When Money Delays, Lives are Lost: The Urgency of Health Financing Reform

At the 9th Devolution Conference in Homa Bay County, a side event on Public Financial Management (PFM) and health service delivery sparked an urgent debate. Health may be Kenya’s most devolved function, yet delays in disbursements, mounting pending bills, and rigid compliance rules continue to weaken frontline care. While billions are allocated to health nationally, the real test lies in whether those resources reach county hospitals and health centres in the form of essential drugs, skilled staff, functional equipment, and timely, responsive services.

Convened by Amref Health Africa and the Council of Governors, the session titled “Financing People-Centred Health: The Role of PFM in Delivering Quality Healthcare in Devolved Units” underscored that financing reforms must match the speed and scale of health needs. Autonomy, accountability, and responsive systems are not optional — they are essential to save lives, build trust, and realise Universal Health Coverage.

The discussion emphasised that although devolution was intended to bring health services closer to people, current funding arrangements often hinder counties from achieving this goal. Fixed ratios between recurrent and development spending no longer match local realities, where facilities urgently need resources to maintain infrastructure, staff, and provide essential services.

At the frontline, health facilities remain hindered by slow disbursements and centralised controls, which delay lifesaving interventions. Emergencies require systems that respond in minutes, not days — yet many facilities wait weeks for funds to be processed. The session emphasised that unless facilities are empowered with autonomy, embedded accountants, and responsive procurement systems, lives will continue to be lost not from lack of knowledge, but from systemic inefficiencies.

Participants emphasised that the financing shortfall extends beyond mere numbers. Current allocations per person are minimal and often delayed, leaving facilities unable to operate consistently. This erodes community trust in health systems, discourages people from seeking care, and weakens progress toward universal health coverage.

The dialogue also emphasised that autonomy without accountability is a missed opportunity. Strong governance structures such as boards and audit committees, alongside digitised systems, are essential to safeguard resources and build public trust. 

The message from Homa Bay was clear: health financing reforms must be as urgent as service delivery. Counties, the Senate, Treasury, frontline managers, oversight bodies, and citizens all play roles in ensuring that resources allocated to health lead to better outcomes for Kenyans.

Our favourite quotes from the session include: 

Senator Catherine Muma: Vice Chairperson, Senate Standing Committee on Devolution and Intergovernmental Relations

“Health is enshrined in our Constitution as a right, not a privilege. Universal health care does not mean free care — it means that resources must be available so that, whether you are in Homa Bay, Garissa, Isiolo, or Nairobi, you can walk into a facility and get services without discrimination. Health is a matter of life and death, second only to the right to life itself, and it must therefore be adequately supported if we are to sustain life. Devolution brought health closer to the people, but if counties fail to prioritise it in their budgets, we undermine the very essence of why health was devolved.”

CPA Alex Nduko Thomas: Chief Officer of Finance & Economic Planning, Kwale County

“Ten years into devolution, it is time we reviewed the Public Finance Management Act. The rigid 70:30 ratio between recurrent and development spending no longer reflects the realities on the ground. Counties have invested heavily in infrastructure, but what our systems urgently require now is recurrent funding to maintain facilities, staff them, and deliver services. If facilities are to function effectively, they must retain 100% of their collections, operate with financial autonomy, and be supported by procurement reforms that enable them to respond to emergencies without being hindered by bureaucracy. Health cannot wait for paperwork.”

Dr. Collins Masika: Medical Superintendent, Vihiga County Referral Hospital

“When emergencies arise — a mother bleeding, a child in distress — health facilities cannot wait 72 hours for funds to be processed. That is the difference between life and death. In the early years of devolution, hospitals were required to surrender a portion of their revenue to county treasuries, and some of those funds were never returned. It took years of struggle for counties to understand why hospitals require direct access to resources. Progress has been made, but unless facility managers are supported with autonomy, accountants are embedded in hospitals, and procurement systems become responsive, we risk losing lives simply because our systems fail to act at the speed that health demands.”

Boniface Mbuthia: Technical Director, Health Financing, Amref Health Africa

“At the county level, allocations to health average between KSh 1,800 and 3,000 per person per year. To put this into perspective, that is the cost of half a bag of maize, yet it is expected to meet every health need of a Kenyan. Ninety per cent of county resources come from national transfers, which often are delayed by months, sometimes up to a year. When facilities are starved of resources, mothers are denied family planning, patients are turned away for lack of supplies, and communities lose confidence in the system. Financing shortfalls not only harm facilities but also erode trust and deter people from seeking care. If we continue to frame this as a standoff between the Treasury and the healthcare sector, we all lose. The way forward is synergy and sustainability — ensuring that every shilling mobilised is translated into services at the frontline.”

Dorcas Kanyevu Muli: Director of Audit – Health, Labour & Social Protection, Office of the Auditor General

The promise of health facility autonomy will not be realised unless capacity and accountability are strengthened at the facility level. In many hospitals, one officer is expected to treat patients, maintain records, collect revenue, and prepare reports. This is unsustainable and dangerous. Boards and audit committees are not just box-ticking exercises; they are essential for accountability and community involvement in facility management. Similarly, digitisation is no longer optional — manual systems cause errors, omissions, and leakages that can cost lives. For FIF to succeed, facilities must be staffed with suitable professionals, supported by digital systems, and embedded within effective oversight mechanisms. Only then will financial autonomy translate into quality health services for Kenyans. 

Follow the whole conversation here – https://www.youtube.com/live/J3NWThfJFOs

Author: Edna Mosiara, Ag. Communications Manager, Amref Health Africa in Kenya.