Reforming Local Government Health Administration in Kenya

The 2010 Kenyan constitution devolves primary health services to 47 new counties. These counties combined staff from city councils and the Ministry of Health (MOH) to form health management teams; in Mombasa County, the merger created separate power centers that sought control over administrative structures. They fought over positions in the organizational structure, reducing administrative effectiveness, and resulting in a budget that deprioritized community services for 2014.

To better align functions and overcome conflict, Mombasa County, with facilitation from the USAID-and PEPFAR-funded Health Policy Project, restructured its health management team in 2014. Staff resisted the change because they did not want to give up powerful administrative roles, and former city council staff feared being sidelined by former MOH staff.

To overcome this resistance, senior management asked the entire management team to form a restructuring committee. The committee employed a stepwise approach, focusing first on principles, then functions and skills, and finally structure. By de-emphasizing structure and engaging the entire team, the committee overcame resistance to reform; the new team was inaugurated in January 2015. As a result of this restructuring process, Mombasa County moved five full-time equivalent doctors to service delivery roles by changing some administrative tasks to part-time positions. It also created job descriptions with clear reporting lines and responsibilities for planning and budgeting, improving administrative effectiveness.

Local government reform holds great promise in resource-constrained settings. By rationalizing functions, Mombasa County was able to significantly improve health worker availability at no extra cost. Additionally, it streamlined oversight, budgeting, and reporting through clear hierarchies and job descriptions. In 2015, the budget includes greater funding for community services.