Nutrition advocacy in Kenya’s newly devolved government system

An ENN article by Titus Mung’ou, Advocacy and Communications Manager at Action Against Hunger (ACF) at the time of writing and Jacob Korir is the Head of Health and Nutrition and Health Department at ACF Kenya Mission. He is the current Chair of the SUN CSA.

Background

The Kenya Demographic Health Survey (KDHS) 2014 indicates significant progress in nutrition in Kenya over the past five years. Stunting levels decreased from 35% to 26%; wasting rates declined from 7% to 4%; and the proportion of underweight children dropped from 16% to 11%. The 2015 Global Nutrition Report declared Kenya the only country in the world classified as being on course to meet all five maternal and child nutrition targets¹. Despite the progress, however, malnutrition continues to pose a risk to the lives and livelihoods of a significant proportion of the population.

Since 2013, stakeholders in Kenya’s nutrition sector have been realigning programmes to address the devolution of political, economic and decision-making power to the 47 newly created counties². Under the new constitution, the health sector – including nutrition – is fully devolved to county-level governments, along with water and some treasury services. Sensitisation of nutrition sector actors on the structures and operations of governments is therefore essential for the successful implementation of nutrition programmes in these counties. This article reflects on some of the progress to date.

National and county-level responsibilities in the health sector

The Kenya Health Policy 2014-2030 proposes the formation of county health departments whose role will be to create and provide an enabling institutional and management structure responsible for “coordinating and managing the delivery of healthcare mandates and services at the county level.” The county health management teams provide “professional and technical management structures” to coordinate the delivery of services through health facilities in each county.

However, allocation of funds remains poor. A World Bank study notes that Kenya, as a signatory to the 2001 Abuja Declaration, “committed to allocating at least 15 percent of its national budget to health. Not only is Kenya spending a relatively low amount (7% in 2013) as a percentage of GDP on healthcare, but the allocation of funds to public facilities has been uneven.” Primary care facilities and community health play a significant role as the first point of contact in the provision of healthcare services.

In recent years, the nutrition spotlight has been on county level. According to the KDHS 2014, more than ten counties are grappling with deteriorating malnutrition levels.

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The Emergency Nutrition Network (ENN) and support to the SUN Movement

ENN is a UK registered charity which was set up to improve practice and strengthen the institutional memory of agencies involved in the emergency food and nutrition sectors. ENN focuses on communities in crisis, typically humanitarian emergencies. ENN enables nutrition networking and learning to build the evidence base for nutrition programming in three ways:

• Field Exchange (FEX), an online and print publication on nutrition and food security in emergencies and high burden contexts. Field Exchange is printed three times per year.
• Nutrition Exchange (NEX), is an online publication of short, easy to read articles on nutrition programme experiences and learning. Nutrition is summarised information from the flagship publication, Field Exchange.
• en-net, a free and open resource that helps practitioners access technical advice for operational challenges through the online forum. A specific area for SUN en-net was launched in 2015. Visit SUN en-net ►

ENN is part of the DFID funded Technical Assistance for Nutrition (TAN) programme under which ENN is providing knowledge management services to the SUN Movement in Phase Two (2016-2020). ENN is focused on capturing, curating and disseminating knowledge and learning about nutrition scale up with a focus on high burden and fragile and conflict affected states. Three regional specialists and a Knowledge Management Coordinator are working with country level SUN actors (government, UN, donors, civil society, business and academia) to capture what is being learnt about the scale up of nutrition specific and sensitive activities.