Everyday in Kakamega County in western Kenya, 37-year-old Hawa Muka Musa feeds and dresses her four children, collects her vegetables, and sets out to sell them in a busy, dusty market. For a full day’s work, she’ll earn about one US dollar, or 100 Kenyan shillings. It isn’t much, but it allows her to keep her children clothed and fed.
Pregnancy was expensive for Hawa with her first three children, because the recommended visits to the health clinic meant time away from work. Attending prenatal visits often took half a day―and that time resulted in lost income.
During her most recent pregnancy, Hawa was able to alleviate that loss of income by enrolling in a county government program called Imarisha Afya ya Mama na Mtoto Program, which was begun in 2013 and provides cash incentives for the county’s neediest women to access prenatal and postnatal care. Program participants are paid about US$20, or 2000 Kenyan shillings, in installments for using specific services―for example, attending four prenatal care visits and delivering the baby with a skilled attendant in an approved health facility. More than 40,000 women currently participate in the program.
For Hawa and her child, Imarisha Afya ya Mama na Mtoto Program was a lifesaver―perhaps literally. For years, preventable child and newborn deaths in Kakamega have ranked among the highest in the country. But since the program’s inception in 2013, maternal and child health care are improving. More women are choosing to deliver their babies with a skilled attendant present, and fertility rates are on the decline. Many health professionals and women credit the program with helping to accelerate this progress.
Still, until this past July, the Imarisha Afya ya Mama na Mtoto Program’s future was uncertain, because it had not been written into law. Without legislation to back the initiative, future funding was not guaranteed, and any change in political leadership could undermine or bring an end to the program.
As advocates for women and children’s health at PATH, we were concerned about the women and families, like Hawa’s, who might be affected by revisions to the program. To ensure that Imarisha Afya ya Mama na Mtoto Program would continue to save lives, we worked with Kakamega County legislators to encode the program into law. Together, we drafted language—first for initial regulations, then for the eventual bill—that would scale the program by converting it into a county fund. We partnered with civil society, including the Kakamega Maternal, Newborn, and Child Health (MNCH) Alliance, which was instrumental in encouraging County Assembly leaders to publicly express their support for the bill.
In late July 2017, the Kakamega County MNCH and Family Planning Bill was signed into law. The legislation sets aside 3 percent of the county health budget for cash transfers to women who utilize the recommended services, and reserves 1.5 percent of the county health budget for stipends for the community health volunteers that support these services, in line with national policy recommendations.
Today the future is bright for Imarisha Afya ya Mama na Mtoto Program and many of its participants. Hawa has now chosen to prevent future pregnancies by accessing family planning services through the encouragement and education provided by the program. She also serves as an informal spokeswoman, encouraging other women to enroll in the program that allowed her to preserve her income without risking her health or that of her children.
As advocates, the passage of the bill encouraged us to continue to press for investments in health—so that every woman and child can fulfill their full potential.