New Sector Working Group in Taita Taveta and Its Advocacy Focus

Kenya’s devolution era is now slightly over a decade. Currently, county governments have a magnificent opportunity to learn from proven best practices even as they steer towards new areas aimed at improving service delivery. In this transformative era of devolution, effective planning and budgeting remains a core driver at the counties.

Contextual background of Taita Taveta

Taita Taveta County, like the rest of the 47 county governments in Kenya has aligned its agenda to provide health for all by 2030 guided within the policy framework and programmes by the national government. Since onset of devolution, Taita Taveta’s health department has made progress; to strengthen primary healthcare facilities, boost its health workforce, provide essential commodities, and even establish a county referral hospital for specialized care.

Despite this progress, it is fair to note Taita Taveta is among the counties receiving the least amount in sharable revenue from the Commission of Revenue Allocation. In the financial year 2024/2025, Taita Taveta county will receive KES5.1 Billion which would be supplemented with KES400 million own source revenue which is a reduction KES7.2B allocated in FY 2022/23. Some counties like Nairobi and Nakuru receive the lion share of the allocation based on the revenue sharing formulae (KES39B and KES21B respectively).

Over the years, Taita Taveta population has grown and stretching demand for quality health care.  The wage bill is also high standing at KES3.5 billion of the county budget.  The health department wage bill is KES1.9 billion which means 6 out of every 10 employees by the Taita Taveta county government comes from the health department.

The county has prioritized the health department such that for every 100 shillings, Taita Taveta county allocates KES39 to health department up from KES34 in current FY23/24. However, most of these funds go to salaries (88%) leaving the department with unmet need for other components such as health commodities.

The situation at Taita Taveta therefore requires increased efforts to optimize opportunities to mobilize domestic resources- especially by the health sector as it competes for development budget in a shrinking fiscal space. This also outlines a great need for effective planning and budgeting in line with the Public Finance Management (PFM) Act 2012.  A missed opportunity over the years has been the lack of a properly constituted and operational Sector Working Groups (SWG).

Taita Taveta operationalizes the Health SWG

“Over the last years, we did not have a properly constituted and active health Sector Working Group. This therefore meant there was no team to develop a county health budget which addresses the specific needs and priorities of the health department.” Highlights Hon. Gifton Mkaya, County Executive Committee Member for Health, Taita Taveta County Government.

Budget development process at the counties is a process with a broad mix of stakeholders. Ideally all departments should develop sector priorities which would be subjected to citizen participation under the coordination of the department of planning. Later, guided within set ceilings the budget is forwarded to the Members of the County Assembly (MCAs), who also provide a window for department through their SWGs to provide clarity and defend budget proposals.

MCAs would then make input on the budget proposals by the Executive and subject it to citizen participation before making final approvals which then informs actual budget allocation for the departments within a financial year.

“The USAID Health Equity and Resource Optimization (USAID HERO) project supported our department to establish and operationalize the health Sector Working Group in November 2023. Consequently, the SWG has been coordinating the budgeting process. In this Medium-Term Expenditure Framework (MTEF) cycle 2024/25-2026/27 period, the SWG produced a sector report. This report is an important guide for the department as it provides a clear pathway towards prioritization of resources, programmes and changes in the county legislative environment touching on health financing.”  Added the CECM-Health.

“The SWG report suggests strategies which we will put in place to increase revenue collection within the health department. Currently due to lack of resources we are losing out on clients who go to neighboring counties to seek specialised care.” Shares the Chief Officer for the Department of Health, Violet Mwamburi.

SWG key steps & presenting advocacy asks to MCAs

Already the new SWG is making inroads. The team developed an advocacy brief which is a summary of the SWG report for the current MTEF period. This advocacy brief has been used in a meeting with MCAs who are members of the health and budgeting committees- including leadership of the Assembly.

Through their advocacy brief, the SWG presented clear asks seeking political support from MCAs. Some of these included:

1. An increment in allocation of the health budget to at least 40% of total County budget.

2. Facilitate county legislation to align to the National Facility Improvement Financing (FIF) Act 2023.

3. Mobilization of citizens to register for the national government Social Health Insurance Fund programme.

4. Ring fence the resource for maintenance for the MES (Managed Equipment Services)

These would allow the department to accelerate service delivery making health products and technologies available, allocate adequate resources to the strategic health sub-programs, increase the health work force, clear pending bills and invest in primary healthcare facilities.

Following the strategic engagements between the department of health and MCAs, there has been a number of key commitments made. MCAs in the county have committed to:

1. Work alongside the executive and act as a pivot to Social Health Insurance Fund (SHIF) enrolment for households in Taita Taveta. This will ensure Taita Taveta benefits from payable claims for services they will offer at their Primary Healthcare facilities.

2. Increase allocation and ring fencing of resources allocated to specific programmes in the health sector. The Department has since received an increased allocation from 34% in FY 2023/2024 to 39% of the County budget in FY 2024/2025. 

3. To freeze construction of new health facilities by the county government and focus on completion and commissioning of already started infrastructure projects.

4. Align the County FIF legislation with the national FIF Act 2023. The county has also repealed its Health Services Act 2021 where FIF was embedded. The new legislative focus is to come up with a standalone FIF draft Taita Taveta Health Improvement Financing Bill 2024 which will be presented for public participation and debated by the County Assembly. The MCAs working with the Executive are developing a new Health Services bill 2024 which will include a law that will reinforce ring fencing of funds for Health Products and Technologies(HPTs).

The SWG has also developed a Programme Based Budget (PBB) which is a positive step away from the itemized budget the county has been using over the years. For the first time HIV under communicable diseases has been allocated KES600,000 up from zero in FY23/24 while PHC has been allocated 40 Million in line with bottom up agenda. On Social protection, the department has set aside 4M part of which will be utilized for SHIF sensitization and enrollment.

“For the first time this year, we will present for approval and upload a Programme Based Budget. Previously the itemized budget made it difficult to track resources through allocation until actual expenditure towards specific programmes.”  Explains Benjamin Odago, Ag. Director for Planning and Budgeting in Taita Taveta.

USAID HERO will continue to provide technical assistance for the department of health aimed at strengthening the SWG and supporting it to gather and generate evidence which would be used to inform budget priorities. The project is cultivating a working relationship between MCAs and the Executive ensuring that political support is maintained, and the county becomes a front-runner in delivering Universal Health Coverage.