two-tiered fight

Kenya’s fight against coronavirus difficult with its two-tiered governance system

By Morris Kiruga

Posted on April 17, 2020 16:21

Virus Outbreak Kenya
County workers practise social distancing and wear masks as they queue to renew their employment contracts in Uhuru Park in downtown Nairobi, Kenya Monday, April 6, 2020. (AP Photo/John Muchucha)

Kenya’s two-tiered governance system is under strain as it battles coronavirus.

On Thursday 17 April, Kenya’s President Uhuru Kenyatta announced the country now had 234 confirmed cases of COVID-19, and 11 deaths, just over a month since the pandemic made landfall in the East African economic giant. In the five weeks since, Nairobi and Mombasa cities have been put under lockdown, as the country tries to stem the spread of the virus.

READ MORE: East Africa’s battle with Coronavirus

While the routine addresses – usually made by his health minister – have covered the work of county governments in the country’s two-tiered governance structure, Kenyatta also made a point of noting that it [devolution] “…continues to show its power to deliver.”

Funding to devolved units

Just a day before the address, the chair of the Council of Governors, Wycliffe Oparanya said that the devolved units had Shs.5 bn in an emergency fund. Of more interest was how devolved units were having a hard time getting much-needed medical supplies and equipment, which he blamed on a virtual monopoly by a state-owned company

From the onset of the COVID-19 response, governors said that their governments were not equipped to handle the pandemic within their borders. One problem was, and still is, that the country has only two public testing centers:  the Kenya Medical Research Institute and National Influenza Center, both centered in Nairobi.

READ MORE: Kenyan government agree to pay cuts, curfew imposed as coronavirus cases grow

President Kenyatta, serving his second and final term amidst heavy debt, high taxes, and an economic downturn, has centered his COVID-19 response in the capital and state structures.

Two-tiered system

“All counties have laboratories that can handle such tests during periods like this; we are waiting for approval from the National Government. Devolution has not been in the heart of some people in the system,” Machakos Governor Dr. Alfred Mutua said at a press conference a month ago.

Now in its eighth year, Kenya’s two-tiered governance structure has had many highs and lows, most of them centered on what role the county governments have in delivering services.

One of the most consistent issues is healthcare, of which Kenyatta’s administration ceded the lower-level hospitals to county units, but has been accused of trying to claw back control.

“Prolonged fight for control of the healthcare system”

Since the first year of devolution, in 2014, county governments have been in a prolonged fight for control of the healthcare system with both the central government and healthcare staff unions.

The unions have supported plans by both the executive and legislature to have the country’s healthcare run by the main government, but county units insist that would harm devolution.

  • With more power to direct local revenues and resources, as well as access to a chunk of the national budget, counties could invest more into healthcare where needed.

A 100-day nationwide strike by doctors in 2017 led to a short-lived detente between the counties and the state, as they both toiled to get them back to work. There were many issues at play, chief among them being how counties were running hospitals.

A Nairobi court jailed union leaders for a time, but their unrelenting demands forced through an agreement. In mid-2019, a wave of new strikes by doctors triggered the issues again after less than half of the 47 counties kept their part of the 2017 deal.

At the time, according to the doctor’s union, the country had 2,500 unemployed doctors “but the governors have refused to employ them directly.” Union officials also said that they [county governors] had also refused to pay health workers’ salaries regularly, or even keep health facilities stocked.

The solution, they added, was to move the health function back to the Kenyatta government. Counties, on their part, have routinely claimed that doctors do not want to work in the close supervision that is brought on when run by a devolved unit.

  • One county fired more than 60 doctors in mid-2019, while several others threatened to do the same.
  • In addition to wages, other issues included lack of working medical equipment, and several systematic layoffs of healthcare support staff as part of austerity measures.

Nairobi depends on devolved units

With Nairobi now cut off from the rest of the country, county governors have assumed a renewed importance in the country. Despite the capital’s role as the country’s economic and political nerve center, it relies on its devolved units for everything from food to labor.

This means the Kenyatta administration has no choice but to relent on its prolonged power struggle with devolution, partly as a means of dealing with COVID-19. The 47 governors, more than half of whom are serving their second terms and cannot stand for re-election, also now need Nairobi more than ever.