Action Now! How to influence leaders to deliver HealthForAll

Advocacy campaigns can accelerate action towards change. Campaigns bring problems and their solutions to the attention of those who hold power to resolve the issue. Bungoma Reproductive, Maternal, New-born, Child and Adolescent Health (RMNCAH) Network, in October 2021 campaigned for improvements to Primary Health Care (PHC). Samuel Nakitare, the chair explains how he led fellow advocates to bring critical decision makers to the table….

Strengthening PHC is essential to resolve many problems facing women and girls in my community. This is a belief I hold and is shared by the membership of the RMNCAH Network, a coalition of local advocates who work together to improve the health and wellbeing of women and children in Bungoma County. Our County, which has a population of 1.6 million people, 18 mothers and 159 newborns lost their lives during pregnancy and childbirth in the year 2020 (KHIS data). This translates to one of the highest rates of maternal mortality in Kenya (an estimated 382 deaths per 100,000 live births) and can be prevented if only several simple and low-cost actions are taken.

The E4A-MamaYe project worked with our coalition to apply the ‘problem tree’ approach to unpack the root causes that lead to deaths of mothers and children. We identified poor access to ANC, a weak referral system and teenage pregnancies as the issues putting women, girls, and their babies at risk of death in Bungoma County. We identified how we will save lives and address this problem through a steps to change model. As the leader of the Bungoma RMNCAH Network, I like the steps to change, as they enable us to map actions towards achieving sustainable change.

A strong PHC system addresses health needs- including sexual and reproductive health of women, girls. Among our three issues, advocates from the RMNCAH Network picked increased access to ANC as a focus area in our PHC campaign. As uptake to ANC services ensures complications are detected early and measures are put in place to save lives.

Using evidence to inform decision making

Access to quality PHC services ensures pregnant women and girls are linked to a health facility right from conception to delivery. Evidence shows that ANC is important to ensure sufficient care during pregnancy and the good health of the mother and healthy development of the unborn baby. For nearly two years now, the global health pandemic (COVID-19) challenged uptake of ANC and access to basic health services for many mothers.

In Bungoma, enrolment for first ANC was at 100 percent (Year 2020/21), however there was a drop of 43 percent in subsequent second, third and fourth visits. This breaks the link in the continuum of care and thereafter impacting safe deliveries.

  • Bungoma RMNCAH members during PHC campaign
  • Bungoma RMNCAH members during PHC campaign

Our campaign on PHC

In order to increase uptake of the fourth ANC we conducted an advocacy campaign during the third anniversary of the Astana Declaration which identified primary health care as a central strategy to the goal of health for all. Our campaign mobilised strategic decision makers to prioritise smart interventions around PHC and particularly higher enrolment and completion of fourth ANC.

We co-developed this campaign with the local media, health service providers, representatives from the county government health department. Using evidence, we developed targeted advocacy messages and used these to engage decision makers through social media, radio talk shows, print media and roundtable discussions.

Commitments from the Campaign

“Looking at data on low 4th ANC uptake & high maternal deaths in Bungoma, as the Budget & Appropriation Committee, we will prioritise on increasing the health budget allocation and how they were utilised.” Hon. Jane Chebet, Member of County Assembly in Bungoma.

As advocates, this was a key commitment from a high-profile decision maker. During the roundtable discussion we linked performance of RMNCAH indicators in service delivery to health financing practices and this moved Hon. Chebet.

Further, she acknowledged the gaps in the county’s financing of PHC services and the need for evidence informed decision making. And that it is time for the county government to prioritise the health needs of women, girls and babies during county planning and budgeting processes.

What now? You can join us

Our next step is to follow up on this commitment and translate it to action. Mid-way into the county budget making process, we will target public participation forums and present memos. Through other closed space meetings, we shall seek audience of decision makers like Hon.Chebet and demand investments that will strengthen PHC.

You can continue to read about our effort on the E4A-MamaYe coalitions news page or follow us on twitter (@BungomaRmncah)

If you have questions about our efforts or would like to work with us to achieve our goals, please email:

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