Protecting institutions: The case for professional autonomy with accountability

The ongoing standoff surrounding The Nairobi Hospital underscores a critical issue facing Kenya’s institutions, that is, the delicate balance between oversight and interference.

From the unfolding fiasco, it is apparent that the controversy revolves around political authority and professional management.

While leaders, including the president, are mandated to safeguard public interests, it is equally essential that institutions and professionals are allowed to operate independently within the framework of established rules and governance structures.

Recent events at The Nairobi Hospital have highlighted the dangers of overreach. The hospital’s Board of Directors, led by Chairman Barclay Onyambu and CEO Felix Osano, has publicly defended its management practices following claims by President William Ruto that the institution was being mismanaged.

The board asserts that the facility posted Sh12 billion in revenue for the 2024/2025 financial year, with Sh1.6 billion in liquidity reserves, demonstrating financial stability and operational sustainability.

These figures suggest that the hospital has been performing responsibly and transparently under its professional management team.

Yet, the intervention by political offices and the subsequent arrest of hospital directors has raised serious concerns about the undermining of institutional autonomy.

Even as the president framed the action as a protective measure to prevent alleged fraud, the methods used—arrests, summonses to the Directorate of Criminal Investigations, and public denunciations—risk creating a climate of fear that can paralyse decision-making, deter skilled professionals, and compromise the quality of services.

Institutions thrive when professionals are empowered to act based on expertise, guided by governance frameworks and ethical standards, rather than fear of reprisal or coercion.

Professional autonomy does not imply absence of oversight. Institutions like The Nairobi Hospital, whether public, semi-private, or private, must operate under clear checks and balances, including audit mechanisms, board oversight, regulatory compliance, and internal accountability systems.

These structures ensure that misconduct, fraud, or mismanagement can be addressed efficiently without dismantling the authority of professional leaders or creating instability.

In the case of The Nairobi Hospital, the Board maintains that claims by a small group of doctors seeking government intervention were “unofficial” and contrary to established governance procedures, underscoring the importance of following proper channels before invoking external oversight.

When institutions are coerced or micromanaged, several risks emerge.

To begin with, decision-making becomes politicised, with leaders prioritising perceived loyalty over expertise.

Secondly, talented professionals may leave the sector, preferring environments where expertise is respected and operational independence is guaranteed.

Additionally, service delivery suffers as fear of political reprisal can delay critical administrative or clinical decisions. In healthcare, where timely interventions can save lives, the consequences of such interference are particularly severe.

The situation also raises questions about proportionality in intervention.

While the state has a legitimate role in preventing fraud, ensuring accountability, and protecting public assets, measures must be targeted, transparent, and legally grounded.

Blanket arrests or public vilification of professionals before due process undermines the credibility of both the institution and the state itself. Proper enforcement mechanisms, including internal audits, independent investigations, and judicial review, provide the necessary oversight without dismantling professional autonomy.

Kenya’s broader development trajectory depends on strong institutions that function independently but responsibly. Hospitals, universities, regulatory bodies, and government agencies must be insulated from undue political coercion while remaining accountable to legal frameworks, boards, and stakeholders.

The trust of citizens, investors, and professionals hinges on the perception that institutions operate fairly, efficiently, and without arbitrary interference.

The Nairobi Hospital episode should serve as a reminder that leadership involves more than intervention—it requires respecting governance structures, empowering professionals, and enforcing accountability within established rules.

Institutions are the pillars of social, economic, and public service stability. Political actors have a duty to safeguard these pillars without undermining the expertise and judgment of those entrusted to run them.

Ultimately, sustainable governance is built on professional autonomy underpinned by checks and balances and Kenya is not an exemption.

Kenya must ensure that interventions are corrective, not coercive, allowing professionals to work effectively while remaining accountable.