County governments and Health ministry flex muscles on key roles

Health CS Susan Nakhumicha with Principle Secretary, State Department for Medical Services Harry Kimtai before the National Assembly's Health Committee at the Parliament buildings, Nairobi on February 22, 2024. [Elvis Ogina, Standard]

The wrangling between national and county governments over control of the health sector is hindering service delivery.

The absence of governors during the launch of the stipend programme for Community Health Promoters (CHPs) was the latest sign of fights between the two levels of government.

The governors felt their views were not considered regarding the implementation of the programme that will see each CHP earn a monthly allowance of Sh5,000.

Council of Governors (CoG) Chief Executive Officer Mary Mwiti says the council will meet to deliberate on emerging issues including payment of the allowances, disbursement of county government allocation, Health Act, and the deliberate attempt by national government to usurp their role.

It is not yet clear if the county bosses will adapt the laws, governed by Social Health Insurance Act (SHIA), 2023.

Health Cabinet Secretary Susan Nakhumicha said the Social Health Insurance Regulations 2024 will be officially released today. The regulations will lead to drastic changes in the health scheme and other health functions.

Even with hyped reforms, county bosses have distanced themselves from the changes, saying they have not been engaged.

On Saturday, Bungoma Governor Kenneth Lusaka admitted that there has been controversy in managing health under devolved units.

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“I understand that health is devolved, therefore we share. There has been a problem between the national and county governments,” said Lusaka, during official flag off of 3,580 CHPs in Bungoma.

Appearing before the Senate Finance Committee last week, CoG chairperson Anne Waiguru said counties require addition of Sh3.34 billion to actualise CHPs.

Money wrangles

An insider at the ministry said wrangling was about money and not roles.

“They (counties) didn’t want CHPs paid. Counties don’t want to make commitments. They wanted money sent to their accounts for them to pay,” said the source.

Last Thursday last week, Nakhumicha was taken to task by the National Assembly Health Committee to explain about the CHP controversy.

In defense, the CS said according to CHP structures, payment is to be shared 50:50 between the ministry and the county governments.

“CHPs have been working, it is only fair we start payment of stipends,” Nakhumicha told the Robert Pukose-led committee.

“The list we are paying has been signed by county governments. They know who is receiving the pay and who is paying,” she added.

In a heated exchange over the matter, Pukose further demanded to know why tender to distribute and replenish the kits used by CHPs was not given to KEMSA.

Nakhumicha said during CoG summit held last year, governors requested to be given time to work on their budgets on replenishment. During the summit, the governors agreed that the national government will replenish the kits for three years.

There are some 107,000 CHPs working across the country, allocated a budget of Sh3 billion annually, from The National Treasury.

In an exclusive interview with The Standard, Head of Community Health Dr Maureen Kimani said before the official roll-out of CHPs, there was an engagement of national and county governments in February, last year.

It was agreed to have promoters receive a stipend of Sh5,000, shared between the two governments, at Sh2,500 each.

At least 2.9 million households have been screened by CHPs from October, last year.

Last October, governors said they had been sidelined in reforms taking place at the ministry, and in initial stage of preparing the bills, namely Social Health Insurance Fund Bill, Facility Improvement Financing Bill, Primary Health Care Bill 2023 and Digital Health Bill 2023.

The bills were later signed into acts by President William Ruto on October 19, 2023.