How bill would better fund Nairobi's public hospitals

For years, Nairobians have endured long queues, overworked medical staff and empty pharmacy shelves at public hospitals and clinics.

Better days could be ahead for struggling health facilities if a proposed bill passes in the county assembly.

The Nairobi City County Health Services Bill, 2025, proposes a bold shift in management of public hospitals — granting them financial autonomy and the power to manage their operations more directly.

Under the proposed legislation, Nairobi public hospitals would retain patients’ payments, instead of depositing them into the county treasury’s central account. The aim is to address long-standing delays in accessing essential services caused by financial bottlenecks and red tape.

Majority whip Moses Ogeto, one sponsor of the legislation, paints a sobering picture of Nairobi’s public healthcare. Speaking at a recent assembly session, he described how the city’s most vulnerable residents, and others, are failed by underfunded and understaffed facilities.

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

 “Many hospitals operate with limited personnel and underpaid workers, making it extremely difficult for patients to receive timely care.”

The bill proposes that even modest fees — such as the Sh100 many patients pay — should stay within the clinics that collect them, providing a lifeline for facilities in desperate need of funding for basic supplies and maintenance.

“We want to decentralise the management of the hospitals, especially when the budgets have been approved,” Ogeto said, highlighting how delays by the Treasury in releasing funds — even after budgets have been passed — cripple day-to-day hospital operations.

The proposed law would also establish more robust management structures at the facility level. Hospital boards would be created to meet quarterly to oversee performance and financial decisions. These boards would work alongside internal committees handling daily operations — adding a layer of oversight and accountability that has long been missing. 

Significantly, members of the Nairobi assembly would, for the first time, be formally included on hospital boards. Their membership is expected to improve transparency and ensure elected leaders can directly monitor how resources are being used in the communities they serve.

Another key aspect of the bill is the formal recognition of hospital chief executive officers. Currently, many CEOs operate in a legal grey area, without a formal appointment process or defined powers.

“We want to strengthen the CEO position; currently, they are there illegally, so we want to make them legal,” sponsor Ogeto said.

“They should have powers similar to those of private hospital executives.”

If passed, the Nairobi City County Health Services Bill, 2025, could mark a turning point for public healthcare. By empowering clinics and hospitals to manage their own resources and staff, the law aims to slash the bureaucratic delays that have for years left patients waiting, and sometimes suffering.

For mothers queueing for hours at maternity wards, for children needing urgent treatment, and for overworked nurses doing their best with too little, the bill is more than policy reform. It is a chance for dignity, efficiency, and a return to genuine care in Nairobi’s public health system.