The budget tells its all; national government is behind the healthcare crisis

Kenyans must ask some difficult but necessary questions regarding this year's budget. How do counties fund healthcare without the money? How do they pay doctors, buy essential drugs, or keep hospitals running when billions meant for devolved health services are still locked up in Nairobi? Treasury Cabinet Secretary John Mbadi, make this make sense. The numbers tell a story of deliberate sabotage of devolution. Let us break it down.

Moi Teaching and Referral Hospital, a single national hospital in Eldoret, will receive Sh10.8 billion from the National Treasury in this budget cycle. Now compare that to the total allocation for the entire Uasin Gishu County, a county government responsible for not just healthcare but also roads, agriculture, education, water, and salaries which will receive Sh8.8 billion. One hospital will receive more money than an entire county.

Even more staggering, the national government directly runs only seven national referral hospitals across the country. These seven facilities are set to receive a massive Sh54 billion more than half of Kenya’s entire national healthcare budget. Meanwhile, county governments, which are responsible for managing over 8,000 public clinics, dispensaries, and county hospitals, are left struggling with crumbs.

This is not just an accounting problem; it is a governance crisis. The 2010 Constitution of Kenya was crystal clear: Healthcare is a devolved function. County governments have full responsibility for managing primary and secondary healthcare. The very hospitals where ordinary Kenyans go for treatment daily.

The role of the national government is limited to policy, standards, and managing national referral hospitals. But instead of supporting counties, Nairobi continues to cling to power and resources that do not belong to it.

Take, for example, the Sh16 billion budgeted for maternal healthcare. Under the Constitution, maternal health services are fully devolved. These funds are supposed to go directly to counties to ensure free maternity care for expectant mothers.

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Yet year after year, the national government retains this money in Nairobi under various national programmes, while maternity services across the country collapse. Pregnant mothers are being turned away from underfunded county hospitals. They suffer in silence while Nairobi hoards billions meant for them.

Is it any wonder then that doctors across counties are constantly on strike? That healthcare workers go for months without salaries? That basic drugs and medical supplies are perennially out of stock in county hospitals? When counties do not receive their rightful share of funds, they simply cannot deliver services.

The failure of healthcare is then weaponised politically. Governors are blamed. County governments are accused of incompetence and mismanagement. Meanwhile, the real problem lies at the top: A national government that is choking devolution by starving counties of funds while holding billions in Nairobi under the pretext of ‘national programmes.’

This is a deliberate assault on devolution. It is an attempt to reverse the gains Kenyans fought for in 2010 when they voted overwhelmingly to bring services closer to the people. What we are witnessing is devolution under siege.

The irony is not lost on Kenyans. President William Ruto, who in 2010 strongly opposed the Constitution and the devolution it created, is today the Head of State sworn to uphold and defend that very Constitution. Mr President, you now carry the ultimate responsibility to ensure devolution works. That starts with letting counties control the resources that belong to them.

If healthcare in Kenya is to be fixed, the solution is simple: Let the money follow the function. Send the Sh16 billion for maternal healthcare to the counties. End the national government’s stranglehold over healthcare funds.

Stop expanding national referral hospitals at the expense of county facilities that serve the majority of Kenyans. Ensure counties receive their full equitable share on time and in full, without unnecessary bureaucratic delays and deductions.