Memorandum submitted by HelpAge International
HelpAge International is a global network of
not-for-profit organisations with a mission to work with and for
disadvantaged older people worldwide to achieve a lasting improvement
in the quality of their lives. In Kenya we work with a range of
partners and non-governmental organisations working with and for
older women and men in poverty. This memorandum sets out the core
concerns of those organisations and of HelpAge International in
terms of the three questions put to the Committee, as follows
— What are the prospects of Kenya meeting
the MDGs?
— What are the main challenges which
Kenya faces in meeting the MDGs?
— To what extent does DfID's Country
Assistance Plan identify accurately the challenges which Kenya
faces, and outline appropriate strategies to help Kenya to make
faster progress towards the MDGs?
INTRODUCTION
Overall Kenya's economic performance has declined
over the years due to a multiplicity of problems, including poor
governance, the decline in external resources and commodity prices,
rising input costs, instability, poor infrastructure and insufficient
investment in priority social sectors. Poverty amongst the already
poor has increased. About 56% of the population live below the
poverty datum line, of which three quarters live in the rural
areas, but with the number of urban poor also rising. Current
estimates put the numbers of 60 plus age group at 4% of the population,
and evidence on chronic poverty and rural poverty point to the
older poor counting amongst the very poorest of all. The majority
of the older poor have no regular income, are subsistence farmers
with declining outputs due to age and the sale of assets and yet
are increasingly assuming the role of primary carers due to the
HIV/AIDS pandemic. Despite the existence of a poverty reduction
strategy and a draft "Kenya National Policy on Older persons
and Ageing 2003" older populations report a decline in living
conditions and corresponding rise in experiences of acute poverty,
lack of access to essential services and hunger.
In general current predictions are that the
Millennium Development Goals in Kenya will not be achieved by
2015. This corresponds to analysis across the developing world;
both resourcing for MDGs needs to be substantially increased,
and development programming needs to be improved. The experience
of HelpAge International and its civil society partners points
to the failure of development programming and related analysis
which does not take into account issues of poverty and vulnerability
across the life course, and especially in older age. For this
reason we argue that MDG achievement is contingent upon development
analysis and pro-poor investment that explores, supports and targets
the assets, as well as vulnerabilities, of all poor people, including
the old, in the developing world. HelpAge International and its
partners also espouse a rights based approach, as we know from
evidence gathered that any policy that doesn't take into account
the rights, views, needs and contributions of people of all ages
and gender will fail a substantial part of citizens in any developing
country. It will also compromise its overall aim of poverty reduction
within the human rights framework.
KENYA AND
THE MDGS
The prospect of Kenya meeting the MDGs is a
challenge. Poverty and HIV/AIDS continues to affect increasing
numbers. HIV/AIDS is claiming a large proportion of people aged
14-49 who are the most productive age group, further casting doubts
on the MDGs being met as the workforce is diminished.
In relation to whether the DfID Country Assistance
Plan identifies accurately the challenges which Kenya faces, and
outlines appropriate strategies to help Kenya make faster progress
towards MDGs, we have to point out that the failure to recognise
older people and the households which they head up as key targets
for poverty reduction makes planning incomplete. The Kenyan government
has recognised the importance of the ageing and poverty relationship[6]and
support from DfID to help the government integrate a response
to the older poor in their poverty programmes would be very timely.
THE EVIDENCE
ON POVERTY
AND OLD
AGE IN
KENYA
In Kenya and many countries in Africa, older
people who have suffered a lifetime of poverty enter old age with
few resources and very often in poor health[7]Kenya
has over 1.2 million people over 60, representing 4%[8]of
the population. Through programme implementation experience and
research, there is evidence that older people are among the poorest
groups in Kenya. A recent study undertaken for the World Bank
by K Subbarao which analyses the living conditions and poverty
levels of older persons in relation to other vulnerable groups
in 15 African countries, including Kenya, indicates that the poverty
gap[9]is
15.9% for older households with older people in and 21% for those
households with older persons and younger dependants. Furthermore,
using sickness as a non income dimension of poverty, the same
study reveals that older Kenyans present a 25.7% average of sickness
as compared to younger age group levels of 15%, yet this population
is least well served by health services. Such findings correspond
with HAI's evidence that the poverty, rights and needs of older
people are neither met not taken into account by development investment
realting to poverty reduction.
The rights of older people to independence,
participation, care, self-fulfilment and dignity (as stated in
the 1991 UN Principles for Older Persons ) are not being met in
Kenya. Changes to the family structure due to—for example—migration,
the impact of HIV/AIDS, economic decline, and fail of government
programmes to reach older people have resulted in further marginalisation
of older people. Older women are particularly affected, because
of a lifetime of discrimination, limited access to pensions and
the fact that they are less likely to remarry if they are abandoned
or widowed.
HAI is working in the district of Machakos,
one of the most densely populated areas. Contrary to government
aggregate figures, life expectancy is 68.1 years. There is a 29%
malnourishment rate of children under five years of age and 63%
of its population is considered among the absolute poor of the
46 ranked districts in the country.
A HAI policy monitoring project, supported by
DfID, in this area is supporting older citizens to monitor policy
issues of key importance to them. The major concerns are:
— Health/HIV/AIDS—Most of the
older persons in the area care for orphans and lack affordable
and accessible health facilities. The grandparents take care of
between two and eight orphans.
— Poverty—Despite the area being
an agricultural area, the level of production of food is low due
to lack of farm inputs like fertilizer, seeds, agricultural equipments
and pesticides.
— Housing—Most of the older persons
in the area have mud walled, iron roofed houses except for some
who are in temporary structures.
— Lack of participation. Older persons
in the project area cited ignorance and lack of awareness of their
rights and of policy processes, as a factor that has greatly contributed
to their situation.
The majority of older people in Kenya are rural
farmers, with no means of sustenance in old age. Pensions are
only accessible to 6.6% of the total population of older people
who have worked in the formal sector. In a country where there
is no universal pension, the majority of older people who have
not contributed to any form of pension find themselves in extreme
poverty at a time when their health due to life long hardship
and age is compromised and they have lost their means of income.
A study[10]carried
out on the structure of employment and income-generating opportunities
for older persons in Machakos and Nairobi revealed a higher rate
of malnutrition in the rural areas of Machakos (BMI<185 KG/M2)
was 29.8%, compared to the urban community in Kibera (36.1% and
18.5% respectively). In Nairobi, more men (32.6%) than women (12.8%)
were underweight. In Machakos the prevalence of malnutrition among
older men was 32.3% compared to that among older women which was
24.7%.
Poverty needs assessments carried out in Ukwala
and Alego divisions as part of the Poverty Reduction consultations
defined poverty as lack of essential basic requirements such as
shelter, food, medical services and education, access to good
clean portable water, insecurity, lack of education and information
(ignorance), lack of infrastructure, environmental degradation,
public health problems and lack of health services. Poverty was
perceived as "a state of helplessness and powerlessness."
Those critically affected by poverty were identified as, older
parents (who have to care for PLWHAS and orphans), widows and
widowers, orphans and children from poor families. The community
reiterated that poverty manifests itself in the inability to get
food, high levels of school dropouts, lack of proper shelter,
insecurity, inability to afford proper health care, inability
to afford farm inputs and implements and unemployment, degraded
environment due to poor coping mechanisms such as charcoal burning,
brick making and tree cutting.
In addition, older people and their communities
felt that there is an overall neglect of the division by the government
as demonstrated by poor service delivery, over taxation by local
authorities. Older people talked about the abuse they face in
the hands of health care workers who see them as waste of resources.
A study carried out on Elder Abuse in Primary Health Care Services
in Kenya in 2001[11]found
out that negative attitudes of health care workers, lack of awareness
about the rights of older people are the main causes of denial
of health care services to older people. Older Citizens Monitoring
Project being currently implemented in Kenya, with DfID support,
highlighted the lack of drugs, lack of respect, distance to health
care services, discrimination, cost of medication, lack of health
education and poor hospital facilities as older people's main
concerns.
Lack of data on older people has a compounded
effect on the planning for services that target older persons.
In this sense, HAI welcomes DfID recognition of the need to increase
the quality and quantity of data available and seek to ensure
that the interest of poorest Kenyans are fully taken into account
(CAP, Part II: UK Assistance Plans, E2). In this sense, it is
important that DfID recognises the need for data disaggregated
by age and gender. Data available is not sufficiently disaggregated
thereby obscuring older people's poverty and hampering well-targeted
development assistance. It is also important that gender bias
and inequality in later life is acknowledged and acted on, as
this discrimination has a cumulative effect on older women and
men and must be addressed by poverty reduction strategies. The
absence of safety nets in older age argues for special social
protection measures to support the households of older persons
and to address the feminisation of poverty in particular among
older women.
KEY RECOMMENDATIONS
— That DfID support the integration
of old age concerns into the poverty reduction strategy of the
government, and ensure that responses to old age are incorporated
into the measurement of the Millennium Development Goals. HAI
is working with UNDP to deliver policy and programme guidelines
to support this process. The Madrid International Plan of Action
on Ageing[12]reiterates
Member States' commitment to reduce poverty by half by 2015 and
stipulates that older persons must be included in policies and
programmes to reach the poverty reduction target. The Africa Union
Plan of Action on Ageing, and the constitutional review of Kenya,
recommends that older persons be taken into account in poverty
planning and rights based development. A recent workshop on ageing
and poverty in Tanzania supported by the United Nations (department
of Economic and Social Affairs), HAI and the government of Tanzania
recommended that "Governments need to ensure that policy
responses to the older poor are explicitly integrated into future
poverty and development processes, including MDG programmes. Strengthening
national capacity and awareness of the rights and priority needs
of the older poor is needed. Mechanisms to advance this include
responses to ageing in national poverty monitoring systems as
well as the development of age sensitive monitoring under MDG
and PRSP programmes[13]"
— That DfID support the poverty focus
of the ERS by support to the collection and analysis of old age
poverty, in particular in rural areas and slum areas, and in multigenerational
households.
— That DfID support the collection
and analysis of household data disaggregated by age and household
type, and include findings in DfID analysis and work with the
government on poverty monitoring.
MDG 6: COMBAT
HIV/AIDS, MALARIA AND
OTHER DISEASES
UK Assistance Plan, under Key objective iii: Effective
Multi-sectorial Response to HIV/AIDS fails to spell out DfID strategy
in relation to OVC and carers
The section on effective multi-sectoral response
to HIV/AIDS does not recognise the role of older people in care
and support programmes. Furthermore, the plan does not address
the intergenerational linkages between older people and orphans
in care and support programmes, yet researches have confirmed
that co-existence.
The data available on HIV/AIDS deaths and rates
of infection in the developing world indicate that older people
are now primary carers and supporters of younger family members,
both those dying of the disease and orphans of the middle cohort
who are currently dying in ever increasing numbers. Older people
who are already poor face the loss of economic support from their
adult children, little social security and pension support (only
South Africa has universal pension coverage in the countries where
the epidemic is most serious) and unexpected social, psychological
and economic burdens due to the caring role they assume. Older
people are also contracting the virus in increasing numbers although
research is limited on the cases of HIV/AIDS in the over 50s.
There are few national, local and community based programmes that
target the needs of older people as they shoulder the new roles
the pandemic is occasioning and little general awareness in the
community at large, including the donor community, about the issues
at stake.
A recent study carried out in Ahero and Asumbi
(Homa Bay and Nyando districts) as part of a one year project
Supporting the needs of Older Men and Women Affected by HIV/AIDS
in Kenya (HAI 2003) revealed that older people shoulder a heavy
burden of caring for PLWHAS and orphans. Older people care for
an average of seven orphans, most of whom are below the age of
15. Of the 179 older men and women who attended the consultation
meetings, 75% of them had lost at least four sons and daughters
through HIV/AIDS.
There is an absence of targeted programmes to
support older carers and there is limited recognition or support
of the pivotal role older people play in responding to the AIDS
pandemic. The cumulative economic costs of caring are not cushioned
by programmes aimed at older carers, and there are few education
programmes targeting older people, and still fewer counselling
services that can be easily accessed by older people.
KEY RECOMMENDATIONS
— The growing role of older woman and
men as primary carers in households affected by HIV/AIDS argues
for the increase of quantitative and qualitative research on the
impact of AIDS/HIV on older people. Such evidence is necessary
to develop effective programmes to support older people as primary
carers of people with AIDS/HIV and their orphans and determine
the risks to older persons of contracting and HIV/AIDS.
— DfID should give attention to rights
based, social development and income generation programmes that
support and target older people's active participation at community
and household level. Development programmes, credit, education
and training schemes that are currently open to other age groups
should be made inclusive of older people.
— In line with the key recommendations
of the recent HelpAge International/HIV/AIDS Alliance policy report;
"Forgotten Families" support should be given to older
carers for direct and indirect school costs of orphans and housing
costs of older people with young dependants.
— Priority needs to be given to targeted
gender sensitive economic and social support to vulnerable older
carers, including counselling, education, condom supply and support
for parenting responsibilities. Priority should be given to programmes
that use older people as educators.
— Support information gathering and
governmental/NGO and community level awareness raising of the
risk of HIV infection to older persons and the silent crisis faced
by the many thousands of older persons who are living with the
virus.
— Support and develop gender sensitive
and older people focused peer counselling and education programmes
on coping mechanisms to live with HIV/AIDS.
— Prioritise awareness raising among
medical professionals and health providers on issues faced by
older people coping with AIDS, and the development of strategies
with older people to improve services and older people's access
to them.
— Support awareness raising programmes
amongst younger community members on the economic and psycho-social
impact of HIV/AIDS on older people.
February 2004
6 See "Ageing and Poverty in Kenya", intersectoral
government report for the UN regional workshop on ageing and poverty,
Tanzania, October 2003. Back
7
HAI, "The Ageing and Development Report-Poverty, Independence
and the world's older people", 1999. Back
8
1999 National Population and Housing Census. Back
9
The poverty gap ratio that measures the average distance of the
group or household type from the poverty threshold expenditure
level. Back
10
Study on the structure of employment and income-generating opportunities
for older persons in Machakos and Nairobi by Jane Omalla Nyakecho
et al (2000). Back
11
Elder Abuse in Primary Health Care Services in Kenya in 2001 (HAI). Back
12
Adopted by 159 member states, including Kenya and the UK, at the
Second World Assembly on Ageing, Madrid, April 8-12, 2002. Back
13
See recommendation 1, report of the Regional workshop on ageing
and poverty, The implications for national poverty policies and
achieving the MDGs inEastern and Central Africa, United Nations,
2004. Back
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