CSO Budget academy / Advocating for domestic epidemic prepardness funding to increase health security ownership in Kenya

Advocating for domestic epidemic preparedness funding to increase health security ownership

Civil Society Advocacy for Domestic Investment in Epidemic Preparedness

From 2018 to 2025, Resolve to Save Lives, the Global Health Advocacy Incubator and more than a dozen civil society organizations from nine countries—Ethiopia, Ghana, Kenya, Nigeria, Senegal, South Africa, Tanzania, Uganda and Zambia—partnered to increase domestic investment in epidemic preparedness.

Activities spanned coalition building and toolkit development, advocacy and media training and targeted engagement with political and financial leaders to make the case for investments in epidemic preparedness. The program is a testament to civil society’s potential to change policy, catalyze change, bolster domestic resources and safeguard communities.

Country context

Kenya regularly faces disease outbreaks—including anthrax, chikungunya, Rift Valley Fever, mpox, and cholera¹–and has worked with partners and donors on effective advanced warning and response systems. This approach has produced notable successes, preventing many outbreaks from becoming larger epidemics².

Timeline and key achievements

Jul 2023	NOPE participates in Tanzania CSO budget advocacy training developing lighter touch advocacy model
Oct 2023	NOPE chosen to lead budget advocacy work in Kenya
Feb 2024	NOPE and CSO coalition begin meeting with national and county authorities
Sep 2024	Team participates in JEE evaluation
Nov 2024	Budget lines for epidemic preparedness created at national level and in Kericho County; NOPE co-organizes meeting with NPHI to create national strategic plan for health security
Mar 2025	With NOPE support, NPHI finalizes strategic plan 2024-2028 and budget

As documented in Resolve to Save Lives’ Epidemics that Didn’t Happen report³ a 2019 Anthrax outbreak in Narok County was quickly identified through community-level surveillance and notified to high levels who could mount a response. This triggered swift vaccination of sheep and cattle, preventing further disease spread.

While these systems are a linchpin of epidemic preparedness, limited domestic funding and heavy reliance on external donors threatens sustainability⁴. The Narok County program, for instance, was partially funded by USAID. More broadly, Kenya’s health system—and epidemic preparedness and response— remain vulnerable to changes in external funding. In recent years, donor health contributions have exceeded domestic expenditures, with over half of external funding coming from the United States alone⁵. The 2017 WHO-led Joint External Evaluation (JEE) of readiness to prevent, detect, and respond to epidemics repeatedly cites lack of domestic financial resources as a critical gap⁶.

A lot of Kenyans have been calling for reduced dependency on foreign aid. There have been those discussions both among the public and in government to look inward to see how these gaps can be filled.
Abdullahi Hamza Hassan In-country coordinator for Kano State, Nigeria and coordinator for Kenya, Global Health Advocacy Incubator

A new, lighter advocacy model

In January 2024, Resolve to Save Lives (RSTL) and the Global Health Advocacy Incubator (GHAI) began advocacy work in Kenya. They identified the National Organization of Peer Educators (NOPE), a local civil society organization (CSO) that focuses on empowering communities in health, climate change, and governance, as the right partner to improve Kenya’s domestic funding for epidemic preparedness.

Six months earlier, in July 2023, NOPE was chosen to participate in a capacity building workshop in Tanzania. The meeting was the culmination of many years of campaigning in Nigeria, Senegal, and Ghana and sought to field test new advocacy tools such as the Budget Advocacy Toolkit for Epidemic Preparedness that had been developed using country lessons. The gathering also sought to explore how a lighter touch model could work in practice. While the earlier campaigns had larger budgets ranging from US$200-300K, these amounts were not sustainable in the long-term and hard to scale, leading to a search for new models.

RTSL and GHAI invited CSOs from RTSL countries of interest—Ethiopia, Kenya, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe—with the view to identify new potential partners in these geographies, who could implement the new model and champion health security efforts. The workshop leveraged RTSL, GHAI, and Nigerian CSO partners as faculty and sought to test the new tools in training modules.

Following the Tanzania workshop, NOPE presented a proposal and was chosen in October to lead work in Kenya. The sister epidemic preparedness budget advocacy campaigns in Uganda, Kenya, and Zambia that began in 2023 and 2024 were the first to implement the lighter touch model. These new efforts in Kenya and Zambia were organized to operate in a leaner way and structured as “incubation grants” (US$50-70K) to test whether meaningful impact could be achieved with fewer resources. Like Zambia, Kenya marked a further evolution of the advocacy model where countries operated without a local in-country coordinator. Rather, Kenya was supported remotely and through visits from the Kano State in-country coordinator.

Launching the campaign

NOPE and GHAI began strategy and advocacy calls in January, using the Toolkit as a basis for campaign planning. This process identified key stakeholders who needed to be engaged early and specific policy objectives. Direct support from the Kano State in-country coordinator helped the team integrate lessons learned from many years of campaigning in Nigeria.

You have to understand the context. That is one of the key strategies that GHAI’s advocacy action guide teaches. You do mapping and analysis to understand what the intricacies are that you have to take on, and work based on what the findings are.
Abdullahi Hamza Hassan In-country coordinator for Kano State, Nigeria and coordinator for Kenya, Global Health Advocacy Incubator

Meetings with officials began in February with the Kenya National Public Health Institute (NPHI). The NPHI was established in 2022 via a Legal Notice—not an act of parliament. As a result, it lacked proper legal and budgeting authority. Despite these limitations, the NPHI, launched with support from the United States CDC, was a key player in epidemic preparedness, and advocates sought to understand how they could support and collaborate with it.

The team decided to leverage NOPE’s network to advocate for epidemic preparedness funding at the central and county levels, the political subdivision below the national government. Meetings were held with leaders in Narok and Kericho Counties, which were both selected in consultation with government officials due to their large population influxes. Kericho County sits on the border with Uganda, and Narok County is home to Masai Mara, a major tourist destination. The meetings sought to share the campaign goals to expand epidemic preparedness funding and understand local conditions.

You can’t use just one strategy. You must use multiple strategies.
Peter Njunguna KaranjaEpidemic Preparedness Project Manager, National Organization of Peer Educators

NOPE engaged a wide network of CSOs, media outlets, influencers, and community champions to advance its work. Drawing on its extensive connections, NOPE mobilized CSO coalitions at the national and county levels. These partners participated in meetings and jointly drafted memorandums to officials explaining the need for additional epidemic preparedness funding.

CSOs, media outlets, and influencers received targeted training—advocacy skills for CSOs, reporting techniques for media outlets, and effective message amplification for influencers and community champions—to enhance their respective roles in epidemic preparedness funding and ultimately amplify key messages to public officials and local communities. The coalitions also engaged knowledgeable allies with deep knowledge of relevant parts of national and county budgets and partners who could make introductions to decision-makers. NOPE regularly appeared on television, radio, and in print media, and also organized media awards to recognize and further encourage high-quality epidemic preparedness reporting.

The community champions, we didn’t pay them or give them a coin, but they were always there for us. And when you have a team of these local champions who you empower, you succeed.
Peter Njunguna KaranjaEpidemic Preparedness Project Manager, National Organization of Peer Educators

From the campaign’s early days, NOPE engaged in budget processes— the Medium-Term Expenditure Framework and Budget Estimates 2024/2025-2026/2027—and meetings that sought county-level inputs for the national budget. The team was also in regular contact with county and national appropriators through meetings and memoranda. This multi-level campaigning ensured that the message to a wide swath of government players was clear and consistent: Kenya needs to increase domestic funding for epidemic preparedness and reduce dependence on foreign aid.

One of the things we realized was that our advocacy brought out officials’ concerns about the lack of domestic resources. Everyone was asking: why are we so dependent on USAID to fund our own workers? We pay parliament, but we don’t pay our own health workers.
Peter Njunguna KaranjaEpidemic Preparedness Project Manager, National Organization of Peer Educators

As the team deepened its engagement with officials and developed a stronger understanding of the political context, their policy objectives became clearer. At the county and national levels, they sought dedicated epidemic preparedness budget lines. At the national level, NOPE also sought to transform the COVID-19 fund—established during the pandemic to mobilize individual and private sector contributions—into a permanent public health emergency fund. Advocates envisioned this fund having a dedicated funding stream to enable sustainable epidemic preparedness funding.

Recognizing that effective use of any new funding would require an understanding of preparedness gaps, NOPE participated in Kenya’s 2024 JEE process. The resulting report noted both legal and financial gaps in epidemic preparedness. On the legal front, it emphasized the need for an act of parliament to give firm legal standing to the NPHI. Public health laws also needed further development to illuminate county roles in epidemic preparedness given the new powers devolved to them in 2013.⁷ On the financial front, the report called for increased funding to strengthen preparedness at the national and county levels, improvements to fund allocation, and mapping to understand which National Plan for Health Security activities (designed to implement JEE findings) are funded and where gaps remained.

Following up on the JEE findings, NOPE met with the NPHI. There was optimism that advocacy efforts from NOPE, its partners and the NPHI would result in the creation of an epidemic preparedness budget line. Similarly, in Kericho County, there were signals from county government that a budget line would be approved. And indeed, in November 2024, Kericho County created an epidemic preparedness budget line while the Kenyan National Treasury created two new lines: one for public health epidemic preparedness and response and another for One Health.

Advocates also helped strengthen the National Public Health Institute by supporting the creation of the National Strategic Plan for Epidemic Preparedness and Response (2024-2028) and an accompanying organizational budget, which was submitted to the national government. The national strategic plan was an important step for the NPHI as it was fully costed, set measurable objectives for epidemic preparedness and response, and outlined strategies and activities to achieve the objectives.

Getting an epidemic preparedness and response budget line created in Kenya was a tough one. Kenya’s system requires you to engage different stakeholders and convince them with a lot of evidence as well as proposing a funding stream before a budget line can be created.
Abdullahi Hamza Hassan In-country coordinator for Kano State, Nigeria and coordinator for Kenya, Global Health Advocacy Incubator

Establishing the budget lines was an important milestone and created a placeholder for future funding. However, to date, these lines have remained unfunded and there are still challenges to navigate, including identifying a suitable funding source, a prerequisite to any budget allocation in Kenya. In Kericho County, advocates were nonetheless able to secure amendments to bills to ensure improved tracking and accountability measures for any future funding related to epidemic preparedness and response. In Narok County, there was less political support; higher-level politicians regularly refused meetings, so the campaign did not progress as expected and no budget line was created, demonstrating how critical local context is to campaign success or failure. At the national level, a political crisis, taxation protests, and a short campaigning timeline also limited opportunities to build relationships and public support necessary for deeper engagement from political leaders.

Passion is the number one driver. This work is very frustrating. You have to come back to meet many times, particularly when it’s a topic people haven’t heard about it.
Peter Njunguna KaranjaEpidemic Preparedness Project Manager, National Organization of Peer Educators

Lessons learned and legacy

Actively understanding, supporting, and partnering with government leaders is essential to success. The starting point is building relationships of trust by listening, as government health leaders often want to do better but lack the resources and bandwidth to do so. Understanding the barriers they face and identifying ways to overcome obstacles can foster trust that makes advocacy more effective. NPHI and Kericho County health leaders appreciated having advocates on their side and actively engaged with them because they saw tangible outcomes from their partnership.
With a clear roadmap and thoughtful support, a campaign can move quickly to make important change. Even before the formal launch of activities in Kenya, NOPE’s extensive experience and networks and capacity building for epidemic preparedness budget advocacy ensured that it was well positioned for meaningful impact in a short time frame.
Finding the right model for advocacy success is an iterative process. The Nigeria campaigns, which achieved notable wins over eight years, benefited from a long runway, consistent support, and a strong in-country presence by GHAI and RTSL. While countries like Kenya faced greater challenges in achieving similar breakthroughs, their experiences highlight the possibility of tailoring strategies to the resources and timelines available. Rather than suggesting that large-scale investment over many years is the only viable path, emerging models demonstrate that targeted, strategic investments, combined with sustained relationship-building, can offer a more resource-efficient approach, pointing toward an adaptive and sustainable path to scale.
Advocates must rely on multiple strategies to advance the epidemic preparedness budget agenda. NOPE had a prestigious reputation and recognized the power of reaching decision-makers through coalition voices, community input developed via local champions, direct links made by connected allies, and attention-grabbing media. Such multi-modal advocacy amplifies key messages and makes it clear that requests are not coming from one person or group but, rather, from a broad-based, diverse coalition.
External events like Kenya’s taxation crisis can overshadow even well planned and executed advocacy. Advocates reached multiple levels of government and communicated the critical need for domestic funding for epidemic preparedness, but the political crisis created significant barriers to achieving campaign goals. Even in the face of such adversity, NOPE and allies made substantial progress, laying the groundwork for renewed advocacy.

When the USAID cuts came, it just enhanced such conversations. Of course, we are part of that conversation and telling the government that apart from the Abuja Declaration where 15% of the national budget should be allocated to health, we are telling them, you see health is losing every day.
Peter Njunguna KaranjaEpidemic Preparedness Project Manager, National Organization of Peer Educators

Conclusion

The deep funding cuts to U.S. global health programs—USAID, PEPFAR, the Global Fund, and WHO, among others—and ODA decline from other traditional donors have created significant challenges for national health budgets in low- and middle-income countries. In the first half of 2025, Kenya was deeply affected by abrupt U.S. cuts, losing over US$100 million that not only supported the NPHI but also wide HIV treatment coverage, medicines, tens of thousands of health staff, and much more.^8,9 NOPE has also been impacted; it had to conduct significant layoffs and cut salaries for remaining staff. This hobbled efforts to advocate for funding for the budget lines. Kenya’s dependence on donor funds for its health budget has hastened conversations about the need for increased domestic funding.

Though the project has officially concluded, the work in Kenya leaves a lasting legacy. CSOs that received support remain invested in the issue, and some continue to support the advocacy work. Trained and awarded journalists continue to write articles and bring epidemic preparedness issues to the public and governments. These advocates will be more critical than ever as policymakers make difficult decisions about funding priorities and begin implementing new bilateral arrangements with the US government. And important groundwork has been laid— there are national and subnational level lines and NPHI’s strategic plan and budget are ready to be presented to policymakers. In the coming years, there is a compelling case for domestic funding for epidemic preparedness in Kenya.

It’s inspiring to see how advocacy can really change people’s interest and get policymakers like MPs to support an idea they haven’t considered before. There are MPs that then make statements independently in support just because we have sensitized them enough to understand.
Stephen AtasigeGHAI In-Country Coordinator