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Making Devolution Work for Service Delivery in Kenya
Essential drug availability has also improved, with one-third of these drugs having greater availability in facilities in poorer counties. The rural county with the fewest health facilities relative to population, Mandera, has reduced the average population each one serves from 21,033 to 14,590 through the construction of new facilities—and this is likely to be an important factor in improving skilled birth attendance rates. Similar disparities can be seen in ECDE, but again disparities in preprimary gross enrollment rates have been reduced postdevolution. Gross enrollment rates varied between 12 percent and 113 percent in 2018 (figure 2.14, panels a and b). Those counties with enrollment rates below 70 percent in 2013 increased enrollment by an average of 27 percent. Those counties with enrollment rates above 70 percent increased enrollments by a far lower average of 15 percent— illustrating a significant reduction in disparities. However, this reduction has not been entirely equitable. While there was little difference between average enrollment rates of poorer and wealthier counties and rural and urban counties before devolution, disparities have emerged since. The change between 2014 and 2018 was worse for poorer counties than for richer counties, indicating a divergence of preprimary net enrollment in the years following devolution. The pupil-toteacher ratio ranged from a low of 19:1 in Tharaka Nithi County to a high of 79:1 in Turkana County, showing the disproportional distribution of ECDE teachers across counties (figure 2.14, panels c and d). There are also significant disparities in water access, which varied from 28 percent to 93 percent in 2016 (figure 2.14, panels e and f ). Beyond this, the paucity of data means that it has been challenging to assess trends in disparities in water, agriculture, or urban development. It is likely that disparities in access to water in rural areas will have begun to be addressed: as described below, counties with lower water coverage have tended to invest more.
DISPARITIES IN COUNTY EXPENDITURE ON DEVOLVED SERVICES There are large variations in per capita expenditure by counties overall and within sectors alongside the large variations in the scope and levels of services and investments being delivered by counties (figures 2.15–2.18). Overall per capita expenditure varies between K Sh 5,200 (Kiambu County) and K Sh 21,000 (Lamu County). Overall, it is the poorer, larger, and least populated counties that have higher per capita expenditures, which is a feature of the formula for the equitable share. Those counties with higher expenditure need to spend more; some populous and urbanized counties have relatively low per capita expenditures. Sectoral shares of expenditures also vary significantly across counties, implying different service delivery priorities in different counties as well as the legacy of the scope and level of services provided before devolution (map 2.3). In health, per capita spending varies from K Sh 1,181 (Kakamega) to K Sh 6,505 (Lamu) (map 2.3, panel b). In water and agriculture, the degree of variability is similar. Agriculture spending per capita varies from K Sh 92 (Nairobi) to K Sh 1,500 (Lamu) (map 2.3, panel e); and education spending per capita varies from K Sh 166 (Nyeri) to K Sh 1,300 (Kwale) (map 2.3, panel c). The variation in water expenditure is even greater, varying from near zero investment (K Sh 17 in Murang’a) to K Sh 2,500 (Isiolo) (map 2.3, panel d).
