If you are a student of health systems or public policy, you’ve likely realized that Devolution and Health Care Services is where theory meets a very messy reality. On paper, devolution is about bringing services closer to the people. In an exam room, however, it’s about explaining the friction between national policy and county execution, the crisis of human resources, and the technicalities of intergovernmental relations.
Below is the exam paper download link
Past Paper On Devolution And Health Care Services For Revision
Above is the exam paper download link
Many students fail because they give “activist” answers—talking about how things should be—rather than “analyst” answers that cite the Constitution of Kenya 2010. To help you sharpen your academic edge, we have provided a Past Paper on Devolution and Health Care Services for download.
Below, we’ve broken down the “must-know” questions that appear in almost every revision cycle.
High-Yield Revision Q&A: The Devolved System
Q1: Contrast the functions of the National Government vs. County Governments in health.
A: This is the most common “Part A” question. According to the Fourth Schedule of the Constitution:
National Government: Responsible for health policy, national referral facilities (like KNH and MTRH), capacity building, and technical assistance to counties.
County Government: Responsible for “County Health Services,” which include all primary and secondary healthcare, pharmacies, ambulance services, and the management of all local health workers.
Q2: What are the primary ‘Human Resources for Health’ (HRH) challenges under devolution?
A: Devolution caused a massive shift in how doctors and nurses are managed. Key challenges include:
Disparities in Pay: Different counties offer different perks, leading to internal “brain drain.”
Promotions and Stagnation: Many health workers feel their career growth stalled once they were moved from the national payroll to county management.
Strikes: Intergovernmental disputes often result in delayed salaries, leading to frequent industrial action.
Q3: Explain the ‘Intergovernmental Relations’ (IGR) framework in the health sector.
A: Health is a “concurrent” function. This means the two levels of government must work together.
The Mechanism: This happens through the Council of Governors (CoG) and the Intergovernmental Relations Technical Committee (IGRTC).
The Goal: To ensure that when a national policy (like Universal Health Coverage) is made, the counties have the funds and the “buy-in” to implement it.
How to Use the Past Paper for a Distinction
Don’t just look at the questions; try to “answer like a consultant.” Use these three steps:
The “Gap Analysis” Method: When you read a question about Makueni County’s health model or Garissa’s challenges, don’t just list facts. Compare the intent of the law (The Health Act 2017) with the actual outcome (e.g., drug shortages). Examiners love to see critical thinking.
The Legal Cite: If a question asks about the rights of a patient in a devolved system, always mention Article 43 of the Constitution (The right to the highest attainable standard of health).
Timed Case Studies: Use the downloaded paper to practice one long-form question in exactly 20 minutes. Can you explain “Fiscal Decentralization” without rambling?
Final Thoughts: Beyond the Classroom
In a devolution exam, remember that the system is still “teething.” Whether you are discussing the Managed Equipment Services (MES) saga or the push for a Health Service Commission, always acknowledge that the goal of devolution is Equity. If your answer shows how a policy helps a person in a remote village get the same care as someone in the city, you’ve understood the core of the subject.
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Last updated on: March 7, 2026
New information gained / new value takehome
- Key challenges include:Disparities in Pay: Different counties offer different perks, leading to internal “brain drain.
- Strikes: Intergovernmental disputes often result in delayed salaries, leading to frequent industrial action.
- The Goal: To ensure that when a national policy (like Universal Health Coverage) is made, the counties have the funds and the “buy-in” to implement it.
This content was developed using AI as part of our research process. To ensure absolute accuracy, all information has been rigorously fact-checked and validated by our human editor, Collins Murithi.
External resource 1: Google Scholar Academic Papers
External resource 2: Khan Academy Test Prep
Reference 1: KNEC National Examinations
Reference 2: JSTOR Academic Archive
Reference 3: Shulefiti Revision Materials
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