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Part 2: The Nairobi Hospital Facing Imminent Collapse

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With new revelations that have continued to arise—squabbles, wrangles, pushes, and pulls within the management of the once great Nairobi hospital—it is now beyond reasonable doubt that the institution is on its death bed, as Kenya Insights in-depth investigations have unearthed and can authoritatively confirm .

The leadership deficiency in the organization, is even more marinated in tribalism, greed, and dictatorship than we highlighted in Part 1.

In this second part, we get deeper into the anatomy of the troubles facing Nairobi Hospital.

But first, the origin of this great institution: –

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Who built The Nairobi Hospital?

The Nairobi Hospital was established to replace the older Nairobi European Hospital (1902), that had become too small and hence inadequate, as the new European Hospital. The institution was officially opened on 9 April 1954, as an exclusively European Hospital, in Kenya, which was then a colony of the United Kingdom. On 19 October 1961, it began serving non-Europeans and the name was changed to The Nairobi Hospital. Subsequently the Kenya Hospital Association was created to own and run it. All those who had this vision are no longer here, nor are their families even involved as you would expect. This was a gift given to this country by philanthropists.

Who Owns The Nairobi Hospital?

Kenya Hospital Association (KHA), now loosely owns therenowned medical facility. Members of this association are the shareholders responsible for appointing and removing directors and other senior managers in charge of day to day operations of the facility. As mentioned, the hospital was largely built by philanthropists and, unfortunately, they forgot to work on guidelines to safeguard the institution from the greed of our times. Those who have inherited The Nairobi Hospital, have also failed to put in strong structures to protect the institution from the vultures.

The Kenya Hospital Association (KHA)

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This is an association that was created to have ownership and to oversee the running of the hospital. All the Admitting Staff (ASA), of over 600 are members of the lager KHA whose membership from both the ASA and the general public is about 3,000. There is a joining fee and annual membership fee. You can loosely say that these are the owners of the hospital. The main reason most people joined KHA voluntarily was just giving back to society by supporting the hospital. As members of KHA, there are some discount benefits as patients, but that’s not good enough reason to be a member.

However, lately there has been mass recruitment of members by particular board members, like Magdalene Muthoka and Philemon Mwaisaka – and the purpose isn’t philanthropic. They are basically recruiting voters to help them cling to the KHA board. The articles do not allow anyone to introduce more than five members per year. These two, were bringing in one hundred and fifty new members in one go. In a situation where the total vote count can be less than 300, you can imagine how those numbers can tilt the balance in one’s favor.

Therefore, there are now many new members at the level of house helps, gardeners, watchmen etc., who cannot afford treatment at the Nairobi Hospital and obviously have no idea what KHA is, yet they were made to join KHAjust for the purpose of voting for in their benefactor.

Because voting has been virtual since the COVID pandemic, it is very easy for one in control of the voting machine to use these newly recruited votes whichever way the one in control chooses. Currently, the board chair is the one that controls the voting machine, behind the scenes. The electronic voting system has been so misused at the KHA elections, to the extent “you can vote, even before you vote”. This are just some few examples of loose KHA rules being taken advantage of by cunning board members.

KHA/ASA must take time to make the institution safe by strengthening the articles to levels that can be safe-guarded. The institution cannot go on in this time and age with such weak articles.

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Manipulations in the Board

In ideal situations, the purpose of a Board of Management is mainly oversight and operational support. But in a predatory board, oversight can be stretched further and further until it becomes total control. The latter is the current situation in the Nairobi Hospital.

The Nairobi Hospital’s Board of Management has 10 members voted in. Its composition includes two membersfrom the Admitting Staff Association (ASA). These are the MAC Chair and the Vice Chair, whose role is therefore to represent ASA. There are currently three other ASA members voted in not through ASA, but the larger KHA membership. So, five of the board members originate from ASA. The rest come from the wider KHA membership, and are not doctors. Once Board elections are over, the board members vote for their Chair and Vice.

If most of the board members are aligned to the chair and not the institution, then they pass votes to the whim of the chair. And in return, they are rewarded handsomely. This is the situation at the KHA board currently. Those aligned come to vote, and not to reason. And that’s how The Nairobi Hospital ends up in its current situation, paying arbitration lawyers more money than the HMIS they are arbitrating in an open market would cost.

What has generated the increasing ASA unrest is that the current Bichage Board has taken total control of ASA because the then MAC Chairman, Dr. Kambuni has beenrepresenting Chairman Bichage and CEO Nyamongo’s interests and not those of ASA. This is the reason, ASAremoved Kambuni on the 25th April 2024, and he remains removed.

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Much of the KHA Board’s work is supposed to be done through committees selected by the Board. If the Board Chairman has the interest, the eyes and ears of the institution, then he/she consults, and the committees are constituted in a balanced way looking at the special skill mix that the KHA Members have voted in.

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Sometimes special skills have to be sought from outside the elected board members, to make a committee fully functional. In such cases, the board jointly co-opts professionals of good standing in society, with the required skills. The co-opted members according to the articles aren’t supposed vote on board matters, they just offer their skills. But that is in an ideal situation. The KHA board isn’t one of those.

What actually happens currently at the KHA board is,chairman Bichage comes up with names he has co-opted from his magic box. The board is just informed of new committee members, and no opinion of theirs is sought. And what’s more, these members are actually allowed to vote, in contravention of the KHA articles. So, in the board, the chair bolsters his power of having his way by bringing in three or so more loyal voters, not special skills (but maybe voting is a special skill). Members of a different opinion may have their say, but evidently nevertheir way.

We therefore have board members caught in this trap, do they resign and let the ship sink, or do they continue fighting hopelessly from within? Is it possible these board members need KHA members to know what’s going on and call matters to order, but don’t have channels of communication with the membership? Please reach to your board members, they need you now more than before.

Emergency Reshuffle of the Board Committees at the end of May, 2024

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This is a real example of an occurrence, just last week of how the chairman manipulates KHA committees to have his way:

There was a planned interview of several new staff this coming week, amongst the vacancies to be filled are Finance Director, and Human Resource Director. And inboth these positions the successful candidates and already known, and tribe you already know.

At the same time to be relieved of their positions are five or so Senior Management Staff, who apparently are independent minded, and cannot be tolerated anymore. They just don’t fit in with the new matrix at TNH.

So, last week the then Human Resource Committee converged to assess the situation. Unfortunately, they asked many silly questions, including how the shortlisting had been done. Amongst those delivering the shortlist for interviews is also a candidate herself for human resource directorship, Linet Kerubo Oeba. And what’s more shocking? Her own name had been short-listed. Again the tribe, you guessed right – gaki!

The HR committee decided on a date to reconvene and go through the original list of applicants, and review the shortlisting criteria. A day later, in the deep of the night, chairman Bichage reshuffled the committees.

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The new Human Resource Committee, as previously, is still chaired by Loyal Dr. Barcley Onyambu, but now hasnew members, namely Dr. Fred Kambuni, Dr. Magdalene Muthoka and Mr. Philemon Mwaisaka.  These are the blue eyed boys and girl” of the Chairman. The old members of that committee were scattered around to other committees with no immediate crucial matters concerningChairman Bichage. As times change, they will be reshuffled again, as the situation demands in the game of “moneymusical chairs”.

These are real things, and they are documented, withdetails which were readily available to Kenya Insights from multiple sources willing to share their frustrations with their current board.

The previous human resources committee, of the board has been unilaterally scattered by the chair after failing to agree to facilitate the shortlisting plus hiring of a Kisii financial director, clearly an intention to control the purse strings even after any change of guard at the level of the chairmanship of the board.  The committee was in the process of interviewing for positions of the HR director, the finance director, finance manager, amongst others, and firing five senior managers.

There is skewed hiring of manpower to favor one community that the Human Resource Chair, Board Chair and the CEO belong to regardless of competency. This is evident across the junior newly hired nursing staff and the support staff. An audit commissioned to assess this state by the Board was shelved as soon as results emerged highlighting this anomaly.

Due to the insistence on ensuring adherence to good practice and fiduciary duty to KHA by the Chief Operating Officer, The Medical Director and the Hospital Engineer, the CEO and board chair are intent on terminating their contracts with connivance by the Chair of the Human Resource Committee, Barcley Onyambu. This is similar to a move undertaken last year by the CEO and current Board Vice Chairman Philemon Mwaisaka, to elbow out the thenFinancial Director who was strict in matters of prudence, an action that has largely led to the current shaky financial status.

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Procurement Reshuffle

Last week, a member of the Procurement Committee, or so he still believed, met one of the managers and expressed that he was puzzled, as he had not been called for a Procurement Committee meeting in a long time, unlike in the past. He wondered what was happening with Procurement. To his surprise, he was told that he had been replaced. He said it was not possible as he hadn’t received a letter. He has lived to confirm it was indeed true that he had at some point, without reference to him, been replaced!

When one is appointed to these committees you receive a letter of appointment, which you have to accept before appointment is official. Also when your term ends, you receive an official letter. This had not happened. When he enquired on who had replaced him, he was told it was Dr. Mathew Akama who took his place. The pattern continues– kindred. Dr. Mathew Akama, an ever smiling, soft spoken doctor from kisii (not sure about Keroka) is now apparently the Chair of the Procurement Committee. One wonders when this abuse of the 41 other Kenyans will end? Can’t we even try to pretend?

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New Emergency Tenders

On 1st June 2024, new tenders, TNH/ITB/012-018/ENGINEERING were advertised in the Daily Nation.These projects had been shelved by the board due to lackof value and exorbitant cost. The time line given for tender submission was 13th June, yet these are major infrastructure projects on already pre-existing old buildings that may require reconfiguration with an impact on already existing use and patient traffic/inpatient care.These are construction tenders, at a time when the hospital is struggling to pay salaries and suppliers have closed accounts due to non-payment. It is understood that the plan is to borrow KES 2 Billion for these projects. Is it not reasonable to ask oneself if this is responsible stewardship by the Board, of an institution on it knees?

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The projects as per the tender notices were:

a. Conversion of the old kitchen into a cardiac unit, with 8 critical care beds at a cost of 600 million.
b. Conversion of St. Luke’s ward from a 24 bed facility to a sixteen single and ensuite room facility at a cost of 50 million: the actual cost resulting from disruption to the wards above and below haven’t been factored in yet.
c. Creation of eight extra doctor’s rooms at Anderson Centre at a cost of 25 million.
d. Creation of a parking space (non-silo) at 40 million.
e. These projects are in addition to purchase of a linear accelerator at 750 million, costs which anyone checking with the shortlisted companies andcompetitor hospitals will easily recognize are grossly inflated.  

Soreide, in 2002, pointed out that owing to discretion allowed in the process of designing the evaluation criteria, officials have been known to improperly exercise their power to decide what firms to invite to tender by designing evaluation criteria that favor a particular company, or by manipulating the process to award a contract to a preferred firm (Soreide, 2002). or to obtain confidential information on the tender or on competitors (Soreide 2002).  It is also noted that some have been known to split a large contract into several small contracts to circumvent rules that require publication and transparency for larger contracts (Williams-Elegbe, 2012). Bichage and his allies appear to have been good students of Soreide and Williams-Elegbe.

Focus on these major CAPEX at exaggerated prices while ignoring purchase of simple functional day to day basic medical and surgical consumables and tools has had the impact of some younger doctors unable unable to buy own equipment opting to admit patients elsewhere to facilitate safe practice.

To fund these projects, the board chair has also reshuffled the Finance Committee to enable him to get a loyal team willing to facilitate the offshore borrowing of KES 2 Billion, in dollars, from the commercial banks. Check the finance committee, and you will see that the” blue eyed boys and girl” outnumber the others: six against two. So, whatever the chair wishes will pass by that margin. You can’t argue with tyranny of numbers can you?

Barcley Onyambu

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Soft spoken young Gynaecologist is a first term member of the KHA Board. The doctors had a lot of hope in him when he offered himself for the last board elections. His youthfulness and balanced thinking were some of the positives he carried, tenderly.

But, it was a surprise when he was selected by Mr. Chris Bichage to head the important docket of Human Resource, from amongst older and more experienced board members. From that moment, ASA and KHA Members smelt a rat, and a rat it is. He has carried out Bichage’s and Nyamongo’s agenda of cronyism and nepotism in employment with alacrity.

Interestingly, the Chairman and CEO now commission this young man to explain to all and sundry subjects like the ICT procurement. He has become a consultant in this difficult subject of the HMIS. He will turn a lie into a truth softly and smoothly without blinking. It is said that he can sell ice to and eskimo.

Just the way Barclay Onyambu explained to his mesmerized audience at the now infamous SGM, that the hospital was at 110% bed occupancy. The doctors who had done rounds earlier, that day, vaguely remembered walking past many empty rooms and beds. The doctors generally agreed, even though they were not mathematicians, that at 100% occupancy, there would be no empty rooms, let alone beds. None could figure out what the 10% on top of the 100 would look like. But it was later revealed that the actual occupancy then, was just above 40%.

The rate at which Kisiis from Keroka are being “imported” and employed in the Nairobi Hospital is alarming and telling. In fact, other members of staff who unfortunately happen to come from other tribes are now beginning to familiarize themselves with Kisii as a hospital language. It’s now widely spoken along the corridors and offices. Recently Nyamongo and Dr. Onyambu decided to employ 30 community nurses from Kisii, Keroka village, without caring about the quality of nursing care in the hospital. The talk among members of staff is t0 seek to know what is special about this Keroka village in Kisii land. Kenya Insights also learnt that the corridor to Chairman Bichage’s office has recently witnessed a flurry of activities, and has been dubbed “Keroka Highway”. Staff at the hospital speculate this heightened activity is attributed to the possible correct “arrangements” being made by key allies ahead of the 2-week tender deadline notice which was sent out.

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Fred Kambuni

He is a paediatric surgeon by profession, and still has time for surgery in the middle of all this quagmire. He is the immediate past Chairman of the MAC before its recall. He had been irregularly elected into that position about seven months ago, even though he didn’t even qualify to offer himself. The articles of association state that the Chair and Vice Chair of MAC have to have PREVIOUSLY served in the MAC. He was just on his first few months in MAC, when he offered himself, in a rather predetermined way, by the predeterminers of ASA. His election was therefore illegal, but none objected to it at that time for many reasons.

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Just about three months into his chairmanship, it was noted at the MAC meetings that he habitually came with a predetermined outcome, and if he wanted your opinion, he would give it to you. Then the same started happening at the ASA meetings, and by end of last year, ASA membersstarted questioning how he came to be on that seat. This led to a cascade of reactions, and in part 1 of this series, you’ve seen how he predetermined ASA meeting outcomes or sabotaged them.

On 25th April the MAC was recalled, but he has refused to go home (don’t know if he’s supposed to go to Keroka too)and has decided to hang in there, even if by a thread. The Board Chair and the CEO, continue to force him down the throat of the ASA.

It has been so much so that one of the irreducible conditions of the Board Chair and CEO is Kambuni remains Chair of MAC, and no interference with MAC, Management or the Board from ASA. The board Chairman and the CEO, seem to suggest, sorry, insist that Dr. Fred Kambuni is the only one fit to be Chair of MAC, despite the ASA thoughts to the contrary. It is a strange situation, because they aren’t the ones who vote for MAC Chair, and they are expected to work with whoever ASA gives them. His refusal to leave the position of chairmanship after ASA followed the law and their regulations to recall him leaves a lot to be desired and speaks volumes about his association with Bichage, Nyamongo, Philemon Mwaisaka and Magdalene Muthoka, who have been flagged with serious conflicts of interest in the hospital. They meet mostly at the Panafric Hotel apparently on a listed credit account at the expense of the hospital.

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Since the ASA elected him to represent them and he choseto abandon them and instead represent the CEO, Mr. James Nyamongo and Board Chair, Mr. Chris Bichage, the ASA realize he has betrayed them. Therefore, he is now generally referred to as “Iscariot”, after the famous man who did a similar thing to the “Son of God. They have decided on the surname, instead of the Christian one, since they say he isn’t as bad as “Judas”, yet, but they think given a little more time, he will. So, they have saved him from himself and removed him. He can no longer betray them.

The Nurses of Nairobi Hospital

Their operations in the hospital continue to be compromised, and they have raised serious concerns aboutand related to the recruitment of nurses at The Nairobi Hospital:

a) Half of the Senior Management Team and Heads of Departments are related to a person of influence in the hospital either by blood or otherwise.

b) Recruitment of close relatives of Chris Bichage, James Nyamongo, Philemon Mwaisaka, Magdalene Muthoka, Fred Kambuni, Barcley Onyambu, Meshack Onguti and Gilbert Nyamweya to the hospital in sensitive areas likeNursing, Finance and Marketing. Majority of the allies to the top offices are found in Procurement, Strategy and Innovation, Finance, Risk and Compliance departments, and now very worryingly, even Nursing.

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c) Employment of people who have not been successful in the interviews conducted in the hospital.

d) The recent employment, by the hospital, of a batch of30 community nurses from Kisii, Keroka village.

e) Appointment of staff in acting positions and later relegated to lower positions or fired after being “used” to do the wrong things.

f) Planting of relatives of senior officers in every space even when they don’t qualify for the positions they hold soas to intimidate the rest by publicly declaring how some staff are marked people and in the black books of the high offices.

g) Who is the beneficiary of the proceeds/kick-backs from the recently procured patient beds with broken lockers, immovable tables, whose payment was made using overdrafts, petty cash and all the monies in the hospital, leaving employees without salaries?

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Word has it that these beds were brought in by a very senior board member. When the issue of these patient beds was questioned by one of the admitting staff, the backlash on the senior nurses was immediate and severe. One was told in no uncertain terms that she was facing dismissal. We are waiting for her letter of dismissal from Barcley Onyambu, or James Nyamongo (incase Onyambu is caught up with more important dismissals of senior managers), with great anticipation.

Kenya Insights has classified information on the procurement of these beds and will reveal much more on this convoluted network of crookedness beyond measure. The unfolding story continues. Watch this space for Part 3…….

N.B. Just for your information, our computers have insisted that we add new words to their limited vocabulary, before the spelling and grammar check is allowed as complete! The two words: you guessed it, “Keroka and Kisii!”

Stand by for PART III

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