Health services in Kenya have improved remarkably following devolution to the counties. This was the unanimous conclusion of the 4th. Devolution Conference held in Naivasha from 7-9 March, 2017. Despite initial challenges, achievements far outweigh the hiccups experienced while the health function was devolved.


Since devolution of health function in accordance with the Constitution, Kenya’s health system has undergone significant changes. Devolution has radically changed the fabric of governance mechanisms, financing, procurement, and human resource management. The shifted responsibility in health sector from national government to county governments, has seen counties allocate substantial amount of resources in the development of health care. Most hospitals have been upgraded to level 4 status from the previous 5 with the necessary equipment installed, drug availability improved and staff skills enhanced. This has greatly improved the quality of health services to Kenyans.


However, as would be expected of any major change and shift of responsibility, health devolution has experienced challenges mainly related to administrative processes. The most notable of these is human resource management that eventually erupted into a protracted labour disagreement with medical staff. Participants at the conference though were of the view that the future of Kenya’s health system lies on recognizing the unique health dynamics, navigating the obstacles through negotiation among stakeholders and policy discussions bearing in mind health is a litmus test of the success of devolution.


Speaking in Naivasha, where the 4th Annual Devolution Conference took place, the National Council for Population and Development, Director General, Dr. Josephine Kibaru-Mbae who is also an expert in reproductive health, reiterated the need for more funds towards health care. “Health is receiving 25 percent of county budget with 20 percent going to recurrent expenditure’, Dr. Kibaru-Mbae observed that usually less than 3 percent is left for improvement of health care. Another challenge in health financing is to do with evidence for decision-making. While alluding to the National Adolescent and Youth Survey carried out by NCPD that specifies areas counties need to focus investment on in order to harness the demographic dividend, Dr. Kibaru-Mbae encouraged Counties to use available data for planning and budgeting.


During the discussions participants called for additional funding observing that currently it is skewed with counties receiving 60 billion while the national government has 90 billion though the bulk of health care is borne by counties. Coordination between the national and county government levels also needs strengthening.