IMFIN brief 25: Kenya, decentralization and immunization financing

Decentralization can pose challenges to immunization if roles and responsibilities for key functions are not clear. How have Kenya’s recent decentralization efforts affected immunization financing?

Key points

• Many countries are implementing decentralization—the shifting of functions from higher to lower levels of government—in health and other sectors. Decentralization can improve responsiveness to population needs, but it can also hinder the delivery of health services if roles and responsibilities are not clearly defined and the levels of government taking on new functions are not supported during the transition.
• Decentralization can make subnational decision-makers such as local mayors good targets for immunization financing advocacy.
• In some country contexts, it may be possible to pilot-test decentralization and related capacity building efforts and then roll them out gradually.
• Kenya experienced challenges with shifting fund management to subnational levels. For immunization, this resulted in some gaps in funding for vaccine and injection supplies and delivery, operational costs, and cold chain maintenance, resulting in a drop in immunization coverage.
• A compelling argument can be made for keeping certain health functions, especially vaccine financing and procurement, at the national level.