County SRHR Financing Brief 2025

The five asks are not new spending categories. Four of the five are already implicit in existing programmes, they simply lack a dedicated budget line, a public reporting requirement, or both. Making them explicit is the work of one county budget cycle.

The FY 2025/26 county budget cycle is underway. The Kisumu County Fiscal Strategy Paper for 2025/26 reaffirms health as one of the county's priority sectors^[1]. ARI's position is that this commitment must translate into a protected, ring-fenced line for adolescent and youth-friendly SRHR services, and a transparent reporting line that civil society and the County Assembly can hold to account.

Three things make this particular cycle the right moment.

The pattern is consistent: Kenya is a signatory or author of every framework that would, if fully implemented, close the adolescent SRHR financing gap. The brief that follows is therefore not an argument for a new policy. It is an argument for budgetary coherence with the policy that already exists.

Kenya's national budget allocation to health has hovered between 9 and 10 percent for more than a decade, well short of the 15 percent Abuja Declaration target^[9][10]. The Parliamentary Budget Office's unpacking of the FY 2024/25 Estimates confirms the pattern^[11].

Within Ministry of Health spending, Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) commands a small slice, and explicit adolescent SRHR programming a smaller slice still. National budget tagging does not currently disaggregate adolescent-specific spend at a level that allows year-on-year comparison^[12].

Kisumu's County Approved Budget Estimates and successive County Budget Review and Implementation Reports (CBRIRs)^[14]show health consistently as the largest or second-largest sector by allocation. The Office of the Controller of Budget's annual county implementation review^[15] places Kisumu among the higher-share counties on health.

The pattern is an absorption rate consistently in the 88–93 percent range, strong, but with a recurring under-execution on development spending in particular. Within the development line, adolescent-specific infrastructure (such as adolescent-friendly corners and youth-friendly outpatient spaces) is small.

The truth is, on the days the youth corner is open, queues halve in the main outpatient. Closing it because a donor invoice is late is a false economy. We are paying for it in the maternity ward six months later.

Kisumu County is divided into seven sub-counties. Below is an ARI synthesis of adolescent SRHR service availability at Level 4 facilities, drawn from county service availability records and ARI-led facility visits in 2024–2025. The matrix is illustrative and intended to support a transparent, contestable scorecard process, not to grade individual facilities.

Of the funding that does reach adolescents and young people in Kisumu, the largest single category is HIV testing and prevention, largely donor co-financed. Family planning commodities are partly nationally procured through KEMSA. Standalone budget lines for adolescent-friendly health corners, peer-led SRHR education, post-rape care kits, and survivor accompaniment are either small, irregular, or absent.

The shape of this cascade is the brief in one image. The drop-off between need and contact, and between contact and adolescent- appropriate service, is what county SRHR financing has the authority and the means to address.

The cascade above is statistical. The decisions inside it are not. The two composite case studies below illustrate where county financing decisions land in a single life.

Donor financing is not, in itself, a problem. The problem is its location in the financing stack. Across Kisumu's adolescent SRHR provision, donor money has migrated from filling gaps to holding up structural posts: peer educator stipends, adolescent corner rents, transport for survivor accompaniment, and even some consumables. When that financing slows, the structure does not flex, it closes.

1. No dedicated, ring-fenced adolescent SRHR line in the county health vote, making mid-year reallocations easy and predictable.
2. Limited explicit budget for survivor pathways: post-rape care kits, forensic-quality referral, and accompaniment costs.
3. No public quarterly scorecard tracking adolescent SRHR outcomes against allocations.
4. Heavy dependence on donor co-financing for the most adolescent-facing services, with no published transition plan.
5. Comprehensive sexuality education delivery in schools is uneven and largely an unfunded mandate at the school level^[16].
6. No standing co-decision forum where adolescents themselves are consulted on the line items that affect them most.

The recommendations below are designed to be costed, traceable, and feasible within existing county fiscal space. Each is paired with a budget owner and a measurable indicator that can be reported quarterly.

Total indicative ask: KES 50 million, less than 0.7 percent of the projected county health vote. ARI is willing to co-develop a fully costed annexe with the Department of Health and the County Assembly's relevant committees within 30 days of a formal request.

ARI is building, with partners, a public quarterly scorecard tracking the recommended budget lines, post-rape care kit availability, adolescent-friendly service utilisation, and a small bank of community-reported indicators. We invite the Department of Health and the County Assembly to co-own it from the outset.

ASRH

Adolescent Sexual and Reproductive Health.

Abuja Declaration

2001 commitment by African Union states to allocate ≥15% of national budgets to health.

CBRIR

County Budget Review and Implementation Report, a quarterly/annual report on county budget execution.

CFSP

County Fiscal Strategy Paper, an annual policy document setting the broad parameters of a county's next budget.

CIDP

County Integrated Development Plan, a five-year plan setting county priorities and targets.

CSE

Comprehensive Sexuality Education, age- and developmentally-appropriate sexuality education.

DHIS2

District Health Information System 2, Kenya's routine health information platform.

FTE

Full-time equivalent, staffing measure equivalent to one full-time post.

GBV

Gender-Based Violence.

ICPD25

The 2019 Nairobi Summit on the 25th anniversary of the International Conference on Population and Development.

JOOTRH

Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu.

KDHS

Kenya Demographic and Health Survey, a periodic nationally representative household survey.

KEMSA

Kenya Medical Supplies Authority, central medical commodities procurement and distribution agency.

KNBS

Kenya National Bureau of Statistics.

MTEF

Medium Term Expenditure Framework, three-year rolling national budget envelope.

OSC

One-Stop Centre for survivors of sexual and gender-based violence.

PEP

Post-Exposure Prophylaxis, antiretroviral medication started within 72 hours of HIV exposure.

PMA

Performance Monitoring for Action, a multi-country health survey programme.

PRC

Post-rape care, clinical and psychosocial care provided to survivors of sexual violence.

RMNCAH

Reproductive, Maternal, Newborn, Child and Adolescent Health.