The current situation at the Kenya Medical Supplies Authority (KEMSA) is not merely an argument between counties and a government agency, but a wake-up call. It signals grave problems with the devolution of healthcare provision in Kenya. How? Payment delays and mounting debts have begun to undermine the provision of vital medical supplies. The epicentre of this conflict is Nairobi County, which currently ranks at the top of the list of counties that deprive KEMSA of funding.

According to the Daily Nation, counties and the Ministry of Health owe KEMSA KSh7.6 billion in arrears, which they have not paid over the past five years.

Nairobi County is among the top 10 debtors, owing the organisation a significant amount. Here is the list:

• Nairobi: KSh254 million
• Kilifi: KSh234 million
• Turkana: KSh229 million
• Tharaka Nithi: KSh186 million
• Marsabit: KSh138 million
• Wajir: KSh131 million
• Kakamega: KSh124 million
• Homa Bay: KSh122 million
• Meru: KSh108 million
• Bomet: KSh103 million
• Samburu: KSh101 million

This is only the tip of the iceberg, as KEMSA representatives say that mounting debt has hampered the agency’s procurement of essential drugs and equipment.

Implications are broader than bookkeeping. Public hospitals rely heavily on KEMSA for antibiotics, painkillers, oncology drugs, surgical disposables, and other life-saving medications. If counties fail to pay for their goods promptly, the logistics chain will be disrupted. Stock levels will run dry. Patients will have to purchase medications from private pharmacies or go untreated. In economically disadvantaged areas, this usually leads to prolonged hospitalisation, deterioration of their condition, or even untimely fatalities.

Interestingly, Nairobi appears prominently on this list despite being Kenya’s economic hub. This metropolitan area generates the largest share of revenue for each county and is home to several important health institutions nationwide. However, Nairobi is frequently cited among counties plagued by poor financial management, inadequate budget allocation for development, and ever-growing arrears. This irony cannot be overlooked, as a region with tremendous economic potential struggles to pay its bills for medical assistance.

In contrast, KEMSA finds itself caught between its responsibilities to society and its own survival. Because KEMSA provides county governments with vital support, the organisation depends on prompt reimbursement to maintain its purchasing cycles. Earlier this year, KEMSA disclosed that almost all county governments owed the company, and a call was made for the National Treasury to settle the counties’ debts on their behalf.

The more important issue is the message the problem sends about the whole process of devolution. The devolution of healthcare services in Kenya was intended to enable greater access for the Kenyan population. The system does provide such accessibility in many ways. However, this problem shows that decentralisation can sometimes harm rather than benefit.

According to recent reports, there has been a shortage of vital medicines for patient survival in at least 24 counties following KEMSA’s failure to supply medicines due to its arrears. This situation places ordinary citizens on the front lines of the effects of poor governance, especially for patients who need dialysis medicines, chemotherapy drugs, and even surgical supplies.

It will not suffice to address only the debt dilemma. To ensure a sustainable supply of medical products, the relevant parties must be financially responsible, prioritise investment in health, and treat these supplies as critical to the process. Otherwise, the current situation will become not just a financial, but also a healthcare crisis.