The Council of Governors (CoG) has accused the Ministry of Health of sidelining counties and making unilateral decisions on how healthcare is run under the Social Health Authority (SHA), deepening tensions between the two levels of government.
CoG Chairperson Ahmed Abdullahi said counties are increasingly frustrated by what they see as interference from Afya House, particularly in areas that are fully devolved. He singled out Health Cabinet Secretary Aden Duale, accusing him of micromanaging county health functions.
Speaking in Naivasha during a symposium on the Affordable Housing Programme and SHA, Abdullahi said the Ministry and SHA were making decisions that directly affect county hospitals without any form of consultation.
“Indiscriminate and unilateral closure of hospitals and downgrading of the same… since SHA, MoH Afya House has become too powerful. It’s like they are running our hospitals from Afya House. Downgrading, regrading… how do you downgrade my hospital without talking to me?” the Wajir Governor said.
The governors further lamented delayed claims under SHA, saying the slow pace of payments has pushed public hospitals into a combined debt of Ksh.32 billion a burden they say is now crippling service delivery across counties.
Abdullahi warned that the push to upgrade more hospitals from Level 5 to Level 6 may look good on paper but has serious financial consequences for devolved units.
“Literally, it means counties are being asked to hand over their hospitals. It would be nice if we value these hospitals and they give us the money so that we can construct more hospitals. According to Article 209, own-source revenue comes from user levies and the services you provide. So if your premier facility is taken from you, it has consequences on own-source revenue,” he said.
He added that claims rejection often without clear explanations is demoralising healthcare workers who have already delivered services.
“It is very demotivating for our staff when they have actually provided service and the claims they have logged in are being rejected under very flimsy reasons,” Abdullahi said.
Mombasa Governor Abdulswamad Sheriff Nassir echoed the concerns, saying the lack of an appeals mechanism leaves counties at the mercy of individuals handling claims.
“If something is rejected right now, there is no follow-up mechanism. That means there is no appeal. So we depend on one person or a group of people to make a decision,” Nassir said.
SHA’s supply chain challenges also came up, with MEDS’ Titus Munene noting that counties deliver services at the lowest level. “We deliver to dispensaries, to the remotest parts, not the central stores,” he said.
CS Duale, who addressed a separate event in Nairobi, said the Ministry is reviewing and upgrading packages under SHA.
“We have listened to cancer survivors, cancer patients, parents, and leaders. So there is something we are doing in line with the benefit and advisory panel, and we want to get feedback from you all on how we can make sure we have a more sustainable healthcare delivery for our citizens,” he said.
