Devolved heath care in Kenya: In 2010, Kenyans overwhelmingly voted in the new constitution. One of the major changes that came with this was the change in the form of governance from the central governance system to the devolved system. Healthcare was one of the major sectors that was devolved. Devolution of health services meant that county governments are entrusted with all functions related to health care while the national government is responsible for health policy and national referral health facilities such as Kenyatta National Hospital and Moi teaching and Referral Hospital.

To facilitate this some of the changes had to be made in the health sector which included;

• Health staff employed and directly managed by county government including payment of salaries.
• Prioritization, planning, budgeting and resource allocation done at county and approved by county assembly members.
• Direct management of public health facilities and health services at the county level.
• Counties procure medical commodities
• National government to fund and manage medical training and is responsible for emergencies.

Devolution of health services was generally hoped to benefit all citizens especially those in the marginalized communities by increasing accessibility to health care services. Each county was to have a county referral hospital most of which were previously provincial hospitals. District hospitals were also upgraded to sub-county hospitals to act as referral units within the sub-counties. All this was to ensure that:

• Communities are granted the right to manage their own affairs and to further their development.
• The rights and interest of minorities and marginalized communities are promoted and protected.
• Health services were easily accessible to all Kenyans.
• There is equitable distribution of national resources.

However, the devolution of health services has not come easy for the healthcare workers who have expressed extreme dissatisfaction on how the health sector in the county governments is managed. This has led to frequent strikes at county level and national level and many of them openly suggesting that the health sector should be returned to the national government. Some of the challenges sited by healthcare workers include

• Salaries: inter-county disparities, delaying of salaries and poor pay
• Lack of job security as most counties are now employing on contract basis.
• Lack of medical supplies and other resources required to effectively deliver their services.
• Inadequate staff in health facilities.

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Devolution of the health services in Kenya! County Healthcare