Table 1

Comparison between Kenya and Indonesia35 37 44 46 57 59 66–74

IndonesiaKenya
Context and informal practices, norms and structures255.18 million people, lower middle-income country.
Gained independence in 1945.
Former centralised government.
Wide geographic, socioeconomic and disease burden disparities across the country (17 000 islands).
Wide health service coverage and outcome disparities.
International pressure to devolve.
Little authority or autonomy prior to devolution.
President desired a rapid reform and transfer of responsibilities to district level to avoid provincial level unrest (following previous violence at this level).		46 million people, lower middle-income country.
Gained independence in 1963.
Former centralised government.
Wide geographic, socioeconomic and disease burden disparities across the country (single land mass).
Wide health service coverage and outcome disparities.
International pressure to devolve.
Former deconcentration of administrative functions.
Rapid reforms and transfer of responsibilities to county level, following pressure from county level actors, although structures not yet established and capacity not in place to manage devolved functions at that time.
Content of formal devolution reformsPolitical
Started in 2001 with rapid roll out.
Three-tier government (national, provincial and district).
32 provinces and 440 districts.		Political
Started in 2013 with rapid roll out.
Two-tier government (national and county).
47 counties.
Fiscal
National level retain control of the greatest share of revenue.
Funding at subnational levels from three possible sources:

  1. Transfers from central government, including tax-sharing from nationally generated revenue.

  2. Locally generated revenue, including taxation.

  3. Special allocation funds for remote or less developed areas, plus emergency financing in the event of a natural disaster).

Fiscal
Minimum of 15% of revenue is to be shared with counties.
Funding at subnational county level from five possible sources:

  1. Transfers from central government.

  2. Locally generated revenue.

  3. Donor funding.

  4. Conditional grants.

  5. An equalisation fund from national level for 14 previously marginalised counties

Administrative (health).
Provincial level – coordinate functions among districts; draft policies that should then be implemented by all districts within the province; supervision of districts.
District level – make decisions on priorities; deliver public goods and services, including health.		Administrative (health).
County government holds responsibility for planning, management and budgeting.
County level – make decisions on priorities by drafting county integrated development plan; annual planning and budgeting; service delivery for public health, disease surveillance, community health services, primary health services, ambulance, county hospital services; recruitment and human resource management (includes facility and community health workers); and partner coordination.