On health funds, counties are their own weak points

Health CS Susan Nakhumicha during launch of corruption and unethical conduct report for National and County Governments on Kenyan healthcare projects at Nairobi hotel on May 17, 2023. [Samson Wire, Standard]

Provision of health services is among functions that were devolved to counties under the 2010 Constitution.

Consequently, the 47 devolved units were put in charge of key management functions such as planning, budgeting and financial management, human resources and provision of emergency medicines and medical supplies.

However, while there are many gains made over the first decade of devolution, various policy and legislative barriers continue to hamper devolved health services. For instance, there are legislations enacted before 2010 and which result in overlapping mandates between the national and county governments.

During a stakeholders consultative meeting held in December 2021, some of the pieces of legislation flagged include Public Health Act, NHIF Act, Mental Health Act, Malaria Prevention Act as well as the HIV/AIDS Prevention and Control Act among others.

The national government has also been accused of devolution mantra that funds should follow functions.

It has refused, for instance, to allow county governments procure critical medicines and other supplies independent of the Kenya Medical Supplies Authority.

This is seen as a strategy to continue to hold massive donor funds pumped into the health sector annually. During the Covid-19 crisis, governors pushed to be allowed to independently source for Personal Protective Equipment (PPEs) and other essentials but never succeeded.

At the end of the day, we ended up with a mega scandal at Kemsa after an audit by the International Monetary Fund (IMF) established that Sh17 billion worth of stocks could not be accounted for.

To date, no one has been held accountable for the scandal, which has allowed corruption merchants at Afya House and the various agencies to continue siphoning funds meant for the public as witnessed in the recent Sh3.7 billion anti-mosquito nets scam.

Indeed, during their press conference on Friday over delayed release of funds, Council of Governors chairperson Anne Waiguru called on donors to work with the devolved units instead of favouring the national government. While this is a step friends of devolution should readily support, the sad reality is there is no assurance that the funds will be utilised any better.

This is because while devolution was supposed to improve service delivery at the grassroots level, this has not been the case in many counties due to mismanagement and corruption.

For instance, the Senate Standing Committee on Health is currently investigating Vihiga County Referral Hospital following numerous complaints of poor service delivery and demand for bribes before a patient can be attended to.

It is such stories and others of negligence and theft of hospital supplies that undermine the devolved governments' case.