Nairobi County Health Budget Trend Analysis€¦ · 4 Nairobi County Health Budget Three Year Trend...

Nairobi County Health Budget Trend Analysis For The Fiscal Years 2016-17, 2017-18 & 2018-19

Published by Network For Adolescent and Youth of Africa

Analysis Conducted by Nelson Onyimbi and Esther Ndinya

http://www.imagesofempowerment.org/kenya/j5x68j46gls8tgwwpouujypwh9zp7k© APHRC Nairobi Korogocho Maternity Clinic

http://www.imagesofempowerment.org/kenya/j5x68j46gls8tgwwpouujypwh9zp7k

The Nairobi County Three Year Trend Analysis was

conducted by Youth Advocates Nelson Onyimbi and Esther Ndinya with technical support from

Victor Rasugu, Denis Otundo, Robert Aseda and Immaculate Oliech.

The design and layout is a creation of Brian Alili.

Published by the Network for Adolescents and Youth of Africa Kenya, 2019 as part

of the Right Here Right Now Network Kenya.

Nairobi County Health BudgetTrend AnalysisFor The Fiscal Years

2016/2017, 2017/2018 & 2018/2019

Nairobi County Health Budget Three Year Trend Analysis4

Nelson Onyimbi

NAYA Youth Advocate-Kisumu

Nelson has been a youth advocate with NAYA Kenya for over a year

where he has been involved in policy, budget and media advocacy

for youth Sexual and Reproductive Health and Rights. Nelson holds

a Bachelors in Economics (Mathematics option) with Information

Technology. He is a regular writer for the NAYA Kenya blog and has

been published in national dailies in Kenya. Nelson is very passionate

about Sexual and Reproductive Health and Rights advocacy, driven

by observed and felt gaps of adolescents and youth. Nelson has been

trained on policy and budget advocacy and has been involved in

advocacy campaigns on youth Sexual and Reproductive Health and

Rights. He has also successfully submitted abstracts and presented

them at regional and national conferences.

Esther Ndinya

NAYA Youth Advocate-Kisumu

Esther is a passionate Sexual and Reproductive Health and Rights

Advocate, with a Bachelor’s Degree in Applied statistics. She is skilled

in research, media advocacy, policy advocacy and budget advocacy.

Esther has been involved in the budget analysis and advocacy in

Kisii and Kisumu Counties to advocate for increased funding for

Reproductive Health services. Esther successfully completed the

yearlong Knowles Educational and Charitable Trust for International

(ECTIL) Leadership Program. Esther works towards a favorable

environment where young people can freely vocalise their opinions on

Reproductive Health; the challenges they face and suggest possible

solutions, through conducting community forums, engagements on

social media platforms and periodical commentaries on social issues.

Contents:

List of Abbreviations………........................................................................……………….. 6

1.0. Introduction............................................................................... 7

2.0. Background................................................................................ 8

3.0. Purpose and Methodology of the Analysis................... 11 3.1. Purpose of The Analysis 3.2. Methodology

4.0. Findings and Analysis............................................................ 12

4.1. Health Sector Allocation Trend Analys 4.1.0. Sources of Revenue

4.1.1. Programme 1: General administration, planning and support services

4.1.2. Programme 2: Preventive and Promotive Health Services

4.1.3. Programme 3: Curative services

4.2. Health Budget Strengths and Concerns 4.2.1. Strengths

Programs

5.0. Findings and Analysis.............................................................. 20

References......................................................................................................................... 21


ADP ANNUAL DEVELOPMENT PLAN

BROP BUDGET REVIEW OUTLOOK PAPER

CFSP COUNTY FISCAL STRATEGY PAPER

CIDP COUNTY INTERGRATED DEVELOPMENT PLAN

CIP COSTED IMPLEMENTATION PLAN

CBK CENTRAL BANK OF KENYA

DANIDA DANISH INTERNATIONAL DEVELOPMENT AGENCY

KDHS KENYA DEMOGRAPHIC HEALTH SURVEY

KDP KENYA DEMOGRAPHIC PROFILE

KNBS KENYA NATIONAL BUREAU OF STATISTICS

List of Abbreviations:


Introduction1.0The commitment of the Government of Kenya to the highest attainable standards of health for every

citizen, alongside making health a basic commodity and constantly improving the standards of health in

the country is enshrined in the Constitution of Kenya, 2010.

The President of Kenya has further made health among his top priority areas in The Big 4 Agenda, besides

manufacturing, housing and infrastructure. Within the stretch of the agenda, health systems have seen

a steady improvement, starting with waived maternity fees in order to see through every pregnancy to

successful delivery, also with support from the Beyond Zero Initiative by the First Lady of Kenya. With

the piloting counties taking the first phase of Universal Health Coverage, UHC, for evaluation purposes

before a countrywide rollout, the government has demonstrated commitment to making high quality

health services accessible and available.

The 4th Schedule of The Constitution of Kenya, 2010, makes health a devolved function of the government,

where counties took up their responsibilities for:-

1. County Health Facilities and Pharmacies.

2. Promotion of primary healthcare.

3. Ambulance services.

4. Licensing and control of food sold to the public.

5. Refuse removal and waste disposal.

6. Veterinary services (apart from regulating).

7. Cemeteries, funeral homes and crematoria.

Thus, the National Government retains control of Health Policies, County capacity building and National

Health Referral Systems. This brought health closer to grass-roots and an increase in utility of services

was noted. However, a few conflicts between the National and Devolved Health Systems have been

reported as challenges that face the health sector such as lack of or late delivery of crucial medicine at

the health facilities, negligence in service, detention of corpses over outstanding hospital bills, and high

out-of-pocket costs. In the Sustainable Development Goals, goal 3 talks about Good Health and Well-

being that the Government has pledged to see through up to the realization of Vision 2030.


Background2.0

Childhood Mortality:

Nairobi has the second highest under-5 mortality

rate; following Nyanza (72 deaths per 1,000 live

births). Male children are more likely than female

children to die during their first year of life (44

deaths versus 37 deaths per 1,000 live births).

Once past infancy, male and female children aged

between 1 and 4 years of age experience the

same level of mortality (16 deaths per 1,000 live

births). The neonatal mortality rate for the five

years preceding the survey is 22 deaths per 1,000

live births, 1.4 times the post neonatal rate. The

perinatal mortality rate for the same reference

period is 29 deaths per 1,000 pregnancies (KDHS

2014).

Nairobi County, assigned County Code 047, is under the leadership of Governor Mike Mbuvi Sonko. Nairobi

has the added advantage of hosting a number of National and International offices that support the

health systems including the Ministry of Health Nationally, by the virtue of being the largest city, and the

Capital City of the country. According to the 2009 National Population Census (KNBS), the population was

about 3,138,369, which is estimated to be about 4 million by 2018 (Kenya Demographics Profile, 2018). The

general percentage of population is 51% male, 49% female. Nairobi County sits on about 696 km2 of area,

with a population density of 4,515/km2.

Health-wise, the number of nurses per 100,000 people is 53, for doctors are 14 only (Kenya Service

Availability and Readiness Mapping Report, 2013).

There are about 161 public health facilities, 118 NGO run facilities, 100 Faith Based and about 543 private

facilities making the private sector the majority shareholder of health services in the county. The total

National Hospital Insurance Fund (NHIF) coverage stands at 35.2% (NHIF; Current (2014) projections

based on 2012 data). However, only 10% of public health facilities provide comprehensive youth friendly

services. (SARAM)

Averagely a woman in Nyanza had their first birth about three years earlier than a woman in Nairobi


Age at First Marriage:

In health statistics, the age at first birth influences

total fertility rate, how many children that are born

to a woman eventually and family planning, due

to the predisposal to child bearing at early ages.

These figures reduce with age. In Nairobi, the

median age stands at about 22.1 years, the highest

median age for the same. This is attributed to a

number of factors such as education uptake and

literacy (KDHS, 2014). This research also showed

that men in urban areas such as Nairobi also

have high median ages at first marriage, at 23.8.

Subsequently, the age at first sexual intercourse

is also a factor that influences population growth

in many indicators. The KDHS, 2014 reported that

there was very minimal change, if any, compared

to the 2008-09 KDHS. Nairobi still maintains the

lowest age in sexual debut, at 19.3 years. This was

also attributed to education levels and wealth

quintile disparities. The age at first birth was

recorded in median, and Nairobi County recorded

the highest median age at first birth for women

between ages 25-49, at 22.2, compared to the

lowest being Nyanza with 18.9 years, median. This

implies that averagely a woman in Nyanza had

their first birth about three years earlier than a

woman in Nairobi (KDHS, 2014).

Teenage Pregnancy and Motherhood:

The implication of teenage pregnancy and

motherhood on mortality alongside morbidity

remained a health issue for both mother and child.

This was generally in containable levels, attributed

to the level of education in the county. The ideal

family size, if measured by teenage pregnancy

transitioned to motherhood, was lowest in Nairobi

County at 3.0 children, compared to the highest at

North Eastern being 9.3 children (KDHS 2014).

Current Use of Contraception:

Contraceptive prevalence rate stands at 58.3%

(KNBS, 2014) and the births delivered at a health

facility are at 88.7%, and looks to increase over

time given the investment in maternal health.

National statistics show that about 65% in

unmarried women and 58% (6/10) married women

currently use a family planning method, with

modern contraceptives being used more (53%).

Narrowing down to these modern contraceptives,

injectable contraception was more preferred.

Unmet Need for Contraception:

this refers to the desire to postpone or stop the

next birth by fecund women who are not using or

cannot access any method of contraception. The

unmet need in Nairobi is 11 percent.

Maternal and Child Health:

Nairobi had the second highest under-5 mortality

rate, at 72 deaths per 1000 births.

HIV/AIDS Prevalence and Knowledge:

Consistency in reporting of KDHS 08-09 and KDHS

2014 show that about 99.8% of respondents in a

survey in Nairobi are aware of HIV/AIDS. Besides

that, 86.8% of the respondents of the survey

were aware of HIV/AIDS prevention methods

and general management of the same, including

where to get services such as HIV testing and

Counseling.


The Kenya Health Policy 2014-2030 identifies the below key principles

as important in health delivery:

1. A participatory approach to delivery of interventions;

2. A people-centered approach to health and health interventions.

3. Equity in the distribution of health services and interventions.

4. Social accountability.

5. A multi-sectoral approach to realizing health goals.

6. Efficiency in the application of health technologies.

Purpose and Methodology of the Analysis3.0

The budget analysis was conducted to determine the budgetary allocations trends in the health

sector in Nairobi County. Specifically, it sought to:

1. Providing essential information on resource allocation in the FY 2015/16, FY 2017/18 and FY 2018/19

and the distribution of the resources per programme area in Nairobi County.

2. Ascertain Nairobi County’s three year progress in addressing health issues through budgetary

allocation.

3. Assess the Department of Health Budget allocation by the County Government of Nairobi over the

last three fiscal years. That is the FY 2016/17, 201718 and 2018/19.

3.1. Purpose of this Analysis


3. 2 Methodology

The study was a desk review of existing information, analysis and interpretation of available data and

documents on budgets and budget making process in Nairobi County. The primary documents were the

2016/17, 2017/18 and 2018/19 Financial Year Nairobi County Program Based Budgets.

Findings and Analysis4.0

4.1. Health Sector Allocation Trend Analysis: (By Programs)

The Nairobi County Integrated Development Plan 2018-2022 recognizes high youth population as a major

challenge but also a critical opportunity to tap into. Youth (15 - 29 years) represents 38.75 per cent of the

total population in the County. The CIDP however recognizes that youth face several challenges including

HIV/AIDS and other STDs. The county further recognizes Reproductive health of the youth as a major

challenge in Nairobi leading to teenage pregnancies and abortion. The county commits to provide youth

friendly services in the health care facilities in order to enhance access by this age group.

Further, the CIDP in Pillar Seven on Youth, Women, People Living with Disabilities and Social Protection,

the county identifies Lack of resource centers i.e. ICT, WIFI centers, High prevalence of STIs and HIV/AIDS

Teenage pregnancies, Low access to quality health services e.g. maternity and family planning and seeks

to among others increase resources for reproductive health services and construct and equip resource

centers. This is further reinforced in Pillar 3 on Education and Health where the county commits to among

others Prevent and manage HIV /AIDS and STIs through; promoting safe sex; preventing mother to child

transmission; screening of blood and safe use of medical instruments and strengthen county capacity to

respond to AIDS epidemic through improved funding, training, sensitization and awareness campaigns.

The CIDP also further commits to striving for commodity security in the health sector.

For the FY 2018/19, Nairobi County allocated the health department Ksh. 6,976,605,327 which is an


increase from the Ksh 6,921,002,549 and Ksh. 6,550,000,000 allocated to the department in FYs 2017/18,

2016/17 respectively. For the three fiscal years, General Administration, Planning and Support services

has had the highest allocation, This was followed by Curative services, Preventive and Promotive services

has had the least allocation.

FY 2018/19 FY 2017/18 FY 2016/17

General Administration, Planning and Support services

Ksh 5,831,042,286 Ksh 5,919,357,385 Ksh 5,092,404,009

Curative services Ksh 129,286,501 Ksh 57,184,287 Ksh 43,000,000

Preventive and Promotive services

Ksh 1,016,276,540 Ksh 944,460,877 Ksh 1,414,595,991

0

1,000,0

00,000

2,000,0

00,000

3,000,0

00,000

4,000,0

00,000

5,000,0

00,000

6,000,0

00,000

7,000,0

00,000

2018/19

2017/18

2016/17

Programmatic Allocation

Holding FY 2016/17 as the base year, the tabular representation for the figures is as follows: -

Year 2016/17 2017/18 2016/17 2018/19

Health Sector Allocation 6,550,000,000 6,921,002,549 6,550,000,000 6,976,605,327

Decrease/ Increase (230,893,851) 426,605,327

Percentage Change (3.53%) (6.51%)

Table 1: FY 2016/17-2018/19 allocations to health sector, tabular illustration.


4.1.0. Sources of Revenue

Nairobi County has its revenue sources in two categories; external and internal revenue. The amounts

collected are outlined in the table below;

Revenue Streams Fiscal years

2016/17 2017/18 2018/19

External sources Amount (KSH)

Equitable Share 14,277,000,000 15,402,000,000 15,794,200,000

Free Maternal Health Care 303,000,000 - -

Compensation For User Fees Forgone 73,000,000 79,423,252 79,423,251

Leasing of Medical Equipment 96,000,000 - -

Road Maintenance Levy 214,000,000 553,745,527 611,000,000

KDSP (Level 1 grant + FY 2016/17 Allocation) 77,910,897 86,000,000

Health Sector Support Fund- DANIDA 28,000,000 58,162,149 51,637,500

Conditional Grants to Development of Youth Polytechnics - 30,654,947 34,570,000

Donor Funded- World Bank 1,430,000,000 17,009,120 54,429,184

Agriculture Development Support Programme- ADSPII 9,400,000 -

Sub-total 16,421,000,000 16,228,305,892 16,513,531,609

Local sources

Rates 5,500,000,000 4,842,136,838 4,600,000,000

Parking Fees 3,540,000,000 3,116,226,678 2,973,000,000

Single Business Permits 3,600,000,000 3,169,398,657 2,900,000,000

Building Permits 1,700,000,000 1,496,660,477 1,473,000,000

Billboards & Adverts 1,200,000,000 1,056,466,219 1,400,000,000

Liquor Licenses 379,000,000 333,850,299 -

Rents 300,000,000 264,116,555 303,000,000

Eastlands 300,000,000 264,116,555 303,000,000

Decentralization-Wards 240,000,000 210,944,575 100,000,000

Lease Fees NSWC - - -

Other Markets 144,000,000 126,392,411 130,000,000

Wakulima Market 144,000,000 126,392,411 130,000,000

Fire Inspection Cert 180,000,000 158,644,267 400,000,000

Regulation of Building/ Change/ Amalgam/ Sub 260,000,000 229,249,683 100,000,000

Construction Site Board 200,000,000 176,077,703 200,000,000

Food Handlers Cert - 190,896,124 200,000,000

Other Incomes 1,879,000,000 1,467,895,308 1,860,968,391

Adjustment to Cash in CRF - - 300,000,000

Sub-total 19,566,000,000 17,229,464,758 17,372,968,391

TOTAL REVENUES 35,986,000,000 33,457,770,650 33,886,500,000


Recurrent vs. Development Expenditure

In FY 2016/17, Nairobi County spent KSH 5,450,000,000 on recurrent expenditure while KSH 1,100,000,000

was spent on development.

In FY 2017/18, Nairobi County spent KSH 6,319,106,149 on recurrent expenditure while KSH 601,389,400

was spent on development.

In FY 2018/19, Nairobi County expects to spend KSH 6,375,249,327 on recurrent expenditure while KSH

601,356,000 to be spent on development.

5,450,000,000

Recurrent vs Development Expenditure

1,100,000,000

2016/17 2017/18 2018/19

601,896,400 601,356,000

6,319,106,149

Recurrent

Development

6,375,249,327

4.1.1. Programme 1:

General administration, planning and support services

In FY 2016/2017, Nairobi County spent Kshs. 179,204,000 on Administration/ Human Resources for

Health, Kshs. 4,190,000 on Health Policy, Planning and Financing, Kshs. 480,000 on Health Commodities,

Kshs. 42,000,000 on Research, Quality assurance & Standards, Kshs. 201,200,000 on Coroner Services

Unit.

In FY 2017/2018, Nairobi County spent Kshs. 5,343,897,545 on Administration/ Human Resource


for Health, Kshs. 18,221,146 on Health Policies, Planning and Financing, Kshs. 484,000,000 on Health

Commodities, KSH. 12,294,494 on Research, Quality assurance and standards, Kshs. 844,200 on Coroner

service unit.

In FY 2018/2019, Nairobi County expects to spent KSH.4,984,904,558 (85.5%) on Administration/ Human

Resources for Health, KSH. 30,400,000 (0.5%) on Health Policy, Planning & Financing, KSH. 757,940,000

(13%) on Health Commodities, KSH. 25,825,228 (0.4%) on Research, Quality assurance and Standards

unit, KSH. 31,972,500 (0.5%) on Coroner Services Unit.

4.1.2. Programme 2:

Preventive and Promotive Health Services

In FY 2016/2017, Nairobi County spent Kshs. 4,019,430 on HIV/AIDS prevention and control unit, KSH

2,183,300 on TB control, Kshs. 1,646,750 on Malaria control and other Communicable diseases, Kshs.

9,674,720 on Reproductive Health, Maternal, Neonatal, and Child Adolescent Health (RMNCAH) Kshs.

25,475,800 on Environmental / Public Health.

In FY 2017/2018, Nairobi County spent Kshs. 2,815,006 on HIV/AIDS prevention and control unit, Kshs.

3,032,476 TB control, Kshs. 1,176,969 on Malaria control and other communicable diseases, KSH. 2,680,000

on Reproductive Health and Maternal Health (RMNCAH).

In FY 2018/2019, Nairobi County spent Kshs. 4,440,402 on HIV/AIDS Prevention and control unit, Kshs.

2,392,465 on TB control, Kshs. 1,789,088 on Malaria control and other communicable diseases, Kshs.

86,754,956 on Reproductive Health & Maternal Health (RMNCAH).

0

6,000,000,000

5,000,000,000

4,000,000,000

3,000,000,000

2,000,000,000

1,000,000,000

Administration/Human Resources for

Health

General Administration, Planning and Support Services

Programme 1: General administration, planning and support services

2016/2017 2017/2018 2018/2019

Health Policy,Planning and Financing

Health commodities

Research, Quality Assurance & Standards Coroner Services

Unit


0

20,000,000

40,000,000

60,000,000

80,000,000

100,000,000

HIV/AIDSPrevention and

Control Unit

TB Control Malaria Control and other

Communicable Diseases

Reproductive Health and

Maternal Health

Environmental /Public Health

2016/2017

2016/2017

2017/2018

2017/2018

2018/2019

2018/2019

Preventive and Promotive Health Services

Curative Services

Programme 2: Preventive and Promotive Health Services

Programme 3: Curative Services

4.1.3. Programme 3: Curative services

In FY 2016/2017 Nairobi County expects to spend Kshs. 911,700,000 on County Referral Hospitals, Kshs.

502,895,991 on Health centers and dispensaries.

In FY 2017/2018, Nairobi County expects to spend Kshs. 264,326,698 on County referral hospitals, Kshs.

138,335,779 on Health centers and dispensaries.

In the FY 2018/2019, Nairobi County expects to spend Kshs. 548,482,600 on County referral, Kshs.

467,793,940 on health centers and dispensaries.

0

200,000,000

400,000,000

600,000,000

800,000,000

1,000,000,000


4.2. Health Budget Strengths and Concerns 4.2.1. Strengths:

There’s been a gradual increase in the amount allocated to the health department from the county budget;

in the FY 2016/17, the health department was allocated 18.20% of the total budget, 20.56% in FY 2017/18,

and 21.76% in FY 2018/19.

The county has also invested in Preventive and Promotive services through the 3 fiscal years which will

see few occurrences of infections and deaths; the program was allocated Ksh 43,000,000 in FY 2016/17,

Ksh 57,184,287 in FY 2017/18 and Ksh 129,286,501 in FY 2018.19. Of this allocation, Reproductive Health

& Maternal Health got the highest percentage in FYs 2017/18, 2018/17 with amounts Ksh 28,158,456 and

86,754,956 respectively.

Strengthening of community health units, 210 centers were established in FY 2016/17, FY 2018/19

provides for a stipend for the CHVs at these centers.

Reduced amount of revenue got from donors (World Bank), Ksh 1,430,000,000 in FY 2016/17, Ksh 17,009,120

in FY 2017/18 Ksh. 54,429,184 in FY 2018/19 is an indication that the county is becoming less dependent

on donors and maximizing local revenue sources.

3.3.2. Concerns:

During our analysis, we noted some gaps within the budgets: -

General budget

1. Recurrent expenditure is continually increasing with KSH. 5,450,000,000 in FY 2016/17, KSH.

6,319,106,386 in FY 2017/18 and KSH. 6,375,249,327 in FY 2018/19 while development expenditure

has been decreasing over the fiscal years; KSH. 1,100,000,000 in FY 2016/17, Ksh 601,896,400 in FY

2017/18 and KSH. 601,356,000 in FY 2018/19

2. The ceilings set in the county fiscal strategy paper have also been declining when the budgets are

formulated. For the FY 2016/17, the ceiling was set at KSH. 678, the budget estimates totaled to

KSH. 6,550,000,000. For the FY 2017/18, the ceiling was set at KSH. 7.6billion, the budget estimates


amounted to KSH. 6,921,002,549. For FY 2018/19, the ceiling was set at 7.6billion, the budget estimates

totaled to 6,976,605,327

3. The county government continues to invest in curative services instead of investing more in Preventive

and Promotive services

Programs:

1. Medical rehabilitation sub-program has 3 outputs but has not been allocated any amount in the

budget for FY 2016/17, 2017/18, 2018/19

2. RMNCAH sub-program in the 2016/17, 2017/18, 2018/19 budget lacks an output specific to youth; there

is no provision for establishment of youth friendly centers, an investment towards their reproductive

health despite youth friendly services being a key county commitment.

3. 2016/17 budget had purchase of 3 ambulances @ 22.5M as an achievement; however, the 2018/19

budget targets to have 2 fully equipped ambulances.

4. Among the health objectives in budgets for FYs 16/17, 2017/18, 2018/19 is the prevention and reduction

of NCDs in the county. However, in all the budgets, there is no money allocated for this sub-program.

In FY 2016/17, NCD appears in the budget but has 0 allocation, in FY 2017/18, 2018/19, NCD neither

appears in the budget nor has allocation


Findings and Analysis5.0

1. Align budget with key national and county documents including the National Adolescent Sexual and

Reproductive Health Policy Implementation Framework 2018- 2022, County Development Integrated

Plan 2018-2022, County Annual Development Plan, Adolescent Health Framework and the Family

Planning Costed Implementation Plan. 2018-2021 and County Annual Work Plans.

2. Increase budgetary allocation to health in line with the County Integrated Development Plan and

increase development expenditure to at least 30% as provided for by the Public Finance Management

Act, 2012 in order to address and support critical programs such as youth friendly services as per the

CIDP.

3. County treasury to provide a report on the continuous deviation of ceilings set in the County Fiscal

Strategy Paper from those availed as county budget estimates. This report should be tabled at the

assembly and shared with the public.

4. Establish and equip at least one youth friendly center per sub county and integrate youth friendly

services within facilities in line with county CIDP and Universal Health Care to address key issues

affecting young people such as high HIV prevalence rate, high cases of unsafe abortion, teenage

pregnancies major cause of maternal and child mortality in the county.

5. Establish and allocate resources to Reproductive Health as a sub program.

6. Strengthen public participation for all including young people as per the Public Finance Management

Act, 2012 by availing key documents including the Budget Estimates and County Fiscal Strategy

papers, informing the public in time through media most accessible by Nairobi residents, using available

youth structures in mobilization for public participation and convenient days for all young people and

application of innovative platforms including online communication platforms. Further, there is need

for the county to strengthen feedback mechanisms and provide justifications for decisions made.


REFERENCES

1. Kenya Health Policy (KHP). 2012-2030: ministry of public health and sanitation (MOPHS), ministry of medical services, (MOMS). Nairobi, Kenya: Government of Kenya.

Nairobi County Integrated Development Plan, (2018-2022), Nairobi County, Kenya, Department of Economic Planning and Development, County Government of Nairobi.

2. Nairobi County Budget.2016/2017,2017/2018 and 2018/19 Nairobi Kenya: County Government of Nairobi.

3. Service Availability and Readiness Assessment Measure, 2013, USAID, WHO

4. National Council for Population and Development. (NCPD) Kenya .2013, Policy brief No: 38.Nairobi, Kenya: Government of Kenya.

5. The Kenya Demographic and health survey, (2014).Central bureau of statistics (CBS), Ministry of Health (MOH), National AIDS control council (NACC).Nairobi, Kenya:

government of Kenya.

6. The National AIDS and STI Control Programme, (2015). Ministry of Health. Nairobi, Kenya. Government of Kenya.

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