It’s been over year since the government, through the ministry of health launched the expanded free maternity programme dubbed “Linda mama – Boresha Jamii” programme. The programme meant to improve access and quality of Maternal, Newborn and Child Health services in the country, provides a package of basic health services accessed by all in the targeted population on the basis of need and not ability to pay. Linda mama’s main goal is to achieve universal cases to maternal and child health services and contributes to the country’s progress towards Universal Health Coverage.

Under the programme all pregnant women can access antenatal, delivery and postnatal care free of charge in all public, some faith based and private healthcare facilities national wide. The redesigned initiative expands the network of healthcare providers to include faith based facilities through direct re-imbursement mechanism that pays for number of deliveries reported by the facility to a health insurance plan to be administered by NHIF.

Although the programme is set to position Kenya on the pathway to Universal Health Coverage, lack of awareness about the programme is the biggest challenge that will negatively affect its realization in Kenya especially in the rural areas. Most of the health care workers do not know about the programme and those that do have very limited knowledge of how and when to start implementing the program. In Kilfi County for instance, most of the health care workers have no knowledge of the programme especially in dispensaries where even the facility in-charges have no knowledge of it. If Kenya is to realize Universal Health Coverage, awareness of the government initiative should be made not only to the health care workers in rural areas but also the communities. When the free maternity program was launched in 2013 by president Uhuru Kenyatta, 35% increase in the number of deliveries in public health facilities was registered this means, more than 2,000 women and 30,000 maternal and child deaths were averted by the year 2016. The Linda mama programme if well implemented is set to be a great step towards improving access and quality of maternal, newborn and child health care services in the country as well as attainment of health goals  as outlined in the vision 2030 which is to attain the highest possible health standards in a manner responsive to the population needs.

The beneficiaries should be aware of the programme for them to benefit from it. Awareness on what the programme is about, the benefits and how to register should be done especially in the rural areas through public barazas, community and opinion leaders, community dialogues and through health meetings for the programme to be successful.

As a group of new leaders take the leadership positions in the counties, what should come to mind is how these leaders will engage the public in ensuring public participation in the budget making process. The County Government Act and the Public Finance Management Act, require public participation in matters of public finance. While there are numerous references to public participation in these laws, most are vague and contain no further guidance. However, there is one major exception to this, which is the very specific requirement that every county set up a County Budget and Economic Forum (CBEF).

The first devolved government took advantage of the public’s naivety and some county governments went on to constitute a CBEF that only had the governors cronies as members, while others did not constitute one at all. It is upon the CSOs in each county to put the government to task in constituting functional CBEFs that have the citizens’ interests. The PFM Act 2012 clearly outlines under article 137 that the County Budget and Economic Forum shall consist of the Governor of the county who shall be the chairperson; other members of the county executive committee; and a number of representatives, not being county public officers, equal to the number of executive committee members appointed by the Governor from persons nominated by organizations representing professionals, business, labor issues, women, persons with disabilities, the elderly and faith based groups at the county level.  The persons need to have been nominated by the said groups and not just appointed directly. This is so as to ensure that the citizens in the CBEF represent the citizens’ views and not their own interests.

The purpose of the Forum is to provide a means for consultation by the county government on preparation of county plans, the County Fiscal Strategy Paper and the Budget Review and Outlook Paper for the county; and matters relating to budgeting the economy and financial management at the county level. In addition to the above, consultations shall be in accordance with the consultation process provided in the law relating to county governments.

Despite this requirement in law, most of the counties have not been adhering to it. According to a research study by the Centre for International Private Enterprise (CIPE) which sort to establish the extent to which citizens have been engaged in the budget making process in Kenya through the CBEF structures in eleven counties, only one County – Kwale reported having an active and operational CBEF, there was also a mention of the existence of CBEF in 3 other counties namely, Elgeyo Markwet, Makueni and Migori Counties. Some counties have attempted to enact legislations on public participation; these include in addition to the three with CBEFs Kakamega, Nairobi, Nyeri and Busia County thus the extents to which these structures have been operationalized still remain low. Despite the Counties reporting to have CBEFs, the manner in which the structures are working is still in question. As reported in nearly all the counties, the manner in which CBEF officials operate and the interests they represent are questionable as they do not represent interest of any constituents. It also came out that most CBEFs exist on paper but do not do any work or play any role in the budget making process.

Article 1 of the Constitution states that all sovereign power belongs to the people of Kenya. It further states that the people may exercise this sovereign power either directly or indirectly through their democratically elected representatives. The objects of devolution enshrined in the Constitution give powers of self-governance to the people and enhance the participation of the people in the exercise of the powers of the state and in making decisions affecting them; and to recognize the right of communities to manage their own affairs and to further their development. It is time, we as constituents rise and take up our role as enshrined in our constitution and other devolved policies. The CBEF is a good place to start with and with the backing of the law, the citizens ought to ensure that the operation CBEFs is as per the standards they require as the government officials appointed work for the people and not the other way round.

While access to quality health care is a constitutional right, millions of Kenyans are denied access to quality health care due to various reasons such as, affordability, geographical barriers, shortage of health care providers among others. The structure of the Kenyan Health Care system can be divided into three sub-sectors namely; (a) the public sector which includes government health facilities, medical schools and the public pharmaceutical chain called KEMSA, (b) the non-commercial private sector; FBOs, NGOs which include mission health facilities, medical schools and MEDs and (c) the private commercial (“for-profit”) include health care facilities, medical distributors / supplies, ICT in health, health management advisory and training institutions.

A major concern in the health sector is the infant and under-five mortality rates. According to the World Health Organization, the infant mortality rate stands at 48%, a number that is very high considering the changes that have taken place in medicine’s history. The number is experienced due to several causes including; malaria, which is the main cause, respiratory infection, malnutrition due to high levels of poverty, diarrhea diseases, HIV/AIDS, and TB. To reduce the under-five mortality rates, sensitization programs have been done by private companies and other organisations such as the Kenya Red Cross to sensitize people on the importance of hand washing in the prevention of diseases, and also raising funds to help those that have a chance of recovering (Help a child reach five campaign). Additionally, there has been enhanced sensitization on the need to sleep under insecticides treated mosquito nets and improved treatment on malaria infected cases to help reduce cases of infant deaths.

Besides infant mortality, several cases of maternal mortality are also on the rise where women lose their lives during child birth. This is highly associated with the fact that most women especially in the rural areas still make use of traditional birth attendants mainly due to inaccessibility to medical services or preference on traditional birth attendants as compared to skilled birth attendants. Some myths and religious beliefs are no exception. Hospitals and clinics are located far as per the recommended 5 km radius within reach from their homes forcing most of them to skip clinic days as required, therefore, relying on midwives. Lack of skilled attendance at birth, delayed treatment, and high costs incurred at hospitals are also key contributors to maternity mortality.

The government of Kenya has however put in place measures that will greatly reduce the maternity mortality cases. Such measures include; the presidential directive on free maternity services to women giving birth in public hospitals since June 2013, mobile clinics specifically designed to reach women in areas where clinics are hard to access (beyond zero), campaigns that aim in educating women on the importance of prenatal care, improved infrastructure and equipment in hospitals and increased number of health care givers. The government abolished user fees in public sector at the dispensaries and health centers levels for specific groups i.e. children less than five years of age, pregnant women and orphans and vulnerable children. The government has also provided funding to compensate the facilities for the revenue loss from the limited user fee income.

Health care workers from various cadres have been expressing their grievances and demands in form of nationwide strikes, as witnessed in the recent past. Among these demands include; improved working conditions, poor working environment due to lack of equipment, inadequate health care workers with increased workload, poor remuneration, acute shortage of drugs and inadequate supplies which leads to poor service delivery. Recruitment and deployment of health care workers is another point of focus since the rural areas are lagging behind in terms of health care development and yet it is the goal of the government to change this since the Constitution of Kenya was promulgated paving way for devolution. It is evident therefore, that geographical disparities in health care access in Kenya are very high.

In conclusion, there has been tremendous improvement in the health sector where for instance, most people have taken up insurance covers after several campaigns and introduction of affordable rates across all classes of people, mostly convenient is the NHIF medical cover. The rate of HIV/AIDS infections has also gone down to 6.7% as compared to 10% in the 1990s. This was made possible due to awareness on how to prevent acquiring the virus, provision of free condoms and behavior change communication amongst the youth, availability of medical care to those who are prone to getting infected, and sensitization on the importance of living positively amongst PLWHIV. Besides, there has been an increase in numbers of dispensing clinics to prevent congestion in referral hospitals. The government has also increased its total expenditure on the health sector to up to 30%. More workers and medicine has been acquired. The government has also cut more deals with foreign countries like Japan, European countries, and USA on bringing the state of art.