Nairobi is setting the stage for a major shift in how public hospitals are run, with the County Assembly backing a new Bill that seeks to decentralise healthcare management across its facilities. The move is designed to ease access to medical services, improve efficiency, and tackle longstanding issues within the public health sector.

Minority Whip Moses Ogeto, a key supporter of the Bill, raised concern over the tough conditions faced by both health workers and patients. He described the current situation as dire, noting that many clinics lack adequate staff and pay some workers as little as Sh300 to Sh500 per day.

“You see, they are unable to access public clinics simply because these public clinics don’t even have the staff,” he said.

Under the proposed law, management authority will be transferred to individual hospitals, beginning with local clinics.

One of the main changes is that revenue collected by these facilities—no matter how small, even Sh100—will stay within the hospital rather than being sent to the County Treasury under the Consolidated Fund Services.

“We want to decentralise the management of the hospitals, especially when the budgets have been approved,” Ogeto said.

He criticised the current system, where accessing funds requires several extra approvals even after the County Assembly has passed the budget. He argued that this creates unnecessary delays and inefficiencies.

The Bill will also establish and strengthen hospital boards, giving them the responsibility to oversee operations and meet at least four times a year to assess performance. In addition, each hospital will form an internal board to handle day-to-day management.

A major element of the legislation is the inclusion of County Assembly members in the hospital boards. Their presence is expected to enhance accountability by enabling them to directly monitor how funds are used at the hospital level.

The position of hospital Chief Executive Officer will also be formalised and legally empowered under the new framework. Ogeto observed that many current CEOs are working without a proper legal basis.

“We want to strengthen the CEO position; currently, they are there illegally, so we want to make them legal,” he said. The Bill proposes giving these CEOs similar authority to their counterparts in private healthcare institutions.

If passed, the law would mark a major transformation in how health services are delivered in Nairobi, aiming to close gaps that have for years hindered effective service to the city’s residents.