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Sufficient health resources and efficiencies in the health sector are critical for achieving universal health coverage (UHC). In response to this need, African Institute for Development Policy (AFIDEP) and Partners in Population and Development Africa Regional Office (PPD-ARO), through the Advance Domestic Health Financing (ADHF) project, strengthened the capacities of state actors, the private sector, civil society organisations (CSOs) and media in Kenya using the SMART advocacy approach to enhance their ability in championing policy reforms in the health sector.
SMART advocacy training equips stakeholders with strategic tools to drive impactful healthcare financing reforms. By focusing on Specific, Measurable, Attainable, Relevant, and Time-bound goals, it ensures advocacy efforts are focused, accountable, and results-driven, addressing critical issues like inadequate funding and resource inefficiencies.
The stakeholders trained in SMART advocacy have made notable progress in implementing the SMART objectives set during the initial capacity strengthening training held in 2023. Their progress highlights the project’s contribution in improving healthcare delivery at both national and subnational levels.
Driving tangible impact
During Kenya’s 2024 vaccine stockout, the Health NGOs Network (HENNET) emerged as a key advocate, championing the urgent need to replenish vaccine supplies. Working with other partners and drawing on insights from SMART advocacy training, HENNET strategically identified key decision-makers and crafted compelling messages to amplify the voices of caregivers and children in underserved communities who were missing essential vaccinations. These targeted efforts led to a significant breakthrough, with the National Treasury allocating Kes 1.25 billion to address the crisis and ensure vaccines reached those who needed them most.
Penda Health, in partnership with the Clinton Health Access Initiative (CHAI), successfully championed the settlement of over Kes 8.4 billion in pending claims by the National Hospital Insurance Fund (NHIF) to private healthcare facilities in 2023. Through the Kenya Healthcare Federation (KHF) and the Rural Private Hospitals Association, Penda Health and CHAI engaged the former Cabinet Secretary for Health, Susan Nakhumicha, leading to a Ministry of Health directive that released funds for critical programmes like Linda Mama (an initiative providing free maternity services to pregnant women) and Edu Afya (a health insurance programme providing free medical services to public secondary school students). This effort eased financial pressures on primary healthcare providers, ensuring continued care for vulnerable populations nationwide.
In Nairobi County, the Centre for the Study of Adolescence (CSA) successfully advocated for a 2% increase in the health budget, raising the allocation from 20% to 22% of the total county budget for FY 2024/25. Through active participation in public forums and consultative meetings with the County Health Management Team and Members of the County Assembly, CSA advocated for the budget rise from Kes 8.1 billion in FY 2023/24 to Kes 8.9 billion. This included a dedicated Kes 22 million allocations for primary healthcare, reflecting a growing commitment to strengthening healthcare services in the county.
In Laikipia County, the Laikipia County Civil Society Forum (LACCSOF) successfully advocated for an increase in the county health budget, raising it from Kes 2.641 billion to Kes 2.715 billion for FY 2024/25. This included a modest but notable boost in reproductive health funding, from Kes 2 million to Kes 2.2 million. Through strategic engagement, including submitting detailed memos and holding meetings with key stakeholders such as the County Director of Budget and the Chief Officer for Finance, LACCSOF emphasised the need for enhanced funding for maternal and reproductive health services. Their evidence-based advocacy and active involvement in the County Fiscal Strategy Paper (CFSP) process underscored the impact of civil society in shaping resource allocation for critical healthcare services.
Similarly, Deutsche Stiftung Weltbevölkerung (DSW) Kenya’s efforts in Kwale County highlighted the critical need for investment in adolescent sexual and reproductive health (ASRHR). Through the engagement of adolescent champions with the county’s executive and legislative leadership, DSW Kenya advocated for increased resource allocation for ASRHR during the development of key budget documents, including the County Integrated Development Plan (CIDP), Annual Development Plan (ADP), and County Fiscal Strategy Paper (CFSP). As a result, ASRHR funding saw a 32% increase in the financial year 2023/24, rising to Kes 132,713,223 from Kes 100,725,908 in FY 2022/23. This achievement underscores the power of community-driven advocacy in securing sustainable investments in youth health.
In Taita Taveta County, the Taita Taveta CSOs Movement (TTCSOM) leveraged its advocacy to secure a health budget increase from Kes 1.9 billion to Kes 2.3 billion. This funding included a dedicated budget line for reproductive, maternal, neonatal, child, and adolescent health (RMNCAH) services. The movement’s collaboration with county officials resulted in tangible outcomes, such as drafting and validating the Health Improvement Financing Bill, underscoring the value of consistent engagement and evidence-based proposals.
Overcoming systemic challenges and lessons learned
Despite notable achievements, the journey faced systemic challenges, such as frequent leadership changes within key health sector bodies such as the Ministry of Health, which caused delays and uncertainty. CSOs grappled with limited resources, difficulties accessing critical budget documents, and navigating complex political dynamics, including power struggles between the legislative and executive arms of government. These hurdles tested the resilience and adaptability of advocates but also provided valuable lessons.
The challenges underscored the importance of SMART advocacy strategies that are results-driven. Data-driven approaches proved essential for ensuring evidence-based and impactful advocacy, while building trust through stakeholder engagement fostered long-term collaboration. Empowering local communities with knowledge about budget processes, as seen in Kwale County, enhanced accountability and intentional resource planning. These experiences highlight how collaborative, informed advocacy can overcome systemic barriers and drive meaningful improvements in healthcare financing and outcomes.
A path towards sustainability
The ADHF project has shown that SMART advocacy can drive transformative change in the health sector. By strengthening the advocacy capacity key actors in the sector, the project has played a key role in unlocking resources to improve health outcomes at both national and county levels in Kenya. While challenges persist, the lessons learned pave the way for more resilient and equitable healthcare systems. As Kenya moves closer to UHC, the work of organisations engaging in SMART advocacy through the ADHF project highlights the importance of evidence-based initiatives and partnerships in achieving accessible, quality healthcare for all.