Centre for the Study of Adolescence: what we learnt about budget advocacy
Health Budget Advocacy
Health Care Financing
The Centre for the Study of Adolescence aims to improve young people’s health in Kenya, by improving access to reproductive health services and information for adolescents and improving their quality. This is a guest blog by them.
A few years ago, we did a survey of public health facilities on the subject of youth-friendly reproductive health services. The facility managers told us they weren’t receiving any budgets for family planning and reproductive health, as there was no reproductive health budget line. From that point, we realised that health budget advocacy needed to be a major part of our advocacy strategy.
When devolution started taking shape in the wake of the March 2013 elections, our focus had to move from the national government to the county governments, who now have the responsibility to budget for, plan and deliver health services. We started out health budget advocacy work with Busia County in Western Kenya. It was a good choice for us as Busia has disappointing health outcomes for young people, high drop-out rates from school due to teenage pregnancy, high HIV infection among youth, and poor access to reproductive health services.
We started working with the county government to support them in drawing up a reproductive health strategy, which will involve a costed family planning plan. Once this plan is developed, we will be able to use it to support our budget advocacy demands. In Kenya, the budget process begins with county sector teams drafting a budget strategy paper in January to February which includes the priority areas for the year, and which are then included in the overall fiscal strategy paper for the county. There are no guidelines for how much should be spent on reproductive health or even health more broadly by the counties, so budget advocacy is especially important.
We have learned that engaging early in the budgeting process – at the sector strategy paper stage - is crucial to influencing allocations. Furthermore, we are supporting the development of a costed family planning strategy in order to be ready when policy-makers ask us how much our demands would cost to implement.
Just because we engage in budget advocacy doesn’t mean we don’t also use more straightforward advocacy tactics. We need to be strategic in reaching out to politicians about this issue. In Kenya, politics is ruled by the tyranny of numbers in that larger populations win more votes. So instead of saying that family planning will result in smaller, healthier families, we talk about the demographic dividend, which is when a reduction in fertility triggers a virtuous cycle of human development and leads to more rapid economic growth. We also managed to get the County Executive of Health (most senior political official for health at the county level) on our side by arguing that girls cannot reach their full potential if they get pregnant by age 12.
Despite the challenges of conducting advocacy in the devolved system, we’re optimistic that it is giving us better opportunities to engage in the budget process, in order to improve young people’s reproductive health.