I watched fellow Kenyans go through party primary elections this past April in preparation for the August General elections. This is when political parties nominate one candidate to represent them prior to the actual elections. This occurs for the lowest administrative office right up to the presidential seat. I had never really paid attention to party primaries before, but I noticed them this time due to huge voter turn-out - one would think it was the general election. In Kenya’s history, this year’s elections will be the second ever under devolution, and perhaps the first where citizens actually understand what devolution really means. The huge party primary turn-out was probably because Kenyans are serious about whom they want (or don’t want) to represent them at county level. I believe this level of interest in politics front has implications for public service delivery, and specifically, health and nutrition services.

Under devolution, the Ministry of Health (where nutrition is housed) is run by two levels of government. The national government develops standards and polices and counties provide frontline health services, manage finances and human resources. For me the reality of what this means in practice is not really a division between national and county level, rather, a co-dependence between them. My learning-by-doing experience taught me that while the two appear distinctly defined on paper, they actually operate with a blurring of functions which has presented a big opportunity for citizen engagement.

Citizen engagement:

My experience of this has come via working with the UN at county level in  Kenya supporting the government to provide nutrition services. A few months after the elections that ushered in devolution in 2013, I remember receiving an enquiry from management asking how much had been allocated for nutrition within the budget for that county. I was stunned. Prior to this, finances were allocated from national level to the districts. In this new system budget planning and allocation was taking place just a few offices from where I sat, and many people (myself included) didn’t realise this was taking place. It was a radical shift for these conversations to now be taking place at county level.

The following year there was greater awareness of these processes and some UN agencies and civil society organisations at national level had prepared by informing county representatives of key calendar dates within the budgeting cycle, which county actors would be engaged during those dates and how to partner with them for key health interests. So what are key health interests? The answer to that question is the heart behind devolution. The constitution states that the citizen is sovereign. This means key health interests are those the citizens deem vital.

As I educated myself about the constitution, I was happy to learn that the issues to be included and budgeted for in annual health plans had to go through several citizen participation exercises at county level. Citizen participation exercises were not just about health priorities, but also about key development issues affecting citizens . While to some extent this had happened before devolution, it was piecemeal and ‘nice to do’ but now it had become mandatory with constitutionally stipulated dates. I felt this presented a unique opportunity to truly provide "context specific services".

Co-dependence and blurring of functions

I noticed that many citizens were unaware, just as I had been, that such an opportunity for citizen engagement existed. For many non-state actors, this challenge created an opportunity to facilitate citizen-to-government dialogue by educating citizens on these new constitutional rights. It was also an opportunity for conversations where non-state actors would gain local level perspective and provide an external perspective to citizens.  While local actors tend to ‘know more’ about their local contexts, external actors tend to ‘see more’ and have bigger picture insights. For instance an external actor would know more about limited dietary diversity, but a local actor would know which people can influence uptake of diversified foods, and which foods would be (un)acceptable if introduced.

As I participated in such engagements the reality of how blurry my functions were dawned on me. I felt like I was both an external and local actor. I was external to the local community but I depended on them to gain perspective on health problems they deemed key. They depended on external actors, such as I, to gain perspective of big picture health and nutrition issues and to be sensitised of how to hold their leaders accountable. To my organisation, I was a local actor and they depended on me to know how the internal county governance and community processes were working in practice.

Going forward:

Going back to the party primaries, I believe one of very many reasons behind the huge turn-out was the reality of the potential that devolution presents for citizen engagement. No doubt there is likely some dissatisfaction in how it was approached (or not), and thus a desire by citizens to get leaders that can be held accountable. For health and nutrition actors, the potential of using this devolution-presented opportunity is far from being realised. To begin with, the approach was a reaction to some missed opportunities as opposed to an intentional proactive approach. In future, continuous community engagement before and after the constitutionally set dates for engagement would have long term benefits in empowering citizens. In addition, it would provide an opportunity to influence citizens’ perceptions to the less visible but significant nutrition issues and underlying causes so that they can be articulated from grass root levels to county leaders. To attain well-orchestrated engagement, the acknowledgement of the co-dependence of actors at all levels will be key.