Changing Face of Family Planning Funding in Kenya: A Cross-Sectional Survey of Two Urban Counties

Abstract

As international development partners reduce funding for family planning (FP) programs, the need to estimate the financial resources devoted to FP is becoming increasingly important both at all levels. This cross-sectional assessment examined the FP financing sources, agents, and expenditures in two counties of Kenya for fiscal years 2010/2011 and 2011/2012 to guide local decision-making on financial allocations. Data were collected through a participatory process. This involved stakeholder interviews, review of financial records and service statistics, and a survey of facilities offering FP services. Financing sources and agents were identified, and source amounts calculated. Types of FP provider organizations and the amounts spent by expenditure categories were identified. Overall, five financing sources and seven agents for FP were identified. Total two-year expenditures were KSh 307.8 M (US$ 3.62 M). The government's share of funding rose from 12% to 21% over the two years (p=0.029). In 2010/2011, the largest expense categories were administration, commodities, and labor; however, spending on commodities increased by 47% (p=0.042). This study provides local managers with FP financing and expenditure information for use in budget allocation decision-making. These analyses can be done routinely and replicated in other local counties or countries in a context of devolution. (Afr J Reprod Health 2017; 21[4]: 24-32).

Urban Family Planning in Low- and Middle-Income Countries: A Critical Scoping Review

“…In Kenya, for example, the devolution of health services over the past decade saw the national government retain strategic oversight with subnational county governments tasked with decisionmaking and the delivery of services, including FP. The resulting mismatch of strategic capacity and local delivery mechanisms has resulted in national policies and guidelines that are less attuned to local contextual factors and needs; government ownership has been undermined and processes of funding, procurement, and monitoring complicated (58)(59)(60).…”

Assessing the cost-effectiveness of contraceptive methods from a health provider perspective: case study of Kiambu County Hospital, Kenya

“…For Kenya, the decline is likely to be even more pronounced due to attainment of lower-middle income status since 2014 [ 49 ]. There is need to mobilize more domestic funding to ensure adequate service delivery and long-term sustainability [ 47 , 50 ]. Unfortunately, domestic resources which are based on government annual budgets may not promote long-term planning.…”

“…Whether the budgets are ring-fenced for FP commodities and services is subject for a separate discussion. For Kenya, utilization of the inadequate domestic funds is complicated by devolution of health services where policy direction is a function of the national government while service delivery is at the county level (sub-national level) [ 47 , 50 ]. Some counties in Kenya have FP budgets [ 50 , 51 ] but unfortunately, the budgets are inadequate and much of the FP related expenditure at the county level only cater for FP commodities and service delivery [ 51 ] other than the comprehensive investment that has been shown to increase utilization of long-term contraceptive methods.…”

Assessing the Cost-Effectiveness of Contraceptive Methods from a Health Provider Perspective: Case Study of Kiambu County Hospital, Kenya

“…For Kenya, the decline is likely to be even more pronounced due to attainment of lower-middle income status since 2014 49 . There is need to mobilize more domestic funding to ensure adequate service delivery and long-term sustainability 47,50 . Unfortunately, domestic resources which are based on government annual budgets may not promote long-term planning.…”

“…For Kenya, utilization of the inadequate domestic funds is complicated by devolution of health services where policy direction is a function of the national government while service delivery is at the county level (sub-national level) 47,50 . Some counties in Kenya have FP budgets 51,50 but unfortunately, the budgets are inadequate and much of the FP related expenditure at the county level only cater for FP commodities and service delivery 51 Whereas cost of contraceptives has been identi ed as a barrier to accessing FP services 53 , (especially LARCs 54,55 ) by all women, it is one of the most important barriers to youth and adolescent access to longterm contraceptive methods 30,56−59 . Removing cost barriers among other investment was found to increase uptake of long-term methods 30 by youth and adolescents; which is a growing demography in almost all developing countries including Kenya.…”