Nyamira Dialysis Crisis: Costs Surge as Coverage Declines

By KPC Reporter
Investigative findings from Nyamira County Referral Hospital have revealed a deteriorating situation in the county’s healthcare infrastructure, especially within the renal department.
Information gathered discreetly from multiple patients with kidney issues, as well as direct observation of the renal unit, has cast doubt on official assurances that services remain fully operational and stable.
These developments occur amid a contentious exchange between Health Cabinet Secretary Aden Duale and Nyamira Governor Amos Nyaribo, who are providing conflicting descriptions of healthcare delivery in the region.
Duale, addressing the Senate, had asserted that Nyamira’s health system was effectively non-functional, pointing to systemic problems in service provision.
The statement provoked immediate rejection from Governor Nyaribo, who labeled the claims as unfounded and maintained that essential servicesincluding CT scans, X-rays, and dialysiswere operating normally.
“I dare Duale to visit Nyamira County Referral Hospital to verify that we possess the allegedly missing equipment and that it is functioning,” Nyaribo stated during a press conference held at the facility on Thursday.
He further emphasized that diagnostic and treatment services were operating without interruption, citing continued staffing and service delivery as proof of stability.
However, patient-focused investigations at the hospital’s renal department paint a more challenging pictureone that partially validates concerns about system strain while complicating the narrative of full functionality.
The unit possesses eight dialysis machines, but only a few are consistently in service, with the others frequently malfunctioning due to age, lack of spare parts, and limited maintenance capabilities.
Some machines are described as obsolete, with repairs delayed or impossible because of unavailable components.
Despite this, the unit continues to operate under extreme pressure, functioning almost continuously to meet demand.
It serves an average of 15 patients daily and approximately 56 dialysis sessions weekly, with nurses reportedly working extended hours to maintain services.
Nurses are said to arrive as early as 3 a.m. to prepare patients and manage the demanding treatment schedule, as the few operational machines are pushed to their limits, running day and night.
The unit itself is described as cramped and overcrowded, with some patients forced to seek dialysis services in private hospitals within Kisii Town due to delays and limited capacity.
Nyaribo indicated during his press conference that plans were underway to expand space and capacity of the unit.
KPC also determined that cost remains a growing burden for patients, with each dialysis session costing about Sh10,500.
The Social Health Authority (SHA) systemformerly NHIFcovers only two sessions per week, although some patients require as many as three.
Further, it emerged that coverage gaps are widening, with essential supportive medication such as blood boosters reportedly not covered for the past three months.
Additionally, some laboratory tests previously included in insurance packages are now being paid for out of pocket.
The county reportedly has no resident nephrologist, leaving complex renal cases largely managed by surgical nurses.
Patients who have undergone kidney transplants also face additional financial strain, with immunosuppressive drugs costing at least Sh2,500 out of pocket monthly, while follow-up care remains inconsistent.
These revelations conflict with the county government’s defense of its health system.
Governor Nyaribo accused the Ministry of Health of failing to reimburse Nyamira Sh454 million under the SHA scheme, despite what he described as strong compliance levels.
“We are committed to service delivery even with arrears of Sh454 million. Nyamira is sixth in compliance but last in reimbursement, and this injustice must be addressed,” he said.
County Executive Committee Member for Health Dr Donald Mogoi supported the county’s position, arguing that service delivery continues despite financial constraints.
He pointed to SHA registration figures, stating that Nyamira ranks 16th nationally with 56.9 percent coverage.
“How come SHA has reimbursed us Sh400 million if health services have collapsed in this county?” he questioned.
He also cited performance data, noting that the county handled 5,939 CT scan and X-ray cases in 2025, and maintained that dialysis services continue despite equipment pressure.
As noted above, dialysis, transplant and nephrology services face additional strain since absence of a specialist nephrologist means that cases are managed without dedicated expertise.
A source argued that this was concerning since “kidney disease casesincluding among younger patientsare increasingly presenting late, worsening outcomes and complicating treatment.”
Tracing back to the origin of specialist services in Nyamira, it is a fact that dialysis was never offered within the county before the advent of devolution.
Investigations now trace back to longer-term structural challenges tied to earlier national health investments during the tenure of former President Uhuru Kenyatta.
Under the Managed Equipment Services (MES) programme, counties received high-cost medical equipment such as dialysis machines and CT scanners.
This was a significant relief for patients in the county, who, previously, sought dialysis in major towns including Eldoret and Nairobi.
While the MES initiative expanded access at the time, many facilities now face ageing machines, breakdowns, expired service contracts, and shortages of spare partsleaving counties struggling to maintain functionality years after installation.
So far, only the Nyamira County Referral Hospital handles patients, who come in from the five sub-counties, including the extreme ends of Borabu.
This further drains patients who have to spend more on private transport to get to the hospital on time, a situation that would be resolved for all if the services were taken to the sub-county hospitals.
“The renal unit is one of the busiest in the hospital and should offer the best services,” a patient who sought anonymity due to the sensitivity of the matter said.