The hidden hunger: How public hospitals are starving patients of essential nutrition

It’s 6am. Cecily Nyambura* lies weak in her hospital bed—not from her illness, but from hunger. The breakfast porridge—watery, unsweetened—has left her feeling dizzy.

One week after undergoing surgery in one of Kenya’s leading referral public hospitals, her protein levels have dropped. The nurse shouts: “Eat up!” but the tasteless porridge sticks to Cecily’s lips like paste. Down the hall, a diabetic man leaves his tray untouched—starch on starch.

The sun rises over the hospital ward as patients prepare for another day of recovery, or so they hope. The Healthy Nation team is at the hospital, where it secretly documents what patients are fed from breakfast to dinner. The ritual is the same every morning. Trays arrive bearing a familiar sight: millet porridge. The hospital’s breakfast porridge is a cruel paradox—it fills the stomach but starves the body of the nutrients it truly needs to heal.

Lukewarm and watery

“We are given the same food daily. This is not one of the nutritious, varied porridges one might prepare at home, but institutional porridge—lukewarm and watery. Just to fill the stomach,” says Cecily.

At 10am, a hospital attendant arrives with a coloured plastic bucket, doling out the mid-day “meal”: a cup of watery, milky tea and two slices of white bread. Sometimes, if the budget allows, patients are served an egg. At 12.30pm, ugali arrives. Beside it is a soggy mound of overcooked cabbage—its colour faded to grey, its vitamins long boiled away.

Cecily’s voice cracks as she stares at her lunch tray—again. “Ugali and cabbage. Once in a while, ugali and meat, and it’s either two or three pieces. Other times it’s rice and beans. I need different food. But food from outside is not allowed.”

At 3pm, afternoon tea for special cases, including maternity, paediatric and post-surgery, is served.

From 4pm to 6pm, patients are served dinner—rice and beans. The pattern repeats with minimal variation.

A Healthy Nation analysis of the meal plan in several public hospitals, particularly the leading referral hospitals in the country, has uncovered a devastating truth: the very institutions meant to heal are under-nourishing patients at the most critical time of their recovery. The findings expose a healthcare system that invests millions in medical equipment and infrastructure while overlooking one of the most fundamental aspects—nutrition.

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Patients are being served meals that meet basic caloric needs but fall short of providing the micronutrients essential for recovery, wound-healing, and immune function, undermining patients’ recovery and, in some cases, contributing to prolonged illness or even death. Furthermore, where you fall sick could determine whether you recover or languish in malnutrition. Some counties provide just starch, whilst others offer marginally better but still inadequate meals.

At Nakuru County Referral Hospital, patients receive a structured meal plan with porridge every morning followed by varied combinations of rice, ugali, beans, and vegetables. The hospital’s March 2025 menu shows attempts at dietary diversity, with specialised provisions for breastfeeding mothers, plastic surgery patients, and those requiring modified diets.

Some 300 kilometres away at Kisumu County Referral Hospital, patients wake up to the same predictable, repetitive meals: porridge at 6am, tea and bread at 8.30am and an endless rotation of rice with green grams, ugali with cabbage, or the occasional serving of ugali with beef just twice a week.

Across public hospitals, one culinary duo reigns supreme: a steady rotation of beans and cabbage served with ugali or rice. Most alarming is the complete absence of fresh fruits and vegetables—foods that provide not just vitamins but also boost immune function and speed up the healing process.

At Homa Bay Teaching and Referral Hospital, the meal schedule is predictable—a rigid rotation of porridge, rice, beans, and ugali. For dinner, patients are served ugali paired with eggs, beef, or omena, week after week. The hospital, however, has a policy that allows relatives to bring food to admitted patients—a reminder of the system’s failures.

Mr James Ochieng’, 42, has spent three weeks at Kisumu County Referral Hospital following a motorcycle accident. His experience illustrates the human cost of inadequate hospital nutrition.

“The first week I couldn’t eat the food they brought,” he recalls.

“Rice and beans every day, sometimes ugali and cabbage. I had internal injuries, and my stomach couldn’t handle such heavy food. I was getting by day by day,” he tells Healthy Nation.

Ochieng’s family started bringing him alternative meals: light soups and soft fruits. His recovery accelerated noticeably once his nutrition improved, but not every patient has family support.

“There’s an old man in the bed next to me who has no visitors,” Ochieng continues. “He’s been here longer, and I see him pushing away the hospital food. He’s not getting better. Nobody talks about it, but I think the food is part of his problem.”

The meal routine is the same at Jaramogi Oginga Teaching and Referral Hospital: porridge, beans, cabbage, and green grams for either lunch or dinner. At Tudor Health Centre in Mombasa, patients are served rice with green grams, occasionally varied with ugali and cabbage. The pattern repeats itself at Coast General Teaching and Referral Hospital.

Even the more progressive Kilifi County Hospital, which mentions specialised diets for renal and diabetic patients, defaults to rice with beans or ugali with vegetables for general ward patients.

“Beans and cabbage have become the easy option. This is part of a troubling and unfortunate culture in our public institutions. These foods have been the default staple, just like in public schools. It reflects the lack of creativity as well as underinvestment in a variety of adequate, balanced meals. Patients deserve good food to support their recovery and health,” says Crispus Kinyua, executive director at the Institute for Food Justice and Development, clinical nutritionist, and food safety advocate.

He adds: “The nutritional implications are significant. Beans, whilst a good source of plant protein, can cause digestive discomfort for post-operative patients. Cabbage, often overcooked, loses most of its vitamin C content, crucial for wound-healing and immune function. Starches like rice and ugali provide energy but lack the micronutrients essential for recovery.”

According to the World Health Organization, proper nutrition helps prevent malnutrition, which increases the length of stay in hospital by between 18-55 per cent, or between three to six days.

“Malnutrition during hospitalisation can slow healing, weaken immunity, and increase the risk of complications, including hospital-acquired infections. In the long term, it can lead to poor recovery and frequent readmissions, especially for vulnerable patients,” he says.

Modified diets

Many studies show that the poorer the quality of hospital meals, the longer it will take a patient to recover, and the longer they will stay in the hospital. Modified diets provide the recovering patient with the specific nutrients they need to recover. “For example, a patient in a surgical ward requires a diet high in calories and proteins. Giving them small portions of ugali, cabbage, and small portions of beans with plenty of soup will not help much,” says Kinyua. However, not all public hospitals have resigned themselves to nutritional mediocrity. Lodwar County and Referral Hospital stands out as an example of what’s possible when healthcare facilities invest in food systems.

The hospital has developed an integrated approach to patient nutrition that other counties could emulate.

“We slaughter at least eight goats per week from our farm,” explains CEO Nancy Kinyonge. “We have over 65 goats at any given time to ensure a steady meat supply for two months. Our fish pond produces about 700 fish per harvest, and patients requiring nutritious fish soup are prioritised.”

The hospital’s poultry project contributes seven crates of eggs weekly, and their meal rotation includes fresh fruits, chapati, and varied protein sources. Monday’s menu features rice, beans, and bananas for lunch, followed by meat, cabbage, and ugali for supper. It’s a stark contrast to facilities where fruit appears sporadically and meat is a twice-weekly luxury.

At Mpeketoni Sub-county Hospital in Lamu, Dr Mohamed Moroa has introduced Friday pilau, which patients celebrate as a highlight of their week. The hospital also incorporates traditional grains like millet and sorghum into their porridge, acknowledging local dietary preferences whilst providing nutritional variety.

The contrast becomes even more pronounced when comparing public and private hospitals. At Nairobi Hospital, patients choose from diverse daily menus featuring grilled fish, roasted chicken, fresh vegetables, and specialised dietary options. The Aga Khan University Hospital offers similar variety, with nutritionist-approved meals tailored to specific medical conditions.

“The common assumption is that private hospitals, due to better resource allocation, will have food of superior nutrition standards, but it is not always the case. Some public hospitals do have better food quality, so it’s a matter of administration and the level of involvement of the nutrition departments,” says Mr Kinyua.

“Food is medicine. When we fail to provide appropriate nutrition, we’re essentially sabotaging the very treatment we’re trying to provide. We are treating nutrition as if one size fits all. It’s like prescribing the same medication to every patient regardless of their condition.”He adds that most hospitals have nutritionists who write excellent meal plans, but the health facilities do not provide these foods. As such, most of the food in public hospitals lacks variety and the balance required to provide all the nutrients needed. For example, most hospitals do not provide animal proteins, fruits, and green vegetables regularly.

Dr Lucy Wanjiru, a clinical nutritionist with 15 years’ experience in both public and private healthcare settings, reviews the hospital menus with growing concern. “Looking at these menus, I see missed opportunities everywhere,” she says, spreading the documents across her desk.

“A post-operative patient needs high-protein foods for tissue repair, plenty of vitamin C for wound-healing, and easily digestible options to avoid strain on the digestive system. Instead, they’re getting heavy starches and fibrous beans that can cause discomfort.”

The implications extend beyond individual discomfort to measurable health outcomes, says Dr Wanjiru, citing research showing that proper nutrition can reduce hospital stay duration by 20-30 per cent and significantly decrease infection rates. “When I see diabetic patients getting white rice as their primary carbohydrate source, or cardiac patients receiving high-sodium preserved foods, I know we’re working against our medical interventions,” she explains. “It’s like prescribing medication with one hand and undermining it with the other.”

The bean and cabbage dependency particularly concerns her. Legumes are excellent protein sources, but they need to be prepared properly and combined with other nutrients. Overcooked cabbage loses most of its vitamin content. “These foods could be therapeutic if prepared with nutritional goals in mind rather than just convenience.” Dr Wanjiru emphasises that effective hospital nutrition doesn’t require expensive ingredients. “Sweet potatoes instead of white rice for diabetics, properly cooked vegetables to retain vitamins, bone broth for post-operative patients—these are simple changes that could transform patient outcomes.”

However, hospital administrators defend the limited menu by blaming budget constraints. “We work with what we have,” says one catering manager who requested anonymity. “Our daily food budget per patient is less than what most Kenyans spend on a single soda.”

Kinyua, however, says giving patients nutritious meals isn’t about budgets but about strategic thinking, understanding patient needs, and viewing food as an integral part of treatment. He says many public hospitals have qualified nutritionists involved in meal planning. However, the bigger challenge is the lack of resources dedicated to providing proper food for patients, which undermines the work of nutrition teams.

“The lack of recognition of the nutrition discipline as an important part of patient care is the greatest gap. Hospitals don’t regard nutritionists as important as other cadres, and the departments are often underfunded. Concerning food, this is reflected in the poor quality of food delivered to patients.”

The nutrition crisis in Kenya’s public hospitals reflects deeper systemic issues in healthcare governance. “County health budgets rarely itemise nutrition as a priority, and hospital administrators often view food services as a necessary expense rather than a therapeutic intervention,” he says.

He adds that nutrition is usually lumped under “operational costs”. “It’s not valued as essential healthcare.”

The devolution of healthcare to county governments has created additional challenges. Many counties lack the expertise or political will to prioritise patient feeding, Kinyua notes.

“There’s no national standard for hospital nutrition; each county develops its approach, or more often, doesn’t develop any approach at all. Traditionally, nutrition interventions and financial commitments have always targeted the arid and semi-arid lands whilst neglecting other areas such as the clinical sector. Before devolution, hospitals were serving better quality food because the funding catered for it. After devolution, the burden of feeding patients was left to counties, most of which lack proper policies to charge for meals and guide meal planning,” he said.

As of data from the 2023 Health Labour Market Analysis for Kenya, there are approximately 1,736 nutritionists in public hospitals. Given the general recommendation of a minimum of one dietitian/nutritionist per 10,000 people, it means there need to be at least 5,500 nutritionists in the hospitals. He points to successful international models where hospital nutrition is treated as a specialised field.

“Japan’s approach to food is admirable, considering that levels of obesity [malnutrition] are generally very low. The Japanese government includes dietitians and nutritionists in meal planning for public institutions such as schools and hospitals. However, I believe that the answers we seek can be found within us.”

Both Mr Kinyua and Dr Wanjiru advocate for national standards that would ensure minimum nutritional requirements across all public hospitals, including training of kitchen staff. “Many hospital kitchen staff lack basic nutrition knowledge, viewing their role as food preparation rather than medical support. We need to professionalise hospital cooks as well.” “What’s needed now is the political will to treat nutrition as an essential component of healthcare rather than an afterthought,” Mr Kinyua said.

He calls on county governments to prioritise hospital meals, invest in nutrition departments, and ensure every patient is fed with dignity and purpose. “Food is not just a basic need; in a hospital, it is medicine. Let’s feed to heal.”

*Name changed to protect patient privacy