Nairobi’s Level Five hospitals are entering a new era of management, with a new county law giving them wider control over money, staff and daily decisions while placing fresh duties on hospital managers to protect patients and improve services.
The Nairobi City County Health Services and Management Act, 2026, signed by Governor Johnson Sakaja on August 14, took effect on August 19. The law changes how Level Five hospitals will be run by giving individual facilities more responsibility for their operations while maintaining county supervision and financial controls.
Under the Act, every Level Five hospital will become a county entity with a Hospital Management Board responsible for its management. Each board will work with a chief executive officer who will be competitively appointed by the County Public Service Board.
The CEO will be the hospital’s accounting officer and will take charge of major areas of its operations. These include managing finances, overseeing procurement, handling staffing matters, preparing budgets and monitoring the hospital’s performance.
The new arrangement also gives hospitals more room to plan according to their own needs. Each facility will be able to prepare its strategic plan, annual work plans and budgets instead of relying entirely on decisions made at county level.
However, the greater freedom comes with continued financial accountability. Hospitals must still comply with public finance laws and audit requirements when using money allocated to them or funds generated through their operations.
The Act requires every facility to ensure the “efficient, effective and economical management” of its financial, human and physical resources.
What changes for patients?
One of the biggest areas covered by the new law is the treatment and protection of patients.
The Act gives patients the right to emergency treatment, professional healthcare, dignity and privacy. It also recognises that “every patient has the right to the highest attainable standard of health” and requires patients to be treated with “dignity, respect” while their privacy is protected.
The law introduces a tough penalty for healthcare providers who can offer emergency care but fail to provide it. Such a provider could be fined up to Sh1 million, jailed for up to 12 months, or receive both penalties.
Patients will also have more control over decisions involving their treatment.
Healthcare providers are required to obtain informed consent before providing treatment, except in circumstances allowed under the law, including emergencies. This means patients should be given enough information to understand what is being proposed before making a decision.
The information should cover the available treatment choices, their benefits and risks, the costs involved and the possible consequences. Patients should also be told that they have a right to decline treatment.
What does the law mean for healthcare workers?
Healthcare workers are also covered by the new rules, particularly on safety at the workplace.
The Act guarantees healthcare personnel a safe working environment and gives them the right to refuse to treat patients who are physically or verbally abusive or sexually harassing.
There is, however, an exception where the situation is an emergency and there is no other healthcare worker available to provide treatment.
“A healthcare personnel shall have the right to a safe working environment,” the Act says.
Greater control at hospital level will not mean the facilities are free from checks.
The law requires hospitals to operate quality-management systems and undergo regular inspections and audits. It also provides for integrated digital health information systems, which are expected to support the management of health information across facilities.
Community involvement is another part of the new system, with the Act providing for stronger participation by residents in health matters.
The legislation also requires attention to the distribution of health facilities and resources, including ensuring that primary healthcare units receive adequate support.
Why the changes matter
The new system places more responsibility on hospital management to make decisions and manage resources according to the needs of individual facilities.
At the same time, the county government retains oversight through financial rules, audits and other controls provided for under the law.
The changes come as Kenya continues to review its health reforms following the Kenya Health Summit held at the KICC on August 18 and 19. The summit was held under the theme “Reforms Delivered, Health as a Right.”
For Nairobi residents, the real impact of the law will be seen in how hospitals use their increased freedom. Better planning, proper use of funds, improved staffing and stronger management could help improve services, while the new patient protections give residents clearer rights when seeking care.
The law therefore combines greater responsibility for individual hospitals with continued public oversight, while placing patients and healthcare workers at the centre of the new management framework.