Impact of devolution on health service delivery in Kenya: county roundtable forums

Between August and November 2014 DI conducted research on the impact of devolution on health service delivery in the counties of Mombasa, Busia and Nakuru in Kenya.

In March, DI will host three roundtable forums to bring together sector stakeholders and discuss the findings in the three counties. The events will seek practical solutions to the highlighted challenges, build on good practices and seek increased resource allocation to the health sector to improve health service delivery.

About the research

The research offer useful insights from the perspective of practitioners, health service providers/facilities; county government officials (both executive and legislature); civil society; and citizens on:

1. General quality and efficiency of service delivery after devolution;
2. Inclusiveness in managing health sector – space and depth of citizen participation in prioritization, planning, resource allocation, and monitoring programme implementation; and

• Resources made available to health sector by the 3 county governments from interrogating budget allocations, and any other resource flows to the counties.

Devolution in Kenya

In 2010, a new constitution was promulgated in Kenya. This introduced the concept of devolution of resources and power from the national government to 47 counties 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:

1. To design innovative models and interventions that suit the unique health sector needs in their contexts
2. Sufficient scope to determine their health system and citizen priorities
3. To make autonomous and quick decisions on resource mobilisation, subsector resource allocation and spending, and management of arising issues.

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

About the roundtable forums

The DI Africa hub will host three roundtable forums in the week of 9–13 March, 2015 in the counties of Mombasa, Nakuru and Busia. The multi-stakeholder forums are designed to stimulate constructive dialogue and effective partnerships among civil society, media, county governments, healthcare providers and stakeholders, academia and citizens. They aim to find practical solutions to sector-specific challenges and find ways to improve decision making  on resource allocation for poverty eradication.

For more information please contact Mariam Ibrahim