In 2013, Kenya transitioned into a devolved system of governance comprising two levels: the National government and 47 semiautonomous County governments. Under devolution, the health service delivery function was transferred to County governments while the National government retained policy and regulatory functions.

In 2018, EMKF developed a blueprint for emergency medical care systems development  in Kenya dubbed ‘Project 47’ . To implement this, EMKF initiated projects across the 47 counties in collaboration with the County governments to strengthen their emergency healthcare systems in line with the WHO Emergency Care Systems Framework. This framework was also adopted by the Ministry of Health in the Kenya Emergency Medical Care (EMC) Policy 2020-2030.