A decade on, how devolved Health has fared

 Susan Nakhumicha,

From left: Health Cabinet Secretary Susan Nakhumicha, Tharaka Nithi Governor Muthomi Njuki, Public Health PS Mary Muthoni and other officials during the launch of the health facilities census aimed at assessing and improving health service delivery across the country at Afya House in Nairobi on August 14, 2023.

Photo credit: Billy Ogada | Nation Media Group

Kenya is celebrating the tin jubilee of devolution, marked by the ongoing eighth devolution conference in Uasin Gishu County. Devolution came with many fruits, such as increasing the amount of government resources that impacted the citizens and augmenting citizen voices in their matters.

One notable area to look at when reviewing the impact of devolution is the health sector. The Constitution provides that every citizen has a right to the highest attainable standard of health.

The devolution era has seen significant progress in health. For example, 89 per cent of mothers deliver under skilled care compared to 66 per cent before, hence a rapid decline in maternal and child mortality rates. Under-5 mortality also fell from 52 deaths per 1,000 to 41/1,000 and infant mortality from 39 to 32/1,000.

Notably, county governments have invested significantly to realise these results.

At the onset of devolution in 2013, having inherited a vastly dilapidated health infrastructure, the counties heavily invested in its upgrade. Increasing the scope of services offered followed. Dialysis, specialised surgeries, cardiology services and other important specialist services were now being offered within counties.

Devolution also led to a rapid increase in the number of health workers across the country, which more than doubled in less than a decade. Even the hard-to-reach areas have significantly more health workers.

There is also a more equitable distribution of this critical resource, albeit there persisting some disparities between and within counties that need to be addressed. Distribution of health workers across the country has, however, progressively improved. The number of specialties within counties also went up, allowing a wide range of the devolved units to serve their populations early and within their borders.

Concerted efforts

This has been a result of concerted efforts by county governments as they sought to attract, develop and retain high-quality healthcare workforce. Targeted release of health workers for further studies, investments in partnerships with mid-level colleges like the Kenya Medical Training Colleges, and increased budget allocation to the workforce were among the strategies that bore these fruits. Most county governments allocated up to 30 per cent of their budgets to health despite having 14 devolved functions.

County governments have also made efforts to ensure consistent supply of essential medicines and other medical commodities are central to a good health system, including through working with private sector to launch innovative approaches like the supply of commodities using drone technology.

This area has, however, been hampered by inefficiencies and lack of transparency that has plagued the Kenya Medical Supplies Agency, which the Kenya Kwanza government is addressing.

However, the country’s investments in health has consistently been below the 15 per cent Abuja declaration target. We need to both devolve more funds for health to follow functions and also increase resource allocation to the sector on the overall.

President William Ruto pledged to fast-track the transfer of the remaining devolved functions still at the national government to the counties. When actualised, it will enhance efficiency in the Health docket as the counties’ take up their constitutional mandate over it.

Mr Njuki, the Governor of Tharaka Nithi County, is the chair of the Council of Governors (CoG) Health Committee. [email protected].