For a resident rushing to a health facility with a sick child, an expectant mother in distress or a patient requiring urgent medical attention, the last thing they expect to encounter is a locked gate.
Yet this was one of the most disturbing complaints raised by residents of Mariwa during a community health dialogue that brought them face-to-face with senior officials from the Migori County Department of Health.
The residents alleged that the gate at Mariwa Health Centre is sometimes closed at night, potentially leaving patients seeking emergency services outside the facility when they most need medical attention.
The complaint forced Health Executive Committee Member Caleb Opondi to confront the issue head-on, with the county official apologising to residents and promising immediate corrective measures.
“I unreservedly apologise for the night-time gate closures. This is uncultured behaviour and it violates the rights of patients to emergency medical access,” Opondi told the meeting.
He pledged that Mariwa would remain accessible around the clock.
“We will take corrective measures immediately to ensure 24/7 access to the facility.”
The confrontation at Mariwa exposes a deeper question confronting county health authorities: how can a public facility deliver on the promise of accessible healthcare if patients cannot reliably gain entry when seeking treatment?
Migori County’s own Department of Public Health and Medical Services says its mandate is to provide quality and accessible health services to all residents, with strengthening health facility infrastructure and medical supply chains among its key objectives.
For the residents of Mariwa, however, the reality they described at the community forum was far removed from that policy ambition.
Residents lift lid on service failures
The gate controversy was only one of several concerns raised during the meeting.
Residents complained about what they described as unresponsive health personnel, poor sanitation and operational weaknesses affecting the quality of care at the facility.
They also raised concerns about the politicisation of the facility’s Board of Management and alleged attempts by some officers to manipulate members of the public.
The open-floor session effectively turned into an accountability forum, with residents demanding answers from officials responsible for running the county’s health system.
Instead of complaints being filtered through administrative channels, the health leadership was confronted directly with accounts of what residents say happens when they walk into Mariwa Health Centre seeking help.
The concerns are significant because Mariwa is not an isolated private clinic but one of the government facilities serving the Awendo area. Migori’s planning documents list Mariwa Health Centre among the municipality’s government health facilities.
County promises more workers
Staffing emerged as another major fault line.
Health Director Clement Ayungo acknowledged the need to strengthen the facility’s workforce and promised deployment of additional healthcare personnel.
“We will deploy additional healthcare staff to lighten the workload and improve patient care.”
The proposed deployment is expected to ease pressure on existing workers and improve the experience of patients seeking services.
The county’s stated health policy recognises the importance of a motivated and professional workforce in delivering accessible and quality services.
But residents’ complaints suggest that the issue at Mariwa goes beyond numbers.
Questions of responsiveness, accountability, sanitation and access have now been placed squarely before the county administration.
Drug shortage claims disputed
Residents also raised concerns about healthcare delivery, prompting the county leadership to address the question of medicine availability.
Opondi assured the meeting that essential medicines were adequately stocked across county facilities.
“Essential medicines are fully stocked across county facilities.”
Chief Officer Sam Atula similarly reaffirmed the county’s commitment to maintaining supplies and ensuring continuity of services at Mariwa.
“We remain committed to maintaining a steady supply of drugs and continuous medical services at the Mariwa health facility.”
The assurances will now face the test of what patients encounter at the facility after the officials leave.
Level Four upgrade hangs in the balance
Beyond the immediate complaints lies a larger ambition for Mariwa: upgrading the facility from Level 3 to Level 4.
The proposed upgrade is not new. Migori County’s 2023–2027 Integrated Development Plan specifically lists Mariwa Health Centre for upgrading to Level 4.
The Chief Officer for Public Health told residents that utilisation of the facility would be crucial in supporting the case for expansion.
Residents were urged to register at Mariwa and make greater use of its services, with patient numbers and utilisation expected to demonstrate demand for a higher-level facility.
“Mariwa can only be upgraded from Level 3 to Level 4 if we see an increase in patient registration and utilisation. The community must use this facility so that we can justify its expansion.”
That position, however, places a two-way responsibility on the county and the community.
Residents cannot be expected to embrace a facility they believe is inaccessible or unreliable, while the county cannot easily justify major expansion without demonstrating that the facility is being sufficiently utilised.
The result is a healthcare accountability loop: the county needs residents to use Mariwa to justify expansion, while residents need the county to make Mariwa dependable enough to use.
From promises to action
The Mariwa dialogue therefore ended with more than a list of complaints.
It produced a series of commitments — additional healthcare workers, uninterrupted drug supplies and, most significantly, a promise to end night-time gate closures.
The county administration now faces the more difficult part: implementation.
The Department of Health has publicly stated that its vision is of a Migori where residents have universal access to quality healthcare.
The residents of Mariwa have now provided county officials with a very specific test of that promise.
Can a patient arrive at Mariwa at midnight and get through the gate?
Will there be a healthcare worker available to attend to them?
Will essential medicines be available when prescribed?
And will the promised additional staff and improved services materialise?
Those are questions that cannot be answered by another community meeting.
They will be answered at the facility — particularly after darkness falls, when an emergency patient approaches the gate seeking help.
For now, the county has promised action.
Mariwa residents will be watching to see whether the gate stays open.
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