Achieving Universal Health Coverage (UHC) in Kenya relies heavily on a responsive Primary Health Care (PHC) network. Following the 2013 devolution, county governments assumed management of over 90% of public health infrastructure. However, restricted financial autonomy at the facility level created bureaucratic delays that hindered effective local service delivery.
To resolve this, the Facility Improvement Financing (FIF) Act (2023) was enacted, granting public health facilities the legal framework to retain and manage their generated revenues directly. While promising on paper, successful operationalization depends on county-level execution, resulting in a patchwork of adoption across the country.
Building on existing health financing research, this study examines how public financial management (PFM) systems function across six counties with varying levels of autonomy. By analyzing how PHC managers navigate budgeting and spending on the ground, this resource offers evidence-based recommendations to strengthen facility autonomy and advance Kenya’s UHC goals.
