This story provides an illustration of:
- Advocacy as a catalyst for change
- Mapping the immunisation landscape
- Leveraging parliamentarians with evidence-based messages
- Building partnerships and champions
- Advocating for policy and legislative change
- The value of an advocacy strategy
- Building partnerships and champions
Advocacy as a catalyst for change
In 2010, the introduction of Kenya’s new Constitution redefined the provision of the country’s health care and immunisation – to a devolved system of governance. According to the new Constitution, Kenya’s sub-national county governments are now responsible for the promotion of primary health care, including immunisation.
With the responsibility of immunisation delivery divided between national and county governments, Kenya AIDS NGOs Consortium (KANCO), a nation-wide coalition of civil society organisations (CSOs) working in HIV/AIDS and health and member of the Gavi CSO Constituency, identified the need to clarify the legal and institutional arrangements, and ensure an increase in vaccine coverage across the country. In 2013, in collaboration with immunisation partners, KANCO embarked on a national effort to advocate for increased vaccine coverage at the county level, and for a new national immunisation law that could clearly articulate the role of the national vs county governments in immunisation delivery and scale up.
Mapping the immunisation landscape
At the sub-national level, KANCO realized that information on the current status of vaccine coverage in all 47 counties of Kenya was unavailable. Therefore, the consortium undertook a mapping of all 47 county governments to determine vaccine coverage. The mapping revealed that 57% of the counties and 24% of the districts were below 80% vaccine coverage (the national average for Kenya is 82%).
Leveraging parliamentarians with evidence-based messages
KANCO presented the legislators of the poor performing counties with the collected information and discussed the findings, to sensitise them on the effects on child health of poor immunisation. As a course of action to increase coverage, KANCO suggested the organisation of intensified routine immunisation (RI) campaigns and supplemental immunisation activities (SIAs), especially in hard-to-reach areas. The Consortium also proposed the inclusion of these activities in the county-level micro-plans. These UNICEF-supported plans are still in development in the majority of these counties.
The consortium will continue its advocacy efforts by focusing on securing county governments funding for the implementation of the micro-plans (including RI and SIA activities).
Advocating for policy and legislative change
At the national level, KANCO produced a policy paper (“Immunisation Delivery in Kenya: Devolution and its Implications”) to help increase understanding among parliamentarians of the implications of a devolved health care system, especially in immunisation delivery. The paper led to a proposal by the Consortium to establish a national immunisation law that would stipulate the roles of the national and county governments. The law would clarify the different health care functions, including funding for and implementation of the Expanded Programme for Immunisation (EPI).
KANCO organised two parliamentary briefings to share the findings and to engage parliamentarians in a discussion on immunisation and the challenges and opportunities of a devolved health care system. As a result, the Parliamentary Health Committee drafted a legislation addressing the role of the state in immunisation financing and access and clarifying the functions of the national vs county governments in the delivery of EPI services.
The value of an advocacy strategy and building partnerships and champions
While the successful advocacy effort by KANCO seems simple and straightforward, it required smart strategic advocacy strategising, planning and persistence. An advocacy plan is complex and requires time to build relationships, gather data, and effectively communicate the information to targeted audiences.
Advocating for a new law, while the country was undergoing a constitutional and governmental change -that included new Ministry of Health officials and many competing priorities – was a daunting task. Nevertheless the consortium reached out to the new MOH officials, WHO, UNICEF, and Sabin Vaccine Institute to gain clarity on data and information so to build their case for advocating a legislative change and a new legislation. While the parliamentarians who were championing the process were from the opposition party, KANCO’s advocacy efforts equally focused on building champions among the ruling party especially within the Parliamentary Health Committee.
KANCO will continue to work to ensure that the content of the immunisation law is clear and responds to the needs of all Kenyans and it will also continue to engage the Ministry of Health, parliamentarians, the media and civil society to ensure the passage of the law as well as its funding, implementation and enforcement.
Source: Jackson Ndegwa, Policy and Advocacy Manager, Kenya AIDS NGOs Consortium (KANCO), a member of the Gavi CSO Constituency