This brief gives an overview of the effect devolution has had on several management functions including:

• health sector planning, budgeting and financial management
• human resources for health management
• management of Essential Medicines and Medical Supplies

It highlights the early effects of implementing devolution generally, as well as the effects on the health system and health service delivery. The brief also gives recommendations to policymakers that are considering devolution in their own countries. 

Key points

• The transfer of functions from national to county level occurred before appropriate county-level structures and institutions had been established, and before counties had capacity to undertake new devolved tasks.
• The lack of preparedness initially caused serious disruptions to health services including a loss of funding to facilities, delays in salary payments to health workers and health worker strikes
• The devolved system has increased county level decision space but harnessing the full benefits requires policymakers to clarify the roles and responsibilities of different actors at all levels of the system, and to build capacity of counties to undertake specific tasks.
• Individual and institutional capacity considerations should always ben taken into account when allocating functions between the centre and local levels.