Raila's devolution vision that shaped healthcare agenda

Devolution — a vision strongly championed by former Prime Minister Raila Odinga and enshrined in Kenya’s Constitution as the will of the people — was designed to bring services closer to citizens.

Although some counties have built robust health systems, others continue to grapple with glaring gaps.

Until his death, it remained Raila’s wish to see affordable and accessible healthcare reach every Kenyan. He often argued that the health sector deserved a greater allocation of resources, lamenting that a large share of funds remained at the national level, which he said continued to undermine service delivery.

Dr Christine Sadia, a global health and governance expert, notes that Raila’s relentless push for democracy and good governance greatly shaped Kenya’s healthcare system.

“When you fight for democratic and good governance, it affects health. Human development stems from good health, which the former Prime Minister championed,” says Dr Sadia.

She notes that Raila also helped shape the social pillar of development, having been among those who drafted Kenya’s Universal Health Coverage (UHC) policy under Vision 2030.

“Nobody can wish away Raila’s fight for justice for all. He is behind drafting of Kenyan’s Constitution that has rights to healthcare, education, security, rights that we enjoy as a country,” observed Sadia.

The dawn of devolution brought excitement and hope — hospitals were built, drugs supplied, and in some northern counties, Caesarean sections were conducted for the first time. UHC has been a dream for Kenyans, but there remains disparities in its actualisation because of financial strains.

A former Health Minister once presented a UHC Bill to Parliament during the Narc government, but it was rejected. A second attempt came during the Grand Coalition government, when there was a proposal to transform the NHIF into a social insurance scheme, but this too failed to take off. President Uhuru Kenyatta later revived the dream by piloting UHC in four counties — Isiolo, Kisumu, Nyeri, and Machakos — though it was never scaled up nationwide.

Under President William Ruto, the Social Health Insurance Act 2023 was introduced to guarantee the actualisation of UHC, with the Social Health Authority (SHA) serving as the financier. Even as the new health scheme took shape, Raila reminded Ruto to ensure a smooth transition and to strengthen weaker areas to promote equity and improve care for all.

In August, Ruto acknowledged that if Raila had been President, he would likely have implemented the same reforms pursued by the Kenya Kwanza administration, including the SHA.

Raila, however, urged the government to enhance the scheme and allocate more resources to counties.“We want to see more resources being devolved to the counties so that we can be able to deal with issues such as healthcare and infrastructural development that should be devolved,” Raila said in February. He emphasised the need for the government to fulfil its promises, particularly the implementation of SHA.

In his presidential manifesto in the last election, Raila pledged to strengthen and expand UHC across all 47 counties. He promised to ensure that every Kenyan could access quality and free healthcare — recognising its direct impact on national productivity.

Raila promised affordable and accessible healthcare, the availability of essential drugs in all health facilities, the nationwide rollout of UHC, the establishment of an Emergency Health Fund, promotion of local production of medical supplies, and the integration of health volunteers into the system.

Experts applauded his emphasis on local drug production, viewing it as a key strategy for reducing healthcare costs.

He also championed better management of human resources in the health sector, which has faced repeated strikes.

KMPDU Secretary-General Dr Davji Atellah said that during the broad-based government, Raila advocated the appointment of technocrats to run health departments, such as the appointment of Dr Ouma Oluga as Principal Secretary for Medical Services.

He recalled Raila’s pivotal role during the 2017 doctors’ strike, when he demanded the release of jailed doctors and pushed for the signing and implementation of the 2017 Collective Bargaining Agreement (CBA).

“In 2024, during the nationwide doctors’ strike, he stood with us and urged the government not to reduce the wages of intern doctors as per the 2017 CBA,” Atellah added.

Reflecting on Raila’s passing,KMPDU Deputy Secretary-General Dr Dennis Miskellah said: “We were fortunate to tap into his wisdom. I met him during his final days when he was unwell. I remember walking him down a lift after a clinic visit and telling him how much we doctors appreciated him. It is deeply saddening that he died so far away. We wish Kenyan doctors could have cared for him and perhaps saved his life. But it was God’s will — the union and the entire medical fraternity will miss him dearly.”