A Systematic Approach to Budget Advocacy and Social Accountability: Mobilizing Domestic Funding for Reproductive Health in Kenya’s Counties

Local decisionmakers must be convinced of the benefits of funding these services, and communities must be engaged to demand accountability. The Policy, Advocacy, and Communication Enhanced for Population and Reproductive Health (PACE) Project in Kenya, supported by the U.S. Agency for International Development (USAID), has developed an approach to increasing budget commitments in several Kenyan counties. Working in counties with poor health indicators, PACE has provided technical support for budget advocacy to increase political and financial commitments for family planning and strengthen accountability for those commitments. As a result of PACE's systematic approach, county health teams are using data to support their budget requests for health, including family planning and RMNCAH services. They engage with executive committees and county assemblies at specific stages of the budget cycle, negotiating for increased allocations and tracking budget implementation. Public participation in the county budget process has also increased due to PACE's work with local media, civil society organizations (CSOs), and youth advocates, who are demanding more accountability from their governments. County-Level Decision-Making: Challenges and Opportunities Kenya is a regional leader in developing policies and plans that support voluntary family planning, having met its Family Planning 2020 goal with 58% of married women reporting use of modern contraceptives. However, local governments have not consistently prioritized family planning, with many counties having outdated health facilities, high teenage pregnancy rates, limited access to contraceptives, and high maternal mortality. The Kenyan Constitution of 2010 transferred the responsibility for all health services, including family planning, to county governments. In addition, both the Constitution and the Public Finance Management Act mandate public participation in decision-making. Advocates face both challenges and opportunities to sustain and expand support for family planning within this governance system. Challenges include county governments having uneven capacity, especially in planning and budgeting for family planning, and decisionmakers being often swayed by political forces rather than sound evidence in allocating budgets. Reaching leaders in 47 independent counties is a complicated process, with national advocates often having limited presence within the counties. Opportunities include citizens being able to access local decisionmakers to voice their priorities directly, including their demand for family planning services. County governments are mandated to share sector strategies and budgets and disclose how public resources are used, allowing the media and citizens to hold local officials accountable for their family planning commitments. Program-based budgeting, which allocates budgets by program rather than by input or expense category, puts a greater focus on county priorities and public spending outcomes, including access to quality family planning services. PACE Kenya's Trifold Approach to Budget Advocacy and Accountability A central focus of PACE's work is to support county decisionmakers within the County Health Management Team (CHMT) to demonstrate the consequences of health sector underfunding. PACE's comprehensive approach builds commitment to family planning and RMNCAH by using data to focus decisionmakers' attention on pressing county-level issues, needs, and opportunities. PACE's trifold approach includes capacity strengthening, continuous partnering and mentoring, and catalyzing public participation for accountability. Capacity strengthening involves building the capacity of institutions and individuals to convince decisionmakers to maintain and increase budget allocations for family planning and RMNCAH. Continuous partnering and mentoring involves maintaining close contact with CHMTs to ensure they take advantage of opportunities to interact with financial decisionmakers and are prepared to advocate for health funding at each phase of the budget cycle. Catalyzing participation for social accountability involves encouraging CSOs, the media, and the public to participate in budget hearings and related meetings. Such participation enables decisionmakers to interact with and hear directly from their constituents about local health priorities and respond to their concerns during the budget-making process. Public participation is also key to monitoring the budget's execution and ensuring that committed and allocated funds result in desired health outcomes.