PS Oluga: Discipline and standardization key to devolved healthcare success
Principal Secretary for Medical Services, Ouma Oluga, on Tuesday, noted that while devolution was intended to bring services closer to the people, disparities persist depending on the leadership and management capacity of each county.
The Ministry of Health says Kenya’s devolved system of healthcare requires discipline, vision, and standardization to ensure equitable access and efficiency across all counties.
Principal Secretary for Medical Services, Ouma Oluga, on Tuesday, noted that while devolution was intended to bring services closer to the people, disparities persist depending on the leadership and management capacity of each county.
“Devolution was intended to provide closer services to the people… because the notion is that the people are closer to that facility, and they can account for it more. They can budget for it more. But devolution needs to be accompanied by discipline,” Oluga said.
He added that public interest and long-term vision are critical for effective healthcare delivery under the devolved system.
The PS highlighted three key elements that must guide engagement with county governments. First is standardization, ensuring uniform health services across the country.
Oluga pointed to programs like the National Equipment Service Program and the broader Taifa Care blueprint, which aim to make equipment, medicines, and services affordable and consistent in all counties.
“Standardization is important… so that any corner you are in you will be able to afford it. The equipment we have… and the issues around medicines, you are able to get. We are trying to standardize that,” he explained.
The second element is health security, which ensures that disease outbreaks and public health emergencies are managed nationally rather than depending on individual county performance.
“When a disease comes in through the border… it doesn’t matter whether your governor was doing well in health or not. These are things the national government must handle,” Oluga said.
Third is health service delivery and technology performance, which refers to the package of services available to citizens.
PS Oluga explained that counties cannot negotiate individually with manufacturers for specialized drugs or equipment because the numbers do not make sense at a local level.
Aggregating demand nationally ensures lower costs and wider access.
“For example, even with our population of persons living with HIV, we still have to aggregate with 12 other countries for the numbers to make sense… If a county was to do that alone, that drug could cost 100,000 shillings,” he said.
Going further, the PS also cited the example of MRI and CT scan machines, where county-level procurement can be extremely costly, but a national framework allows shared, fee-for-service access without burdening the county budget.
Oluga emphasized that health must remain a shared function between the national and county governments.
He commended the Council of Governors for supporting standardized systems and single frameworks for service delivery and equipment management, which she said benefit both patients and county finances.
“Health must be a shared function, and it has always been the understanding… the patient goes in, the service is paid for when used, and this saves the governor’s money. This is how we ensure sustainability and equity,” Oluga added, noting that these programs are operational
