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In 2019, Kenya marked its 6th year of devolved governance where power and responsibilities are now closer to the people through local county governments as opposed to having concentration of power and resources at the national level. Since devolution was enforced in 2013 as provided for in the country’s 2010 constitution, county governments have met once every year to discuss progress in implementing devolution, share lessons, successes and challenges in the process.
This year, the conference theme was on “Deliver. Transform. Measure”, “Remaining Accountable”. The Conference was anchored on the “Big Four Agenda” which is the current development blueprint for the Kenya government that looks to drive economic development through creating impact in four key sectors: Trade, Agriculture, Health, Affordable Housing and infrastructure.
The format of the conference was organized along these four areas and AFIDEP engaged with the planning process and at the conference through the health agenda. AFIDEP was part of the health committee and provided input through the data and evidence working group that was led by The Kenya Institute for Public Policy Research and Analysis (KIPPRA). Our contribution emphasized the need to include data on county demographic dividend trends and indicators on youth sexual and reproductive health to allow counties evaluate their performance, compare results with their counterparts and discuss how best to harness the demographic dividend through youth empowerment, skills, and access to sexual reproductive health care services.
The conference provided the right forum to discuss county experiences for those piloting universal health coverage, a key deliverable of the big agenda four items. Pilot counties reported that UHC was working, as more health facilities were equipped with infrastructure to offer services, and there was an increase in the number of people accessing medical care and screening exercises. Caution was however raised on the need to conduct situational analysis as counties have unique contexts and needs, with some facing higher inequalities.
The health breakaway session had key recommendations for UHC. These included ensuring communities access basic health services for free with emphasis placed on promoting services in primary health care. This can be reinforced through strengthening technical assistance at various fronts for example training and empowering extension health workers to monitor immunization and referrals, conducting disease surveillance, and having accurate data records from the counties that can be analysed.
Stakeholders were informed of the development of a UHC dashboard, which when finalized would provide health information governance and data informatics for monitoring achievements. The dashboard will provide visualization tools where counties can monitor how they are performing on their UHC goals. For example, if a county is faring badly, the tool will show that they are in a red zone and provide information on steps they need to take to move to a green zone.
Participants raised the need to devolve health laws and functions, and for UHC to move beyond treatment and look into providing rehabilitative and preventive care. “I look forward to when the national health insurance fund will be paying for my gym, because that is prevention,” said one participant.
AFIDEP looks to engaging further with county governments in developing and providing evidence they need to inform decision-making and development initiatives at the local level.