Memorandum submitted by Wanjiku Kamau
This evidence is submitted by Wanjiku Kamau.
Wanjiku lives in the UK and is policy analyst in the area of health
and development. She works as a consultant for several international
HIV/AIDS organisations. The evidence is not presented on behalf
of any organisation but in a personal capacity.
TESTIMONY
I. I welcome the recent invitation to submit
written evidence to the UK Parliament's Select Committee for International
Development on this important issue. I am happy to support this
written testimony with oral evidence if the Committee deems it
as necessary.
II. This enquiry comes at a good time. It
is difficult to exaggerate how critical the years covered by the
CAP are likely to be for citizens of Kenya. After years of mis-rule
the people of Kenya are looking to the new government to bring
in a new style of democratic and accountable governance that will
lead the country out of the previous path of economic decline
and a marked deterioration in the quality of life of most citizens.[17]
III. The priorities and actions of development
partners such as the UK government at this time is likely to be
critical in determining whether the current government is able
reverse current trends and attain the millennium development goals
and other human development targets. It is therefore encouraging
the UK government and its institutions are considering carefully
how to best support Kenya at this time.
IV. This submission limits itself to commenting
on the Millennium Development Goals related to health. Specifically
it refers to the following three health goals:
— Reduce under-five mortality by
two-thirds of the 1990 level
After many years of progress there is a worrying
increase in the under-five mortality rate. Child mortality has
increased from 97 in 1990 to over 125 deaths per 1,000 births
in the year 2002. The trend is similarly discouraging for infant
mortality which has increased from 63 deaths in 1990 to over 80
deaths per 1,000 live births in 2002.[18]
Recent reports from GAVI also indicate worrying figures in the
coverage of immunisation.
— Reduce maternal mortality by three
quarters of the 1990 level
The trend on this important target is also depressing.
The maternal mortality ratio for Kenya (modelled estimate) is
1,300 maternal deaths per 100,000 live births.[19]
Perhaps more worrying is the fact that Kenya is experiencing a
reduction in the percentage of births that are attended by skilled
health workers. In 1990 it was estimated that 50% of births were
supervised by a health worker that figure is now thought to be
as low as 45% of births.
— Halt and reverse the spread of
AIDS, TB and Malaria
The incidence of HIV/AIDS in Kenya is growing
and the increase is particularly pronounced in the 15-24 year
group. It is also worth noting that there is a significant gender
imbalance in the spread of HIV in this age group. A recent study
noted that for every six new infections in 15-24 year old group,
five are in girls. The number of children that have been orphaned
by AIDS is also growing at a rate that is beyond what the government
and communities can cope with. The incidence of tuberculosis is
485.5 cases per 100,000 people. Kenya continues to bear a very
high burden of disease from these three diseases.[20]
V. THE CONTEXT
— 56% of the Kenyan population classified
as absolutely poor—existing on less than Kshs 80 (US$1)
a day—poverty emerges as the most formidable challenge for
Kenya today.
— There is a high level of out-of-pocket
financing for health care ie many of the poorest households in
Kenya have to pay for health services as there is now a system
of cost-sharing. Moreover the severe constraints on financing
healthcare have contributed to poor quality services and to inequitable
access.
VI THE EFFORTS
OF THE
KENYA GOVERNMENT
— The new government of Kenya has re-affirmed
its commitment to mobilising national efforts towards the attainment
of the MDGs by 2015.
— As the draft DFID CAP recognises,
the government has published and is implementing an ambitious
Economic Recovery Strategy (ERS) which sets out the priorities
of the government and identifies the policy orientation in key
sectors. The ERS has identified the HIV/AIDS epidemic as a major
challenge and identified measures to ensure an effective multi-sectoral
response to the HIV/AIDS epidemic.
In order to achieve the health MDGs the Government
of Kenya (GOK) recognises that it needs to increase the access
to health service for the poorest citizens.
After broad consultation the current government
included, in their manifesto, a pledge to establish a comprehensive
health insurance fund.[21]
The proposed fund is the government's response to ensuring that
the poorest sections of the population can have access to quality
health services.
The Kenya government has published a sessional
paper on the proposed fund and a draft bill will go through the
parliament in the next parliamentary session.[22]
The proposed fund will form a central plank
of the government's health strategy and its multi-sectoral response
to the growing HIV/AIDS epidemic.
It is therefore difficult to understand how
the DFID strategy is silent on the proposed fund as it represents
the single most important health policy that the government will
be taking forward in the years covered by the CAP.
The failure to take into account a key element
of government policy is out of step with DFID's statement to support
nationally drivern development. There is a global consensus that
process of achieving the MDGs must be country-led and must be
attained through nationally driven development strategies, policies
and programmes. It would be unfortunate if DFID failed to take
into account key policy priorities and to consider how its contribution
through the CAP can best strengthen, support and improve existing
policy and help realise the goals of Kenya's democratically elected
government and its citizens.
It is my hope that the Committee will use the
enquiry to seek clarification on whether DFID Kenya supports the
principle of country-led development. It would appear that DFID
have identified their own priorities in the health sector and
are seeking to implement these outside of the existing policy
framework put forward by the GOK.
March 2004
17 After years of commendable economic growth (average
of 6.6% in the 1980s), in the past decade Kenya's economy has
been characterised by poor economic performance. For the five
year period 1997-2001, the economy experienced consistent decline.
In the year 2000 Kenya registered its worst performance since
independence (-03% growth). Back
18
World Development Indicators Database, Millennium Development
Goals Kenya Country Profile. Back
19
World Development Indicators Database, Millennium Development
Goals Kenya Country Profile. Back
20
The definition of "very high" disease burden is as follows:
For HIV/AIDS: if the country's ratio of adult HIV seroprevalence
(as reported by UNAIDS, multiplied by 1,000) to Gross National
Income per capita (Atlas method, as reported by the World Bank)
exceeds five. For tuberculosis: if the country is included on
the WHO list of 22 high burden countries, or on the WHO list of
the 36 countries that account for 95% of all new tuberculosis
cases attributable to HIV/AIDS. For malaria: if the country experiences
more than one death due to malaria per 1,000 people per year. Back
21
The proposed health insurance fund was endorsed by all political
parties and is included in the manifesto of all registered political
parties. In that sense it is clear that is has the support of
the citizenry and broad support across the political spectrum.
There is still need for policy dialogue and a need to build consensus
on the precise kind of fund. Back
22
Sessional Paper on National Social Health Insurance, the National
Social Health Insurance Fund Bill (clauses) and the Manifesto
of National Rainbow Coalition are provided as annexes to this
document. Not printed. Back
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