When a patient walks into a health centre in Bomet or a dispensary in Lamu, they are entering a county facility. The nurse who takes their temperature is a county employee. The records system that logs their symptoms runs on county infrastructure. The data generated belongs to the county health service, a function the 2010 Constitution explicitly devolved from the national government.
So when the national government signed an agreement in Washington committing “Kenya’s health data” to American authorities, a constitutional question should have been front and centre: whose data is this to give?
In my previous articles on the Kenya-US health cooperation framework, I explored what this deal means for ordinary families and why our health data is a national asset. But the devolution question cuts deeper. It is not just about fair terms. It is about whether the agreement was legally valid to begin with.
The Fourth Schedule of Kenya’s Constitution distributes functions between national and county governments. Health appears on both lists, but with a crucial distinction. The national government handles “health policy” and “national referral health facilities.”
Counties handle “county health services,” including county health facilities, pharmacies, ambulance services, and primary health care promotion.
In practice, this means the national government sets policy direction. Counties deliver the services. The clinics, the staff, the equipment, the record-keeping systems: these are county functions.
The data generated through those services flows from county operations.
Article 6(2) of the Constitution is explicit: the relationship between national and county governments must be “consultative and cooperative.” Neither level is senior to the other. When the national government commits county resources, including the data those counties generate, meaningful consultation is not optional. It is constitutionally required.
The Council of Governors, which coordinates Kenya’s 47 counties, confirmed it was not consulted before the agreement was signed. County directors of health report being summoned to Nairobi with almost no notice, not to negotiate, but to review documents already finalised.
“The time was so short we could not even call our peers in the other counties for us to consult before agreeing to greenlight the documents,” that is what one county official told DeFrontera.
Dr Gordon Okomo, chair of all county directors of health in Kenya, was summoned but could not attend due to the sudden notice. Some counties are now seeking clarity directly from the US CDC because the national government has not provided detailed information.
This is not consultation. This is notification after the fact. And county health leaders have seen this pattern before.
County directors cite the medical equipment leasing scheme as precedent, a case where the national government made major health spending decisions without consulting counties, then offloaded the costs onto them. Counties ended up with expensive machines they could not use or maintain.
The US health deal follows the same trajectory. The agreement commits Kenya to “co-investments” of nearly Sh11 billion over five years. It requires hiring thousands of health workers and lab technicians who, when the agreement expires in 2030, must transfer to government payroll. But which government? County health services are a county function. These costs will land on county budgets.
No county assembly debated these commitments. No governor signed off. The Council of Governors learned about the details after the framework was already signed in Washington.
Here is the constitutional knot: if county health services are a devolved function, and data is generated through those services, then county governments have a legitimate claim over that data. The national government sets health policy, but it does not operate the clinics. It does not employ the nurses. It does not run the systems that capture patient information.
When the US agreement commits Kenya to sharing “disease data, biological samples, and genetic information” within days of detection, it is committing resources that counties generate. When it grants access to “digital health systems and outbreak databases,” those systems often run at county level.
This does not mean counties should hoard health data or refuse to participate in national disease surveillance. Public health requires coordination.
But coordination is different from unilateral commitment. Article 187 of the Constitution allows transfer of functions between levels of government, but only by agreement, and only if the receiving government can effectively perform the function.
The court has given the government until January to respond to challenges against the agreement. If the framework is to be renegotiated, and it should be, counties must be at the table as parties, not bystanders.
This means the Council of Governors should be formally included in any revised negotiations. County assemblies should have the opportunity to debate commitments that affect county budgets and county data. Intergovernmental consultation mechanisms under the Constitution should be activated, not bypassed.
It also means governors should be asking hard questions. What happens to data generated in your county facilities? Who controls access? What share of any benefits, whether funding, technology transfer, or intellectual property, flows back to the counties that generated the underlying information?
Kenyans fought for the 2010 Constitution precisely because power had been too centralised for too long. Devolution was not a bureaucratic reshuffling. It was a transfer of authority to the people through their county governments. Health was devolved because Kenyans understood that decisions about their wellbeing should not be made exclusively in Nairobi.
When an agreement that affects county health services, county budgets, and county data is signed without county participation, it does not just raise practical concerns. It undermines the constitutional settlement Kenyans voted for.
Your governor was not in the room. Your county assembly did not debate this. The data generated at your local clinic, data that could be worth billions when processed into AI systems and drug discoveries, was committed without your county’s consent. That is not how devolution is supposed to work.