In May last year, a 23-year-old woman in Lamu developed obstructed labour, a life threatening complication that could have killed the unborn child.
In the past, such a complication could be treated only at the Coast General Hospital, some 240 kilometres away. The other option would have been the Lamu County Hospital. But getting there would have meant a long boat ride on the Indian Ocean, and there was no guarantee that the hospital would have the necessary equipment, or staff, to handle her case.
What happened, though, was that the first-time mother – whose identity the hospital declined to reveal, citing the institution’s doctor-patient confidentiality policy – underwent a caesarean operation at the nearby Faza Hospital, the first time the procedure was conducted in the county since independence, more than 50 years ago.
The hospital, which is in Lamu East, had for decades, only offered basic medical services and treated mild ailments, a situation the county government says it has greatly improved through funds brought by the devolution of health services.
Previously, critically ill patients were referred to Lamu County Hospital on Lamu island, miles away across the Indian Ocean. The incidence of infant mortality and stillbirths was high, since families that could not afford the five-hour speedboat ride were left to their own devices.
The coastal county has received cash disbursement amounting to Sh7.9 billion from the national government in four years, according to data from the Treasury.
But Lamu County, once considered a marginalised region, is not alone. Many of the 47 county governments have in the past four years achieved once unimaginable feats, including brain and heart surgeries, which were once the preserve of the big hospitals in the country.
Besides, many have improved road networks to areas that were previously inaccessible, built schools, improved agriculture and increased access to business opportunities, resources and jobs.
Some counties, like Makueni — which has lately become the poster boy for the fruits of devolution — have been celebrated for providing universal healthcare, conducting the first telemedicine operation, and promoting trade by building milk and fruit-processing factories, the first in any county.
The counties have received about Sh1 trillion since they came into being, according to the Treasury. Most of these funds have been injected into health, education, trade and infrastructure.
Garissa and West Pokot have been celebrated for increasing the number of deliveries in hospitals and reducing maternal mortality rates through a raft of innovative measures.
Meanwhile, Embu, Kakamega, and Mandera counties stand out for improving access to healthcare services by providing free maternal healthcare service kits, incentives to traditional birth attendants and community health workers and using WhatsApp messaging to connect health facilities.
People whom the Nation spoke to painted a rosy picture, and were optimistic about the benefits of county governments.
Mr Kinuthia Wamwangi, a devolution expert and former chairman of the defunct Transitional Authority, singles out health and infrastructure as the biggest success stories of devolution, which have had the greatest impact on people’s.
Mr Wamwangi, who chaired the authority that midwifed devolution, says that devolution has not only improved the economic and social welfare of people in many places, some of which were previously marginalised, but has, to a great extent, increased the democratic space in the country, since the people are now part of the decision-making.
“Devolution is working fantastically. It is productive, effective and efficient in service delivery. The distribution of resources is now running into billions of shillings. People now do not have to lobby for goodies through delegations to State House,” he told the Nation.
“The citizens have become more educated, informed about their rights and entitlement. The checks and balances have improved. People can now choose to picket, demonstrate and go to court to enforce what they consider their rights,” said Mr Wamwangi.
He added: “The devolved units are also able to demand what they consider their right from the national government through forums like the Council of Governors.”
Further, the devolution of the management of the nursery school programme has seen a decline in the number of drop-outs and helped act as an anchor foundation for most school going children.
Prof Winnie Mitullah, a policy expert, says the achievements in health are “a realisation of the benefits of devolution, whose intention was to bring services closer to residents”.
“Some of these things were dreams that we never thought would be achieved. But the little that we are seeing in the counties, despite the few challenges that a number of them faced in the early years, is commendable and a sign of greater things to come,” said the University of Nairobi lecturer.
According to the Fourth Schedule of the Constitution, which outlines counties’ mandates, the regional governments are responsible for functions like planning, licensing businesses, transport, and controlling air pollution, among others.
Council of Governors vice-chairperson Ann Waiguru singled out service delivery as one of the most direct and greatest impacts of devolution.
“Governors have collaborated with the national government to ensure that specific issues affecting their people are resolved either at the national or county level, and this has resulted in improved living standards for Kenyans across the country,” said the Kirinyaga governor.
Other reforms include the rolling out of youth and women empowerment programmes in order to change the lives of the people at the grassroots, added Ms Waiguru.
But devolution has not been without its fair share of challenges. Corruption, infighting. tug-of-war with the national government, wastage of funds and unmet revenues targets have been reported.
The Controller of Budget, Ms Agnes Odhiambo, says that in the first quarter of the 2017/18 financial year, counties have registered a massive drop in revenue collection, from Sh7 billion for the same period in the 2016/17 financial year, to only Sh4.8 billion.
Devolution Cabinet Secretary Eugene Wamalwa is worried about the trend: “I am very concerned about corruption. We wanted to devolve funds, not corruption. It is an area of great concern which we shall be addressing.”
Ms Waiguru says some of the mistakes were part of the learning process, but corrective measures are being put in place to address the shortcomings in the next cycle of devolution.
Still, Mr Wamwangi was optimistic. He argued that the solution is to find long-lasting corrective measures for the problems encountered.
The office of the Auditor-General Edward Ouko, in its annual reports on the use of funds in the counties, indicates that most of the devolved units have presided over wastage of billions of taxpayers’ funds, after governors and officials failed to account.