Devolved Healthcare: Is Kenya’s Two-Tiered System of Government Hampering Response to COVID-19?

Authors: Ouma Atieno Sarah , Rick Wolthusen , Yasir Ahmed Mohammed Elhadi , Rose Sharon Ng’wono , Marie Claire Wangari , Theogene Uwizeyimana , Amos Abimbola Oladunni , Salma Elmukashfi Eltahir Mohammed , Salma Elmukashfi Eltahir Mohammed , Mashkur Abdulhamid Isa and Don Eliseo Lucero Prisno

DOI: 10.23880/eij-16000207

Volume 5, Issue 4

Abstract

In 2013, Kenya transitioned into a two-tiered devolved system of government, comprising the national government and 47 semiautonomous county governments. Under devolution, all health service planning and delivery functions were transferred to county governments while the national government retained overall policy and regulatory functions. This division of roles was largely maintained in organizing and executing the COVID-19 response. As the pandemic spread, Kenya’s policymakers faced the first significant challenge to the rather nascent devolved healthcare system-having to coordinate COVID-19 countermeasures between two tiers of government- the national and county governments. The COVID-19 pandemic presented a unique opportunity for an objective assessment of the performance of devolved healthcare. Nonetheless, unlike countermeasures by the national government which are widely documented, information and records on how the Kenyan counties and their governments dealt with COVID-19 is dearth. Given that they are fully in charge of healthcare delivery, there is a shortfall on clear overall objectives and strategy, general tactical actions, collectively, or as individual counties, which makes assessment difficult. Even in the face of this shortfall, certain instances of difficulty, political, legal, human resource and fiscal, stood out, that would clearly undermine the effort of the Kenyan counties/devolved healthcare. In the war against COVID-19. In peacetime, the health sector in nearly all counties was already laden with monumental challenges ranging from capacity gaps, human resource deficiency and dissatisfaction, lack of critical legal and institutional infrastructure, rampant corruption and a conflictual relationship with the national government. These challenges undermined the healthcare delivery function of the counties, and in a pandemic situation, crippled the efforts and abilities of the devolved units to respond to COVID-19 appropriately

Keywords: Public Health; Health Administration; Kenya; COVID-19; Response Strategy

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