Part 3: The Nairobi Hospital Facing Imminent Collapse

With new revelations continuing to arise—squabbles, wrangles, pushes, and pulls within the management have put the once great Nairobi hospital on its death bed, as Kenya Insights further reveals.

In Part 3, our team found its way into the heart of the dirty wars currently raging between the pro-Bichage mainly Gusii camp on one side and the outcasts – those who do not agree with Chairman Bichage on the other. Along the now famous “Keroka Highway’ in the hospital, as the pro-Bichage celebrated their most recent employment wins expanding their footage in key management positions, the anti-Bichage were very willing to spill the beans on irregular things happening in the Human Resource docket at the height of Bichage’s impunity.

The leadership deficiency in the organization, is getting even deeper marinated in tribalism, greed, and dictatorship than we highlighted in Part 1 and 2 of the Kenya Insights series on The Nairobi Hospital. A lot more is emerging from the Nairobi Hospital, with KHA, ASA and staff members now coming forward and volunteering information that was previously guarded, so as to try to save the institution from collapse. Even more interesting, Kenyans not even affiliated to The Nairobi Hospital in any way, are also now coming forward with information on specific individuals they feel should never have set foot there even as patients, because something would go missing as they were discharged.

The Human Resources Committee Delivers Chairman Bichage’s candidates

Kenya Insights has learnt shocking details following the recent reshuffling of the KHA Board’s Human Resources Committee by Chairman Bichage, which was just the beginning of the saga. The clear aim of the committee reshuffle was to position key allies who were to facilitate the emergency employment of three senior staff. Several irregularities are immediately evident in this employment plot:

1. Although the date ‘advertised’ of the interviews for the three positions was June 13th, 2024, Bichage’s selected candidates had been fast-tracked, already interviewed, offered the employment, and had already reported to take office by June 12th, a day before the date previously scheduled for the interviews! This confirms a few things: They were either waiting to be sacked wherever they were or were jobless. At the level of a Human Resources, Finance or IT Directorfor the Nairobi Hospital, these are seniorappointments. Whoever qualifies will obviously be in respectable, responsible positions elsewhere, and would need to follow due process and give notice to their current employer(s). Otherwise they would be blacklisted in their profession. Absconding from their positions for a new job would be a negative point in their CV, risking being professionally black-listed, and they wouldn’t do it. In the style of their recruitment exercise, the three have behaved like casuals, who can be here today, gone tomorrow, and back another day. It appears they were just hovering somewhere in the corridors waiting to report; the interviews were thus just a formality.

2. This level of employment is, by regulations, a KHA board process. The Human Resources Committeeconducts the interviews from a shortlisted group and select 3 candidates for each position. The names are then forwarded to the Board, who then go through the details of each candidate. The board then selects one candidate who best suits their requirements for each position. Letters of offer then follow. Salaries will then be negotiated, before the individual finally accepts the offer. They are then at liberty to give notice at their work place, and advice the new employer on their proposed reporting date. If they were previously employed, the three then they must have given required termination notice before their interviews, quite strange. The newly-reconstituted Human Resources Committee took it upon themselves to conduct the interviews, select candidates and unilaterally offer employment – all within a day! Meanwhile the rest of the Board remained cluelessyet, of course, in a few months they will be required to confirm the new staff they never employed. Thenagain, as speculated, the confirmation will be ‘Bichage-endorsed’ or ‘Nyamongoed’, without reference to the rest of the KHA Board.

3. In a process riddled with favoritism and injustice, a team of three new staff have already taken up office in an apparent emergency recruitment and are already positioned as favorites, the newest kids on Bichage’s block. They are William Masita – Finance Director, Magdalene W. Kamande –  IT Director and Mohamed D. Said – Human Resources Director. Whatever their qualifications, they are obviously party to a fraudulent employment scheme, and they know it and aretherefore jointly guilty of fraud. Although the hospital has guidelines for its employment processes which are clearly laid out, corruption, cronyism, tribalism and nepotism have become rampant, and have evolved into a complex war of cartels with personal and financial interests at the forefront. The faces of the three new ‘favorites’ were promptly flashed across the hospital’s internal memos and bulletins by CEO Nyamongo, contemptuously, and in an action seemingly more important to Nyamongo thanlegitimate interviews, due handing-over processes and personal introduction within the relevant departments.

4. The pro-Nairobi Hospital (Anti-Bichage) faction of the KHA Board had just days earlier met and objected to their reshuffle from the Human Resources Committee and the irregular manner in which employment was being conducted in the hospital. They called for a board meeting to address this anomaly, but they were ignored and barred from their arranged meeting venue by armed police called in by Chairman Bichage. They still managed to get the required quorum, met elsewhere and served the company secretary, Gilbert Nyamweya, with theminutes and resolutions of their meeting. Theirmeeting concluded that the recruitment for the three positions was being done un-procedurally and therefore was null and void. Their recommendations were as follows: –

a. No letter of appointment should be given to any person/s recruited in the flawed exercise.
b.   Any person recruited in the flawed exerciseshould not report on duty, and
c. No officer of TNH should commit institutional funds for payment of salaries, allowances or any other benefits to any such person.
Once again, after Bichage’s reshuffle in creation of the new HR committee to preferentially include Dr. Onyambu, Chairman Bichage has not been disappointed. Onyambu has made sure another “Omugusi”, with a powerful signature joins the “Gravy Train” as Finance Director, with two other predetermined recruits.

Bichage/Nyamongo Agent in Questionable Employment in Nursing

Word is spreading that under Chairman Bichage, The Nairobi Hospital is now lowering its bar and employing Community Nurses to take care of patients in the wards. This is something that has never before happened at the Nairobi Hospital, and is not in the Nairobi Hospital Charter! Recently thirty community nurses from Keroka were employed in one go. Once employed, they had to betaught basics by the Nairobi Hospital student nurses. But unfortunately, even those basics are too complicatedfor them. A community Nurse is trained for a different role, to work with communities in the health centers. For The Nairobi Hospital’s level of nursing, minimum requirement is a Registered Nurse. While community nurses with no training for the level of care required at the Nairobi Hospital are getting these jobs, more than one hundred nurses trained at The Nairobi Hospital School of Nursing are languishing at home and jobless! These peoplehave no shame? From an institution which had built a name, ‘Healthcare with a Difference’, around highly qualified senior and authentic brands of nurses, the iconic hospital has rapidly evolved into a scenario where the users are put at the mercy of any cadre and caliber of staff brought in by the Board cartels.

The Special Agent engineering the nursing debacle has been identified as Sr. Margaret Muiyuro. She’s been rapidly promoted, by Bichage/Nyamongo, bypassing many senior nurses, and is now Assistant Director of Nursing, and obviously Director of Nursing in waiting. She’s currently the one in direct communication with Nyamongo on nursing matters, and has been well rewarded, details of which are likely to soon be exposed. It is unfortunate that a nurse trained in the Nairobi Hospital School Nursing has been transformed into a dealer by this cartel. Her life is currently a good one.

Employee engagement and eventual disengagement has over the last couple of years followed a path in total contravention to the laid down and board-approved hospital and human resources policies and procedures. This is most evident in the senior management positions where the posts that require competitive recruitment are not advertised, but handled as a CEO/Board Chair led initiative where the ethnic bias seems to be the norm. The signing of contracts by newly engaged senior managementwithout vetting and approval by the whole board seems to be the preferred pathway of getting occupants to office. Any reservations then expressed by Board members becomes an academic exercise with a potential for legal repercussions. The net effect and obvious intention is to buy loyalty by the CEO and chairman Bichage, such that in any event of their leaving office they will have an inner circle to control the hospital finances and activities. The Board Chair and CEO have been heard to boast that even if forced to leave, they will remain in control of the institutional finances, recruitments and IT. Such declaration is difficult to doubt, and has even been amplified by the hiring of these three key personnel in finance, IT and human resource management within the malpractice being fronted by Barley Onyambu, the Human Resource chair, Magdalene Muthoka, Fred Kambuni and Philemon Mwaisaka.

As you already know from Part 1, and a tiring but necessary reminder, the CEO Nyamongo is past retirement age. He has refused to go on leave since employment, opting for a few days from office at a time on few occasionsand never leaving anyone substantively acting in the office,contrary to the hospital’s human resources policy and procedure manual. A project manager, Dr. Anthony Moire,has been retained as a consultant even after the completion of the Western Entrance and the Main Entrance buildings, despite an underwhelming performance and demands by previous project committeefor his termination. He appears to work in a silo, at odds with the designated hospital engineer who has been sidelined: it is instructive that Moire has often been the favorite to accompany the CEO to meet suppliers, usually acting as a go between in negotiations varying the initial board approved construction and major CAPEX installations costs upwards.

Corruption now lives in The Nairobi Hospital

The recent sharp increase in the volumes and speed of suspicious activities, irregular employment and transactions, all done with a background of committees which are formed and dismantled at will and without due procedure is testimony to the lack of transparency on the part of those involved. There are large amounts of money and several employment contracts in question. Alongside the corrupt deals, competent staff are being systematically removed from the institution, apparently to pave way for the new league of employees who understand the Bichage language.

Corruption in the Nairobi Hospital has taken the forms of tribalism, embezzlement of hospital funds, demands on vendors of acutely high mark-ups, rampant bribery and blatant abuse of office. Though clearly stated by the hospital’s articles of association that it is unethical for Board members to conduct business with the hospital due to the attendant conflict of interest generated, procurement corruption continues on an upward trajectory in the hospital. Individuals continue to bypass existing tender regulations, securing tenders instead for self, relatives and friends/cartels. Cartels collude in price-fixing and other behavior that prevent fair competition.

With the poor governance The Nairobi Hospital is currently experiencing, there is virtually no accountability since the common purchase processes of budgeting, accounting and auditing continue to be abused. Large amounts of money are channeled to fraudulent deals. Serious concerns include not having employed a competent Finance Manager for more than a year, and also having questionable lists/regulation of signatories privy to the hospital’s bank accounts. All this has exposed The Nairobi Hospital’s financial management to unethical activities and pilferage, with serious consequences to the cash reserves required for running the core functions of the hospital.

1. Infrastructure and Facility Management

Certainly, the Board has done well by opening the Western entrance and main entrance buildings to improve service delivery and aesthetics. However, the recorded expenditure appears to be exaggerated with attendant conflict of interest being noted, for instance in the plumbing works that are being handled by a firm known as Rabiya Plumbing, with subsequent multiple corrections at the cost of the hospital.
The plumbing firm is owned by an MCA from Embakasi,who happens to be the son-in-law of the Board vice chair, Philemon Mwaisaka. He also recently led a Nairobi Hospital CSR project in Embakasi, and is often in the hospital serving as a power broker, negotiating contracts and employment for persons known to him. He is probably also the DJ at the Nairobi Hospital Gym.

It is also interesting to scrutinize the nexus between the CCTV supplier and the hospital’s security firm and various Board members previously serving or currently in office. A focus on new major construction projects without completing the existing ones seem to be a huge activity by the Board as previously stated. It would have been more logical to queue the recently advertised tender for the changes to the wards and the old kitchen after a final decision and active management of the stalled Paediatric Centre and utility of the monstrous idle and unoccupied, yet furnished East Wing of The Nairobi Hospital.

2. The botched Infamous ICT CONTRACT

Additional to information in Part 1 of the Kenya Insights series, KHA Board chair, Bichage unilaterally cancelled this contract, which he together with the CEO and the previous KHA Board chair had signed, resulting in a legal suit that may cost The Nairobi Hospital more than a billion shilling. Bichage then unilaterally appointed an advocate with an initial price tag of KSh. 55 million, without board approval, and proceeded to pay him KSh. 20 million from the hospital’s finances. It important to note, the previous Medical Advisory Committee had appointed the current Human Resource Chair, Dr. Barcley Onyambu to the board subcommittee that was instrumental in facilitating the cancelled ICT contract, but there was no record at any one time of him registering a written dissent. Dr. Barcley Onyambu has nevertheless, now remained the “defacto” consultant for the Board on ICT matters, despite the fact that his actual specialty is Obstetrics and Gynaecology. Do not forget that he is also an appointed specialist on “Bed Occupancy”, especially when “Bed Occupancy exceeds 100 percent”.

Currently, there is an ongoing tender process for a new HMIS/ERP supplier, while the Tender that was cancelled undergoes legal review. The Board Chair, Bichage, the CEO, Nyamongo and their cartels are in a hurry to have this deal concluded before anyone muddies the waters, again! This is a big kill, and they aren’t about to let it slip through their corrugated hands.

3. EXPENDITURE On Legal Fees:

A corporate body at the level of the Nairobi Hospital ought and indeed does have a legal department that handles matters that range from legal service contracts with suppliers of goods and services, advises senior management on human resources and medico legal challenges as well as fairly straight forward transactions involving hospital assets. Scrutiny of the 2022 AGM financial report shows a startling expenditure on legal fees of close to 500 million and this figure has continued to rise steadily over the last eighteen months. Escalation of this figure is not as a result of incompetence of the in-houselegal team but rather an intentional splurge by the CEO and the litigious Board chair in total disregard of the advice proffered by the in house hospital lawyers, a section of the KHA Board and the existing Board policy on any legal engagement – variously referred to as “The Waki Rules”.

An unholy alliance with a law firm based in Westlands and headed by a flashy advocate from Western Kenya who specializes in construction disputes and serves as dean at a nascent school of law has become the hallmark of wantontheft from the hospital coffers. This advocate has been retained for matters as mundane as:

a. Discharge of hospital titles from creditors at a cost of KSh. 20 million
b. Appearing online in court four times on matters of delayed KHA Board elections in 2022 at KSh. 18 million
c. Suing hospital Admitting Staff at KSh. 10 million
d. Arbitration on the cancelled botched ICT contract at KSh. 65 million
e. The construction disputes and arbitration at KSh. 180 million, among others.

In collaboration with the said advocate, these cases are farmed out by the Board chair and the CEO without full board approval and the deal signed. The Board is then merely notified and, to avoid pecuniary embarrassment plus further legal challenges, there is the assumption that tacit approval pending regularization has occurred. Thesehave exposed the hospital to further potential loses in terms of legal payouts of a sum close to KSh. 250 million.

Meanwhile, it is of note that the advocate referred to, after realizing the inherent weakness of the CEO’s suit against the admitting doctors rushed to court on the eve of the hearing of the case, blocking this in the pretext of requesting the court to allow out-of-court negotiationsover the next three months between the aggrieved doctors and the CEO to settle the matter.

Even to those not legally educated, the conduct and timing of this was clear foul-play: the simple solution would have been to withdraw the suit and refund the hospital the down payment of the KSh. 2.7 Million, plus a sanction on the CEO by the Board. It is widely and largely suspected that this delay being sought by the CEO and his advocate will be used to carry out further nefarious activity, as part of his terms for the negotiation is for the continued stay of Fred Kambuni as the chair of MAC, to facilitate the on-going looting.

4. The Nairobi Hospital Suppliers Closing Accounts:

By early April, the hospital owed creditors of drugs, equipment and food a sum of 1 .2 billion, and was struggling to meet the OPEX budget line. Liquidation of various fixed deposits has had minimal impact on debt management simply because the Board chair and CEO seem bent on extravagant expenditure on incessant legal fees and purchasing non-clinical items. As a consequence, many pharmaceutical drugs suppliers, equipment suppliers and surgical implant suppliers are advising their medical partners (doctors) to utilize other institutions that have a better paying record. This will have damaging effects on the hospitals image, and it may take a long time to win back the trust of the hospital’s long-time suppliers.
According to exasperated suppliers, some of the pro-Bichage team staff in the Procurement docket frustrate them by acting as ‘demi-GODS” like Davis and making outrageous demands to ‘facilitate’ supply chain processes which they are already duty-bound to follow.

5. GOVERNANCE

The Board has not had their scheduled board meeting due to glaring anomalies in financial prudence, human resource matters and infrastructure as the chair appears to be unable to effectively justify and defend the actions he and the CEO have engaged in, to the detriment of the hospital. Subsequently, Bichage has opted to split the board members into camps with an intention of financial incentives for his cronies (Mwaisaka, Muthoka, Kambuni, Mbira and the two coopted members). Further, the Board chair and CEO have refused to meet the trustees to explainthe current scenario faced at the hospital. Consequent to this impropriety, one of the coopted board members with a strong financial and auditing background has resigned citing inability to be effective and the obvious career risk of having a soiled reputation: the other pro-hospital elected Board members have been implored upon by the admitting staff and other concerned KHA members to stay put and help stem the tide by the nefarious looting group.

Dr. Fred Kambuni, despite previous precedent on Medical Advisory Committee recall in 2019, has opted not to resign after he was recalled. He insists on functioning with a lame depopulated committee that has ineffective subcommittees: Without MAC vote, he unilaterally pickeda vice chair (Dr. Mbira), and a new Theatre Users Committee chair (Dr. Mathew Akama), in contravention to the articles of the Medical Advisory Committee. During Kambuni’s short tenure, the Theater User’s Committee hasjust had two meetings, and none of their proposals have seen the light of day. The other standing subcommittees such as Medicine and Therapeutics (emasculated and non-existent, hence the incoherent and unreliable availability of medicine), Doctors and Nurses’ Liaison (non-existent) and Standards and Ethics (no meetings for over nine months) have remained ineffective.  This glaring inability to lead stems from the fact that Dr. Kambuni does not have The Nairobi Hospital’s interests at heart, but rather those of Bichage and Nyamongo who planted him in the position. Having never served in any Medical AdvisoryCommittee position as an elected member for a full term, he was fronted as MAC chair contrary to the MAC charter,hence his evident incompetence. He has also chosen to serve the more lucrative side of the Board Chair, Mr. Bichage and the CEO, Mr. Nyamongo, with obvious favors emanating from those quarters.

It is indeed greed, fear of his ethnic caucus and shameless impunity that have led Kambuni, who in his private capacity complains to the doctors about the incompetence and theft by the CEO and Board chairman, to perilously hang on the chairmanship of the Admitting Staff Association and indeed sue his ASA colleagues for exercising their democratic right. Kambuni has repeatedly told his colleagues that the Board Chairman and CEO have turned rogue against the KHA, and should be removed. He says CEO Nyamongo has told him he must amass not less than 1 Billion before he retires at the end of this year. Confusing matters further, Dr. Meshack Onguti (aka The Butler), has told some ASA Members that he will renew Mr. Nyamongo’s contract for another three years. One wonders in what capacity he is speaking, but they have learnt the hard way to take The Butler very seriously. He isn’t an ordinary butler.
Dr. Kambuni is useful to the Board chairman, Bichage and CEO, Nyamongo. He was one of the “Blue-Eyed” Boys brought into the magic Human Resources Committee by emergency reshuffle, in the deep of the night, to make surethat within days a son of Keroka got the prestigious and highly strategic position of Finance Director. The new Finance Director took up his job a day before the interviews were scheduled and, from informed sources, the banks already had his signature before the interviews.Members of ASA, have now revealed, they can’t deny Kambuni anymore his rightful name, “Judas”. He has been promoted from Iscariot to Judas, with immediate effect.

As we go to press, new revelations are flowing in from Kenyans who have information on The Nairobi Hospital Saga…