Nairobi to decentralise running of public hospitals
By Alvin Mwangi, June 26, 2025The Nairobi County Assembly is pushing for a ground-breaking Bill aimed at decentralising the management of public hospitals.
Minority Whip Moses Ogeto highlighted the need for reform, citing challenges faced by patients and medical facilities.
Ogeto painted a grim picture of the current state, where low minimum wages of Ksh300-Ksh500 for some workers, coupled with a lack of staff in public clinics, leave many unable to access essential medical services. “You see, they are unable to access public clinics simply because these public clinics don’t even have the staff,” Ogeto stated.
The proposed legislation seeks to grant significant autonomy to various levels of hospitals, starting from the grassroots clinics.
Under the new framework, any fees collected by these clinics, even a modest Ksh100, would remain at the facility instead of being remitted to the central County Treasury Office (CTO) in a Consolidated Fund Services account.
“We want to decentralise the management of the hospitals, especially when the budgets have been approved.” He explained that the current process is cumbersome, where even after budget approval by the assembly, further signatures are required from CTO officials, creating unnecessary bottlenecks.
Empower boards
The Bill aims to eliminate these bureaucratic hurdles, empowering hospital boards to oversee operations more effectively.
These boards, mandated to meet quarterly, will monitor hospital performance. Additionally, a new internal hospital board will be established for daily management.
Crucially, the Bill includes County Assembly members as official members of these boards, allowing them to directly monitor budget utilisation at the hospital level.
A key focus of the reform is strengthening the position of hospital Chief Executive Officers (CEOs).
Ogeto noted that current CEOs operate without clear legal authority.
“We want to strengthen the CEO position; currently, they are there illegally, so we want to make them legal,” he explained.
The legislation will grant CEOs powers similar to those seen in other private hospitals