By Carol Gatura, Communications Officer, APHRC
What do you get when you bring together high-level county officials from Western Kenya? An opportunity to shift one’s mind set on where county governments are falling short and focus on improving what’s working in health in these counties.
APHRC convened a learning forum on June 13 in Kisumu to share research on sexual and reproductive health (SRH) with a view across the lifespan – from childhood to adulthood. County health and education officials had a chance to learn from both the research and each other on what works and what is needed to improve the health of communities. The counties represented were Kisumu, Homa Bay, Bungoma, Kakamega, Busia, and Siaya, plus an education official from Bugiri district across the border in Uganda.
Western Kenya is known for its breathtaking views of Lake Victoria, fresh fish, and warm people but also for slow progress to end unplanned pregnancies, high rates of HIV infection, and unsafe abortions. However, some county governments in this region have made small but meaningful changes to this narrative.
Improving access to family planning
Siaya and Busia counties have made remarkable progress in the uptake of long-acting contraceptive among women, men, and adolescents. Following implementation of the Western Kenya Family Planning project, contraceptive use rose from 33% to 51% in Siaya, and from 41% to 57% in Busia. The two counties allocated stipends to Community Health Volunteers (CHVs) who were key in giving family planning (FP) information and services in hard-to-reach areas. The counties also revived youth-friendly health centers and embraced creative approaches such as free hotline services to reach young people with FP information.
However, challenges remain as the counties have still not allocated budget lines specific to FP commodities and services. Counties report only receiving a fraction of the money needed to fully implement their health plans – a systemic problem not unique to Western Kenya. As a result, they are forced to triage health needs based on a shoestring budget. For example in Busia County, the proposed overall health budget was Ksh.1.8 billion (US$18 million), but the county only received Ksh.1.2 billion ($12 million). Out of this money, over 60% goes to salaries and remuneration – leaving very little ($4.8 million) for prevention, treatment, and care. The numbers may be different in Siaya but the challenges are the same. Siaya county health officials are now finalizing a costed plan for FP to begin advocating to national government for increased resource allocation. Siaya has also struggled to use all of its allocated funds, despite its need, according to a Daily Nation analysis.
County-specific policies on health
Health is a devolved function under the constitution, and counties are now responsible for customizing national policies to their context. Homa Bay county has taken a lead on this and taken the national Adolescent Sexual and Reproductive Health (ASRH) Policy and developed a county-specific policy for its context. The ASRH policy intends to bring adolescent sexual and reproductive health and rights issues into the country’s mainstream health and development agenda.
To aid in the challenge of customization, Homa Bay created a multi-sectoral strategic plan to address county issues themselves and avoid dependence on donors and non-governmental organizations to do the work. This plan includes all sectors and ministries in the county so as to work together rather than in silos. This can work well, for example, in implementation of sexuality education programs with health and education sectors working together.
Despite numerous investments by partners working in these counties, results of positive health indicators are minimal but promising. Counties expressed the need for evaluation of these interventions as well as research on county health priorities and funding challenges. Greater investment is also needed from national government coffers to increase overall county health allocations.
The conversations do not end here. This is another touch point along the path of a long-term relationship between APHRC and western Kenya counties to work together to identify the research gaps as well as provided technical assistance in policy implementation.