Background: In Kenya, HIV programming is heavily dependent on foreign aid. By 2015, HIV prevalence reduced to 5.9% from 14% in the 1990s. As a lower-middle income country, foreign aid will be less accessible; this calls for innovative local financing approaches. Fortunately, devolution of this responsibility to counties has increased local decision-making, creating an opportunity for more targeted responses and investments for HIV. Success is heavily dependent on counties'' capacity to mobilize, accumulate, and allocate funds to health priorities. Through the USAID-funded Health Policy Plus (HP+) project, and with Ministry of Health support, counties employed better planning and budgeting strategies by focusing on ways to generate local revenue for sustainable financing for HIV.
Description: To mobilize domestic resources, HP+ used a three-pronged approach: building capacity of 26 counties'' planning and budgeting units through: training and mentorship on program-based-budgeting (PBB); assessing impact of PBB training by evaluating counties'' strength in advocating for more resources for HIV and other health areas; and assessing impact of the training through evaluation of domestic resources mobilized for HIV, by analyzing resource allocation trends.
Lessons learned: PBB focused on identifying key programmes and sub-programmes necessary for achieving proposed health outcomes. While programmes were the same across all counties, counties were able to prioritize funding for key sub-programmes to include HIV. All 26 counties that received HP+ capacity building adopted the PBB approach and created a budget line item for HIV financing. Domestic resources mobilized amounted to US$7 million between fiscal years 2016/17 and 2017/18.
Conclusions/Next steps: This study points to the importance of domestic resource mobilization in greater sustainability for HIV financing within the uncertain context of donor funding. Enhanced capacity of county planning and budgeting units is critical in ensuring more domestic resources are mobilized and allocated to health, with devolved units serving as a critical entry point for domestic resource mobilization activities, in addition to the national government.
Keywords: Devolution, Sustainability, HIV/AIDS Financing, Domestic Resource Mobilization, Capacity Building, Planning and Budgeting.

Key outcome: Increased funding for HIV/AIDS and Health in Kenya
[Key outcome: Increased funding for HIV/AIDS and Health in Kenya]