Kakamega, Isiolo lead in healthcare growth – parliamentary watchdog report

Kakamega and Isiolo counties recorded the highest growth in healthcare provision expansion over the last decade, according to a new parliamentary watchdog report that highlights both progress and persistent inequalities under devolution.

The Devolution Budget Watch 2025 report, released by the Parliamentary Budget Office (PBO), shows that the two counties outperformed others in the health sector growth between 2014 and 2023.

The growth is driven by investments in infrastructure, improved management, and better use of devolved funds.

Kakamega emerged as the top-performing county, registering a 24 per cent growth in its health sector.

Isiolo followed with a growth rate of 12.2 per cent, placing it among the strongest performers nationally.

Other counties that recorded robust expansion included Marsabit at 11.6 per cent, Elgeyo Marakwet at 10.9 per cent, Laikipia at 9.5 per cent, and Kitui at 9.4 per cent.

According to the report, the strong performance in these counties is largely attributed to the construction of new health facilities, improvements in hospital management practices and more efficient utilisation of health budgets.

“Since 2014, Kenya’s county health sector has exhibited a generally positive but uneven growth pattern, reflecting both the opportunities and challenges of devolved healthcare management,” the report states.

Data analysed by the Parliamentary Budget Office show that the sector’s nominal Gross County Product (GCP) grew at an average annual rate of about nine per cent over the period under review.

The growth was supported by expanded health infrastructure, increased recruitment of healthcare workers and enhanced financing through the equitable share and conditional grants from the national government.

The most significant growth momentum was recorded between 2016 and 2017, when many counties scaled up investments in new hospitals and health centres while rolling out pilot programmes under the Universal Health Coverage (UHC) initiative.

During this phase, counties prioritised improving access to healthcare services, particularly at the primary and secondary levels, resulting in notable expansion in service delivery.

However, the report points to sharp disparities across counties, with some regions struggling to sustain growth and others recording outright declines.

Mandera county experienced the steepest contraction in 2023, with its health sector shrinking by 34.6 per cent. West Pokot and Baringo also posted negative growth rates of 14.7 per cent and 1.2 per cent respectively.

Analysts attribute the weak performance in these counties to poor budgeting frameworks, inadequate health infrastructure, insecurity in some areas and persistent shortages of skilled health workers, factors that continue to undermine effective healthcare delivery.

Major urban counties, on the other hand, continued to post relatively stable and consistent growth.

Nairobi recorded a health sector growth rate of 7.2 per cent in 2023, while Kisumu, Mombasa and Nakuru registered growth rates of 8.1 per cent, 8.7 per cent and 7.8 per cent respectively.

The presence of private hospitals, specialised clinics and rising demand for outpatient services helped urban centres maintain steady expansion despite broader economic pressures.

The period between 2021 and 2023 points to a gradual recovery of the county health sector following earlier disruptions, including funding constraints and system shocks.

Counties such as Kakamega, Isiolo, Laikipia and Kitui stood out for relatively strong health sector management.

As counties continue to implement devolved healthcare mandates, the contrasting performance across regions underscores the need for targeted interventions to address structural weaknesses, ensure equitable resource allocation and strengthen health systems in underperforming areas.