Time running out on foreign funded family planning

In July, the media reported that Kenya Medical Supplies Authority (Kemsa) had distributed contaminated contraceptives to various parts of the country.

According to the reports, later confirmed by various public agencies, the contraceptives possibly became contaminated because of delays at the Port of Mombasa while awaiting clearance.

The United Nations Population Fund (UNFPA) shipped the contraceptives in question in October 2020 and failure by the government to allocate a budget for tax clearance caused an eight-month delay.

Eventually, the consignment was released after the National Treasury requested the Kenya Revenue Authority (KRA) to waive the taxes owed.

Although the mouldy contraceptives were quickly recalled, the saga is a symptom of a deeper problem, and if no decisive action is taken in the next 12 months, it could be a sign of things to come.

Furthermore, the entire saga was paradoxical. While the consignment was sitting at the port awaiting clearance, there were reported shortages of contraceptives and other family planning commodities in parts of the country.

In November and December 2020, Performance Monitoring for Action (PMA) Kenya conducted a study in 11 counties (Nairobi, Kilifi, Nandi, Nyamira, Kiambu, Bungoma, Siaya, Kericho, Kitui, Kakamega and West Pokot), and revealed that stock-outs were common in public and private health facilities. Intrauterine devices, implants and injectable contraceptives were among the contraceptives affected by stock-outs.

Over the last two decades, Kenya has made tremendous progress in improving access to modern contraceptives.  The contraceptive prevalence rate among married women of reproductive age stood at 61 per cent in 2020, up from 39 per cent in 1998. Contraceptive prevalence rate is the percentage of women of reproductive age who use – or whose partners use – a contraceptive method at a given point in time.

During these 20 years of progress, Kenya has largely depended on external sources to finance contraceptives, a key component of the country’s family planning programme and an important area in Kenya’s quest for achieving her development aspirations.

The United Kingdom, USAID, United Nations Population Fund (UNFPA), and the Bill and Melinda Gates Foundation have been supplying Kenya with contraceptives at no cost. However, Kenya’s status as a lower middle-income country means we are no longer eligible for such support and are slowly being weaned off development funding for basic services such as health. 

Indeed, the Health Sector Working Group Report 2021/22 to 2023/24 published in October 2020 notes that development partners for health in Kenya (DFID, UNFPA, USAID, and the Bill and Melinda Gates Foundation), have pledged to match the country’s funding for reproductive, maternal, neonatal child and adolescent health (which includes family planning) in a sliding scale until Kenya takes over domestic financing by 2023.

The family planning programme has an Sh863 million budgetary allocation for the procurement of family planning and reproductive health commodities for the 2021/22 fiscal year, against the Ministry of Health’s projection of Sh1.7 billion, according to the draft national family planning costed implementation plan 2021–2024.

Kenya has variously committed to domestic funding for a robust family planning programme. Most recently, at the Nairobi Summit on the 25th anniversary of the International Conference on Population and Development, popularly referred to as ICPD+25, President Uhuru Kenyatta led the country in committing to “…gradually increase financing of family planning commodities from domestic resources.”

We have in the recent past witnessed total breakdown of crucial health services after planned transition of funding. In 2019, the Kenya National Blood Transfusion Service was crippled after a planned transition from the US President’s Emergency Plan for AIDS Relief (PEPFAR) funding to Kenya’s own funding, leading to shortage of blood for medical use.

It is therefore crucial that the transition to Kenya funding of its own contraceptives is managed well to prevent a similar disruption of family planning services due to lack of commodities.

As we join the rest of the world in marking the World Contraception Day 2021, the Ministry of Health must lead advocacy efforts to allocate required funding for procurement of commodities in line with the agreement with funding partners to ensure sufficient funding for contraceptives and for the larger family planning programme by 2023.

The writer is the Kenya Country Director at Deutsche Stiftung Weltbevoelkerung (DSW)