and monitoring of personnel.
The MCAs said improving revenue collection and reducing the wage bill would only be meaningful if the county translated the gains into improved services for residents.
They urged the County Executive to strike a balance between prudent management of personnel costs and the need to recruit enough health workers to ensure that public hospitals are adequately staffed.
The committee’s concerns place the spotlight on the broader challenge facing devolved units: how to control rising personnel costs while ensuring that essential services such as healthcare have enough skilled workers.
For Kiambu, the immediate test will be whether the county can sustain the gains made in revenue collection and wage bill management while closing staffing gaps that continue to affect service delivery in its health facilities.
