The place of international linkages in Africa’s Local Government Responses to Covid-19: Case study of Kenya’s Uasin Gishu County Government

Janet Jebichii Sego

Introduction

The outbreak of Corona Virus Disease 2019 (COVID-19) and its declaration as an international public health emergency and a global pandemic sent states to self-inspection to determine their preparedness to mitigate the effects of the pandemic. Through continuing experiences, Africa has seen the need to invest heavily in developing robust healthcare systems, providing adequate funding and proper monitoring systems to ensure transparency and accountability in the health sector. This is so because the need to contain the pandemic has caused immense pressure on the healthcare system across Africa, ranging from a shortage of healthcare personnel, limited hospital capacity, and the inadequacy of the necessary intensive care units and other key medical equipment and supplies.

With increased COVID-19 infections in the continent between 2020 and 2021, many African countries' health systems, such as Kenya and South Africa, experienced enormous pressure due to the rising number of COVID-19 patients. This shows that the pandemic has provided a reminder of the need for quality and sustainable healthcare systems in Africa and a collaborative approach by governments, civil society, the private sector and international organisations in its response.

Uasin Gishu County Government’s Response to COVID-19

Kenya has two levels of government: the national and county governments. Each level has clear functions that are either performed exclusively by each level or concurrently. The residual functions not legally assigned to either level are to be performed by the national government.

Foreign affairs, policies and international trade fall within the national government's exclusive jurisdiction, and such functions fall under the Ministry of Foreign Affairs (MOFA).  Therefore, any official international linkage is formed through the national government, with the county governors representing the counties only at international events.

Kenya's national and county governments have a concurrent function of providing medical and health services, and the two cooperate under the auspices of the Intergovernmental Relations Act of 2012. As far as health and medical care function is concerned, there is established the Health Sector Intergovernmental Forum (HSIF), which comprises the Ministry of Health, the County Government Health Executive Committees, development partners and other stakeholders, provides an avenue for the two levels of government to discuss issues related to the shared health function.

Before COVID-19 struck Kenya, the National Emergency Responses Committee on Corona Virus (NERCC), chaired by the Cabinet Secretary in the Ministry of Health, was established to develop mitigation measures, among other things. Therefore, on confirmation of the first COVID-19 case, the national government, in consultation with the county governments, issued directives and protocols to curb the spread of the disease and mitigate its effects. 

Kenya's international development and bilateral partners, such as the World Bank, provided immense support through financial and technical assistance to address the pandemic. 

Challenges to Uasin Gishu County’s response to the Covid-19

Uasin Gishu County, just like the other Kenyan counties, experienced several challenges in its response to the pandemic. Some of these challenges were; 

1. Lack of proper coordination between the two levels of government in the entire period of the covid-19 demonstrated by the following;
   

   1. the national government did not immediately involve the county governments when it began to enhance its preparedness as there was no county representation in the emergency committee, NERCC.

   2. The national government monopolises health functions. For instance, at the beginning of the pandemic, tests for Covid-19 were only performed by national centres. Another example is the need for the county governments under the Kenya Medical Supplies Authority Act, 2013, to acquire medical supplies from the Kenya Medical Supplies Authority (KEMSA), thus delaying the working of the county health facilities.
      

2. Insufficient funds result from over-reliance on donors, which then leads to insufficient budget allocation to the health sector. This, coupled with a lack of transparency and accountability in public funds, affects the discharge of the county government's health care and medical services functions.
   

3. Under international law, county governments do not possess the legal personality to enter into exclusive international partnerships with states or international organisations. As such, countries could not bypass the national government to seek international partners, and those who assisted did so purely out of goodwill.

Uasin Gishu County's international linkages

As stated earlier, foreign relations and international trade are the exclusive functions of the national government. As such, there are no specific departments designated for external relations at the county level, and county assemblies cannot purport to legislate on international relations. Even so, although there are no express laws and policies governing the external relations of county governments, the said governments have devised ways of ensuring improved service delivery to their people through forging international partnerships with investors. They do so through their respective county executive committees in charge of various county dockets with the particular governor's authority. For instance, the county executive committee (CEC) in charge of education in Uasin Gishu signed a Memoranda of Understanding with a Finnish University and the Finland Embassy to facilitate travel and studies of the youth wishing to study in Finland.

In another instance, since 2015, Uasin Gishu County has partnered with the Swedish Norrkoping Municipality in solid waste management through the CEC member in charge of Environment, Water, and Natural Resources.

As far as health care is concerned, Academic Model Providing Access to Health Care (AMPATH) (a partnership between the government of Kenya, Moi University, Moi Teaching and Referral Hospital and various Universities from North America) has been operating from Uasin Gishu County at Moi Teaching and Referral Hospital. It has been working with the county government to provide services to people with HIV/AIDs, expectant mothers and children. Recently, the County had talks with ambassadors from Denmark, Norway, Finland, and Sweden to explore new areas for partnership. 

The following section pays special attention to the role of the County's international partners and links in addressing the COVID-19 pandemic.

The Role of International Partnership in the fight against Covid-19 in Uasin Gishu County: Major findings

AMPATH greatly assisted Uasin Gishu County's response to COVID-19 by sending its team leaders to work with the county's health workers. Together with the US Embassy, AMPATH made efforts to provide training to ensure that the personnel at the county hospitals were knowledgeable in handling the deployed machines.

African Medical and Research Foundation (AMREF donated ambulances and other medical supplies such as Personal Protective Equipment (PPE). Even so, it is worth noting that the County's assistance during the pandemic was not based on any legal arrangement. Still, it resulted from the various organisations' desire to assist as part of their corporate social responsibility. The county majorly benefitted as a recipient of goodwill, and the county government witnessed no aggressiveness in seeking international assistance during the pandemic. This can be attributed to the lack of clear-cut laws and policies governing countries' participation in external relations without causing adverse effects on the Country’s interests and foreign relations. As such, the national government had to take huge loans solely to supplement the international assistance received by the country to fight the pandemic and mitigate its effects.

Therefore, as aforementioned, clear policies are needed to promote reinforced relationships between the County and its international development partners.

This is necessitated by the fact that paradiplomacy has played a significant role in the health sector during this pandemic. Partnerships that existed before the pandemic directed their cooperation agenda towards the fight against COVID-19. The impact of the concept of ‘sister cities,’ for instance, in the United States, was felt when, in February 2020, Pittsburg City in the US sent face masks to Wuhan in China, which was its sister city. 

United Cities and Local Governments, an organisation for SNGs globally, also came up with initiatives such as ‘Cities for Global Health’ to help cities exchange experiences and responses to the pandemic and the initiative ‘Emergency Governance for Cities and Regions’ to enable SNGs in the process of recovery from the effects of Covid-19.

Policy Recommendations

To improve subnational governments' roles in political, economic and social aspects and their ability to enter into international partnerships, this paper gives the following policy recommendations;

Establishment of clear engagement guidelines between the national and local governments in shared functions like medical and health services to avoid instances of perceived monopoly by one level over the other.

Develop modalities within which local governments can solely establish international linkages without negatively affecting the sovereignty of states.

Enhanced awareness and training of the national and local governments on paradiplomacy within the Constitutional limits and its potential advantages in attaining sustainable development.

References

The Constitution of Kenya, 2010

The County Governments Act, 2012

Articles

Okech C.T., “Devolution of Public Health Care Services in Kenya and its Implication on Universal Health Coverage” IOSR Journal of Pharmacy www.iosrphr.org (e)-ISSN: 2250-3013, (p)-ISSN: 2319-4219 Volume 7, Issue 5 Version. (May 2017)

Kiruga M., “Kenya’s fight against coronavirus difficult with its two-tiered governance system”, 17 April 2020. Available at < https://www.theafricareport.com/26354/kenyas-fight-against-coronavirus-difficult-with-its-two-tiered-governance-system/> (Accessed on 13th November 2020 at 1:15 pm.)

Njeri Ouma et al. “Health coverage and what Kenya can learn from the COVID-19 pandemic.” Journal of Global Health vol. 10,2 (2020): 020362. doi:10.7189/jogh.10.020362. Available at <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7565744/> (Accessed on 13th November 2020 at 2:47 pm.)

Websites and Online Sources 

Uasin Gishu County will facilitate students' study in Finland on 23rd May 2021. Available at < https://www.kenyanews.go.ke/uasin-gishu-county-to-facilitate-students-to-study-in-finland / >  Accessed on 21st June 2021 at 10:05 pm.)

Governors clash with KEMSA over debts and medical supplies. Available at https://www.the-star.co.ke/counties/coast/2020-11-01-governors-clash-with-kemsa-over-debts-medical-supplies/(Accessed on 13th November, 2020, at 12:28pm).

Tanui C., “Kenya: Council of Governors to Set Up Sh5 Billion COVID-19 Emergency Response Fund” 15 April 2020. Available at < https://allafrica.com/stories/202004160243.html> (Accessed on 13th November 2020 at 1:29 pm.)

COVID-19 cases are rising again in Kenya on October 30, 2020. Available at https://www.ampathkenya.org/news-blog-feed/2020/10/30/covid-19-cases-rising-again-in-kenya> (Accessed on 12th November 2020 at 10:37 pm).

Executive Office of the President, State House, Executive Order No. 2 of 2020. Available at < https://www.health.go.ke/wp-content/uploads/2020/06/Executive-Order-No-2-of-2020_National-Emergency-Response-Committee-on-Coronavirus-28.2.20.pdf> (Accessed on 09 November 2020 at 8:37 am.)

The World Bank, “Kenya receives $ 50 Million World Bank Group Support to address COVID-19 Pandemic,” Washington, April 2, 2020. Available at <https://www.worldbank.org/en/news/press-release/2020/04/02/kenya-receives-50-million-world-bank-group-support-to-address-covid-19-pandemic> (Accessed on 10 November 2020 at 8:50 am)

UG receives a Donation worth Sh. 10 million from AMREF. Available at <https://www.uasingishu.go.ke/ug-receives-donation-worth-sh10-million-from-amre/ > (Accessed on 12th November, 2020 at 22:37pm)

IMF Loan to support economic recovery in Kenya, 18th March 2021. Available athttps://www.imf.org/en/News/Articles/2021/03/17/na031721-imf-loan-to-support-economic-recovery-in-kenya > Accessed on 21st June 2021 at 06.23 pm)

Bang Jiun, “Paradiplomacy and Pandemics.” Available at < https://www.duckofminerva.com/2020/04/paradiplomacy-pandemics.html> (Accessed on 22nd June, 2021 at 13:37pm)

United Cities and Local Governments, Covid-19 Local and Regional Responses. Available at < https://covid-congress-hub.org/en/partner/11-united-cities-and-local-governments.html> (Accessed on 22nd June 2021 at 01:58 pm.)