Kisumu Governor Anyang' Nyong'o now says he is opposed to the national government paying community health workers directly, saying it is against the law.
In a statement, Nyong'o said the move to have the workers managed by the national government goes against the principles of the Constitution, which has devolved the health function to the counties.
"We, the Kisumu County Government, wish to address the issue of the direct payment of stipends to Community Health Workers (CHWs) by the National Government. Our stance on this matter is rooted in legal and constitutional principles, as well as considerations of effective governance and accountability. Schedule 4 of Kenyan Constitution (2010) assigns health as a function of county governments including managing and promoting primary health care," Nyong'o stated.
"Article 202(2) of the constitution clearly stipulates that County Governments may receive additional allocations from the national government's share of revenue, either conditionally or unconditionally. This implies that such funds are intended for counties to manage and spend, within the framework of their mandates."
According to Nyong'o, legally, all funds meant for health-related affairs in government should be managed by county governments and not the national government.
"Article 202(2) of the constitution clearly stipulates that County Governments may receive additional allocations from the national government's share of revenue, either conditionally or unconditionally. This implies that such funds are intended for counties to manage and spend, within the framework of their mandates," Nyong'o added.
"The Primary Health Act of 2023, which governs primary health care services including community health services, mandates the national government to appropriate and transfer funds to county revenue funds for the effective performance of county functions, including the payment of CHWs' stipends."
Nyong'o says it is unconstitutional for the Ministry of Health to directly pay stipends to the workers, as it circumvents the intended process outlined in the law.
Additionally, he says, the autonomy of county governments, as enshrined in Article 235 of the constitution, is crucial for effective governance.
"County governments are responsible for supervising and supporting CHWs, as outlined in the Primary Health Care Act. Direct payment by the national government undermines this supervisory role and may lead to a lack of accountability and transparency in the use of funds," he says.
Nyong'o's plea
Nyong'o wants the national government to stop paying the stipends to CHWs directly, and instead submit the funds to counties as a conditional grant.
"This decision is not only based on legal and constitutional grounds but also aims to uphold principles of good governance, accountability, and the autonomy of county governments. We urge the National government to respect the law and use acceptable and legal methods to support community health in the country," Nyong'o stated.
"We are happy to receive this support as a conditional grant to Kisumu given that fidelity to the Constitution and upholding the autonomy of county governments is essential to good governance and accountability in the delivery of services to our people."
The community health workers in Kenya are trained to provide a range of health services, including prenatal care, immunization, nutrition education, and treatment of common illnesses.
In July 2023, the government announced plans to hire 103,000 community health promoters as part of a preventive approach to healthcare.
Each promoter would be responsible for 100 households and would be kitted with modern medical equipment and deployed in communities across Kenya.
“Preventive healthcare saves lives and resources. This Bottom-Up approach to healthcare will allow us to detect health issues early and manage minor ones at the community level, which will decongest our hospitals and improve service delivery,” President William Ruto explained.
The President also revealed that the United States Agency for International Development (USAID) will train the workers.
