Devolution of health sector hampers UHC

Devolution of health sector hampers UHC

Universal Health Care (UHC) cards at Ichamara Health Centre in Nyeri County on June 10, 2019.

Photo credit: Joseph Kanyi | Nation Media Group

According to the World Health Organization (WHO), Universal Health Coverage (UHC) means that all individuals and communities receive the health services they need without suffering financial hardships.

However, this is still a pipe dream in the counties because plans to meet this target have been caught up in numerous challenges.

The devolved health docket faces serious challenges, thus impeding the implementation of UHC. The seemingly continuous vicious cycle of strikes by health workers is a practical example of this.

Other challenges include limited access to healthcare facilities, and inadequate personnel and expertise to address citizens’ medical needs.

Others are poor or absence of infrastructure, whereby most public health facilities don’t have proper facilities that have ample specialised equipment and/or effective processes and adequate skilled personnel in place to execute the tasks, access to medical records and healthcare financing.

Delayed salaries

Again, poor and delayed salaries for staff has been a challenge in most counties, whereby health workers are unpredictably poorly paid and, even then, the salary is delayed.

For example, health workers in Kisumu County have been organising constant strikes. The latest was last month when they were protesting delayed salaries, payment for promotions and the Covid-19 allowance.

Most county governments have not implemented the collective bargaining agreement (CBA) that they signed with the doctors’ union. Therefore, most public health facilities are no longer operating as required, resulting in more suffering and loss of lives among the poor.

Promotion of health officers has not been addressed, resulting in an almost permanent mess in the health sector. That often forces patients to seek medical services at private health facilities, which are unaffordable to most of them.


Parliament’s Committee on Health has described the healthcare sector as a time bomb following devolution of the function.

The committee chairperson revealed that chaos and disorder have engulfed the sector, paralysing operations of health facilities and putting the lives of millions of Kenyans at risk. He adds that the confusion in the health sector has also led to the increased resignation of doctors.

The national government should not sit back and watch this confusion in the health docket. The more this quagmire persists, the more the people at the grassroots suffer and die.

That will end up in failure of UHC implementation in Kenya.

Spencer Anyango, Kilifi