In Kenya there are about 15 medical doctors for every 100,000 persons, a ratio that is quite low. Due to this, people seek other alternative sources of health care. For this reason, over 70% of Kenyans rely on traditional healers as their primary source of health care. This number is high because healers respond to diverse needs – they work as herbalists and birth attendants and they’re within reach of ordinary citizens. Estimates suggest that there is one healer for every 950 patients operating both in the rural and urban settings. legitimacy and authority are bestowed on them particularly because they act as custodians of precious biodiversity and the bearers of traditional knowledge.
According to a national household survey released by Kenya National Bureau of Statistics, 57 percent of the population seek treatment from traditional healers and herbalists compared to 28 percent who accessed from health facilities.
The same study also revealed that as compared to their counterparts in urban areas rural folk visit traditional healers more by a 13 percent difference, largely due to the distribution and accessibility of health centres in the rural areas viz. urban centres.
At 76 percent, 59 percent and 57 percent respectively, West Pokot, Siaya and Migori Counties reported the highest numbers as regards treatment by traditional healers and Baringo and Kirinyaga Counties recorded the lowest at 36 percent and 39 percent respectively.
For those who seek treatment in the health facilities only 1 in 4 Kenyans have access to private hospitals or clinics while the majority of the population are reported to access treatment through public health government hospitals, dispensaries and health centres.
Urban constituents recorded a higher access to private hospitals at 78.2 percent than their rural counterpart at 64.2 percent.
The government of Kenya seeks to have universal healthcare to all Kenyans by 2022 to guarantee access to quality and affordable health care. As the data suggests, government should therefore lay its emphasis in investing in public health systems and traditional medicine which have the potential to transform primary healthcare and make it more affordable and accessible.
Written by Joe Kobuthi
Data by Juliet Atellah
Graphics design by Mdogo
Follow the Money: Is There a Role for Cash Transfers in Climate Change Adaptation?
While Cash transfers are considered a better way to reach the poor who are in dire need during environmental shocks or as climate change creates ever-harsher conditions funds can still be diverted and embezzled all along the entire cash transfer chain, and the scale and speed of these programmes will intensify the corruption risks involved.
Climate change is significantly affecting everyone but those who are suffering the most are people already in vulnerable situations. In Turkana County – one of the largest counties in the northern part of Kenya – recurring natural disasters, prolonged droughts and excess floods have lead to loss of lives, livelihood and left many people subject to extreme poverty. These harsh climatic challenges have left Turkana residents, a population of 926,976, to not only rely solemnly on frequent supply of relief food but has also disrupted their rich culture and nomadic way of life.
According to a 2015 Human right’s watch report, “climate change has been one of the many factors that contributes to the lack of access to clean water and food to the residents of Turkana. The county’s minimum and maximum air temperatures have increased by 2°C and 3°C, and the rainfall patterns have also changed”, the report adds.
“During prolonged droughts women and children trek for distances in the hot sunny weather in search of the scarce food and water in the dry riverbeds. Families are unable to provide sufficient food and clean water. Most children are malnourished and hunger stricken. Due to competition on grazing lands and water, there is likelihood of an increase in conflict and insecurity,” the report futher states.
A combination with existing political, environmental and economic development challenges in Turkana has had an impact on the Turkana people’s ability to access food, water, health and security.
A proposed solution: cash transfers
In 2013, the government of Kenya through Vision 2030 on the sector for risk drought management declared ending drought emergencies by 2022 through establishment of a government social protection programme called National Safety Net Programme (NSNP) as part of the government’s initiatives to improve and enhance social protection delivery in the country.
NSNP was established to provide a common operating framework for the government’s four Cash Transfer programmes including, Persons With Severe Disabilities Cash Transfer, Older Persons Cash Transfer, Cash Transfer for Orphans and Vulnerable Children Cash (CT- OVC) and the Hunger Safety Net Cash Transfer. Except for Hunger safety Net Cash transfer, the rest are run under the Ministry of Labour and Social protection.
Hunger Safety Net Programme (HSNP) operates under the Ministry of Devolution and Planning, managed by the National Drought Management Authority (NDMA) a state agency, mandated to exercise overall coordination of all matters relating to drought risk management and to establish mechanisms, either on its own or with stakeholders, that will end drought emergencies in Kenya.
During the HSNP launch in 2008, the people of northern Kenya were gald and ready to embrace the programme as they believed it has the potential to improve the lives of the most vulnerable in Northern Kenya.
The program funding
The government of Kenya, with the aid of international donors such as UKAid from the DFID (Department for International Development) partnered with FSD Kenya (Financial Sector Deepening), to cash transfer payments to the people of Wajir, Turkana, Marsabit and Mandera.
FSD Kenya was a specialist development programme originally established by the UK government’s Department for International Development (DFID) to provide a continuing mechanism through which donor agencies in Kenya could pool their efforts to support the development of inclusive financial markets. In addition to DFID, it was funded by the Swedish International Development Agency (SIDA), World Bank, Agence Francaise de Development (AFD) and the Gates Foundation. Because of its local expertise and experience in financial service development, FSD Kenya was tasked by DFID to take responsibility for developing a solution to the payments element of HSNP. FSD undertook a long process of market preparation before issuing an open call for tenders to provide payments services. In April 2008, Equity Bank of Kenya was selected by FSD bid panel to provide the payments.
The programme has been implemented in two phases. Phase 1, starting with a pilot from 2008-2012, funded by DFID & Australian Department for Foreign Affairs and Trade (DFAT). Phase two (HSNP2) of the programme started in 2013 – 2018, funded by the Governments of Kenya and the United Kingdom with a two-year extension in readiness for the third phase in 2020.
The cash transfer programme operates in two groups. Group one are households that regularly receive cash transfers and group two are households that receive emergency cash transfers from HSNP during drought.
Turkana is one of the counties that benefit from the programme. A total of 137,534 households have been registered out of this, 39,918 are households targeted to receive routine HSNP payments.
How it works
“On a particular payroll that contains the name of the beneficiary, identity card, Equity Bank of Kenya account number and the amount, there are instances where funds are co-funded by the Government of Kenya or DFID or both,” opines Peter Thirikwa, the Management Information Systems Specialist under the Hunger Safety Net Programme.
“For the DFID Funds, the money would flow through FSD where NDMA will then direct FSD the amount of money for the particular payroll. FSD would then credit the Equity bank of Kenya which is the service provider that opened the accounts for the beneficiries and then Equity bank would move the funds from the holding account to the individual accounts through the Equity Agents (Dukas),” he further notes.
Every financial year, “NDMA sets a budget for HSNP through the ministry of Devolution and Planning, and the funds will flow from the treasury into an NDMA account sitting at the NIC bank. As an authority, NDMA is regulated to open a bank account where money flows from treasury to the operations account as per the mandate of the authority,” he notes further.
“Then NDMA instructs NIC bank to transfer the money to an Equity account through the central bank. Equity is then instructed by NDMA to pay the beneficiaries according to the payroll, which is done through agents in the communities. Equity Bank of Kenya pays the payroll according to the instructions given by NDMA, credits all the households as per the payroll, totalling to the same value that was transferred to the central bank,” Peter concludes.
Delays and distribution issues
The HSNP originally provided Ksh 2,150 to each beneficiary household (or individual in the case of the social pension) every two months then later to Ksh 2,700 every month. Beneficiaries are given a Smartcard and to access the funds they have to use their biometric information, fingerprints in order to collect cash at any time from a range of pay points mainly small shops called Dukas across the four counties.
As of 23rd July 2014, the first year the government was in charge of the program, out of 100,000 target households for group 1 (the routine payments) 90 percent of accounts were opened, 78 percent were active and 77 percent were being paid. An annual report from 2020 said “over the 12 years, HSNP reached nearly 100,000 households (600,000 people, 60 percent of whom were women). Accordingly, group 1 households received regular payments, increasing from Ksh 1,050 every two months under Phase 1 to KES 5,400 under Phase 2.”
However, a team of journalists working with the Elephant visited several villages in Turkana County in November last year and found that though many people said they had been given cards some have never received cash and they didn’t know when to expect them.
The 2018 Auditors general report states that NDMA could not provide bank statements relating to funds transferred to the beneficiaries under HSNP. As a result, the auditor’s could not confirm the balance of Ksh. 2,119,239,700 and Ksh. 2,744,213,700 reflected in the financial statements relating to the government of Kenya and donor funding respectively.
Further, HSNP’s Government of Kenya and Donor programme expenditure of Ksh. 5,049,328,332 that comprised payments to various beneficiaries did not have a document to support the basis of how the various beneficiaries were identified, and the basis of the rates used for paying the beneficiaries was not supported either.
The then Auditor General Edward Ouko told the Elephant that he could only conclude that the funds were unaccounted for as he was only provided with the documentation he referenced in the audit report.
Is it enough?
Even if the money were paid on time in every case, that doesn’t mean it’s always adequate for people living in the regions affected by severe droughts, floods, or locusts. According to a 2017 Report on the cost of diet analysis in Turkana county, the current cash transfer of Ksh 2,700 for very poor and poor households is not enough.
“Current cash income and available livestock products are not sufficient for a family to access a nutritious diet. Avenues should be explored to allow households to increase their means to access nutritious foods, such as food for work or vouchers,” the report says.
The report suggests that increasing the cash transfer for these groups to Ksh 10,000 a month would increase affordability, but would not be sufficient in closing the affordability gap. Poor infrastructure in Turkana is a barrier to gaining physical access to the foods, that there is sufficient diversity of foods in the region.
However, the frequency with which these foods are available to households and the quantity with which these can be found in the markets is likely to be an obstacle to achieving a nutritious diet. The report adds that better roads will also allow for more efficient transportation of fresh produce and, possibly, decrease the extent of food degradation and nutrient depletion due to heat and travel conditions.
The cash transfer program is intended to continue running for at least another four years. But while these transfer payments can help those in dire need during environmental shocks or as climate change creates ever harsher conditions, experts and reports argue this is just one small part of a larger need for an effective long-term solution.
This article was developed with support from the Money Trail Project
Things Are Elephant: The Effect of COVID-19 in Nairobi Low-Income Areas
The full extent of the impact of the coronavirus crisis in Nairobi low-income areas is yet to be seen but as Juliet Atellah analyses, it will be important to track.
At least 30 percent of low-income earners have lost their jobs since the Government of Kenya placed restrictions to curb the spread of COVID-19 reveals a recently published report.
The report, titled Survey on the Covid-19 Global Pandemic in Nairobi’s low income Areas conducted by Trends and Insights for Africa (TIFA), a local research firm, found that at least 60 percent of those who have suffered loss of daily earnings claim that the restrictions should be lifted so that people can resume their normal economic activities even if this means the virus continues to spread. This is against a backdrop of increased desperation in many of these low-income neigbourhoods, which has strained resources in a least 75 percent of households, the report notes.
Social institutions and movement have not been spared either by the lockdown. According to the report, at least 66 percent of the respondents have been affected by the ban on travel into and out of the metropolitan and the imposition of the 1900 hrs to 0500 hrs curfew. James Mogaka, a resident of Kawangware told the Elephant that he has been unable to travel to his home county of Kisii to spend time with his family. He has not seen them since the regulations were enforced. As is the plight of Mogaka and many others, the report highlights that 57 percent of low-income earners are very worried on the continuation of the Nairobi travel ban and curfew and they advocate for the restrictions to be lifted so people can resume their normal activities.
Increase in crime has been the major reason why over 80 percent of respondents are keen that the curfew and travel restrictions be lifted and economic activities continue. They are concerned about the future levels of crime due to the economic implications of the lockdown. When asked to corroborate this, Eunice Mwaniki, a resident of Huruma and mother of two, told The Elephant that she closes her vegetable business at 1600 hrs everyday because once dusk approaches, gangs of young men troll the streets pickpocketing and mugging citizens of their hard earned money. She emphasised that the last time she witnessed this kind of theft and daylight robbery was during the grim days of the Nyayo era when Nairobi was infamously christened “Nairobbery”
A majority of denizens are pessimistic that things will change and even bigger majorities are “very worried” about contracting the COVID-19 virus with the constant rise in the number of cases and deaths. Indeed, how such perceptions will change as the full extent of the impact of the virus crisis will be important to track moving forward, given the impact of such perceptions on actual behaviour, both related to the disease and the conditions of life more generally.
On 6th June 2020, a clear majority of respondents had hoped that the President would announce an end to both the travel ban and night curfew but what followed was only a reduction of the curfew period and a hinted policy posture to open up the country. As the country gets closer to 6th July 2020, the day the lockdown will likely be lifted; it is yet to be perceived what direction the government will take. What is clear, however, is that Kenyans are eagerly expecting a policy shift that will make their lives better.
COVID-19 in Kenya: A Situational Analysis of the Now and the Near Future
Using mathematical modelling, Professor Waititu simulates the progress of the coronavirus outbreak.
The daily positive cases in Kenya are on an upward trend. The highest daily count of 278 cases was reported on 27/06/2020. The total confirmed cases so far are 6,070.
In Africa, the five countries with the highest number of confirmed cases are South Africa with 138,134 cases, Egypt with 65,188 cases, Nigeria with 24,567 cases, Ghana with 16,742 cases and Algeria with 13,273 cases.
The number of confirmed cases could be attributed to the total number of tests conducted by a country. For example, by 27th June 2020, South Africa had tested 1.53 Million people. Ghana had tested 288,465 people by 25th June 2020, Nigeria had tested 130,164 people by 28th June 2020 while Kenya had 165,196 tests by 29th June 2020. The implication here is that the positive cases in Kenya could increase with increased number of tests. Kenya will therefore have to increase the number of tests across the country incase the government decides to remove its lock down restrictions in the identified hot spots. Early detection of positive cases and proper contact tracing are very important in the recovery of infected cases.
On the death rate, Kenya has registered 143 fatalities, translating to a death rate of 2.36%. South Africa which has the highest number of confirmed cases in Africa at 138,134, has a lower death rate of 1.78%. One of the highest death rates in Africa has been reported in Algeria at 6.78% from 897 deaths. Ghana has one of the lowest reported death rate of 0.67% from 112 deaths. Egypt has a death rate of 4.28% from 2,789 deaths while Nigeria has a death rate of 2.30% from 565 deaths. Kenya is therefore doing relatively well in managing the positive cases compared to other African countries.
Kenya’s recovery rate is currently at 32.47% from 1,971 recoveries. This is a much lower recovery rate compared to statistics from other African countries. South Africa has a recovery rate of 49.90 % from 68,925 recoveries, Algeria has a recovery rate of 70.60% from 9,371 recoveries while Ghana and Nigeria have recovery rates of 75.98 % and 36.66% respectively. Kenya needs to raise the recovery rate to a comfortable figure above 60%. This will help the country release pressure on the health system and also motivate the easing of the existing lockdown restrictions.
How will Kenyan COVID-19 infections look like in the coming days? The answer may not be definite since the spread of the virus is determined by the nature of community response to safety strategies given by MoH such as regular hand washing, social distancing and staying at home. However, as shown in the prediction graph below, the daily infections in Kenya are going to increase as time goes by. It is predicted that in the near future, the daily cases in Kenya will soon be above 300 with the possibility of a maximum of about 400. This conclusion is based on the assumption that the testing samples will be optimally selected.
Has Kenya reached it’s peak? The simple answer is no. As a matter of fact, Kenya will hit the 10,000 mark of confirmed cases within the month of July 2020. As seen in the graph below for cummulative confirmed cases, the positive cases are still on an upward trend. A peak will be experienced when the cummulative cases will start stagnating around a certain figure over time. With the current trend of infections, the earliest time Kenya will reach its peak is around September 2020. It should also be noted that incase the lockdown is relaxed, Kenya will definitely experience a surge in the infections before the situation stabilises. This has happened in other countries such as South Africa, Germany and China. Since COVID-19 has spread to most of the counties in Kenya, the focus now should be on the level of preparedness by the county governments in implementing the MoH guidelines and the avalaibility of functioning and COVID-19 equiped hospitals.
This report is based on the data from the Johns Hopkins University Center for Systems Science and Engineering (JHU CCSE) as at 9:00am E.A.T on 29/06/2010.
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