How counties are battling a health worker crisis despite higher funding

Council of Governors Chair Ahmed Abdullahi delivers the 12th Devolution Address, outlining counties' progress in healthcare, agriculture, disaster management and public finance. [Council of Governors]

County governments have increased health funding and expanded medical infrastructure but warned that the loss of thousands of health workers threatens service delivery across the country.

Council of Governors (COG) Chair Ahmed Abdullahi, in the 12th Devolution Address on Thursday, August 6, said counties increased health allocations by 11.7 per cent to about Sh154.58 billion in the 2025/26 financial year as they stepped up efforts to strengthen Universal Health Coverage (UHC).

However, the county health workforce shrank by 26 per cent, from 149,447 to 98,907 workers, in the previous financial year following the exit of about 41,000 workers funded under United States government (USG) programmes. Of those, 28,600 were frontline healthcare workers.

The transfer of Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) to the national government also contributed to the decline.

Despite the setback, counties continued recruiting clinical officers, laboratory technicians and nurses.

The report also shows that 498 doctors were released for postgraduate training while 40 per cent of those who had been pursuing postgraduate studies resumed duty during the year.

Health infrastructure also expanded, with the number of licensed public health facilities increasing from 6,649 to 6,740.

Hospital bed capacity rose to 49,324 while Intensive Care Unit (ICU) beds increased from 314 to 345 and High Dependency Unit (HDU) beds rose from 141 to 160.

Counties also expanded the ambulance fleet from 566 to 583 and established emergency dispatch centres in 15 counties.

The report further shows that 38 counties adopted the Taifa Care Health Management Information System (HMIS), supported by the distribution of 16,542 digital devices to health facilities.

"The Ministry of Health should therefore undertake consultative engagement with Counties before recategorising facilities to safeguard access to healthcare services for citizens," the report noted, citing concerns over the downgrading of 179 health facilities.

Maternal and child health indicators recorded mixed results. Maternal deaths fell by 6.8 per cent from 2,851 to 2,656 while neonatal deaths dropped from 6,909 to 5,777.

 Teenage pregnancies also declined by 19.7 per cent.

However, skilled birth deliveries dropped by 23 per cent while fourth antenatal care (ANC) visits declined by 19 per cent. Counties attributed the decline to changes in maternity service delivery models and reduced access to maternal healthcare services at primary healthcare facilities.

The report said all 47 counties now conduct weekly Maternal and Perinatal Death Surveillance and Response (MPDSR) reviews, up from 34 counties in the previous financial year.

It also cited Kiambu, Makueni, Homa Bay, Murang'a, Machakos and Kirinyaga as counties that recorded prolonged periods without maternal deaths.

The address further states that 30.1 million Kenyans have registered with the Social Health Authority (SHA) following county-led awareness campaigns to implement the Social Health Insurance Act (SHIA).

Counties received Sh21.36 billion during the financial year, compared with Sh12.7 billion in the previous year. Facility Improvement Financing (FIF) collections also increased from Sh16.9 billion to Sh24.01 billion across the 44 counties that have enacted the law.