NAIROBI, Kenya — Central Organisation of Trade Unions (COTU-K) Secretary-General Francis Atwoli has called for constitutional amendments to return the management of health and land functions from county governments to the national government, arguing that devolution has exposed the two sectors to persistent management and service-delivery challenges.
Speaking at the funeral of COTU National Treasurer Abel Njeru, the labour leader argued that healthcare was too critical to be managed under a system in which some counties struggle with financial and administrative capacity.
He linked recurring strikes by health workers, shortages and disruptions in medical services to what he described as poor prioritisation and management at the county level.
Atwoli wants health returned to national government
Atwoli said returning health functions to the national government would allow for more coordinated management of the sector, improve resource allocation and strengthen service delivery across the country.
“Health is a critical national service,” Atwoli said.
He argued that continued disputes between county governments and health workers could undermine access to essential services for millions of Kenyans.
The proposal would require changes to the constitutional framework governing the division of functions between the national and county governments.
Under Kenya’s devolved system, county governments are responsible for a wide range of healthcare services, while the national government retains functions including health policy, national referral hospitals and capacity building.
Atwoli’s proposal therefore represents a significant departure from the current structure of devolved healthcare.
Health workers’ disputes remain a concern
The COTU secretary-general’s remarks come against a backdrop of recurring disputes involving health workers and county governments.
Health workers’ unions have frequently raised concerns over delayed salaries, working conditions, promotions, staffing levels and implementation of collective bargaining agreements.
Atwoli argued that the fragmentation of healthcare management across counties had contributed to some of these challenges.
He said a centralised system could provide greater uniformity in employment management, funding and service delivery.
However, supporters of devolution have generally argued that county governments are better positioned to understand and respond to local healthcare needs.
Any proposal to transfer functions back to the national government would therefore require consideration of funding, staffing, accountability and the constitutional principles underpinning devolution.
Atwoli also targets land management
The labour leader also called for a review of how land is managed, particularly the protection of agricultural land from uncontrolled development.
He warned that the continued conversion of farmland into residential and commercial developments could threaten Kenya’s food security by reducing land available for agricultural production.
Atwoli urged policymakers to balance urban expansion with the preservation of productive agricultural land.
He said Kenya must protect its agricultural base to ensure future generations have sufficient land for food production.
The proposal comes as rapidly expanding towns and cities continue to put pressure on agricultural land in parts of the country.
Atwoli’s argument focuses particularly on ensuring that development does not permanently erode land that could otherwise support food production.
Constitutional review proposed
Atwoli said the Constitution should not be treated as permanently fixed where experience has exposed weaknesses or unintended consequences.
He argued that emerging challenges should prompt a review of provisions that affect the delivery of essential public services.
The call places renewed attention on the broader debate over the effectiveness of devolution more than a decade after Kenya established county governments.
Critics of the current system have pointed to disparities in county capacity and service delivery, while supporters argue that devolution has brought government and resources closer to citizens.
Any transfer of functions would require a constitutional and legislative process rather than an administrative decision by the national government alone.
Atwoli dismisses Sifuna’s presidential ambitions
On politics, Atwoli also dismissed reported presidential ambitions by Nairobi Senator Edwin Sifuna.
The COTU leader argued that Sifuna does not yet have the political and administrative experience required to seek the presidency.
Atwoli said Sifuna’s experience serving one term as a senator was insufficient preparation for the country’s highest political office.
He challenged the senator to gain broader political and administrative experience before attempting to mount a presidential campaign.
The remarks add another voice to the political debate surrounding potential contenders ahead of the 2027 General Election.
Sifuna has been active in national political affairs through his role as Nairobi senator and ODM secretary-general, while political parties and leaders continue to position themselves ahead of the next presidential contest.
