Kenya’s devolved health system is on the verge of collapse as leadership failures, poor human resource management, and severe underfunding continue to cripple service delivery across counties.
According to Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) deputy secretary general Dr. Dennis Miskellah, the sector faces a Sh50 billion financing gap, compounded by counties’ reluctance to employ, promote, and remunerate medical workers on time.
“The morale is very low. Medics are going for months without pay, no promotions, and denied transfers. Counties are also frustrating doctors seeking further training and capacity building,” Dr. Miskellah said.
While infrastructure has improved under devolution, governance and financial accountability remain the weakest links. Over the past year, numerous counties including Kiambu, Nairobi, Marsabit, and Lamu have witnessed prolonged strikes by doctors, nurses, and clinical officers over unpaid salaries, lack of promotions, and inadequate medical insurance.
In Kiambu, a 151-day doctors’ strike crippled maternity and emergency services, forcing patients to seek care at Kenyatta National Hospital. Similarly, in Marsabit, clinical officers have been on strike for a month demanding implementation of a return-to-work agreement and comprehensive medical cover.
The situation is worsened by the failure of county governments to remit statutory deductions, leading to healthcare workers being blacklisted and unable to access medical services. In addition, some medics contracted under the Global Fund program have reportedly gone 14 months without pay despite continuing to work.
The Council of Governors (CoG) has acknowledged that delayed Exchequer releases have constrained county budgets, exacerbating salary delays and equipment shortages.
A Senate Health Committee oversight mission earlier this year exposed widespread neglect and mismanagement in Mandera, Wajir, and Marsabit counties, highlighting a national crisis that threatens Kenya’s health system from within.
Without urgent reforms in funding, leadership, and accountability, the promise of devolved healthcare risks turning into a cautionary tale of systemic failure.
