Fierce advocacy: what it takes to improve the health of women and girls in Kenya

May 29, 2019 by Kelly Healy

Rosemarie Muganda speaks at the Advocacy Learning Lab on Accountability in Nairobi, Kenya in 2018.

PATH advocate Rosemarie Muganda speaks at the Advocacy Learning Lab on Accountability in Nairobi, Kenya in October of 2018. Photo: PATH/Asha Limo

Far too often women and girls face barriers to accessing quality, affordable health services. Many walk miles to find a health center. When they finally arrive, the doctor or nurse may not even be there. The supplies they need may be out of stock, or they might pay a high price out-of-pocket—and this only when they are empowered to seek care in the first place.

Governments have a role to play in overcoming these barriers and ensuring women and girls have access to high-quality health care, no matter where they live. That is why PATH's dedicated advocacy and policy experts around the world are working to ensure policies that improve the health of women and girls are in place and followed.

Rosemarie Muganda, PATH’s regional advocacy director, and Pauline Irungu, PATH’s lead advocate in Kenya, are two of PATH’s advocates making a positive impact on the lives of women and girls. Below, Rosemarie and Pauline share their perspectives on how advocacy can—and must—be central to efforts to improve the health of women and girls.

Describe the barriers you see women and girls in your country facing?

Pauline: I recently visited Kakamega County, in Western Kenya, and met a woman named Frida (a pseudonym to protect her identity). She had visited the country hospital twice to get her daughter vaccinated. Both times vaccines were out of stock. She was worried and angry. She had spent precious resources—paying bus fare to the health facility, taking time off work, missing out on pay—and her daughter was still unprotected.

Pauline Irungu speaks at PATH session on regulatory harmonisation at AHAIC in March 2019

PATH advocate Pauline Irungu speaks at the Africa Health Agenda International Conference in March 2019. Photo: PATH/Douglas Waudo

Compare this to my own experience: last week I got a call from my son’s pediatrician reminding me to take him for a vaccine he needed. Just because I have the resources to pay for quality health care, the health system followed me and tracked me down. Frida has gone to get her child vaccinated multiple times—of her own accord—and has still never been helped.

The resources a mother has should not determine her ability to access essential health services for her children. The same applies to all health services for which women and children face inequitable barriers to access—from family planning, to pre- and post-natal care, to malaria treatment.

Why is advocacy important for overcoming those barriers?

Rosemarie: Many barriers to access are policy related—from broad systemic issues like a lack of dedicated funding, down to really specific issues like outdated guidelines for healthcare professionals.

However, when developed and implemented with the right intent and expertise, policy has the power to expand access and save lives. So, advocating for better policy is essential. To name one example, we’ve advocated for community health workers to have more authority to distribute health products like injectable contraceptives.

“ As advocates, we cannot let up until better policies are adopted, fully implemented, and fully funded. ”

Unfortunately, policy change doesn’t happen overnight. It can take years for a policy to be developed, passed, and implemented across the entire country. In a place like Kenya where oversight is decentralized—in other words, power is assigned to leaders at the county level—the process is even slower. Lasting change requires passing a policy at the national level and then within each county. That’s why we must be persistent. As advocates, we cannot let up until better policies are adopted, fully implemented, and fully funded.

In late 2018, Kenya passed the Newborn, Child and Adolescent Health Policy. Why is this policy important?

Rosemarie: This is the first time Kenya has ever had a unified policy for improving newborn, child, and adolescent health. This policy is so important because, although Kenya has decreased the mortality rate of children under five, it remains too high—for every 1,000 live births, 45 children still die. Progress in preventing newborn deaths has been even slower.

Rosemarie Muganda speaks at the Advocacy Learning Lab on Decentralization in Nairobi, Kenya in February 2019.

Rosemarie Muganda speaks at the Advocacy Learning Lab on Decentralization in Nairobi, Kenya in February 2019. Photo: PATH/Dan Ewur

What did it take to get this policy passed?

Pauline: It took more than two years of effort by PATH and other advocates. Kenya had a child health strategy, but it wasn’t broad enough to address the entire period from birth through adolescence. That left gaps in the government’s ability to support women and girls. Though a new overarching policy was clearly needed, it wasn’t a priority for some key policymakers and government advisers.

To build momentum, PATH identified a champion in Dr. Rachal Nyamai, head of the Neonatal Child and Adolescent Health Unit. She rallied government support by explaining how the new policy connected to existing priorities, like universal health coverage, which is one of the four big goals President Uhuru Kenyatta has committed to achieving during his term.

To develop the policy itself, we convened child health experts, reviewed other national approaches, and identified important elements for inclusion. We also brought in county-level leaders for their perspectives—a critical step in ensuring the policy would meet the needs of government leaders and partners within the counties.

Once the policy content was developed, we worked hand-in-hand with our champions to shepherd the policy through the Ministry of Health. When the policy finally launched on World Prematurity Day 2018, it was a moment of true fulfillment.

PATH advocate Pauline Irungu celebrates with a group of advocates at the passage of the Vihiga County (Kenya) Newborn Child and Adolescent Health Policy

PATH advocate Pauline Irungu celebrates with a group of advocates at the passage of the Vihiga County (Kenya) Newborn Child and Adolescent Health Policy. Photo: PATH/Pauline Irungu

What are the next steps for ensuring the policy makes an impact?

Rosemarie: Now we are working with county governments to pass policies that align with the national-level policy. We are also monitoring to ensure the government follows through with the commitments made in the policy and, importantly, makes funding available to support it.

What keeps you motivated during long policy processes?

Pauline: Policy can have lasting impact on people’s lives. When I meet people like Frida and see the barriers they face, it makes me want to work hard. It makes me want to break down those barriers so that everyone, no matter their financial means, has access to the same services my children do. That’s what drives my passion for policy advocacy, and what will keep me working until good health is within reach for everyone.

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