If MNCH is truly a priority, then it must be protected, adapted, and reimagined for a changing world. Because behind every statistic is a life, and behind every budget line is a choice.
In many African countries today, conversations about maternal, newborn, and child health (MNCH) have evolved from what needs to be done to what can realistically be afforded. Behind every budget cut or delayed disbursement are real people: a mother waiting longer at a clinic, a newborn missing timely care, a health worker trying to do more with less. As fiscal space continues to shrink, the stakes feel more immediate and closer to home.
For years, external funding has borne much of the cost of MNCH programmes. But that reality is shifting. Donor support is becoming less predictable, and countries are being asked, sometimes abruptly, to take on more responsibility. This transition is not just technical; it is deeply political and, at times, uncomfortable. It forces governments to make tough choices about what to prioritise, and whose needs to place at the centre. And this is where leadership truly matters. Policies and strategies can look strong on paper, but without genuine commitment from decision-makers, they rarely translate into change on the ground. Sustaining MNCH gains requires more than plans, it requires leaders who are willing to champion these issues, even when resources are tight and competing demands are loud.
At the same time, there is a quieter but equally powerful shift happening around data. In constrained environments, stories alone are often not enough, and evidence becomes essential. Being able to show, clearly and convincingly, how investments in MNCH save lives and strengthen communities can make the difference between a programme that survives and one that is sidelined. But building these data systems takes time, trust, and long-term investment. It also requires asking difficult questions about who owns data, who benefits from it, and how it is used.
As countries rethink financing, they must also grapple with the rapid evolution of technology. Across the continent, innovation is no longer a distant concept, it is already shaping how health services are delivered. Artificial intelligence (AI) and digital innovations present a significant opportunity to transform health systems, from improving service delivery and supply chain management to enabling predictive analytics for better planning. Yet, these tools are not neutral. Without thoughtful governance, they can deepen existing inequalities or introduce new risks around ethics, privacy and accountability. This is why conversations about AI cannot be separated from conversations about values, systems and governance. What does responsible innovation look like in our contexts? How do we ensure that technology serves people, rather than the other way around? These are not abstract questions as they are central to the future of health systems in Kenya and, I dare say, Africa in its entirety.
There is, however, reason for cautious optimism. With a young, increasingly tech-savvy population, widespread mobile penetration, and a “late-comer advantage” that allows countries to leapfrog legacy systems, the continent has the potential to chart a different path. In many ways, countries are not starting from scratch but are building forward, drawing on what works, adapting quickly, and learning from each other. Networks like the Health Information Systems Program (HISP), show how locally rooted, collaborative approaches to digital health can strengthen systems in ways that are both practical and sustainable.
But progress will also depend on how seriously we take accountability. As data systems improve, there is an opportunity to rethink how we measure success, not just in terms of outputs, but in terms of real impact on people’s lives. Developing meaningful indicators will not be quick or easy. It will require long, sometimes difficult conversations between governments, communities, and partners. But these conversations are necessary if accountability is to be more than a buzzword because it cannot be imposed; it must be co-created and owned.
Some countries are already showing what is possible. Rwanda, for example, has approached digitalisation not just as a technical upgrade, but as part of a broader vision of dignity and inclusion, captured in the idea of “one citizen, one culture.” It is a reminder that at its core, our work with technology is about people: their dignity, their access to care, and their trust in the systems meant to serve them. Closer to home, civil society in Kenya have in the recent years advanced advocacy efforts to provoke political commitment towards MNCH. International Centre for Reproductive Health Kenya (ICRHK), a non-government organisation working in sexual reproductive health, is currently implementing an advocacy program dubbed ‘Okoa Mama na Mtoto Initiative (OMMI)’ bringing together several consortium partners in academia, media, professional bodies, grassroots, political entiries and technocrats to advance commitment towards improved policy implementation and increased financing for MNCH.
For Kenya therefore, hosting the 2026 International Maternal, Newborn and Child Health Conference was more than a moment of convening; it was a moment of reflection and responsibility. It placed the country at the centre of these critical conversations, not just as a participant but as a leader shaping the agenda. Kenya’s own journey, marked by progress in MNCH, ongoing challenges in health financing, and a growing digital health ecosystem, mirrors many of the tensions mentioned in this piece. The opportunity now is to translate dialogue into action: to strengthen domestic financing commitments, invest in data and accountability systems, and harness innovation in ways that are inclusive and grounded in local realities. In doing so, Kenya can continue to serve not only as a host of conversations but as a model for how countries can navigate constraints while keeping people at the heart of their health systems. Echoing sentiments shared during the opening ceremony of the Conference:
-Solutions exist, but they are not being implemented at scale. We need to focus on financial protection for every mother, strong digital systems and local manufacturing of basic commodities – H.E. Dr. Jean Kaseya, Director General of the Africa Centres for Disease Control and Prevention (Africa CDC)
-It is time that we had a shared declaration that no woman should die giving life. This is a call to our conscience. There is a need for acceleration, coherence, and accountability – Hon. Aden Duale, Cabinet Secretary, Ministry of Health, Kenya
In the end, shrinking fiscal space is not just a financial challenge, it is a test of priorities. It may also be our greatest catalyst for change. It asks governments, and all of us working in the health space, to be clear about what matters. What did we learn from this convening? Countries can build stronger and fairer health systems by investing more of their own resources, using better data to guide decisions, embracing responsible innovation, and showing real political commitment. If MNCH is truly a priority, then it must be protected, adapted, and reimagined for a changing world. Because behind every statistic is a life, and behind every budget line is a choice.
