Stop ‘coup’ and back counties to run health services

A key devolved function, health, has also been the most problematic in the past 10 years. The objective behind putting this crucial portfolio under the counties was so that access to quality healthcare for the majority of Kenyans across the country could be guaranteed.

From the word go, however, it was quite clear that most of the 47 counties lacked the capacity to take charge of this vital function. But even trickier has been the apparent reluctance by the national government to let this major undertaking go. Of course, the Health ministry’s headquarters has, under the guise of policy, continued to literally run the docket.

While the experience of the national government in health management is essential, the counties have also been overburdened by some decisions made without their active involvement. The worst is the medical equipment leasing arrangement that thrust a heavy burden on them.

Though devolution has had a huge impact, enabling the biggest transfer of resources from the centre to the periphery in the 60 years of independence, giving the counties more resources to run the health docket would make a huge difference.

Source of friction

But devolving health services remains a source of friction between the two levels of government. Governors are up in arms over what they allege is a planned coup to wrest the portfolio from them and have vowed to resist it.

The Council of Governors (CoG) claims there is a plot to take over the training, remuneration and deployment of community health workers. According to the Constitution, the governors are in charge of county hospitals and pharmacies. They also run ambulance services, primary healthcare and related services.

The CoG is alarmed over the creation of some institutions and proposed amendments and new legislation. They are particularly concerned about a letter by Chief of Staff and Head of Public Service Felix Koskei directing the ministry to work with the local administration to speed up the assessment of county hospitals. 

Many counties have struggled with health service delivery, but some have made good progress that can be built upon. The national government should support the full devolution of health services.