Devolution of health care system in Kenya: A strategic approach and its implementation in Mombasa County, Kenya

Decentralization of health system structure and management has been and continues to be a key issue for many countries in the achievement of health for all, and development of primary health care. According to WHO (1990), decentralization can be defined in general terms as the transfer of authority, or dispersal of power, in public planning , management and decision making from national to sub national levels. “Decentralization is therefore, not only an important theme in health management but also a confused one”. Discussion about devolving powers to the regional level is a big debate in Kenya today. Indeed, there is a great deal of skepticism about it. Despite this skepticism, most counties will use devolution as the latest panacea for the woes of their health care systems. Following the general elections in March 2013, each county has the task of establishing a “blueprint for change” for its health system. In the new Constitution of Kenya, 2010,fourth schedule in the article 185 ,186 and 187 , it establishes the distribution of functions between the National and the County governments where the National government handles National referral health facilities and Health policy, while County governments handle County health services, including, in particular, county health facilities and pharmacies; ambulance services; promotion of primary health care; licensing and control of undertakings that sell food to the public. Legal notice no. 137 of 2013 indicates all the health services transferred to the counties after the Counties made formal application.. This paper analyzed the dynamics of health care devolution in Kenya within the context of the new constitution, and in particular Mombasa County. The paper looks into how the present level of health devolution can strategically be implemented within the county, and the factors involved in improving health service delivery in the counties under the devolved set up. A case study approach from various countries was used to recommend a model that Mombasa county government can adopt, to successfully implement devolved health care management and also have an impact on the overall public health system.