PRB

The Challenge

In Kenya, counties draw on an equitable share of revenue and conditional grants from the national government as well as their own revenue collections when crafting budgets. Yet, two programs that are critical to supporting a healthy population—HIV/AIDS and maternal and child health—have uncertain futures. These programs receive significant funding from donors. The USAID Stawisha Pwani project supports Kenyan counties in their efforts to raise revenue and allocate resources to develop, improve, and sustain county governments’ investments in HIV/AIDS and maternal and child health.

Funded by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID), Stawisha Pwani is a five-year project led by LVCT Health. As a key partner on the project, PRB supports four coastal counties by strengthening the financing and accountability of their county health systems.

Our Approach

PRB collaborates with county officials to understand their health budgeting constraints and needs, develop support for evidence-based decision-making, and foster dialogue between them and other key parties in the budgeting process.

For instance, we work closely with representatives from the county health department, treasury, and assembly in Kilifi, Kwale, Mombasa, and Taita Taveta to provide them with technical assistance on allocating resources for HIV/AIDS and maternal and child health services. This assistance includes using data to inform resource distribution and identify weaknesses in the health systems that need their attention. We bring these regional decisionmakers together with national health insurance fund (NIHF) managers at the regional level to advance communication and evidence-based health financing allocations. (The NIHF has been renamed to the social health authority, SHA.)

To enhance accountability and sustainability in health financing, we provide support on budget advocacy, negotiations, and tracking to representatives from the county Department of Health and CSOs. This assistance is targeted at focusing on using health data to inform decision-making in line with the county’s budget calendar.

Input from civil society organizations (CSOs) and youth advisory champions for health also plays a key role in county budgeting processes. We work with CSOs and youth from Kwale, Kilifi, Taita Taveta, and Mombasa, mentoring them on policy advocacy communications. This training provides them with tools, data, and skills to articulate health issues that affect their age groups and communities and help advance solutions in their discussions with policymakers. We also provide support to the media through training that builds their skills so they can focus public attention on critical health systems issues through their reporting.

Outcomes

Monitoring progress. In 2021 PRB conducted political economy and sociocultural baseline assessments that provided summaries of profiles on issues affecting county budgeting and financing for health in Kilifi, Kwale, Mombasa, and Taita Taveta counties. We initiated this baseline report to serve as the foundation for monitoring USAID Stawisha Pwani’s achievements and impact during the project’s lifecycle. The report’s scope focused on health laws and policies in the four counties, assessment of health funding levels, health financing indicators that the project will use to track progress, existing departmental structures like health sector working group and county and subcounty health management teams, challenges in health financing and budgeting, and the impact of COVID-19 on health budgeting. It provided a summary of recommendations on four broad areas—regulations and policies, budget tracking, capacity strengthening, and health care financing—that are guiding the project’s monitoring practices.

Explore the reports.

Capacity building and training. USAID Stawisha Pwani partners with the four county treasury departments to enhance health department staff’s capacity to apply a program-based approach to budgeting. This annual training aligns with the budget process and emphasizes the importance of transparent practices and collaboration between county and sub-county levels.

Project staff also facilitated training for 12 youth in Kwale County, focusing on sexual and reproductive health and budget advocacy. In addition, project staff supported the training of 40 journalists in print and digital media from the four counties. The journalists were trained in policy advocacy and health reporting and developed 22 draft pitch stories.

Two of these stories were published as of early 2024. Watch one of the stories on KTN News Kenya and read a story on Kenya Television Media News KMTN. Listen to a story a feature story on prevention of mother to child HIV transmission in Swahili from Radio Kaya.

We have created the momentum, and the trajectory is set for continuous improvement. In the short period, we have identified the challenges, gaps, and learnt the lessons that will help us improve revenue collection, expenditure, reporting, and eventual improvement in health service delivery.

— Elvis Mwandawiro, Taita Taveta County Director of Health during the launch of the operations and supervision manual