Health budget at border counties strained as foreigners stream in

Patients from neighbouring countries are straining health budgets in counties at Kenya’s borders and now their executives want more money from the national government to take care of the foreigners.

To its 850,000 residents, Busia County has an extra 300,000 Ugandans that seek medical care from the referral hospital who are treated at the same subsidised rates as Kenyans.
County executive for Health Maurice Simiyu told Nation: “It is unethical to turn them away, but at the same time they are not budgeted for and that strains the resources that are already scarce.”

The health docket got Sh1.7 billion this financial year, a Sh300 million increase from the last financial year.

Dr Siminyu added that the foreigners are an extra load to the health workers already overwhelmed by people from Siaya near Sega and Bumala as well as Kakamega.


In Turkana, Lodwar Referral Hospital attends to Ethiopians, Ugandans and the South Sudanese who visit the facility mainly for specialised care such as X-rays, dental and surgical care.

A similar pattern is observed in Migori — which hosts the controversial Migingo Islands with Ugandans, Tanzanians, Kenyans and a few Congolese — where patients from Mara District in Tanzania cross over to the county for medical care.

This discussion usually dominates intergovernmental forums for health where county health executives raise concerns several issues on financing including: monies collected from hospitals that should be returned for medical services but is consumed by finance departments for non-health issues; the lists they provide for reagents are crudely cut down even though all are needed for emergencies, among other issues.

Health dockets remain the largest consumers of county budgets since devolved units took over services that were initially shouldered by the national government and some— such as Turkana, Mandera, Garissa – had to build their health system from scratch.


An already complex service to offer, the borders add to these difficulties not only financially but also on disease surveillance from the neighbouring nations whose health situations are different.

Dr Gilchrist Lokoel, the director of Lodwar Hospital in Turkana, constantly worries about expectant women and severely sick children who may have already slipped into shock as they brave the crocodile infested waters of Lake Turkana to come to his facility.

“The other safer option would be a nine-hour drive under the scorching sun on bad road across a desert to get here,” he said.

In an area that suffered neglect for years, surrounded by war-ravaged nations, it is understandable why the South Sudanese from Toposa would come to Turkana: they want to benefit from the first CT scan that the county has as well as the medical specialists whose salaries are paid by Kenyans.


The CT scan, and other diagnostic equipment, once attracted an Ethiopian government official who moved to Turkana through Kibish, although the Ethiopians do not visit as much because of language barrier.

Apart from the finances and workforce, this crossover also presents an epidemiological public health concern.

A few years back, Turkana reported 18 cases of wild polio virus.

In disease surveillance, one confirmed case of Polio is dreaded and labelled an outbreak because of the ease with which the virus gets into water and people.

Turkana Health executive Jane Ajele said that an outbreak thrived because the war had not allowed the South Sudanese to carry out vaccination drives.


Money, the county executives argue, is needed not just for the medical commodities that the foreigners consume, but monitoring and controlling diseases: The Avian Flu at the Kenya-Uganda border in Busia; Turkana conducts medical camps slightly into South Sudan and Uganda to protect Kenyans.

Migori County Head of Disease Prevention and Control Samuel Oketch said they are certain that they take care of Tanzanians, with HIV, malaria and TB, and it is hard to tell locals from foreigners because Kenyans in Migori and Tanzanians speak Kuria and Luo.

“We may be doing all we can on our side, but we have no control on what happens in North Mara in Tanzania,” he said.

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