Devolution gave counties responsibility for healthcare delivery, but it did not solve the underlying problem of an uneven distribution of health workers across the country, and in some ways it has made coordinated solutions harder.
Why Counties Alone Can't Fix This
Health worker retention in rural postings depends on factors — career progression pathways, specialist training access, competitive terms across counties — that are difficult for any single county to solve unilaterally without risking a bidding war with neighboring counties for the same scarce specialists.
What's needed is a national framework, developed jointly by the Ministry of Health and county governments, that sets baseline terms and creates coordinated incentives for postings in underserved areas.
The Cost of Inaction
Every year this remains unresolved, counties with weaker tax bases continue to lose skilled health workers to counties and private facilities that can offer better terms, deepening the very inequality devolution was meant to address.
