A battle over the proposed location of a Sh1.5 billion, 300-bed referral hospital has opened a fresh political fault line in Migori County, pitting leaders from Nyatike against the county administration over who should host the major health investment.
At the centre of the dispute is a proposal to establish the Level 5 referral facility at Awendo Sub-County Hospital—a plan that Nyatike leaders say should be reconsidered on the basis of population, disease burden, accessibility and existing health infrastructure.
Nyatike MP Tom Odege has now entered the fray, arguing that the decision on where to locate the facility should be driven by health data rather than political influence.
His intervention adds weight to an earlier protest by North Kadem MCA Samson Olima, which has now reached the national government.
The outcry has been extrapolated by several other leaders from Nyatike including Macalder Kanyarwanda Ward representative Felix Okwanyo, her nominated counterpart Doreen Inda, parliamentary aspirants Fredrick Odiso Ogenga and Robley Ngoje who have piled pressure on Governor Ayacko’s administration to exercise equity.
The dispute has become sufficiently serious for Health Cabinet Secretary Aden Duale to ask Governor Ochilo Ayacko to convene a meeting of leaders to deliberate on the proposed site and communicate the outcome to the Ministry of Health.
In a letter dated September 17, 2026, addressed to Governor Ayacko, Duale acknowledged that questions had been raised over population healthcare needs, equity, accessibility, disease burden and referral pathways in determining where the hospital should be located.
The CS requested the governor to bring the leaders together and agree on the way forward.
That intervention has transformed what might have been a county-level disagreement into a wider national conversation over how the Sh1.5 billion investment should be distributed.
Nyatike says need—not politics—should decide
Odege has framed the dispute as a question of healthcare equity rather than a contest between Awendo and Nyatike.
“My argument is not that Awendo should not get a hospital. My argument is that Awendo can have a hospital, but Nyatike deserves a referral hospital more than any other sub-county in Migori County,” he said.
The MP argues that the national government’s criteria for distributing the new generation of 300-bed Level 5 hospitals should be applied at the local level.
The Ministry of Health has previously said the national programme, covering 13 counties, was selected on the basis of factors including population size, disease burden, existing health infrastructure and funding availability. Migori is among the counties selected for the programme.
It is this principle that Nyatike leaders are now seeking to use in challenging the proposed Awendo site.
Odege says the health indicators in his constituency should be examined before a final decision is made.
“If you look at the health indicators and disease burden across Migori County: Nyatike leads in HIV/AIDS cases, Nyatike leads in malaria cases, Nyatike leads in diarrheal diseases, Nyatike leads in TB, child mortality, and maternal mortality.”
Those claims were made by Odege in an interview and would require verification against current county and national health datasets before being presented as independently established county rankings.
But politically, the argument has already gained traction because it goes to the heart of a long-running complaint by leaders from peripheral parts of Migori that development resources should follow need rather than political influence.
The Awendo question
Awendo’s proposed selection has become the lightning rod in the debate.
The county administration has invested in upgrading the Awendo Sub-County Hospital.
County records show that the facility has undergone significant development, including maternal-health infrastructure, while the hospital conducted its first Caesarean section in November 2025.
The county’s current project information also lists an ongoing maternity-complex project at Awendo Sub-County Hospital, with an indicated budget of Sh185 million.
For Nyatike leaders, however, those investments raise another question: whether the new national referral hospital should reinforce a location that is already receiving substantial healthcare investment, or whether it should address a more pronounced infrastructure gap elsewhere.
Odege says Nyatike’s problem is not simply the absence of a prestigious referral designation.
It is the lack of basic capacity to handle emergencies.
He says facilities in the sub-county continue to struggle with staffing and infrastructure, with some facilities described as Level 4 operating without resident medical doctors.
“They lack adequate health facilities,” he said, adding that the number of clinical officers serving the constituency is also inadequate.
His argument is therefore that the referral hospital should be used to correct an existing geographical imbalance in healthcare access.
A battle over geography
The political argument is also increasingly becoming a debate about geography.
Odege says Nyatike’s proximity to the Isebania-Migori road corridor creates an opportunity to serve a wider population if a major referral facility is strategically positioned in the area.
He argues that locating the facility at Awendo could leave residents in distant parts of the county facing lengthy journeys when seeking specialised treatment.
“When you locate a referral hospital over there in Awendo, it does not adequately serve the rest of Migori,” he said.
He specifically cited residents of Kuria East and Nyatike as communities that could continue to face challenges accessing specialised services.
The argument comes against the backdrop of substantial health infrastructure investments elsewhere in Migori.
Kuria East, for example, already has a major hospital project at Kegonga. County and government records indicate that a new five-storey facility with a 300-bed capacity was launched there, with the project intended to improve healthcare access in the Kuria region.
The Ministry of Health has also been involved in new Level 4 hospital projects in Bugumbe and Nyamaraga, illustrating the broader push to expand healthcare infrastructure across the county.
The distribution of these projects has now become part of the political conversation about where the new national referral hospital should go.
Ayacko administration caught in the middle
For Governor Ayacko, the dispute comes at a politically sensitive moment.
The governor sits on the national health infrastructure programme’s consultative structures, having attended a high-level Ministry of Health meeting on the rollout of the 13 new 300-bed Level 5 hospitals.
The Ministry says county governments are expected to work closely with the national government on land, approvals, utilities, staffing and operational preparedness.
That places the county administration at the centre of the decision-making process.
Nyatike leaders are now demanding greater consultation, with Odege warning that decisions perceived as favouring one part of the county could deepen political tensions.
“As leaders, when we make decisions, let us ensure they are fair and balanced,” he said.
He also appealed directly to the governor to involve leaders from across the county before a final position is communicated to Nairobi.
“My call to the Governor is simple: let us play mature politics. Let us involve all leaders to ensure unbiased decisions.”
National government forced into the dispute
The Ministry of Health’s response is significant because it does not simply dismiss the objections.
Instead, Duale’s September 17 letter specifically identifies equity, accessibility, disease burden, population healthcare needs and referral pathways as matters requiring deliberation.
The CS has consequently asked Governor Ayacko to convene the county’s leaders and establish a common position before the Ministry takes further action.
That means the proposed Awendo site is not, based on the supplied ministry letter, a matter that the national government considers closed.
The letter effectively puts the responsibility for political and technical consultation back on Migori’s leadership.
Politics lurking beneath the health debate
The hospital controversy is unfolding as Migori’s political temperatures rise ahead of the 2027 elections.
Odege insists his intervention is about healthcare rather than politics, but the siting of a Sh1.5 billion facility carries obvious political significance.
A major referral hospital means jobs, roads, utilities, business opportunities and increased government presence around the selected site.
For elected leaders, therefore, where the facility is located is not merely a technical question.
It is also a question of which communities benefit directly from one of the biggest public investments in the county.
That is why Nyatike leaders are resisting what they perceive as a fait accompli.
Odege says public resources should not be allocated on the basis of political influence.
“Healthcare allocation should not be driven by political influence. It must be guided by technical factors.”
His statement places the governor and his administration under pressure to demonstrate that the final decision can withstand scrutiny on objective criteria.
The Awendo argument
The counterargument is that Awendo is not an arbitrary choice.
The sub-county already has a hospital whose capacity has been expanded, including surgical services and maternal-health infrastructure.
From a planning perspective, an existing health facility may offer land, utilities, staffing structures, patient volumes and other infrastructure that can facilitate development of a larger referral centre.
The Ministry itself has stressed that county preparedness—including land, approvals, utilities and staffing—must accompany construction of the new facilities.
Whether those factors favour Awendo over Nyatike, however, is ultimately a matter for the technical assessment and the consultations now being demanded by the Ministry.
A county at a crossroads
The dispute therefore presents Migori with a choice that extends beyond Awendo versus Nyatike.
It raises a larger question about how major public investments should be distributed in a county where healthcare gaps exist in virtually every region.
Odege wants the county leadership to step back, examine the health data and engage all elected leaders before committing to the site.
“If people lack information about health needs, they should sit down and review the actual health data before making declarations,” he said.
He also linked the hospital dispute to broader concerns about development distribution as President William Ruto prepares for engagements and project launches in different parts of Migori.
For Nyatike, he said, development projects—including the proposed affordable housing project—should not be allowed to stall over technical or land-related issues.
“We want the leadership to address these technical issues so Nyatike is not left behind in development.”
The coming leaders’ meeting requested by CS Duale could therefore prove decisive.
It will have to reconcile two competing arguments: Awendo’s existing infrastructure and preparedness on one side, and Nyatike’s demand for greater investment based on health need, accessibility and equity on the other.
What is clear is that the proposed hospital has become much more than a construction project.
It is now a test of how Migori distributes scarce public investment, how national and county governments negotiate devolved healthcare, and whether political leaders can agree on a health infrastructure decision without turning it into another front in the county’s widening political contest.
And with the Ministry of Health now formally asking the county to convene its leaders, the final word on where Migori’s Sh1.5 billion referral hospital will stand may yet emerge from a political negotiation—but one that will increasingly be expected to rest on verifiable health data.
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