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Concerns high as Kenya lacks clear strategy on FP commodity financing transition

By George Kebaso
Thursday, October 15th, 2020
A section of 33-year old Kukat Kamartum's family of four wives and 19 children in Riong'o village, Tiaty, Baringo County.
In summary

Will Kenya sustain provision of sufficient contraceptives needed for family planning beyond June 2024 as donors announce they will end their financial support in June 2023 with the country staring at a deficit of Sh9.1 billion?

This is the question that remains unanswered even as the country’s population continues to grow unchecked. Family Planning advocates are further questioning the government’s strategy past 2024.

Attempts by the People Daily this week to seek the National Treasury’s commitment towards increased financing of Family Planning commodities, such as condoms; injectables, implants and pills among others, was in vain.

Treasury Cabinet Secretary, Ukur Yattani could not respond to a question whether the government will increase funding for FP commodities procurement beyond Sh800 million announced in the Financial Year 2020-2021.

Health Principal Secretary, Susan Mochache, the Ministry’s accounting officer, did not offer a response despite inquiries on the same.

In November 2019 during the ICPD+25 conference on reproductive health in Nairobi, President Uhuru Kenyatta made a commitment to ensure zero unmet need for family planning and for it to be realised, the need for domestic financing of FP commodities is a no brainer.

It is argued that FP programmes and effective contraception can increase economic growth and growth per capita output by about 20-30 per cent and ensure sustainable use of environmental resource. Every Sh100 (US$1) invested in FP services saves between Sh400 to Sh700 (US$4-US$7) in healthcare costs according to Guttmacher Instiutute.

In view of child mortality, there is a strong feeling that reduction of unintended pregnancies through increase in access to contraceptives would avert 54 per cent of the total preventable child deaths. According to the World Health Organisation (WHO), FP is the most cost effective intervention for preventing maternal mortality.

In October last year, the donors – who were expected to spend about Sh8.7 billion buying contraceptives for the next five years - announced they will only spend about Sh3 billion over the same period and expect the government to foot the balance of about Sh5.8 billion.

The donors — the UK's Department for International Development (DFID); its US counterpart, USAID and the Bill and Melinda Gates Foundation — said the cutbacks will be gradual, beginning the FY 2019-2020 until 2025 when the government will fully take over the bill.

DFID's head of human and social development, Tessa Mattholie said Kenya was now a middle-income country capable of financing its own family planning programme.

"In the next five years, we will be back to 100 per cent domestic funding for family planning," Tessa said on Wednesday during last year’s World Contraception Day in Nairobi.

Family planning was fully funded by the Kenyan government before health services were devolved. However, donors moved in when the new county governments failed to allocate money for the same since 2013.

FP commodity security takes up a large share of the FP resource requirement, yet  the  current  financing  level  is largely dependent on donor support that is inadequate or unsustainable, or both.

This has been a cause for worry among a number of civil society groups working in the reproductive health sector. And this is despite an existing Reproductive Health Commodity Security (RHCS) Strategy 2013-17 which took into consideration financing commitments for contraceptives from all sources. They include; investment of public funds by government; external financing or in-kind investment by donors and private investments.

Africa Healthcare Foundation, Kenya (AHF-K), Advocacy manager, Faith Ndungu, said the prevailing situation gives a picture of a country that’s not prepared to confront the challenge of donor transition especially because Kenya is a lower middle income Country.

She poses, “what will happen in the next five years if Kenya does not increase her domestic resources for health, Kenya is still not meeting her condom need?”

She said what’s likely to be witnessed would be a country struggling to address challenges of increased sexually transmitted diseases (STDs), new HIV infections and unwanted pregnancies.

“We haven’t met our condom needs even as donors are pulling out, yet as a country, we heavily depend on donors in the health sector. We need a clear plan and strategy of how Kenya plans to take over projects and activities currently funded by donors. We can also look at a multi sectoral approach and engage private sector and cooperates in supporting health in Kenya,” she added.

However, she called for an honest national conversation among players led by the government if at all the country intends to safeguard the gains it has made. AHF, Kenya uses distributes condoms for free through social marketing strategy in raising awareness on reproductive health issues and HIV.

On her part, Kenya AIDS NGOs Consortium (KANCO) campaigns manager, Rahab Mwaniki, the government strategy on how it will transit after donors have pulled out, is not clear, and the country risks losing the gains realised a few years ago.

“Besides the expected rise in HIV infections, the country is likely to witness increased unwanted pregnancies among adults. As our core mandate at KANCO, we are worried that the prevalence in HIV will go up despite last year’s data showing a slump of 5.6 percent,” she said noting that having uncontrolled populations, it will be difficult to manage development.

However, at the Ministry of Health (MoH) level, the government is confident; the situation will be brought under control with the budgeting process underway.

Health Chief Administrative Secretary, Dr. Mercy Mwangangi told People Daily yesterday that once the Medium Term Expenditure Framework (MTEF) process is completed in the next two weeks it will be possible to have the rough in the estimates on how the FP commodity financing budget will look like in the next FY.

“We are on the right path,” she said.

In the RHCS, it is estimated  that  Kenya’s  FP  programme would be supported by commitments from international donors  and  the  GoK  to  secure  increased  financing  for FP  commodities  and  services  between  2016/17  and 2019/20.

Similarly, in the FP-Costed Implementation Plan (CIP) (2017-2020), FP financing was envisaged to    remain heavily dependent on development partners over the implementation period, with 75 percent of the required funding projected to come from external sources according to the United Nations Population Fund (UNFPA), 2019 report.

Observations show that FP commodity funding in the country for a ten-year period, between FYs 2010/11 and 2012/13, GoK contributed significantly by directing Sh1 billion (US$10  million) to the MoH for the purchase of FP commodities.

However, from the onset of devolution in FY 2013/14, that money was  redirected  to Kenya’s  47  newly  created  counties, leaving  the  national  budget without  a  dedicated  line item for the purchase of FP commodities.

Donor contributions have also decreased as a reflection of declining global funding commitments since they increasingly expect governments to take on a greater share of the responsibility for financing healthcare, particularly in lower middle income countries (LMIC) such as Kenya. The  above  situation  resulted  in  an  erratic  FP  commodity  funding  landscape,  with  GoK  completely  halting  its  funding  for  FP  commodities between FYs 2013/14 to 2015/16.

This worsened the funding gap, from more than Sh1.2 billion (US$12 million) in FY 2013/14 when there was still a budget line for commodities, to less than a total of Sh150 million (US$1.5 million) between 2014/15 and 2017/18 combined.

But, the country’s historic reliance on donor support and recent ambition among development partners to transition away from externally funding FP programmes threatens the programme’s sustainability as well as Kenya’s goal of ensuring greater and more equitable access and uptake of family planning services.

This has compelled stakeholders to collaborate in advocating for policy-makers to increase public investment in FP.

During a tour of Baringo County recently, People Daily came face to face with a family of a 33-year old man with 19 children, and held firmly by a strict culture that advocates for child bearing without any sense of spacing.

The closing of the financial gap in funding of commodities and the realisation of the president's promise is therefore in the hands of the ministry of health and that of Treasury and Kenyans will be waiting to see if at all the issue at hand will be prioritised.

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