Most counties spend more on health than any other sector

Thirty-nine counties earmarked more money to health than any other function in the last financial year, a Nation Newsplex analysis of budgets reveals.

The eight counties in which health did not top the allocations were Kakamega, Laikipia, Mandera, Mombasa, Nairobi, Samburu, Taita-Taveta and Turkana. However, Mombasa and Nairobi still spent more on health than any other sector.

Although in Machakos health was apportioned a bigger slice than any other department, it ranked fourth in the expenditure budget.

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Health, along with agriculture and water, are some of the key services functions that were devolved to counties from the national government.

During the financial year 2015/16, the same number of counties did not have health as their top allocation.

Murang’a had the most costly individual health project in allocation, with Sh435 million being assigned to drugs and other supplies. This was 22 per cent of the budget allocated for the 10 major projects.

They were Garissa, Laikipia, Migori, Narok, Samburu, Turkana, Vihiga and Mandera. But in Migori and Samburu, more was still spent on health than any other function.

In Kisumu, health topped the budget allocations, but was number three in expenditure.

A deeper look at the budgets reveals that counties now prioritise health more than in the initial years of devolution.
In the 2014/15 fiscal year, 20 counties (43 per cent) did not have health as their largest allocation. They were Bungoma, Busia, Embu, Garissa, Kajiado, Kakamega, Kirinyaga, Laikipia, Mandera, Marsabit, Migori, Mombasa, Nairobi, Narok, Samburu, Taita-Taveta, Tana River, Uasin Gishu, Wajir and West Pokot

That year, Kisumu and Turkana earmarked more money to health than any other function but it only received the third largest expenditure.
In counties where health did not receive the top allocations or spending, the sector lost out to county public service and administration, governors, offices, infrastructure and transport, finance, governance and economic planning and water.

Highest expenditure

Of the 861 major projects with the highest expenditure across the 47 counties in the last financial year, 79 were in the health, according to the Newsplex review.

Health accounted for seven per cent of the total budget allocation for all the major projects, equivalent to Sh5 billion.

Total budget allocation for all the 861 high-expenditure projects was Sh72 billion, according to the 2017 Annual County Governments Budget Implementation Review Report.
The health projects focused on construction of hospitals (48 per cent), buying health supplies, drugs and equipment (32 per cent), renovations (12 per cent) and maternal services (four per cent).

Four counties did not have any major health project. They were Machakos, Kisumu, Mombasa and West Pokot.

Lamu and Siaya allocated more than 50 per cent of the total budget assigned to high-expenditure projects to health.
In Lamu, two out of the five big projects were related to health. Some Sh140 million (58 per cent of the Sh243 million allocated to major projects) went to renovation of hospitals, including King Fahad and Faza hospitals and Mokowe Health Centre and completion of Witu Accident and Emergency Unit.

In Siaya, four of its major projects focused on health, with a budget totalling Sh170 million (50 per cent of the top projects budget). They were construction of twin wards at Urenga Dispensary and the building of a maternity ward and theatre at Bondo Hospital.

Nearly half of the counties used up more than 50 per cent of the budget allocated to high-expenditure health projects.
Kakamega had the highest absorption rate for its major health project, at 404 per cent, meaning it spent more than it allocated for the project. A total of Sh887 million was spent on the construction of Kakamega Teaching and Referral Hospital, against the Sh200 million that had been allocated.

Siaya (28 per cent), Taita-Taveta (28 per cent) and Baringo (25 per cent) had the lowest absorption rates.

Murang’a had the most costly individual health project in allocation, with Sh435 million being assigned to drugs and other supplies. This was 22 per cent of the budget allocated for the 10 major projects.
When population is factored for every county, Isiolo led spending ShS22,755 per person. It was followed by Marsabit (Sh19,839), Wajir (Sh18,641), Garissa (Sh17,108) and Lamu (Sh16,662). At the bottom were Uasin Gishu (Sh5,303), Homa Bay (Sh5,324), Bungoma (Sh5,324), Bomet (Sh5,589) and Nakuru (Sh5,637).