Counties reveal the hidden cost of national health deals

Murang’a Deputy Governor Stephen Munania. [Courtesy]

County governments are being left to shoulder the cost of  health agreements negotiated by the national government, Murang’a Deputy Governor Stephen Munania has said.

Munania said counties were being caught between national commitments to health workers and the financial and legal limits governing their budgets, worsening the crisis in the sector as nurses remain on strike.

Speaking to Spice FM on Wednesday, he said health is a shared function under devolution, with counties responsible for staffing and equipping public hospitals while the national government sets policy.

The problem, he said, arises when the national government negotiates agreements with health workers without providing counties with the resources needed to implement them.

“One of the greatest challenges that I have seen within this, and it still remains to be one of the biggest challenges, is that the national government commits itself, then throws the ball to the counties without the funds,” Munania said.

The dispute has become particularly acute over collective bargaining agreements (CBAs) affecting nurses, some of which Munania said have remained unresolved since 2017.

He said counties cannot implement the agreements without funds being appropriated and transferred to them, yet they remain responsible for paying health workers.

Munania said Murang’a allocates about Sh3.4 billion of its budget to healthcare, with roughly Sh2.4 billion going towards salaries for nurses, doctors, clinical officers, pharmacists and other health workers.

He said the county's wage bill stands at about 54 per cent of its total budget, above the 35 per cent threshold counties are expected to work towards.

This has left counties facing competing demands to increase spending on health while reducing their wage bills.

“We cannot spend more than we have,” Munania noted, arguing that counties cannot absorb additional costs without corresponding funding and approval under the public finance framework.

The standoff has disrupted services in public hospitals, leaving patients to bear the brunt of the prolonged nurses’ strike.

Munania said Murang’a had introduced temporary measures, including a locum policy that allows the county to hire temporary staff to fill gaps created by the strike.

The county has also invested in telemedicine to ease pressure on referral hospitals.

Munania said attendance at one Level Five hospital had risen from about 800 patients a day to nearly 2,000, prompting the county to introduce digital health interventions.

However, he warned that such measures could only provide temporary relief.

“My responsibility as a county is to ensure that the hospitals are functioning,” he said.

“But whatever I do as a county can only be temporary if the national CBA agreement is not honoured at the national level.”

Munania said resolving the crisis would require the national and county governments to work together to ensure health agreements are matched with funding, instead of leaving counties with obligations they cannot afford to meet