Sakaja approves new law giving Nairobi County hospitals more financial autonomy

The Nairobi City County Health Services and Management Act, 2026, was assented to by Sakaja and came into force on August 19.

Under the law, each Level Five county hospital will operate as a county entity responsible for managing its financial, human and physical resources.

The facilities 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 running of the hospitals, including financial management, budgeting, procurement, staffing and performance.

The hospitals will also be required to develop and implement strategic plans, annual work plans and budgets while complying with public finance laws, audit requirements and other accountability measures.

The Act provides that Level Five hospitals will be responsible for the “efficient, effective and economical management” of their financial, human and physical resources.

They will also be allowed to receive, administer and account for funds allocated or accruing to them in accordance with the law and the Public Finance Management Act, 2012.

The new framework gives individual hospitals greater control over their resources while retaining county oversight and public financial safeguards.

The reforms come as the country reviews progress in the health sector during the Kenya Health Summit held at the Kenyatta International Convention Centre on August 18 and 19 under the theme, “Reforms Delivered, Health as a Right.”

The summit focused on health-sector reforms, including access to healthcare, quality of services, financing, primary healthcare, digital health and accountability.

At the county level, Nairobi’s new law places hospital governance and patients’ rights at the centre of its health reforms.

The legislation guarantees patients access to emergency treatment, dignity, privacy and professional care. It also provides that every patient is entitled to the highest attainable standard of health.

A first-contact healthcare provider is prohibited from denying a patient emergency treatment. A provider with the capacity to offer emergency care who fails to do so risks a fine of up to Sh1 million, imprisonment for up to 12 months, or both.

Patients will also have greater control over decisions concerning their treatment, with healthcare providers required to obtain informed consent before administering services, except in circumstances provided for under the law, including emergencies.

Providers must explain available treatment options, their benefits, risks, costs and consequences, as well as a patient's right to refuse treatment.

The law also introduces protections for healthcare workers, including the right to a safe working environment that minimises the risk of disease transmission, injury and other harm.

Healthcare personnel may refuse to treat physically or verbally abusive or sexually harassing users, except in emergencies where no alternative healthcare worker is available.

The Act further requires hospitals to establish quality-management systems, undergo regular inspections and audits, and adopt integrated digital health information systems.

It also provides for greater community participation, equitable distribution of health facilities and adequate resourcing of primary healthcare units.

The new framework therefore shifts Nairobi towards a hospital management model in which Level Five facilities have greater responsibility for their finances, administration and performance while remaining subject to county oversight, public finance laws, audits and community accountability.

The law comes at a time when the national government is seeking to translate health reforms into improved services, providing Nairobi with a county-level framework for linking greater institutional responsibility with stronger accountability and protection of patients’ rights.