Kenya: How Devolution Has Impacted Budgeting for Compensation and Distribution of Health Workers

April 2018 | by Mokeira Nyagaka, International Budget Partnership Kenya

There is a long history of unequal access to services in Kenya, including core social services such as education and health. In 2010, Kenya adopted a new constitution and introduced devolution in part to address these inequalities. Devolution saw the transfer of significant health functions to county governments with the national government left to play the role of policy making and running top referral hospitals. But ensuring vulnerable and marginalized groups have accessible health care can be a challenge, necessitating deliberate interventions by government.

Health workers are the largest input into health services and therefore, the distribution of these workers is a major indicator of equitable access. Under devolution, counties have control over their own health budgets and workforces and therefore should be able to change their spending patterns to adjust the number and distribution of health workers.

This paper examines evidence from a sampling of counties in Kenya to determine the impact of devolution on the health sector. It looks at the distribution of health workers in Elgeyo Marakwet, Bungoma, Kilifi, West Pokot, Samburu, Turkana, and Baringo counties to understand what changes have taken place in terms of the number and skills of health workers during the devolution era (2014-2017).



kenya devolution impact on budgeting for health workers ibp 2018.pdf

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Mokeira Nyagaka

Capacity Building and Learning Officer,

As the Capacity Building and Learning Officer at IBP Kenya (IBPK), Mokeira leads the team in developing, updating and facilitating training materials on the budget processes, budget analysis and participation in budgeting at the national and sub-national levels. Mokeira coordinates the monitoring and evaluation, learning and reporting of IBP Kenya’s work. She works closely with IBPK’s partners to develop their tools related to the work done in partnership with IBPK.

Prior to employment as full-time staff at IBPK, Mokeira worked as a consultant researching the adequacy of public justifications in budget documents in Kenya county governments. Mokeira transitioned to Research Analyst and Trainer at IBPK, a full-time staff position she held from 2016- 2019. In 2020, her role expanded to Capacity Building and Learning Officer.

Mokeira is passionate about developing content for CSOs, community budget champions, and the communities they support to improve their engagement with budgets. She is keen on content development that can be utilized by various audiences.

Mokeira is an advocate of the High Court of Kenya. She graduated with an LL. B and LL.M (public finance) from the University of Nairobi.


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