Has Devolution of the Health Sector in Kenya Succeeded?

In 2010, a new constitution was promulgated in Kenya. This introduced the concept of devolution of resources and power from the national government to the 47 counties that were formed after the March 2013 general elections. Health service delivery was devolved and is now a function of the county governments.

Devolution presents unprecedented opportunities and challenges to the health sector that determine the effectiveness of overall service delivery. Devolution of healthcare services allows county governments to do among other things; design innovative models and interventions that suit the unique health sector needs in their contexts, Sufficient scope to determine their health system and citizen priorities and also making autonomous and quick decisions on resource mobilization, subsector resource allocation and spending, and management of arising issues.

The objectives behind the formation of devolution in Kenya included recognizing the right of communities to manage their own affairs and to further their development, Protecting and promote the interests and rights of minorities and marginalized communities, promoting social and economic development and the provision of proximate, easily accessible services throughout Kenya, Ensuring equitable sharing of national and local resources throughout Kenya, Facilitating  the decentralization of state organs, their functions and services and also Enhancing checks and balances and the separation of powers.

Read: Impact of Devolution on the Kenyan Economy

Devolving the health function also presents institutional and resource allocation and utilization challenges that must be dealt with to assure effective and sustainable healthcare service delivery at the county level.

Kenya’s health sector has been heavily centralized since 1963, with power concentrated in Nairobi. But currently, the national government only provides policy and manages the two national referral hospitals while all other functions rest with the county governments. Statistics reveal health sector was never a bed of roses under the national government.

According to the World Bank, the index of access to health services (measuring the share of newborns delivered at a health facility) in Kenya shows some regions were almost completely forgotten under the centralized system.

It is easy now for people in the counties to access medical services, but still with that at hand, there are still more challenges being faced, including shortage doctors and nurses. Medical facilities too have not been equipped in these hospital thus making it hard for patients with serious illnesses, and some are forced to travel all the easy from their counties to the Kenyatta National Hospital for them to be attended to. More needs to be done for devolution to have succeeded in the country.