When Eileen Sawani began working as the Reproductive Health Coordinator for Kajiado County in Kenya, she knew family planning programs in resource-poor settings can be fragile. However, it is exactly those settings that most need these programs to reduce inequalities in health, reduce maternal and child mortality rates, alleviate poverty and foster economic development.
According to data from the Centre for the Study of Adolescence in Kenya, Kajiado County is grappling with a high teenage pregnancy rate of 20%, which is comparable to the national average of 18%. Cultural practices of early marriages and female genital mutilation coupled with lack of political will from leaders have been the biggest contributors to the high rate. True to Sawani’s expectation, her county showed signs of poor performance in this regard with insufficient funding hampering the implementation of quality family planning and adolescent and youth sexual and reproductive health (AYSRH) services. Sawani noted:
Most programs were dependent on international funding and were constrained by existing policies or lack thereof.”
While family planning programs offer a breadth of benefits – such as decreasing maternal and child mortality or even reducing poverty – they are often not given their due when prioritizing health interventions. According to Sawani:
The end result, at the family level, will positively impact the health of men and women but is underestimated. If resources were availed and adequately utilized for delivery of family planning and information and services, economies would grow significantly.”
When The Challenge Initiative (TCI) team began engaging Kajiado County in January 2022, its advocacy efforts were daunting but ultimately worthwhile, as key champions within the health management team were able to reach out to their political leaders. Dr. Ezekiel Kapkoni, Kajiado County’s Director of Health, said:
The politics of numbers is what hinders the progress in implementation of family planning services. Yet, health disparities are increasing in this county which may pose a significant problem living on extremely tight health budgets.”
In most resource-poor settings, the populace is often more likely to turn to public health facilities as the health services are more affordable or even subsidized in comparison to private health facilities. The World Bank has been supporting various counties in Kenya to address their health systems. However, the funds are not sufficient to cover all health aspects. Sawani said:
Kajiado County has been lauded by the World Bank as the best county in the utilization of the Transforming Health Systems (THS) conditional grant and this can also be seen in our audit report. When TCI came to our county, we knew we had the systems and processes in place and were ready to implement.”
After months of advocacy, the health management team was able to garner support from the Treasury and Ksh 6.9 million (USD$55,000) was allocated towards the implementation of family planning and AYSRH programs in Kajiado. These funds were used to train additional staff to provide long-acting reversible contraceptives (LARCs) and how to conduct outreaches, as well as how to provide mentorship on adolescent and youth-friendly services.
The County leadership has been supportive, giving the health management team full autonomy in the management of the funds. Sawani shared:
When we signed our letter of commitment, we immediately began identifying how our resources would be utilized. We want to have good news to report to the leadership. This is the only program where we manage and allocate funds for activities, they believed in the TCI model, now it up to us to deliver.”
As of June 2022, the County had spent 98% of their allocated funds towards family planning and AYSRH programs. By the time the TCI funds were released, the County had achieved 100% of the milestones in the Annual Work Plan.