As contraceptives vanished from Kilifi health facilities, Leila Abdulkheir transformed a service deficiency into a governance challenge. Leveraging community data, digital solutions, and public engagement platforms, she compelled county authorities to address procurement shortcomings, demonstrating how grassroots innovation can extend beyond outreach to impact budgets, systems, and accountability in reproductive healthcare.
In Kilifi County, healthcare providers frequently respond with: “We have no information, disbursements haven’t arrived.” The absence of contraceptives in health facilities produces immediate and quantifiable effects. Kilifi reports Kenya’s highest teenage pregnancy rate at 71%, with cases increasing by 28.9%.
Concurrently, Kilifi County Government funding for family planning has decreased from 26% to 16% in recent years.
These deficiencies indicate a wider systemic failure. Nationally, 6.6 million women of reproductive age depend on modern contraceptives, with 62% obtaining them through public healthcare institutions.
Contraceptive shortages in counties such as Kilifi are not isolated incidents; they impair the primary care source for millions. Leila Abdulkheir acted promptly. She deployed digital tools, trained community health workers, facilitated trauma-informed adolescent sessions, and conveyed community demands into county decision-making spaces. This response emerges during a period of international donor withdrawal.
A KFF report, an independent health policy research organization, indicates that family planning funding decreased by 8%, from Ksh 189 billion in 2023 to Ksh 175 billion in 2024, significantly below the 2019 peak of Ksh 203 billion. Within this contracting financial environment, Youth Voices and Action Initiative (YVAI) has connected community-based solutions with county budgets, national responsibilities, and African Union pledgesconverting local innovation into a political demand for continued public action.
App, network, and negotiation with authority YVAI’s approach was both pragmatic and political. The organization implemented the Hesperian Health Guide app, a Kiswahili, voice-enabled, low-bandwidth resource that explains contraceptive choices, identifies clinics with available stock, and maintains user confidentiality. The app connects with a trained Community Health Promoters (CHPs) network that confirms shortages, documents patterns, and assists women in locating available services. This technology accomplishes three objectives simultaneously: it restores information autonomy to women, generates verifiable data on supply deficiencies, and establishes an evidentiary foundation for county procurement. “Technology enables women to locate available commodities,” Leila explains. “However, we don’t stop therewe present this data to county officials and request budget allocations and implementation schedules.”
YVAI shares compiled app data with Reproductive Maternal Newborn Child and Adolescent Health (RMNCAH) coordinators and employs it during public engagement sessions to demonstrate where procurement requires improvement. Consequently, the county, as Leila notes, has tested a comparable digital reporting method to monitor family planning commodities, making a procedural advancement in connecting community data with county procurement. According to Kenneth Miriti, Kilifi RMNCAH coordinator, the county has implemented a similar app to track family planning supplies as part of initiatives to develop robust health systems.
Beyond the app, Leila has played a crucial role in advancing healthcare reforms at the county level. In 2021, she directed the grassroots task force that contributed to developing Kilifi’s reproductive health strategy. She also joined the coalition that formulated the Kilifi RMNCAH Act 2024, a county law ratified by the governor that establishes standards for quality, accessible, and respectful care throughout life stages. The legislation creates a legal framework for county responsibilities regarding maternal, newborn, child, and adolescent health and establishes a more solid foundation for budgeting and accountability.
Her advocacy is methodical and targeted, evidenced by YVAI’s involvement in County Integrated Development Plan (CIDP) public participation forums where the organization submitted memoranda requesting dedicated family planning funding, Community Health Promoter stipends to maintain referral systems, and youth-friendly services including childcare for young mothers in vocational programs. She consistently presents app-generated shortage reports at RMNCAH coordination meetings, positioning data as an administrative directive: resolve procurement issues rather than merely addressing distribution gaps. “We function as an interim bridge, a catalyst to support public system operations,” Leila states. “However, our objective is to encourage the county to assume responsibility for solutions, budgets, procurement schedules, and accountability measures.”
Rights, legislation, and continental influence Leila structures her demands in legal and continental contexts. Kenya’s Constitution ensures reproductive rights under Article 43 (1a), while devolution designates counties with responsibility for delivering numerous health services. The Digital Health Act 2023 further enables the integration of resources like Hesperian into public health infrastructures. At the continental level, African Union frameworks including Agenda 2063 and the Gender Equality and Women’s Empowerment (GEWE) Strategy require member states to improve women’s health and remove obstacles to reproductive rights. These frameworks carry significant political influence. Leila utilizes them as leverage, asserting that when counties neglect to budget for contraceptives or incorporate digital reporting, it constitutes not merely a local administrative deficiency but a violation of national and continental commitments. “Agenda 2063 and the AU gender strategy provide us with leverage,” she notes. “They enable us to hold county officials accountable for obligations that transcend political considerations.”
The stakes are evident. Kenya raised contraceptive usage from 32% in 2003 to 57% in 2022, while unmet requirements decreased from 27% to 14%. These achievements now face jeopardy as funding decreases and supply systems grow more precarious. YVAI evaluates two outcomes: accessibility and autonomy. Accessibility determines whether commodities are available when and where required. Autonomy examines whether adolescents comprehend their bodies and can make informed decisions. The app minimizes unnecessary journeys and produces immediate evidence of shortages, while adolescent “empowerment” circles develop menstrual knowledge, broaden contraceptive understanding, and enhance confidence in seeking services. Trained community health workers improve referral completion rates and decrease attrition from follow-up care. To date, YVAI has engaged more than 7,000 adolescent girls and young women, integrating digital resources, community networks, and advocacy to tackle both supply and demand deficiencies in family planning. Leila is now working to formalize these achievements.
She advocates for incorporating YVAI’s indicators into the county RMNCAH dashboard, ensuring community-generated data becomes part of formal monitoring frameworks. “When our indicators appear on the dashboard, the county cannot claim ignorance,” she states. Budget conflicts and the advocacy deficit Budgetary politics determine whether innovation expands. Leila advocates for specific, dedicated allocations for family planning within the CIDP and annual budgetsnot ambiguous percentages, but line items resilient to mid-year reallocations. She also requests Community Health Promoter stipends be included in recurring budgets, preventing referral systems from relying on donor support. Local officials acknowledge these challenges.
Kenneth Miriti, the county RMNCAH coordinator, recognizes that while the United Nations Population Fund provides commodities, deficiencies continue due to national procurement obstacles and fluctuating donor priorities. He welcomes civic data that enhances forecasting capabilities: “When we can identify shortage patterns early, we can adjust procurement strategies and secure funding through initiatives like the Building Resilient and Responsive Health Systems (BREHS).” However, he warns that county financial limitations and national procurement cycles continue to restrict responsiveness. The magnitude of the funding deficit remains considerable. Even with UNFPA allocating Ksh 387 billion (US$3 million) for contraceptives in 2025, combined resources address only 17% of national requirements, forcing counties to cope with ongoing shortages. In response, YVAI is testing livelihood and digital literacy programs to reduce dependency and ensure women can effectively utilize and benefit from the app.
However, Leila is explicit that these interventions cannot substitute for functional public health systems. She advocates for structural reforms: incorporating app-generated data into the county health information system, including CHP stipends in recurring budgets, and dedicating procurement funds. Only then, she argues, can innovation complement rather than replace public service delivery. Her requests are specific: “We must establish a dedicated family planning commodities line in the CIDP and annual budgets.” She also emphasizes the necessity of integrating Hesperian-generated shortage reporting into county procurement forecasting and the RMNCAH dashboard. Leila further stresses the need to fund CHP stipends to maintain referral networks and invest in youth-friendly services and childcare assistance to ensure continuity for young mothers pursuing education. Kilifi’s contraceptive shortages indicate a wider implementation gap. Kenya reports to continental bodies on health and gender commitments; subnational performance must align with those reports.
When counties fail to allocate dedicated funding or implement national procurement plans, Kenya’s capacity to demonstrate substantive progress to the AU and other partners is diminished. Leila’s approach, which generates subnational evidence, advocates for specific budget items, and references constitutional and AU obligations renders local accountability transparent and verifiable. Field experiences Leila and her organization operate a program titled “Building Adolescent Girls Power,” targeting girls aged 10 to 19. One participant, Mekatilili, a 17-year-old, confirms that since joining the program, her perspective has transformed. She characterizes the “empowerment” circle as life-changing: “Nimejifunza mengi kutokana na hii programu kama kujua mzunguko wangu wa hedhi, njia za kujikinga na pia njia mbali mbali za kuzuia kupata mimba” (I have learned so much from this program, including how to track my menstrual cycle, methods of protection, and various contraceptive options) she explains.
Through the training, she now mentors peers. Community Health Promoters report reduced unnecessary trips by women searching for supplies; clinic records demonstrate quicker referrals from YVAI-associated community health volunteers. The RMNCAH Act, the app pilot, and documented public involvement represent concrete outcomes that shift the discussion from charity to obligation. However, Leila recognizes that data matters. She is advocating for the publication of the app’s compiled shortage data and for CHP stipends and commodity allocations to appear in the next CIDP budget document. Despite these efforts, Leila encountered resistance. Many community elders initially opposed family planning messaging; she recollects village meetings where she and her team were accused of “encouraging immorality.” Through persistent engagement, she converted critics into supporters: one village elder now publicly endorses the program.
However, political opposition can be more pronounced in budgetary discussions. Persuading Members of County Assembly to dedicate recurrent funds requires sustained civic engagement and transparent, verifiable evidence that budgets will reduce maternal health risks. Leila’s work highlights a fundamental question: can community-based innovation drive fiscal transformation? She possesses the necessary toolsdata, legal frameworks, public engagement, and community support. The next challenge is whether county assemblies convert memoranda and app evidence into specific budget allocations and whether procurement schedules transition from emergency acquisitions to predictable planning. A broader lesson for AU commitments YVAI’s initiative exemplifies a wider AU challenge: continental commitments necessitate subnational implementation. Agenda 2063 and the AU Gender Strategy advocate for universal access to reproductive healthcare. Realizing these objectives requires counties capable of planning, budgeting, and procuring effectively. By transforming app data into political pressure, Leila has developed a transferable model: civic data generation, public participation, legal positioning, and budget advocacyan approach other African counties could employ to translate AU objectives into local practice. YVAI’s model illustrates how community innovation can bridge information divides, mobilize demand, and create verifiable evidence.
However, Leila’s strategy is unequivocal: technology and outreach serve as leverage only if county governments respond with budget allocations, procurement discipline, and legal acknowledgment. Without enduring domestic funding, Kenya risks undermining hard-won reproductive health achievements as international funding diminishes and local systems remain inadequately resourced. By presenting app data, community testimony, and adolescent outcomes in county forums, Leila converts innovation into a political demand: implement the budgets, incorporate the data, and fulfill national and African Union obligationsor justify why these actions cannot be taken.