Following Kenya’s rapid and ambitious devolution of political power to lower administrative levels, responsibility for family planning services rests with county governments, including responsibility for staffing, training, and supplies. In response to this political shift, the PACE―Policy, Advocacy, Communication Enhanced for Population and Reproductive Health―Project has prioritized domestic resource mobilization in key Kenyan counties, such as Narok, to sustain and expand support for family planning.
Leaders in Narok County recently made a bold change to their allocation of health funds in a way that prioritizes services for family planning and reproductive, maternal, newborn, child, and adolescent health (FP/RMNCAH) across all pillars of the health budget. This type of increased financial commitment from county leaders is a significant step forward in the context of Kenya’s devolved setting.
Even so, leaders in Narok and other Kenyan counties face capacity gaps in budgeting and planning to ensure that such policy commitments are effectively implemented. As a result, PACE has focused its efforts on building county capacity in program-based budgeting (PBB). PACE, which is funded by the United States Agency for International Development, held a workshop in Narok on Nov. 19-25, 2017, that showed county leaders how they could focus public spending according to inputs, outputs, and outcomes. County leaders have traditionally relied on line-item budgeting. PBB instead puts the emphasis on allocating funds by program, tying the resources put into a program to how they are used and the impact they produce.
The workshop combined training on costing health sector programs with hands-on activities to begin drafting departmental budgets. These activities allowed PACE to contribute to Narok’s improved prioritization of health programs, budgeting, and outcome-based budget proposals for fiscal years 2018-2019 through 2020-2021, known as the Medium-Term Expenditure Framework. County leaders who attended the training also formed a sector working group to ensure public participation in the budgeting process.
Throughout the training, the county’s ownership of the health budget process grew. In a testament to their ownership, Narok County leadership independently reconvened from Dec. 13-15, 2017, to work on reviews for the concluding County Integrated Development Plan (CIDP) 2013-2017. This process also informed the development of health priorities for the county’s next CIDP.
The county health team said they greatly appreciated their experience in the PACE PBB training, particularly the opportunity to outline their health programs and subprograms and prioritize their strategy. Participants also said that the PACE training enabled them to better understand the CIDP review and recognize that not enough effort had gone into the previous strategy.
Noting the emerging impact of ongoing budget advocacy led by PACE, Kamau Kinyua of the Economic Planning Unit highlighted “a net increase on the allocation for the health sector in the 2018/19 supplementary budget.” He added, “Although the overall county budget was revised downward, the health sector was unaffected by the reduction and actually benefited—advocacy at work.”
In an acknowledgment of feedback from members of the County Assembly and County Executive Committee on the sector’s proposed budget, the county health management team recognized PACE technical assistance and encouraged the partnership. Narok County Director of Health, Dr. Francis Kiio, voiced appreciation of the advocacy efforts and said his team hopes that the allocated budget will be applied during implementation.
As this experience from Narok County shows, PACE’s work to prioritize domestic resource mobilization in key Kenyan counties is meeting with success. PACE will continue to engage with and support Narok County leadership in developing policies and budgets that recognize FP/RMNCAH as key to the county’s development. The project will also continue to mentor health sector leadership on the budget financing process to ensure adequate allocation of funds to support healthcare development for the county.