Healing the health system in Kenya: Health Service Commission headache

July 1, 2022 - Reading Time: 3 minutes - By Mercy Kamau

Deputy President William Ruto has promised health workers that he will set up a Health Service Commission if he succeeds in his ambitions for the presidency.

A Health Service Commission would be a boon for health workers since unlike teachers and the police, they were late in petitioning during the promulgation of the 2010 Constitution for the creation of a national institution to look into their employment and welfare issues. 

The devolution of the bulk of healthcare provision resulted in a nightmare situation for the workers and a majority of stakeholders have over the last decade urged the government to revert the health system to the national, rather than the county governments.

What is it?

A Health Service Commission is the institution that would regulate the healthcare sector through registration, inspection, monitoring complaints and enforcement activities.

In 2020, the Kenya Medical Association asked the government to come up with a Health Service Commission saying that it would really help in ‘healing the sickly’ public health service in Kenya.

KMA President, Dr Were Onyino, said that the establishment of the HSC would help in addressing issues affecting public health, among them the shortages of health professionals in the country and boost Kenya’s ability to deal with eventualities like Covid-19 and future pandemics.

Dr Onyino decried inadequate personal protective equipment for healthcare workers faulting shambolic healthcare management as the main hindrance to service delivery.

Further, he called for the establishment of “a centralised mechanism for managing human resources for health”.  

He added that the HSC would have the prerequisite professional competence to make decisions pertaining to health services.

“Human resources for health management have proved to be the most difficult aspect of the Covid-19 pandemic. In some counties, the health workers are still unable to access quality PPEs,” Dr Onyino said.

How a commission is formed

Coming up with an HSC would require an amendment to the Constitution as independent commissions are established by Chapter 15 of the supreme law.

While it would also be possible to establish one via an Act of Parliament, there would likely be questions about the legality of that because of the devolution of healthcare.

Chapter 15 states that Parliament would allocate adequate funds to enable each commission and independent office to perform its functions and the budget of each commission and independent office shall be a separate vote.


The establishment of a Health Service Commission will also lead to a push and pull between the two levels of government – national and county – as some counties have invested in the training of health professionals. 

Since the devolution of health services in 2013, industrial strikes have frequently disrupted health services in the public health sector in Kenya. In 2017, health workers recorded about 250 strike days, disrupting health services across the country. Kenyans had a rough time as a majority of them could not afford to get health services from the private facilities.

A doctors’ strike, for example, lasted 100 days. Nurses on the other hand went on a 150 days strike even as the counties and the national government promised to resolve the issue. In 2020, nurses spread across 20 counties went on strike in February citing salary delays.

 A health service commission will not only bring together about 90,000 healthcare workers in the country, but also create a conducive labour environment in the public health sector, addressing localised industrial actions in the county governments.

The creation of a Health Service Commission was among the issues dropped from the Building Bridges Initiative during horse trading on the provisions and medical professionals were once again left out. 

Another implication is on the budgetary allocation since a section of leaders in the counties feel that taking away the health function from counties means reducing their allocations. Most governors also claim that they know better than the national government on what health services their people need.

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