Kenya’s healthcare system is in crisis because of the rushed and unstructured devolution of health services, and unless it is fixed, it could determine the outcome of the next general election, says Dennis Miskellah, Deputy Secretary General of the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU).

Speaking during an interview with Radio Generation, Miskellah said the decision to devolve health without first costing the function or creating proper structures was a major policy blunder that continues to harm both healthcare workers and ordinary Kenyans.

“Kenya did a very big mistake by devolving healthcare,” he said on Wednesday.

“There are certain functions that were too important to be devolved, like security, like education. But somebody sat back and thought healthcare was just a perfect idea,” the official added.

Miskellah added that while education stakeholders resisted devolution, the medical sector was caught off-guard because it was distracted by other debates.

“When teachers were resisting education being devolved, doctors were busy discussing when does life begin, what is abortion… and then the carpet was pulled right under our feet,” he explained further.

According to Miskellah, the process could have been better managed had the advice of former President Uhuru Kenyatta been followed. He said Uhuru initially asked governors to take a phased approach, beginning with lower-level facilities, so the system could be observed and adjusted. But governors, led by then Bomet Governor Isaac Ruto, refused.

“He told the governors, don’t rush to devolve this thing in mass. Know the amount of money you will need to run this program… But the governors said no, and Isaac Ruto told him, you are fighting devolution — give it to us,” said Miskellah.

As a result, health services were handed over to counties without uniform standards, resources, or accountability. Miskellah said this fragmented the system into 48 directions — including the 47 counties, the national government, and the private sector — all operating independently.

“We have 48 different ways. 49, because you have national government doing their own thing, 47 governors doing whatever they want, private sector doing whatever they want,” he said.

He warned that this chaotic setup has left the poorest Kenyans and frontline healthcare workers to suffer the most. While patients endure long waits and underfunded services, health workers are burdened by salary delays and financial hardship.

“As we speak, most counties in Kenya have not paid July salaries. Some haven’t even paid June salaries,” said Miskellah. “You find a place where they deduct third-party deductions like your loans, your insurance policies for your children, SACCO contributions… but they don’t remit them.”

He said the consequences of these failures are severe. “You’re in CRB, the insurance for your child has elapsed, because somebody pocketed the money they gathered from your salary.”

Miskellah believes Kenyans are starting to wake up to the importance of healthcare as a public issue, not just a personal burden and that President William Ruto’s re-election will depend heavily on whether his administration addresses the sector’s deep-rooted problems.

“I can dare say that health could be a very, very critical issue in the coming election. President Ruto’s re-election or failure is going to be largely attributed to the healthcare agenda,” he added.