Nairobi — Nairobi's new health law is giving Level Five hospitals greater financial and administrative autonomy, but the facilities will remain firmly subject to public accountability rules.

The Nairobi City County Health Services and Management Act, 2026, establishes Level Five hospitals as county entities responsible for managing their financial, human and physical resources.

However, greater control over resources comes with corresponding responsibilities.

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Hospital Chief Executive Officers will serve as accounting officers and will oversee budgets, procurement, staffing and financial management.

Hospitals will be required to account for funds allocated or accruing to them in accordance with the Act and the Public Finance Management Act.

They will also remain subject to audits and other public finance requirements.

The framework is designed to give hospitals greater flexibility without creating institutions operating outside county oversight.

The approach is similar to giving a branch manager more control over a business while still requiring the manager to account for every shilling and meet the organisation's performance standards.

The law also introduces regular facility inspections, quality-management systems, digital health information systems and community participation.

The changes are expected to make Nairobi's public hospitals more accountable for both the resources they receive and the quality of services they provide.