A programme tasked with preparing specialist surgeons for Kenya and other countries in the region is facing fresh scrutiny after an audit revealed a series of management, training and supervision failures at Machakos Level Five Hospital, prompting the regional training body to halt new admissions until the issues are addressed.
The concerns relate to the hospital's training programme under the College of Surgeons of East, Central and Southern Africa (COSECSA), a regional institution that oversees specialist surgical training in 14 countries.
The review questioned whether the programme was meeting the standards expected of institutions entrusted with producing surgeons who later practise independently.
Doctors pursuing a career in surgery in Kenya can qualify through two recognised routes. One follows the conventional path of completing a bachelor's degree, internship, working as a medical doctor before enrolling for a master's degree in medicine.
The other is the collegiate system, where doctors begin serving in public hospitals after graduation while receiving specialist training under COSECSA.
The collegiate model was introduced to strengthen specialist training by using public hospitals as teaching centres. Through the programme, doctors earn Membership (MCS) and Fellowship (FCS) qualifications after completing practical training and meeting the required academic standards.
Despite the programme's role in producing surgeons for hospitals across the region, records reviewed during the audit raised concerns over its implementation at Machakos Level Five Hospital.
On September 5, 2025, COSECSA country representatives Dr Karen Mbaabu and Dr Caesar Bitta wrote to the hospital's programme director informing the facility that admissions into the collegiate programme had been suspended.
The letter outlined several shortcomings. It found that trainers had not signed appointment letters or formal agreements assigning them teaching responsibilities. It also established that both the programme director and the assistant programme director had no official appointment letters from the hospital.
Auditors further found that residents had no human resource files, lacked clear terms of reference and did not have monitored duty schedules. They also established that the programme had no structured clinical rotation plans, teaching timetable or formal assessment system for trainees.
Following the findings, COSECSA stopped the January 2026 intake and warned that all residents could be withdrawn from the programme if the identified weaknesses remained unresolved.
The suspension prompted a follow-up inspection later that month, after which the hospital told the Nation that the concerns raised by the college had been addressed.
However, a source familiar with the programme maintained that trainers had never been formally recognised by the hospital despite being expected to supervise specialist trainees. The source said consultants had no official appointment letters, defined responsibilities or institutional support for the work they were undertaking.
"My job description is a surgeon to discharge clinical duties," the source said. "I am now given a responsibility to train them, but the support is lacking."
The source compared COSECSA to "the Uber or Airbnb of surgical training", arguing that while the college coordinates specialist education, it neither owns hospitals nor employs faculty members on site, leaving local consultants to shoulder teaching duties without compensation.
The source also claimed residents failed to submit duty rotas for extended periods, forcing nurses to contact consultants whenever trainees assigned to clinical shifts failed to report to work.
Machakos Level Five Hospital Medical Superintendent Dr K.D. Katua rejected claims that the training programme had broken down.
Although an internal review reportedly found that at least three surgical residents had been treating patients without active county employment contracts or civil service engagement letters, Dr Katua insisted that all COSECSA residents had valid admission letters and worked under specialist supervision.
The hospital also denied claims that consultants who questioned the programme were victimised.
It further dismissed allegations that a departmental head had been transferred to protect residents from "psychological torture", saying the doctor had instead been given an opportunity to pursue studies abroad.
The administration also rejected claims that the programme lacked leadership during the programme director's two-year study leave, maintaining that a deputy continued overseeing operations throughout the period.
COSECSA declined to release records showing residents' logged working hours, saying the information was protected by privacy requirements. The college also said allegations that consultants who failed residents faced administrative pressure or transfers were matters that fell under the hospital's human resource office.
"We are not aware of any documented structural challenges at Machakos Level Five Hospital since the inception of its training programme," said Dr Mbaabu, one of the signatories to the September 5, 2025 letter suspending further intake.
Even so, audit reports prepared by COSECSA's Kenya Secretariat presented findings that appeared to contradict those assurances.
One fourth-year resident, identified as the son of a powerful politician, had completed only 203 surgical cases instead of the required minimum of 500. The resident's electronic logbook showed no surgical cases in 2023 and only one in 2024.
The audit also found no documented evidence that the trainee had performed key emergency procedures, including tendon repairs and neurosurgical operations required during training.
Another fourth-year resident recorded only 228 surgical cases after four years in the programme. Auditors recommended that the resident repeat the third year after identifying major gaps in basic surgical knowledge.
Questions were also raised over surgical procedures entered into digital logbooks during the four-month nationwide doctors' strike in 2024, when public hospitals were largely paralysed and residents had left Machakos.
Despite their absence, several trainees' online records reportedly showed they had carried out complex operations during the strike, with the entries accepted by the COSECSA online system without verification.
Consultants at the hospital said they had no access to the electronic platform used to monitor trainees' progress.
"Apparently, before, when COSECSA came and started this programme, they left the then surgeons who retired within a year or two with an online platform," the source said.
"Many of us have never seen it. Apparently, it is called the School of Surgeons platform.
We do not have access. But we are the teachers, the trainers. No one is filing."
Auditors also reviewed the case of a fifth-year resident preparing to sit the final fellowship examination.
Although the trainee had logged 502 surgical procedures, the audit established that many of the operations had been performed in hospitals that were not accredited for specialist training, meaning the resident had not achieved the required clinical exposure.
In November 2024, the COSECSA Secretariat found the resident's records inadequate and declared the trainee ineligible for the final clinical examination.
However, the college's central office later cleared the resident to sit the fellowship examination the following month after accepting updated electronic records despite missing supporting documentation from the local training programme.
Sources further claimed that whenever consultants attempted to enforce discipline or maintain training standards, hospital administrators sided with residents instead of the trainers.
Leaked duty rosters and internal audit records also indicated that up to three of the seven active residents were providing clinical services for Machakos County without receiving salaries, relying instead on promises that they would eventually be employed.
According to the documents, the arrangement worked in favour of both parties, with the county receiving free specialist labour while the residents continued working without facing disciplinary action.