These provisions in the Constitution were formulated with the goal of boosting efficiency and accountability.
The devolved health system is four tiered: community health services, primary care services, county referral services and national referral services. All but national referral services are managed at county level. Table 1 details the responsibilities of the national and county governments under the new dispensation (KPMG 2013).

However, even though roles and responsibilities are elaborately outlined, in practice the transition from national to county governments has been marred by inconsistency, poor understanding of the system, management challenges and lack of coordination between the national and county governments. At national level, poor management and inefficiencies in resource distribution have largely contributed to poor working conditions at county level including delays in salary payments.
Additionally, there are still misconceptions on roles and responsibilities of the two levels of government. Limited knowledge on devolution by health care workers at all levels, and especially county level, has contributed to this.
A survey conducted by the Center for Health Solutions (CHS) among health care workers in Central Kenya revealed that only 11 percent have a full understanding of the devolved health system, 78 per cent partly understood, while 9 per cent had no understanding. Though this survey may not be representative of Kenya, it is indicative that without training and sensitisation, effective delivery of healthcare services may not be realised.