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Universal health coverage is essential to achieve health goals and broader socio-economic development. The World Health Organization defines universal health coverage (UHC) as ‘all individuals having access to required health services, of sufficient quality, without suffering financial hardship’. Effective strategies for financing healthcare are critical in achieving this ambitious yet attainable goal.

Health remains a major development challenge in many countries in sub-Saharan Africa (SSA), including Kenya. In 2020, the total infant mortality rate and neonatal mortality rate in Kenya stood at 31.2 and 20.5 deaths per 1000 births, respectively, as compared to 4.1 and 1 death per 1000 births in high-income countries. Inadequate financing for health remains a key challenge to the realisation of UHC in Kenya.

Notably, Kenya has a supportive political and policy environment for improving domestic health financing demonstrated through its commitments at national and regional levels. At the regional level, Kenya has signed onto several commitments to increase health financing, including the 2019 African Leadership Meeting (ALM) declaration commitments and the Abuja Declaration. Other regional and global commitments related to primary health care (PHC), and girls’ and women’s health that the country is signatory to include: the International Conference on Population and Development 25 year review (ICPD+25), FP2030, the 2021 Generation Equality Forum, 2030 Agenda for Sustainable Development, and Agenda 2063.

At the national level, the country has made notable political and policy progress towards health investment. Through the Kenya Health Financing Strategy 2020-2030 the government seeks to ensure adequacy, efficiency and fairness in financing health services, mobilize resources required for health, maximize efficiency and value for money and ensure equity in the allocation of health funds. Other notable efforts include the ongoing UHC efforts, new commitment to expand insurance coverage, a renewed focus on “putting people at the centre of the health system”, and the Ministry of Health and Council of Governors’ pronounced commitment to improving access to health.

However, while the country’s health budget has grown steadily over the past decade, it has not matched the rapidly growing population. Data from the Ministry of Health shows that Kenya’s population has grown by 5% in the last three years, and per capita allocation to health has increased by only 2.5%. Thus, the government’s expenditure on health remains sub-optimal, resulting in high levels of out-of-pocket expenditure. Furthermore, the health budget allocation to primary healthcare (PHC) and girl’s and women’s health is minimal despite their importance in preventing serious and chronic health conditions and reducing related catastrophic costs, disabilities and deaths.

The 2022 Global Fund Results Report highlighted that persistent challenges undermining sufficient domestic investments in health and efficiency in the use of health budgets include governments’ low prioritisation of health in public budgets; weak public financial management (PFM) processes; limitations in quality, comprehensiveness and timeliness of health financing data; and lack of dialogue between the ministries of health and finance, which would facilitate the identification of relevant macro-economic interventions. Consequently, in most of SSA, health and development indicators, including girls’ and women’s health and well-being, lag behind the global levels and trends. To improve the chances of reaping the health and development benefits of UHC, SSA governments need to increase domestic funding for health and, within this prioritise PHC and girls’ and women’s health.

One way to achieve sustainable domestic health financing is by engaging with the legislature. Parliamentarians play a crucial role in driving the sustainable increase in and use of health financing for the realisation of UHC, including monitoring the implementation of Kenya’s PFM Act and other laws and leading reforms needed to improve the expenditure of public resources, sustaining increments in health budgets, tracking expenditures, and taking actions necessary to improve efficiency and reduce wastage; and advocating for sustained increments in health budgets and interrogating health budgets to raise the priority given to preventive and promotive services.

For this reason, on December 6, 2022, the African Institute for Development Policy (AFIDEP) and Partners in Population and Development Africa Regional Office (PPD-ARO) jointly hosted a breakfast meeting with the Kenya Parliamentary and Senate Committees on Health to introduce the project Advancing Domestic Health Financing, and raise awareness of regional and national commitments made by the country towards health financing including at the 2018 Network of African Parliamentary Committees of Health (NEAPACOH).

The Advancing Domestic Health Financing project seeks to work with parliamentarians and other decision-makers to strengthen their capacity to advocate for increased domestic health financing both at the national and sub-national levels. The project builds on the ongoing efforts to support countries in sub-Saharan Africa to translate their commitments into actions that sustain increments in domestic financing for health, and improve efficiency in the use of health budgets and allocations. The project, which commenced in October 2022, will run for three years, and it is hoped that, by then, the project’s focus countries will be on a path to achieving or would have realised an increased and efficient use of domestic health financing focusing on PHC and women’s and girls’ health.

The meeting provided insights on how the project can support the Kenya parliament to execute their oversight and budget approval functions better, including their evidence and capacity building needs as it relates to domestic health financing with a focus on PHC and girls’ and women’s health.