MIGORI: A sharp and increasingly public divide has opened among leaders in Migori County over the location of a proposed 300-bed Level 5 referral hospital valued at Sh1.5 billion.

County leadership, led by Governor Ochilo Ayacko, is pushing strongly for the facility to be established in Awendo, building on ongoing upgrades at Awendo Sub-County Hospital.

Nyatike leaders, however, are mounting a determined challenge, insisting that the national government should instead consider their constituency as the more deserving and strategically appropriate site.

The disagreement has intensified in recent weeks amid a county-led public participation exercise held on September 1 at Awendo Sub-County Hospital to discuss proposed expansion plans.

That process has drawn vocal support from Kenya Medical Training College (KMTC) officials.

During the handover of a bus to the Awendo KMTC campus, Dr Kelly Oluoch and other college leaders urged the county government to prioritise upgrading the hospital.

They argued that a stronger clinical facility would provide medical students with a proper training environment while simultaneously improving healthcare delivery for the surrounding population.

Nyatike leaders reject the assumption that Awendo is the natural or automatic choice.

Nyatike Member of Parliament Tom Odege has emerged as the most prominent voice opposing what he describes as politically convenient decision-making.

Odege maintains that the placement of a major referral hospital must be guided by objective health needs rather than administrative convenience or local political influence.

The factors that should matter most, he says, include the size and distribution of the population served, geographical coverage, disease burden, maternal and child health indicators, physical accessibility, existing referral patterns, the quality of current health infrastructure, road connectivity, and the availability of specialised services.

Planners, he argues, must identify where the biggest gaps in referral care currently exist and ensure that any new national investment complements rather than duplicates services already available elsewhere in the county.

An entire constituency without a single medical doctor

In a series of recent statements, Odege has painted a stark picture of healthcare conditions in Nyatike.

He notes that the expansive sub-county still lacks any facility that qualifies as a fully fledged hospital.

Across Muhuru, Kadem, Macalder, Karungu and the long stretch of Lake Victoria shoreline that defines much of the constituency, there is not a single hospital staffed by a resident medical doctor.

Clinical officers running local health centres are, in his words, “overwhelmed.”

Residents facing serious illness or obstetric emergencies must undertake long, difficult journeys to Migori Town or further afield.

“Nyatike has no hospital,” Odege stated.

“There is no facility across the entire constituency that qualifies to be called more than a dispensary, because in all of Nyatike there is not a single hospital staffed by a medical doctor. Clinical officers running local health centres are overwhelmed. If we are to distribute resources fairly, how can we ignore a population left entirely to nature’s mercy?”

The MP contrasts Nyatike’s geography with that of Awendo. Awendo sits along a major highway corridor, allowing many residents to reach Migori County Referral Hospital in under thirty minutes.

Nyatike and parts of Kuria East, by contrast, remain among the most isolated and underserved regions of the county.

Patients from the lakeshore and interior settlements routinely face multi-hour journeys on poor roads, often arriving at referral centres in critical condition.

Health indicators point to Nyatike’s greater need

Odege dismisses claims that Awendo’s existing infrastructure makes it the superior site.

National hospital funding secured through presidential partnerships, he argues, should be directed where the health deficit and disease burden are greatest.

According to the lawmaker, epidemiological data places Nyatike at the top of several key indicators, including the highest prevalence of HIV, malaria, tuberculosis and diarrhoeal diseases in the county, the highest child and maternal mortality rates, and the longest average distances and travel times to existing referral care.

“When building a referral facility, you look at health indicators,” Odege said.

“Nyatike leads the county in HIV, malaria, TB, diarrhoeal diseases, child mortality and maternal mortality. Why build another major facility near existing infrastructure while leaving the region with the greatest need completely unsupported?”

The Nyatike case has been formalised by North Kadem Member of the County Assembly Sam Obonyo Olima.

In a written submission to the Ministry of Health and the Office of the Head of Public Service, Olima requested a review of the Awendo proposal and asked that Nyatike be considered as an alternative site.

He emphasises the constituency’s vast geography and the long journeys many residents already undertake for specialised and emergency care, journeys that frequently end at Migori County Referral Hospital.

Olima further notes that Awendo already benefits from relative proximity to Migori town and its existing referral infrastructure.

Locating another major facility there, he warns, risks concentrating high-level services in one corridor of the county while leaving peripheral areas underserved.

He also points to recent investments already made at Awendo Sub-County Hospital, including a Sh50 million integrated maternal, neonatal and child health unit funded by the M-Pesa Foundation.

The hospital performed its first Caesarean section in November 2025, an achievement supporters of the Awendo site cite as evidence of growing capacity.

Two competing visions

Supporters of the Awendo location present a different set of arguments.

They emphasise the foundation already laid by county and partner investments, the presence of the Awendo KMTC campus, and the practical advantages of expanding an existing facility rather than starting from scratch in a more remote location.

An upgraded hospital at Awendo, they say, would immediately strengthen clinical training opportunities for medical students while serving a significant population along a major transport corridor.

Nyatike leaders counter that national funds of this scale should be used to close genuine access gaps rather than reinforce existing concentrations of services.

They are calling for a rigorous technical comparison of the two sites covering population size and distribution, disease burden, maternal and neonatal outcomes, current staffing levels, availability of specialist services, bed capacity, operating theatres, intensive care capability, diagnostic capacity, road access, emergency referral times, and the scale of previous investments.

The result is two clear and competing visions for the same Sh1.5 billion investment.

One side prioritises building on existing infrastructure, ongoing county upgrade plans and the training benefits of the KMTC presence in Awendo.

The other insists the money should extend specialised care to the parts of Migori County that currently face the longest journeys, the highest disease burden and the greatest access challenges.

A decision with long-term consequences

Because healthcare is a devolved function, the final site selection will require coordination between the national government and the Migori County administration.

Nyatike leaders have urged Governor Ayacko and the county executive to approach the decision as leaders of the entire county rather than as advocates for any single sub-county.

Odege has also linked the hospital debate to broader frustrations over delayed national projects in Nyatike, including the long-stalled Muhuru–Masara road, arguing that the constituency has repeatedly been promised development that has yet to materialise.

For ordinary residents, the debate ultimately reduces to a single practical question: will the new Level 5 hospital strengthen services where infrastructure and training capacity already exist, or will it extend specialised care to the underserved areas that currently bear the heaviest disease burden and the longest referral distances?