When the health department in Kenya’s Busia County faced budget reductions during planning for the 2018/19 fiscal year, the PACE—Policy Advocacy and Communication Enhanced for Population and Reproductive Health—project provided support that helped ensure a 7 percent budget increase.

The proposed reductions would have created severe resource shortfalls for Busia residents, diminishing their health services in vital areas such as maternal, newborn, child, and adolescent health, and prevention of teenage pregnancy. PACE provided significant support to the County Assembly and health management team in their development of an evidence-based approach to strengthen the health program’s priorities by aligning them with proposed funding in the budget documents and justifying increased resources.

National priorities, individual county planning, debt burdens, and political concerns are among the factors that influence county budget-making in Kenya, and county governments face constant challenges to allocate budgets according to program needs. Advocates seeking to prioritize healthcare provision—particularly health promotion services like family planning—must engage with the right policymakers at the right time. They may find the most success with active, targeted advocacy efforts within departments and with relevant legislative units throughout the financial year.

Kenya’s county health departments are often vulnerable to budget reductions related to factors like centralized spending and procurement, and high administrative and operational costs. These factors leave only minimal funds for health systems’ development and preventive care. PACE capacity-strengthening activities like program-based budgeting training with and technical assistance to county health management teams (CHMTs), and budget advocacy with county assemblies have met with success in the past. With Busia’s health budget facing reductions, PACE project staff mobilized to offer their support.

Busia’s county health management team and county directors of health gather for a PACE training on program-based budgeting.

In October 2018, PACE held an advocacy meeting with the Busia County Assembly’s budget and health committees and CHMT members to ensure legislators did not proceed with the planned budget cuts. Presenting health services and financing data for several Kenyan counties, PACE’s technical experts explained why it was important to specifically guard health budget ceilings and illustrated the link between annual budgets and long-term development policies.

This advocacy process allowed for open dialogue among attendees. It also fostered understanding of problems that affect and influence health budgetmaking and how budgeting can impact health goals like reduction of maternal deaths and teenage pregnancies.

In late 2018, the Busia County Assembly successfully passed the county’s supplementary budget, not only safeguarding the full initial health budget proposed but also advocating for an increased allocation of 7 percent.

Over the course of PACE’s capacity-strengthening activities, county legislators committed to supporting Busia’s health department in safeguarding and unlocking budgetary allocations. Their support included a review of the supplementary budget pending approval by the County Assembly to secure and increase allocations. The Assembly also renewed their dedication to tracking health spending and ensuring allocations for essential commodities and materials in consultation with the CHMT.

These legislator commitments reinforce PACE’s work to highlight family planning’s importance within the county health budget. As the 2019/20 health budget process gets underway, PACE will continue its evidence-led advocacy efforts with county legislators and stakeholders in the health and finance departments to ensure family planning is included as a key funding component within a program-based budget structure.