Stakeholders agree on implementation of health reforms in Nairobi
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Stakeholders in the health sector have agreed on key guidelines that will help implement a report by the Nairobi City County Government (NCCG) Health Reforms Taskforce.
The new move is aimed at putting an end to the deep-rooted problems undermining the delivery of healthcare services in the capital.
Chaired by Dorcas Kemunto, OGW, the taskforce’s findings depict a health system stretched to its limits by population growth, disease burden, infrastructural decay, and resource mismanagement.
The report not only diagnoses the systemic failures but also offers a bold blueprint for overhauling the sector.
Nairobi, with a population of approximately 4.85 million—rising to over 7 million during the workweek—faces mounting pressure on its health services. Rapid urbanization, youthful demographics, and a dual burden of communicable and non-communicable diseases have left the system reeling. From air pollution to unsafe water and inadequate sanitation, environmental factors are driving high rates of illness and death, particularly among children and vulnerable populations.
The report identifies pneumonia, respiratory infections, TB, and malnutrition as leading killers, while structural social issues like unemployment, substance abuse, and poor housing further complicate health outcomes.
The taskforce conducted a detailed audit of Nairobi’s devolved health services, examining accessibility, infrastructure, supply chain systems, information technology, human resources, and financing models. It found that public health facilities are vastly outnumbered by private ones, accounting for only 15% of the county’s 803 facilities. These public centers are often outdated, overcrowded, and poorly maintained, leaving the most vulnerable with limited options.
Access to quality services remains a major hurdle. Many facilities operate below standard, emergency care is underdeveloped, and community health services are fragmented and underfunded. Referral systems are weak, leaving patients stuck in lower-level facilities or improperly transferred.
The report recommends completing stalled projects, operationalizing facility upgrades, and expanding the use of a “hub and spoke” model to improve primary and emergency care delivery. Strengthening the role of community health units and volunteers is also seen as essential.
On infrastructure, the taskforce found many public facilities in disrepair, plagued by obsolete equipment and lacking preventative maintenance. It called for immediate investments to rehabilitate facilities and finish construction projects currently stalled due to unpaid bills.
A coordinated health master plan is needed to guide this expansion.
Supply chain management, though showing some improvement, is still hindered by inefficiencies in procurement, distribution, and regulation of health products.
The report urges a governance overhaul, backed by an investment plan, transparent distribution practices, and enhanced public-private partnerships.
A county formulary and updated ordering system would help stabilize supply chains and ensure timely delivery of essential medical goods.
Health information systems are another weak link, with fragmented and duplicative electronic records systems that hinder data-driven decision-making.
The taskforce advocates for a consolidated and integrated digital health strategy, complete with modern ICT infrastructure, improved data management, and a county-wide health research platform.
Perhaps most alarming are the findings related to human resources.
Nairobi’s health workforce is far below national standards, with critical shortages in nearly every category. Chronic understaffing, poor working conditions, long-standing vacancies, and delayed salaries have led to a demoralized and overstretched workforce.
The report recommends urgent hiring, fair promotions, better compensation, and comprehensive workforce planning to attract and retain talent.
The financial picture is equally dire. The county lacks a clear financing strategy, relying heavily on donor support for primary care and prevention. Only 7% of the health budget is allocated to development spending, and delays in national disbursements exacerbate underfunding.
The taskforce proposes a shift to a results-oriented financing model that leverages both public and private funding streams. Key measures include increasing health’s share of the county budget to 12%, boosting development expenditure, and creating a Health Services Fund to ring-fence resources.
Social protection mechanisms, especially for indigent and informal sector populations, are seen as essential to achieving universal health coverage.
The NCCG Health Reforms Taskforce’s report paints a stark but accurate picture of a health system in distress. Yet it also provides a practical and comprehensive roadmap for revitalization. With strong political will and coordinated implementation, Nairobi can reposition itself to offer equitable, quality healthcare to its fast-growing population.
The next steps, stakeholders agree, must be urgent and unrelenting.
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