By Dr Boniface Oyugi, Cynthia Charchi and Dr Hope Simiyu
Every year, Kenya’s county governments allocate billions of shillings to health. Yet facilities still run short of medicines, mothers deliver without essential commodities, and critical equipment sometimes sits idle. How can both realities coexist?
The answer lies in a distinction that rarely features in public debate: budgeting for health is not the same as financing healthcare delivery. A budget line is a promise. Between that promise and a patient receiving care lies a long and obstacle-filled journey.
Funds enter county health systems through national transfers, county allocations, and locally generated revenue. They move through treasury and departmental budgets before reaching health facilities, where they should support procurement, outreach, and service delivery. In reality, bottlenecks emerge at every stage; delayed treasury releases, procurement backlogs, and uneven distribution, where some facilities run dry while others hold medicines that risk expiry.
A recent assessment by the Savannah Global Health Institute examined financing and service delivery across ten counties with the highest maternal and neonatal mortality burdens. What emerged was a picture of systems under strain, and of county teams quietly innovating within those constraints.
