State takeover looms for stalled Sh1.5 billion J.M. Kariuki Memorial Hospital expansion

The ambitious plan to elevate the J.M. Kariuki Memorial Hospital in Ol’Kalou to a Level 6 National Referral Hospital has hit a financial wall, leaving the project at a standstill with less than half of the work completed. Construction of the 500-bed ultra-modern facility was designed to provide specialized medical services and research capabilities on par with the Kenyatta National Hospital in Nairobi and the Moi Teaching and Referral Hospital in Eldoret. However, the Nyandarua County government has now admitted it lacks the fiscal capacity to see the project through to its conclusion.
 
Site inspections reveal that the expansion currently sits at roughly 48 percent completion. To date, approximately Sh1 billion has been sunk into the infrastructure, but the skeletal remains of the planned high-level facility have become a visible reminder of the budgetary constraints facing regional governments. The county administration is now petitioning the national government for a capital injection of at least Sh500 million to restart works and bring the facility into operation.

This development comes during the tenure of Governor Moses Kiarie Badilisha, who took office in August 2022. Badilisha, the third governor of Nyandarua, inherited a legacy of capital-intensive projects from his predecessors, Francis Kimemia and the county’s pioneer governor, Daniel Waithaka Mwangi. The transition of the hospital to a national referral status would shift the burden of specialized healthcare away from the county’s strained primary healthcare budget and onto the national treasury, which traditionally manages Level 6 institutions.

The hospital is not the only major infrastructure project in Ol’Kalou plagued by delays and rising costs. The county headquarters building has faced a similarly turbulent path. Originally budgeted at approximately Sh617.6 million, the administrative block has remained unfinished for several years. The delay has been attributed to a combination of contractor performance issues and protracted payment disputes that have seen the final cost estimates climb significantly from the initial projections.

Legislative intervention has provided some movement for the administrative sector, as the Senate recently approved additional allocations intended to bail out several county office projects, including the Nyandarua headquarters. However, the healthcare sector remains in a state of uncertainty as the physical structure of the J.M. Kariuki expansion remains exposed to the elements without a clear timeline for the resumption of interior fit-outs and specialized equipment installation.

The necessity of the expansion is rooted in the region’s growing demand for advanced medical care. As a Level 6 facility, the hospital would serve as a hub for the central rift and surrounding regions, reducing the travel time for patients who currently must seek specialized surgery or oncology services in Nairobi. For the local community, the stalled site represents more than a financial deficit; it is a delay in the delivery of life-saving infrastructure that was promised over two political cycles.

Project managers on-site indicate that the Sh1 billion already utilized covered the bulk of the heavy structural works. The remaining 52 percent of the project typically involves the most expensive components of hospital construction, including the installation of medical gas piping, HVAC systems for surgical suites, and the procurement of diagnostic imaging technology. Without the requested Sh500 million from the national government, the project risks becoming a stranded asset.

The situation in Nyandarua highlights the ongoing debate regarding the financial sustainability of large-scale healthcare projects under devolved units. While the 2010 Constitution devolved healthcare services, the massive capital expenditure required for Level 6 infrastructure often exceeds the annual development budgets of individual counties. The potential takeover by the national government would not only provide the necessary cash flow to finish construction but would also change the long-term management structure of the hospital, placing it under a national board rather than the county executive.