The Kenya National Audit Office has Won the African Performance Audit Report award for 2013
Release date: Jun 19, 2013
The Office of the Auditor-General of Kenya has won an international prize for an audit it conducted on the performance of Kenyatta National Hospital in providing health-care services to cancer, heart and kidney patients. The award ceremony took place on Friday, 21st June, 2013 at the Nairobi Safari Club in a ceremony graced by the Swedish ambassador to Kenya, Johan Borgstam.
The winning report was Kenya’s first entry to the competition since its launch in 2008. The Kenya National Audit Office led by Edward R.O. Ouko emerged as a winner from a total of 23 English speaking African countries who had made entries to this elite international competition.
The Auditor General, Mr. Edward Ouko, said during the award, “Performance audit is an emerging proactive way to address service delivery in carrying out what is popularly known as “value for money audit,” by going beyond audit of financial transactions to auditing levels of service delivery to establish whether the funds are being used economically, efficiently, effectively, environmentally sustainable and in an equitable manner. This is a method we believe will enhance service delivery to the ordinary Kenyan people.”
The AG added that the performance audit approach is a driver for the third pillar in the Auditor General’s Office strategic plan for 2012/2015 which strives to ensure there is improved service delivery for the Kenyan people through value for manner in public sector expenditure.
Mr Ouko futher stated, “ It’s not about figures recorded well. It’s about what has been the impact on the lives of people. This is what performance audit is all about.” The auditor general explained that winning the award was a culmination of training that staff at the national audit office has undergone since he assumed office in 2011. That is why the award singled out the Kenya National Audit report for a detailed, logical and coherent report on Kenyatta national Hospital specialized treatment.
Mr Borgstam lauded the Cooperation between the Swedish Government and the Kenya National audit, especially in capacity building. He congratulated Mr. Ouko and his team for being true to their calling in ensuring there are high quality audit systems that are an important ingredient of good governance.
Mr Edward Ouko added that performance audit is the way to go to address the myriad challenges facing service delivery in the Kenyan public sector. He promised Kenyans to expect many of such reports that meet international threshold.
The AFROSAI-E Performance Audit Prize is awarded annually to the best performance audit report published by a state audit office in English-speaking Africa. The Prize is sponsored by the African Organization of State Audit Institutions (AFROSAI-E) based in Pretoria, South Africa, and the Auditor-General of Sweden.
Performance audits examine the economy, efficiency and effectiveness with which public organizations use resources at their disposal. The approach of this type of audit is to examine an entire system of an organization to establish what ails it. This particular performance audit at Kenyatta National Hospital took place from 2009 to 2010 and got updated in October 2012.
The Auditor-General obtains his mandate to conduct the audits from Section 29 of the Public Audit Act 2003. The goal of the audits is to bring beneficial change in public service delivery and resource management.
Objective of the Audit
The objective of this particular audit was to assess length and causes of the delays endured by patients who seek treatment for cancer, kidney and heart ailments at Kenyatta National Hospital.
What the audit found out
The audit revealed that cancer, heart and kidney patients at the Hospital wait for long periods before they are attended to. Patients diagnosed with Cancer at the Hospital wait for an average of 63 days (over two months)
to see a clinical specialist for the first time.
Those booked for radiotherapy sessions wait for four months
before they attend the first session while those due for chemotherapy wait for one and a half months
. Cervical cancer
patients wait for an average of five months
before they access treatment services for the first time.
Among the cancer patients booked for chemotherapy, only one out of every two in the audit sample received the service on schedule.
Although international guidelines on renal therapy require patients to be dialyzed for at least four (4) hours, three times every week, or a total 12 hours
in each week the Hospital’s target is to put renal patients on dialysis for at least eight (8) hours each week
due to lack of sufficient equipments. However, most patients are dialyzed only once per week (4 hours) and some only once in two weeks. On average, the patients wait for eight (8) days from one dialysis session to another contrary to the recommended waiting time of three (3) days.
Records in the Cardiology Department revealed that patients wait for an average of 34 days (one month)
to consult a specialist doctor for the first time and 112 days (threeand-a-half- months)
to appear before a multi-disciplinary committee that recommends the mode of treatment for each patient.
Further, the patients wait for an average of 207 days (seven months)
before they are admitted into the Ward to prepare for heart-surgery. Upon admission, patients stay in the Ward for an average of 22 days (three weeks) before surgery.
Reasons for the long-waiting times
The audit identified resource constraints and weaknesses in the hospital’s operational system as the causes for the inability of the Hospital to provide efficient services to its cancer, heart and Kidney patients:
- Many patients suffering from ordinary ailments seek treatment at the specialized Hospital because the national health-care referral system does not function as well as intended
- The Hospital lacks sufficient numbers of functional specialized medical equipment-
- Most of its specialized equipment are old and breakdown often
- The Hospital lacks sufficient space for all the patients that it admits
- The Hospital has too few of the specialists it requires to deliver its unique mandate effectively
- Efficiency standards and guidelines on the Hospital’s key operations are not fully developed and do not therefore support efficient delivery of services
Among the key reasons for the shortage of resources facing the Hospital is because the Hospital spends more than it collects, all financial allocations are not honored and further the Hospital does not manage revenue collection as well as it should.
Recommendations made by the Auditor-General
The Auditor-General has made several recommendations to the Ministry of Health and the management of the Kenyatta National Hospital on ways to improve efficiency in delivery of the Hospital’s specialized services.
Among the recommendations is the re-equipping of district and provincial hospitals so that they may be able to provide the services sought by patients at the Hospital and thus ease the acute pressure exerted on its limited resources.
In addition, a definitive programme to renew and increase the Hospital’s specialized equipment should be implemented immediately.
Programme to improve the working conditions for staff and provide specialized training will be required to safeguard and improve the knowledge, skills and experience required to provide the specialized services.
Further, the management should improve the efficiency of the Hospital’s operations by enhancing its management information system to facilitate effective decision-making and control.
In addition, the management should safeguard revenue collected under the cost-sharing programme from leakages and establish service delivery standards against which operational performance may be measured and controlled.
To enhance debt management the management should devise and follow a prudent debt management policy. However, the Government may have to institute a comprehensive policy on provision of medical services to the poor.
Appreciation to the KNH Management
The Auditor –General thanked the management of Kenyatta National Hospital for providing the audit team with all the co-operation it required to accomplish the objectives of the audit and noted that he was happy that the management has embarked on a reform of the management systems and has indicated its willingness to implement the recommendations of the report.
The report has been submitted to the Speaker of the National Assembly for tabling in Parliament where it is expected to be discussed by the relevant Parliamentary Committee which will thereafter make its proposals how the Government may implement its recommendations.
Office of the Auditor-General
P.O.Box 30084, 0100, Nairobi, Kenya