Access to essential health products and technologies (HPTs) is fundamental for effective health care and significantly influences health outcomes. Under Kenya’s devolved governance system, counties are primarily responsible for ensuring these lifesaving commodities are available and accessible. However, despite recent health sector reforms, unreliable and insufficient funding—often strained by competing budget priorities—continues to weaken the sustainability and efficiency of the HPT supply chain at the county level.
In response to these persistent challenges, Nyamira County has taken a bold step by developing legislation to ring-fence funds for essential HPTs. This legislative effort aims to establish sustainable financing mechanisms that guarantee consistent resource allocation. By embedding principles of transparency, accountability, and cost-effectiveness into the procurement and distribution processes, the county aims to strengthen the reliability and resilience of its supply chain.
A strategic partnership for policy reform
PATH engages policymakers, influencers, and communities to make health accessible to all. Operating at the intersection of technical expertise and political decision-making, PATH leverages both evidence-based and advocacy-driven approaches to shape and advance policy solutions that scale impactful health innovations.
In August 2024, Nyamira County, with support from PATH’s Center for Advocacy and Policy and PATH Kenya embarked on a journey to strengthen the policy environment, including through legal frameworks, necessary to deliver quality, responsive, and people-centered primary health care services for its population. This initiative specifically focused on securing sustainable access to essential HPTs, with Nyamira County prioritizing the establishment of revolving drug financing (RDF) through legislation.
This strategic partnership directly followed PATH’s prior support in reviewing the county’s Facility Improvement Financing (FIF) legislation and aligning it with the national Facility Improvement Financing (FIF) Act, 2023, for which the RDF legislation is a critical component for operationalization. The FIF Act establishes minimum norms and standards to facilitate the flow of funds within the health sector. It incorporates various tools and legislative frameworks necessary to support health facility autonomy and includes provisions conducive to the successful establishment of a sustainable drug financing facility.
The incoming RDF legislation, referred to as the Nyamira County Revolving Health Products and Technologies Financing Bill, 2025, is designed to establish a dedicated, self-sustaining fund for the procurement of essential health commodities. This will reduce reliance on unpredictable budgetary allocations and mitigate the risk of stockouts.
“Nyamira’s proactive approach to legislation shows local leadership in action. Leveraging our policy expertise, PATH is proud to have supported institutional mechanisms that ensure consistent access to essential health products.”— Melissa Wanda, PATH Kenya Advocacy and Policy Manager.
Learning from the past: The 2001 Nyamira RDF pilot project
Nyamira County’s current pursuit for sustainable drug financing draws on its experience from developing an earlier fund. In 2001, a collaborative effort between the governments of Kenya and Belgium established an RDF pilot project in Nyamira District (now part of Nyamira County). This four-year project aimed to explore potential avenues for sustainable drug financing.
The fundamental principle of a revolving drug fund involves an initial capital investment to establish the fund, with its ongoing operation sustained by revenue generated from the sales of medical commodities. Under the Nyamira RDF pilot project, the fund procured an initial stock of HPTs, which were then distributed to all public health facilities within the district, using a “pull system.” This demand-driven system allowed health care providers to order supplies based on anticipated needs, and commodities were then dispatched from a central store. The pricing strategy was designed to achieve 100 percent cost recovery, generating a surplus to cover logistical expenses. Crucially, the project mandated health facilities to deposit all revenue into a central RDF account and implemented rigorous quarterly internal audits to ensure accountability.
This system yielded positive results. Reports indicated an uninterrupted supply of essential medicines to health facilities, a significant reduction in stockouts and redundant stock, the establishment of sound inventory management practices, strong community support for the RDF concept, and the accumulation of more than KES 70 million (USD 972,000) in the RDF account.
However, despite its initial success, the Nyamira RDF pilot project was discontinued in 2004. Key contributing factors included national policy shifts; the Kenya Ministry of Health's failure to reimburse the RDF for drugs dispensed to patients under the free malaria treatment program; introduction of mandatory free treatment for children under five years of age in December 2006, which disrupted the RDF cost recovery model; revision of the district administrative boundary by the government of Kenya in 2006; and the reintroduction of the kit supply system (“push system”) by Kenya Medical Supplies Authority, which replaced the demand-driven approach central to the model.
“The 2001 RDF pilot proved that uninterrupted access to essential medicines is achievable with the right systems in place.”— Dr. George Otieno, Head of Pharmaceutical Services, Nyamira County.
Reviving the RDF model through legislation
Building on the lessons learned from the 2001 RDF pilot project and other tested financing mechanisms, Nyamira County, in partnership with PATH, conducted comprehensive consultations to design a more resilient and legally grounded financing mechanism for essential health commodities. This collaborative effort focused on developing a clear operational framework, a robust legal foundation, and key design principles aimed at ensuring a consistent, suitable, sustainable, and affordable supply of HPTs to all county public health facilities.
A critical aspect of this review entailed aligning the proposed bill with existing national and county laws, including the Health Act, 2017; the Kenya Medical Supplies Authority Act, 2013; the Public Finance Management Act, 2012; and the Public Procurement and Asset Disposal Act, 2015. This alignment was essential to ensure legal coherence and avoid potential conflicts with and duplications of existing laws.
Recognizing the importance of inclusivity and transparency, the review process actively incorporated public participation and engaged relevant stakeholders such as the Kenya Law Reform Commission and the county attorney to ensure legal accuracy and adherence to best practices.
Leveraging our deep expertise in health systems, health care financing, and policy development, PATH’s contribution as a policy hub to the development of the RDF legislation included providing technical guidance on the bill’s content, facilitating the formation of an RDF task force for legal refinement, identifying key strategic stakeholders for advocacy, creating a detailed implementation roadmap with cost estimates, actively engaging with county leadership to secure high-level commitment, and designing the operational framework for the bill’s effective implementation.
The journey toward implementation
In August 2025, Nyamira County successfully finalized the drafting of the Nyamira County Revolving Health Products and Technologies Financing Bill, 2025, conducted public participation, and updated the bill to reflect feedback. The bill was then presented before the County Assembly, where it passed through all three required readings, and finally it was assented to by H.E. Hon. Amos Nyaribo, the current governor of Nyamira County. With this assent, the bill officially became the Nyamira County Revolving Health Products and Technologies Financing Act, 2025.
The Nyamira County Revolving Health Products and Technologies Financing Act, 2025, addresses several critical areas to ensure the effectiveness and sustainability of the new system. It establishes clear financing mechanisms, including provisions for the retention of resources, and sets up strong governance and administrative structures to enhance oversight and accountability. Furthermore, the Act introduces transparent procurement processes and accountability measures to promote efficiency and integrity in resource management. Public participation is embedded as a core principle, ensuring that community voices are reflected in decision-making. Lastly, the Act incorporates comprehensive risk management strategies to anticipate and mitigate potential disruptions, thereby strengthening the overall resilience of the financing model.
“This time, Nyamira is not just piloting a fund—it is legislating a future. The incoming Act embeds sustainability, accountability, and autonomy into the county’s health system.”— Dr. George Otieno, Head of Pharmaceutical Services, Nyamira County.
Reflecting strong political will and institutional commitment, bolstered by PATH’s advocacy support, the county health team has secured pledges amounting to KES 100 million (approximately USD 774,000) as initial seed capital for the revolving drug fund. These funds are intended to support the initial procurement of essential HPTs.
The Act is expected to be launched in the coming months and will be published in the Kenya Gazette, marking the official commencement of its implementation.
