Nairobi’s public health system is set for a major management overhaul following the commencement of the Nairobi City County Health Services and Management Act, 2026, which gives Level Five hospitals greater institutional and financial responsibility while introducing stronger layers of oversight, accountability and patient protection.
The law, which was assented to by Nairobi Governor Sakaja Johnson on August 14 and came into force on August 19, establishes every Level Five county hospital as a county entity with responsibility for managing its financial, human and physical resources. The hospitals will be governed by Hospital Management Boards and headed by Chief Executive Officers appointed competitively by the County Public Service Board.
The CEOs will serve as accounting officers and oversee the day-to-day administration of the hospitals, including financial management, budgets, procurement, staffing and performance. The Act also gives hospitals responsibility for developing and implementing strategic plans, annual work plans and budgets, while remaining subject to public finance laws and audit requirements.
“Every County Hospital (Level 5) shall be a County entity… managed in accordance with this Act by the respective Hospital Management Board and the Chief Executive Officer… [and] be responsible for the efficient, effective and economical management of its financial, human and physical resources.”
The Act further provides a framework for hospitals to receive, administer and account for funds allocated or accruing to them in accordance with the law and the Public Finance Management Act. This gives facilities greater responsibility over the resources available to them while maintaining public financial controls and accountability.
“[The hospital shall] receive, administer and account for funds allocated or accruing to the hospital in accordance with this Act and the Public Finance Management Act, 2012.”
The reforms come as Kenya takes stock of its health transformation agenda during the Kenya Health Summit, held at the KICC on August 18–19 under the theme “Reforms Delivered, Health as a Right.” The summit has focused on translating health-sector reforms into practical improvements in access, quality, financing, primary healthcare, digital health and health-system accountability.
Against that national backdrop, Nairobi’s new law places hospital governance and patient rights at the centre of the county’s next phase of health reforms. By giving hospitals greater responsibility for their own resources and management, while strengthening oversight and accountability, the law seeks to move decision-making closer to the facilities where healthcare is actually delivered.
The Act also strengthens patients’ rights by guaranteeing access to emergency treatment, dignity, privacy and professional care. Every patient is entitled to the highest attainable standard of health, while no person may be denied emergency treatment by a first-contact health provider. A provider who has the capacity to provide emergency treatment but fails to do so faces a fine of up to Sh1 million, imprisonment for up to 12 months, or both.
“Every patient has the right to the highest attainable standard of health… to be treated with professional standard of care… and to be treated with dignity, respect and have their privacy respected.”
The law also gives patients greater control over decisions concerning their care by requiring informed consent before health services are provided, subject to specified exceptions, including emergencies. Healthcare providers are required to explain available treatment options, their benefits, risks, costs and consequences, as well as the patient’s right to refuse treatment.
The legislation simultaneously strengthens protections for healthcare workers. It guarantees them a safe working environment and recognises their right to refuse treatment of physically or verbally abusive or sexually harassing users, except in emergencies where no alternative healthcare worker is available.
“A healthcare personnel shall have the right to a safe working environment that minimizes the risk of disease transmission and injury or damage to the health care personnel, their clients, families and property.”
The Act further introduces mandatory quality-management systems, regular health-facility inspections and audits, integrated digital health information systems and stronger mechanisms for community participation. It also requires equitable distribution of health facilities and adequate resourcing of primary healthcare units.
The reforms effectively shift Nairobi’s health system towards a model in which individual hospitals carry greater responsibility for management, finances and performance while remaining accountable to county oversight, public finance laws, audits and community representation.
In the wake of this week’s Kenya Health Summit theme, the Nairobi law provides a county-level example of what “Reforms Delivered, Health as a Right” can mean in practice: giving health institutions the management capacity to deliver while placing patients’ rights, quality of care and accountability at the heart of the system.
