A heavily centralised system, without the elected county governments established by the new Constitution.
The reform changed responsibilities as well as administrative names. The constitutional framework allocated county functions, created county assemblies and elected governors, and required public participation in assembly business. County responsibilities include county health services, agriculture and pre-primary education.[9]
Three changes that people can understand
Kenya
More dispensaries were recorded
Number of facilities
+1,419 dispensaries
2013 is the reform-year baseline. Facility counts do not establish staffing, supplies or quality.[10]
Mandera county
Skilled help at birth
Share of births, from administrative health reporting
+27 percentage points
11% in 2013 to 38% in 2018. This is not an isolated estimate of the effect of devolution.[10]
| Indicator | Earlier observation | Later observation | Measured change |
|---|---|---|---|
| Dispensaries | 3,127 in 2013 | 4,546 in 2018 | +1,419; about 45% more[10] |
| Mandera: skilled birth attendance | 11% in 2013 | 38% in 2018 | +27 percentage points[10] |
| County equitable-share transfers | KSh190 billion, FY2013/14 | KSh302 billion, FY2017/18 | +KSh112 billion, nominal[10] |
2013 is the reform-year baseline for the first two measures. The funding comparison is between two post-reform years. Transfers are not total county budgets, and the cash increase is not adjusted for inflation.
Why the figures matter to a family
The Mandera indicator makes the human stakes visible: a larger share of births was recorded as attended by skilled personnel. The dispensary count indicates a broader network of facilities. The report also documents uneven performance and continuing service gaps.[10]
The practical interpretation is conditional. A building helps only when staff, medicines and referral arrangements are available. A larger budget helps only when money arrives, is spent properly and reaches the intended service. Neither a construction count nor a transfer allocation measures all of that.
Who became responsible for local decisions?
The Constitution gives voters a county governor to elect and a county assembly through which local affairs can be scrutinised. It also requires assemblies to facilitate public participation. These are identifiable opportunities for accountability, not a guarantee that every meeting is inclusive or every official responds.[9]
For a resident asking why a county clinic is poorly supplied, the reform creates a clearer local political address for the question. The relationship between responsibility, funding and electoral accountability is an institutional change that can be examined separately from service outcomes.
Which institution would be responsible for a service, which budget would fund it, and how would citizens question its decisions?
Sources & data notes
Historical observations are labelled with their years. The figures are not a current statistical dashboard. The notes identify original publications and any calculated changes.
- Parliament of KenyaThe Constitution of Kenya, 2010 ↗
Chapter Eleven, especially Articles 174, 176–180 and 196; First Schedule (47 counties); Fourth Schedule (county functions).
- Government of Kenya and World BankMaking Devolution Work for Service Delivery in Kenya (2022) ↗
Printed page 16, Figure 2.4: dispensaries. Page 25: Mandera skilled birth attendance. Page 65, Figure 4.3: equitable-share transfers. These are PDF pages 38, 47 and 87 respectively.