Kakamega County Governor H.E. Wycliffe Oparanya of Western Kenya signed the Kakamega County Maternal Child Health and Family Planning Bill 2017 into law, guaranteeing pregnant women living on less than one US dollar a day additional support to access essential antenatal and postnatal care for themselves and their babies. PATH Kenya advocates, UNICEF, and other partners played a key role in guiding the overarching strategy for the bill, drafting core language, and securing critical buy-in from high-level leaders and civil society members.
The law effectively scales up an existing program aimed at increasing maternal and newborn health and survival levels, and secures its funding for those efforts, making it easier for the area’s most vulnerable women and children to afford lifesaving services—many of which are recommended by national policies and the World Health Organization. This groundbreaking action by the Kakamega County government demonstrates its commitment to reduce the county’s maternal, newborn, and child mortality rates, which are among the worst in Kenya.
“PATH commends Governor Oparanya and the Kakamega County government on this outstanding demonstration of how effective legislation at the county level can serve as a tool for unlocking local resources and channeling them to protect the health and well-being of mothers and their children,” said Rikka Trangsrud, PATH’s country director for Kenya. “Kakamega County’s action on this law is a clear example of decentralized government stewardship and the application of global recommendations to subnational settings.”
Specifically, the law provides 2,000 Kenyan shillings to a mother at specified intervals when she utilizes recommended services. The services include when the woman completes her fourth antenatal care visit; delivers her baby in a program-sanctioned health facility; brings her child to a postnatal clinic for checkup and immunization six weeks after delivery, for administration of vitamin A at six months, and for immunization at nine months; and completes her child’s recommended course of immunizations at 18 months. The law also reserves funding for postnatal family planning and HIV/AIDS prevention activities in the county, as well as for community health volunteer stipends.
PATH advocates were instrumental in advising Governor Oparanya to develop the program to support a combination of exclusive breastfeeding and incentivizing essential antenatal and postnatal care to better protect women’s lives and the lives of their children.
“We were seeing firsthand that the low rate of skilled delivery combined with low rates of antenatal and postnatal care were directly contributing to high mortality rates for children in Kakamega County, particularly in the neonatal and infant periods,” said Pauline Irungu, policy and advocacy manager for PATH Kenya. “Yet the women who needed these services the most were the least likely to be able to access them due to hidden costs.”
To address this issue and help secure longer-term support from the County Assembly, Ms. Irungu and other PATH advocates drafted language—first for initial regulations, then for the eventual bill—that would help scale the program by converting it into a county fund. Both PATH and UNICEF aligned their technical and financial resources to support the county to maintain momentum for developing the bill and bring it to completion. This included working with key stakeholders from the county’s Ministry of Health, Health Committee, and Deputy Governor’s Committee to incorporate language that sets aside 3 percent of the county health budget for cash transfers to women who utilize the recommended services, and reserves 1.5 percent of the county health budget for stipends for the community health volunteers that support these services, in line with national policy recommendations.
Critical to ensuring the passage of the bill into law was PATH’s involvement in securing civil society support by mobilizing members of the Kakamega Maternal, Newborn, and Child health (MNCH) Alliance. Made up of members of civil society, the Kakamega MNCH Alliance directly engaged County Assembly leaders to express their support for the bill and participated in hearings in each of Kakamega’s 12 sub-counties.
“Organizing civil society support for the bill was a crucial step from both a constitutional standpoint and in ensuring widespread buy-in for the bill across communities,” Ms. Irungu said. “The members of the Kakamega MNCH Alliance plan to continue their efforts to mobilize civil society and hold the county government accountable for prioritizing and strengthening systems to meet MNCH needs.”
The Kakamega County MNCH and Family Planning Bill not only helps to expand access to lifesaving services to mothers in need, but also serves as a bold and effective policy model that other counties can adopt at the local level to strengthen their health systems and the health systems of the nation overall.
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Posted July 26, 2017.