Community led advocacy recognizes the immense ability of an informed citizenry to monitor public services and hold duty bearers accountable for improved realization of constitutional guarantees and other government commitments. Citizens are empowered to influence change through locally collected evidence, sustained advocacy and demand for accountability. This is anchored on;

• Progressive empowerment of citizens on the right to health, including to quality mental health services equipping citizens with knowledge, skills, and tools to advocate for themselves and their communities\
• Community-centered initiatives whereby community members are best placed to assess their own needs and drive solutions, identify local issues and lead advocacy initiatives for change.
•  Social Accountability where citizens leverage feedback mechanisms to monitor government performance and demand improved services.
• Citizen-collected data for instance on quality of health services for evidence-based advocacy.
• Collaboration between communities, service providers, and decision-makers for dialogue and joint action.

The Social Health Insurance Fund (SHIF) laws were rushed through the legislative process and at one point, they were declared unconstitutional for lack of public participation by the High Court. The greenlight for implementation was granted by the Court of Appeal and the government proceeded to implement the laws. However, lack of clear transition plan for the NHIF staff to SHA has proved to be a major obstacle. The staff need to be assured and motivated to embrace and implement the new scheme without looking behind their backs. Unfortunately, their contracts were extended for a period of six months awaiting SHA to undertake its staff establishment. As they lender services they are awaited by three fates, redeployment to SHA or other public institutions, or retire voluntarily. Why was the rush to rollout a new scheme before undertaking staff establishment? Indeed, this was a huge gabble no wonder the parent Ministry of Health seems to be the driving force behind the SHA. Listening to some high-level ministry officials discussing SHA indicates their comprehension is better as compared to that of SHA board and staff.

The promises and realities of SHA are a contrast. Citizens were mobilized to register and promised rosy services, far better than the ones offered by NHIF. But alas, those that sought services from health facilities were heartbroken. The digital registration, approval and claim process were often faced with technical hitches that took longer than anticipated hindering access to services.  Most of the health facilities including the private sector took longer to be boarded into the scheme due to trust levels as a result of debts owed to them under the defunct NHIF, forcing many patients to pay out of pocket in order to access the services or miss the services all together. In paper the benefit packages under SHIF far outweigh the NHIF’s as they included outpatient care, inpatient care, chronic diseases management, and specialized treatments. However, this came with an increase in contributions at 2.75% of household income.

These patient stories are a call to action. The question of ‘why the rush?’ is now secondary to the question of ‘how do we fix this?’ We must learn from these experiences, engage with communities, and work collaboratively to build a healthcare system that truly serves the needs of all Kenyans. Let’s move forward with a commitment to a complete and effective SHA, not a half-baked idea.

Change is a gradual process, often driven by active community involvement in advocacy, inclusive decision-making, and governance. By participating in activities such as budget planning, monitoring public service delivery, and auditing implementation processes, citizens can foster accountability and transparency among public officers and political leaders. When communities take the initiative to oversee public service delivery and financial management, they encourage leaders at both county and national levels to provide timely and quality services.

Health Rights Advocacy Forum (HERAF), a non-governmental organization focused on transforming health systems through strengthened voice and accountability, identified challenges within the Civil Society Organizations (CSO) network in Masinga and Yatta sub-counties, Machakos County. Over the years of project implementation, the lack of active Community-Based Organizations (CBOs) has limited the effectiveness of advocacy and oversight efforts in these areas. Mapping exercises revealed that while self-help groups, women’s groups, and youth groups were active, no formal CBOs were operational.

To address this gap, HERAF trained leaders of these groups on the Public Benefits Organizations (PBO) Act and County Governments Relations (CGR) Act. The goal was to integrate these smaller groups into structured CBOs at the ward level and connect them to the Machakos County CSO Network (MCCN). This integration aims to enhance community oversight, monitor service delivery, and strengthen engagement with stakeholders in Machakos County.

By supporting the formation and integration of CBOs under the MCCN umbrella, HERAF has facilitated collaboration among CSOs, CBOs, and NGOs. This partnership will boost visibility for community groups advocating for their rights and priorities while fostering social enterprises to address local challenges.

The non-state framework promotes effective information sharing, as the network operates at the sub-county level, with representatives from each village. Members benefit from opportunities to benchmark, participate in training sessions, and build capacity in areas such as budget audits, fundraising, and resource mobilization. This structured approach empowers communities to drive sustainable change and ensure their voices are heard in governance and decision-making processes.

The establishment of the dental unit at Masinga Level 4 Hospital is a testament to the government’s responsiveness to the needs of its constituents. It reflects a collaborative effort between the government and the community. By voicing their concerns and advocating for better access to dental care, the community played a pivotal role in influencing the government to establish the unit. Their voices were heard. The newly equipped Dental Unit at Masinga Level 4 Hospital stands as a beacon of progress, showcasing the tangible outcomes that empowered communities contribute towards better health.