Participants listen to a presentation on facility improvement funds during an exchange learning session in Nakuru County.
The Government of Kenya, through the Ministry of Health at both the national and county levels, has made significant strides in promoting family planning, with a current modern contraceptive prevalence (mCPR) rate of 58% (Kenya Demographic Health Survey, 2022).
These achievements can be attributed to increased political will and commitment at the sub-national level to allocate and fund family planning activities. The Family Planning Costed Implementation Plan (FP CIP 2021-2024) outlines key strategies, investment areas, and resource requirements to sustain progress made in mCPR performance. The country has set a goal under its FP2030 commitments to reach an mCPR of 64% by 2030 (FP CIP 2021-2024).
Ensuring universal health coverage by improving access and increasing the uptake of primary and community healthcare services is a key strategy being deployed by the Ministry of Health towards achieving this goal. Adequate health financing to support scaling up of these services is critical, especially in the current context of significant health funding gaps characterized by huge out-of-pocket expenditures.
Kenya’s constitution of 2010 introduced a devolved system of government and shifted significant healthcare decision-making and management to the county governments. The county governments are now mandated to provide effective governance of public finances for health, including the collection of revenue and strategic purchasing of health.
The Challenge Initiative (TCI) provides continuous coaching on SMART advocacy for political and technical leaders to secure allocation and ring-fencing of family planning financing. So far, the counties have committed close to $6 million USD to implement TCI’s family planning interventions. For instance, in collaboration with Nakuru County and with support from other partners, TCI led a knowledge café event that provided a platform to share knowledge and discuss leveraging facility improvement funds for better family planning service delivery. Top health leadership from six TCI-supported counties and two non-TCI supported counties participated in the event.
Since TCI first engaged Kenya counties in 2017, local governments have committed a total of $5.82 million and spent $3.71 million.
TCI has also provided support in developing resource mobilization plans to help leaders leverage existing resources. Working with the National Council for Population and Development (NCPD), TCI has driven advocacy efforts with key political leaders involved in county-level health budgeting and policy development. For example, through the NCPD-led Triple Threat Campaign, the government instituted measures to help address the challenge of teen pregnancy. Through this campaign, the TCI-supported counties of Vihiga, Uasin Gishu and Migori developed frameworks to ensure inclusion and implementation of activities geared towards reducing teenage pregnancy rates in their counties.
Other effective strategies to financing family planning and adolescent and youth sexual and reproductive health (AYSRH) high-impact practices and other interventions (HIPs & HIIs) implemented in TCI-supported geographies include:
- Actualizing gains from public-private partnerships through corporate social responsibility (CSR) programs. For example, in Nakuru County, the health management teams now collaborate with private entities such as Safaricom Foundation to fund health facility renovations.
- Effectively leveraging stakeholders for cost-sharing and resource efficiency to promote an integrated and holistic approach in addressing health system gaps. For example, Kajiado County’s health management team allocated budgetary amounts on a World Bank conditional grant for Transforming Health Systems (THS) which included family planning HIPs & HIIs. TCI’s coaching for public finance management led to the team receiving recognition from the World Bank for the effective resource utilization during an audit.
Eileen Sawani, the former reproductive health Coordinator in Kajiado County, said:
After months of advocacy, our department was able to secure additional resources of about Ksh 6.9 million for implementing family planning interventions.”
His excellency Wilber Otichello, governor of Vihiga County, at the launch of a multisectoral action plan for adolescents and youth.
In September 2023, four new Acts of Parliament were passed that focus on health reforms, including a social health insurance fund, facility improvement financing, primary healthcare, and digital health. These four Acts are set to cause a paradigm shift in Kenya’s health financing landscape, while ensuring equity in access of primary health care services for all.
However, the health financing gap remains a major challenge for the sustainability of family planning programs. The resource gap further accentuates the shortfalls in other sectors of the health system such as human resources, commodities, and equipment availability.
As Kenya’s counties commit to improving access and the quality of primary and community health services, it is crucial to integrate family planning within their health budgets and explore innovative financing models such as results-based financing, catalytic funding, and impact investing. Furthermore, engaging local communities through awareness campaigns and education initiatives can help generate support and resources for family planning programs by enhancing community engagement and accountability mechanisms to ensure equitable distribution and access of primary healthcare services including family planning.
