Millennium Development Goals

Millennium Development Goals Progress Report for Kenya REPUBLIC OF KENYA 2003 DEVELOP A GLOBAL PARTNERSHIP FOR DEVELOPMENT COMBAT HIV/AIDS, MALARIA...
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Millennium Development Goals Progress Report for Kenya REPUBLIC OF KENYA

2003

DEVELOP A GLOBAL PARTNERSHIP FOR DEVELOPMENT

COMBAT HIV/AIDS, MALARIA AND OTHER DISEASES

IMPROVE MATERNAL HEALTH

PROMOTE GENDER EQUALITY AND EMPOWER WOMEN

ERADICATE EXTREME POVERTY AND HUNGER

ACHIEVE UNIVERSAL PRIMARY EDUCATION

REDUCE CHILD MORTALITY

ENSURE ENVIRONMENTAL SUSTAINABILITY

8

4567

123

under five years of age

proportion of people who suffer from hunger

Current

Reduce child mortality

2015, the under-five mortality rate

Reduce by two-thirds, between 1990 and

Fair

Potentially 2000 76.1%

Proportion of one-year old children immunized against measles

Fair

Fair

Weak

Unlikely

Unlikely

Unlikely

Weak

1998

1999

2002

1997-

Unlikely

70.7

100/1,000

4.1%

2001

Fair

Fair

Fair

Fair

Fair

Weak

Weak

Weak

Infant mortality rate

Under-five mortality rate

national parliament

Proportion of seats held by women in

in the non-agricultural sector

Share of women in wage employment

30.7%

Likely

2000

90.5%

among 15-24 year-olds

Ratio of literate females to males

universities (unlikely)

in all levels of education no later than 2015

public universities (48.8%)

women

polytechnic and public

Primary (potentially),

(89.5%), polytechnic (44.2%),

secondary and tertiary education

2001

Primary (97.3%), secondary

Ratio of girls to boys in primary,

Potentially

secondary education preferably by 2005 and

(70.2%), total (73.6%)

women, men, total

Eliminate gender disparity in primary and

Men (77.6%), women

Literacy rates of 15-24 year-olds –

Potentially

equality and empower

total (80.7%)

Potentially

Lack of data

Unlikely

Probably

Unlikely

Weak

weak but improving, weak)

potentially, unlikely, lack of data)?

State of supportive environment (strong, fair,

Will development goal be achieved (probably,

Promote gender

2000

Boys (78.7%0, girls (82.9%),

who reach grade 5 – boys, girls, total

2001

2000

2000

1997

1997

1997

Year

Proportion of pupils starting grade 1

total (73.7%)

boys, girls, total

boys and girls alike, will be able to complete

a full course of primary schooling

Boys (72.7%0, girls (74.8%),

Net enrolment in primary education –

Ensure that, by 2015, children everywhere,

primary education

Achievement

Achieve universal

consumption

minimum level of dietary energy

Proportion of the population below

Prevalence of underweight in children

Halve, between 1990 and 2015, the

21.2%

6.1%

Share of the poorest quintile in national consumption

18.7%

52.3%

Poverty gap ratio

below $1 per day

proportion of people whose income is less

than one dollar a day

The proportion of the population

Halve, between 1990 and 2015, the

Indicators

poverty and hunger

Target

Eradicate extreme

Goal

MDGs Status at a Glance

Strong

Strong

Strong

Strong

Fair

Strong

Strong

validate survey data)

Fair (require objective testing to

Strong

Weak

Weak

Strong

Strong

Strong

Strong

(strong, fair, weak)

Monitoring capacity

year-old pregnant women

the spread of HIV/AIDS

malaria and other

maintain biological diversity The proportion of population with sustainable access to an improved water source Proportion of population with access to improved sanitation

Halve, by 2015, the proportion of people

without sustainable access to safe drinking

water

Have achieved, by 2020, significant

improvement in the lives of at least 100

Unemployment rate of 15 to 24-year-

and productive work for youth

partnership for

subscribers per 1,000 population

available the benefits of new technologies,

especially information and communication

Telephone lines and cellular

In cooperation with the private sector, make

olds for each sex and total

to secure tenure, owned or rented

develop and implement strategies for decent

development

Proportion of population with access

In cooperation with developing countries,

Develop a global

million slum dwellers

Proportion of land area protected to

Change in land area covered by forest

environmental resources

development into country policies and

programmes and reverse the loss of

Integrate the principles of sustainable

sustainability

treatment short course (dots)

cured under directly observed

Proportion of TB cases detected and

with tuberculosis

Prevalence and death rates associated

prevention and treatment measures

risk areas using effective malaria

Proportion of population in malaria-

with malaria

diseases

Prevalence and death rates associated

the incidence of malaria and other major

HIV/AIDS

Number of children orphaned by

prevalence rate

Condom use rate of the contraceptive

Have halted by 2015, and begun to reverse

Ensure environmental

diseases

HIV prevalence among 15- to 24-

Have halted by 2015 and begun to reverse

Combat HIV/AIDS,

skilled health personnel

Proportion of births attended by

2015, the maternal mortality ratio

health

Maternal mortality ratio

Reduce by three-quarters, between 1990 and

Improve maternal

81.1%

48%

1.3%

44.3%

590/100,000

2000

2000

1998

1998

1998

Potentially

Unlikely

Potentially

Unlikely

Potentially

Potentially

Potentially

Potentially

Potentially

Potentially

Unlikely

Unlikely

Weak

Weak

Fair

Weak

Strong

Strong

Fair

Fair

Fair

Strong

Weak

Weak

Fair

Fair

Strong

Strong

Fair

Fair

Fair

Fair

Fair

Strong

Weak

Weak

The Role of the UN Country Team in Kenya Since Kenya gained independence in 1963, the United Nations has maintained a close partnership with its people and Government. The UN works hard in Kenya, wherever one of its agencies has the comparative expertise, or capabilities, that are needed to establish capacity in one of its respective areas of competence. The work ranges from social and economic development, including education, health, water, to governance, to human rights, to gender issues, to the management or prevention of disasters. In 1998, the combined direct and indirect benefits of the UN agencies to Kenya amounted to more than $350 million or 19% of exports, second only to tea as a source of foreign exchange and equivalent to 3 per cent of Gross National Product. (UNDAF, 2004-2008) The UN system in Kenya is composed of the following funds, programmes as well as specialized agencies: FAO, ICAO, IFC, ILO, IMF, IMO, IOM, UNAIDS, UNDP, UNEP, UNESCO, UNFPA, UN-HABITAT, UNHCR, UNIC, UNICEF, UNIDO, UNIFEM, UNOCHA, UNODC, UNON, UNOPS, WFP, WHO, World Bank, WMO

This document has been prepared by the Government of Kenya and the United Nations Kenya Country Team in consultation with Civil Society Organizations, the private sector and other development partners. The UNDP Kenya Country Office facilitated the process. The analysis, conclusions and recommendations of the report reflect such consultations. Excerpts from this publication may be reproduced without authorization on condition that the source is indicated.

Published by:

The Government of Kenya

The United Nations, Kenya

Ministry of Planning and National

UN Complex, Gigiri, Nairobi

Development

Block Q - Room 315

P.O. Box 30005 - 00100 Nairobi

P.O. Box 30218 - 00100 Nairobi

Tel: 254-(0)20-338111

Tel: 254-(0)20-624469

Fax: 254-(0)20-218475

Fax: 254-(0)20-624463

E-mail: [email protected]

E-mail: [email protected]

Web-site: www.kenya.go.ke

Web-site: www.un-kenya.org

REPUBLIC OF KENYA

Design and layout: APHRC, Michael Jones Software Photos courtesy: UNICEF, UNDP, UNEP, APHRC.

Foreword

2

Acknowledgements

3

List of Acronyms

4

Introduction

5

Kenya: Development Context

8

Goal 1:

Eradicate Extreme Poverty and Hunger

10

Goal 2:

Achieve Universal Primary Education

13

Goal 3:

Promote Gender Equality and Empower Women

15

Goal 4:

Reduce Child Mortality

18

Goal 5:

Improve Maternal Health

21

Goal 6:

Combat HIV/AIDS, Malaria and Other Diseases

24

Goal 7:

Ensure Environmental Sustainability

29

Goal 8:

Develop a Global Partnership for Development

33

Conclusion

35

References

36

Administrative Map of Kenya

38

Kenya MDGs Progress Report 2003

TABLE OF CONTENTS

1

FOREWORD his is the inaugural Millennium Development Goals (MDGs) progress report for Kenya and presents a simple message: reducing poverty and advancing human development is the priority agenda for the Kenya Government today.

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The Kenya Government endorsed the Millennium Declaration at the Millennium Summit in September 2000. The then Kenyan President was among the 147 Heads of State and Government that adopted the Millennium Declaration. With this, they set themselves a limited number of achievable goals to be reached by the year 2015, foremost of which is to halve the proportion of the world’s people who are absolutely poor. Accordingly, the entire UN family of member states, international organizations, funds, programmes and specialized agencies have joined together to fight poverty and improve people’s lives. This is precisely the mission of the UN family and other development partners in Kenya. The report makes an assessment of Kenya’s performance in relation to each of the eight MDGs, identifies where problems are, analyzes what needs to be done to reverse the problems and offers concrete proposals on priority actions to accelerate progress towards achieving the goals. In doing so, it provides a persuasive argument for why there is now a renewed hope that the goals can be met: indeed, the entry of the new National Rainbow Coalition (NARC) Government, following the December 2002 general elections in Kenya ushers in a new commitment to reduce poverty, create jobs, improve access to education and health care, fight crime and root out corruption.

Kenya MDGs Progress Report 2003

It is the dawn of a new compact – a compact that puts responsibilities on both sides: the government to move boldly and institute reforms and on the Kenyan people to step forward and support those efforts by re-dedicating themselves to a nation of Working People – a key message of the new Government. A new political dispensation is in the offing. It is an exciting time for Kenya and expectations are high. The challenge is to keep the promises made and help Kenyans achieve their aspirations.

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The MDGs represent a departure from past approaches in addressing poverty. By focusing attention on a core set of inter-related goals and targets, development partners will now more easily track progress and measure impact of development interventions. The MDGs provide us with an opportunity to mobilize partners into action, forge new alliances for development and build national capacity for monitoring and periodic reporting. As a tool for awareness raising, advocacy and policy dialogue, this report will be useful for the general public, civil society, the media as well as politicians and decision-makers in the country.

_______________________________

________________________________

Hon. Prof. Peter Anyang’ Nyong’o

Mr. Paul Andre de la Porte

Minister for Planning and National Development Government of the Republic of Kenya

Resident Coordinator United Nations, Kenya

ACKNOWLEDGEMENTS

his first Millennium Development Goals progress report for Kenya has been

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prepared by the Government of Kenya and the United Nations Country Team in Kenya under the leadership of the UNDP Kenya Country Office. The

consultation process leading up to the report was led by a national stakeholder task force convened by the PRSP Secretariat, Ministry of Planning and National Development and involved many partners drawn from the Government, UN agencies, Civil Society Organizations and the Private Sector. The initial draft was compiled by Mr. John Mukui and was subjected to technical and stakeholder review and validation in a number of forums. The information and statistics used in the report were provided by the Central Bureau of Statistics, various government technical departments, UN agencies, the World Bank and other partners. A number of these partners also participated in a validation workshop held on 29 April 2003. This support and contribution is duly acknowledged. The finalization of this report has been facilitated by the African Population and Health Research Center (APHRC), an international NGO with its headquarters in Nairobi, Kenya. Finally we wish to express appreciation for the many valuable

Kenya MDGs Progress Report 2003

contributions of UN staff and line ministries in editing and proof reading the report.

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LIST OF ACRONYMS AIDS

Acquired Immune Deficiency Syndrome

MICS

Multiple Indicator Cluster Survey

ARVs

Anti-Retrovirals

MP

Member of Parliament

CBS

Central Bureau of Statistics

MTEF

CCA

Common Country Assessment

Medium Term Expenditure Framework

CPR

Contraceptive Prevalence Rate

NACC

National Aids Control Council

CSO

Civil Society Organizations

NARC

National Rainbow Coalition

FAO

FGM

Female Genital Mutilation

GoK

Government of Kenya

HDI

Human Development Index

HDR

Human Development Report

HIPC

Highly Indebted Poor Countries

HIV

Human Immuno-deficiency Virus

IMCI

Integrated Material Child Illnesses

IMR

Infant Mortality Rate

ITN

Insecticide Treated Net

KCSE

Kenya Certificate of Secondary Education

JICC

Joint Inter-Agency Coordinating Committee

KDHS

Kenya Demographic and Health Survey

Kenya MDGs Progress Report 2003

KEPI

4

Food and Agriculture Organization of the United Nations

Kenya Expanded Programme on Immunization

KHDR

Kenya Human Development Report

KHPF

Kenya Health Policy Framework

MDG

Millennium Development Goals

MMR

Maternal Mortality Ratio

MOH

Ministry of Health

NASCOP National AIDS/STD Control Programme NEMA

National Environment Management Authority

NEPAD

New Partnership for Africa’s Development

NGO

Non-Governmental Organization

PEM

Protein-Energy Malnutrition

PRSP

Poverty Reduction Strategy Paper

STI

Sexually Transmitted Infection

TB

Tuberculosis

TBA

Traditional Birth Attendant

TFR

Total Fertility Rate

U5MR

Under-Five Mortality Rate

UNAIDS Joint United Nations Programme on AIDS UNDP

United Nations Development Programme

UNDAF United Nations Development Assistance Framework UNICEF

United Nations Children’s Fund

UPE

Universal Primary Education

VCT

Voluntary Counselling and Testing

WHO

World Health Organization

WMSES Welfare Monitoring Survey and Evaluation System

INTRODUCTION

I

Halving extreme poverty and hunger Achieving universal primary education Promoting gender equality Reducing under-five mortality by two-thirds Reducing maternal mortality by three quarters Reversing the spread of HIV/AIDS, malaria and TB Ensuring environmental sustainability Developing a global partnership for development, with targets for aid, trade and debt relief Through the Millennium Summit, the General Assembly gave the SecretaryGeneral and the UN system the important mandate of supporting national governments in implementing the Declaration. Accordingly, the entire United Nations family of Member States, international organizations,

The MDGs are hinged on two main principles: First, national ownership, where the processes and products for monitoring progress towards the MDGs must be nationally-driven and inspired. Secondly, capacity development, where priority will be accorded to investments in capacity building for monitoring as well as the use of data for informed policy-making and programming. The Kenya Government’s commitment to the Millennium Declaration was underlined by high-level participation in the Summit. The Government in collaboration with partners is therefore expected to play a crucial role in facilitating realization of the goals set in the Declaration.

MDGs and Links with Other National Planning Tools and Frameworks The MDGs will build on, and contribute to, on-going national frameworks, initiatives and processes such as the Poverty Reduction Strategy Paper (PRSP); the new government’s Economic Recovery Strategy for wealth and Employment Creation; the UN's Common Country Assessment (CCA) and UN Development Assistance Framework (UNDAF), as well as the frameworks of other development partners. These different frameworks provide a mechanism for monitoring progress towards attainment of the MDGs. The MDGs are also closely linked to the New Partnership for Africa Development (NEPAD): indeed the Government of Kenya is committed to the principles of the NEPAD and has already set up an office within the Ministry of Planning and National Development to focus specifically on NEPAD. The location of NEPAD within the ministry, where MDG activities are also centered, demonstrates the government’s commitment to integrate

Kenya MDGs Progress Report 2003

n September 2000, all the 191 Member States of the United Nations adopted the Millennium Declaration (GA Resolution A/54/2000) which outlined measures necessary to attain peace, security and development. This was further elaborated in the subsequent UN Secretary-General's Report entitled "A Road Map Towards the Implementation of the UN Millennium Declaration" (GA Resolution A/56/326). The Millennium Declaration, among other things, mainstreamed a set of inter-connected and mutually reinforcing goals into the global agenda. In subsequent meetings, an agreement was reached among the UN, OECD/DAC, World Bank and the International Monetary Fund (IMF) on key elements of a framework of this global agenda in the context of goals, targets and indicators, collectively referred to as the Millennium Development Goals (MDGs). The MDGs comprise ambitious global targets set for 2015 as follows:

funds, agencies, programs, the private sector and civil society have an obligation to ensure achievement of the goals set in the Millennium Declaration and MDG targets.

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development priorities into NEPAD, particularly in linking NEPAD to the national planning, poverty reduction and economic recovery process. In the context of UNDAF, the UN Kenya Country Team has agreed on its program priorities for the period 200408. The four areas of co-operation, which are closely linked to the MDGs, are as follows: 1. Promote and contribute to good governance and realization of rights; 2. Contribute to the reduction of incidence and mitigation of the social economic impact of HIV/AIDS, Malaria & TB; 3. Contribute to the strengthening of national and local systems for emergency preparedness, prevention, response and mitigation; and 4. Contribute to sustainable livelihoods and environment.

Launch of the MDGs Campaign in Kenya An MDG campaign was initiated in Kenya to raise awareness on the importance of different dimensions of development. A national MDGs taskforce, comprising Ministry of Planning and National Development, the UN system, NGOs, and the private sector was created to spearhead the process.

Kenya MDGs Progress Report 2003

Various activities have preceded the production of this report. These include sensitization workshops with NGOs, media briefings and technical seminars.

Action Aid Kenya together with the National Council of NGOs spearheaded the NGOs campaign. The main objective of these activities was to seek consensus and promote understanding of the significance of the MDGs, their links to the national planning frameworks, and mode and frequency of country level reporting.

Organization of the Report This report is organized according to the format developed by the UN Development Group Office (UNDGO) for Country Reports. The first section outlines the overall development context in broad terms. The eight successive sections assess the country’s progress towards the attainment of each of the MDGs. Each section deals with status and trends, challenges, programming environment, recommendations and the monitoring environment. Trends are based on information at three points in time, where possible: 1990, 2000 and 2015. Whenever data is not available for 1990 or 2000, the estimates cited refer to years closest to the two points of time. The year of data reference is indicated in the tables. For 2015, estimates are obtained by applying a simple extrapolation and trend analysis using the 1990 baseline.

Analytical Framework Some MDG goals and targets directly focus on policy e.g. basic education, literacy, gender parity in education, child immunization, access to sanitation facilities, and access to safe water. A second set of goals and targets are outcomes rather than specific targets of policy e.g. poverty indicators such as underweight in children and child mortality rates. A third set of goals and targets can be achieved through a change in attitudes e.g. HIV/AIDS, contraceptive use, and the share of elected women members of parliament. As such the goals are analyzed using different methods. Achieving universal primary education is one of MDGs global targets for 2015. Pic: UNICEF

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The analysis in the third group of goals and targets is complemented by information on attitudes (e.g. on contraceptive use), and knowledge and misconceptions (e.g. HIV/AIDS). HIV/AIDS is a special problem because it impacts on poverty, child mortality, education, and incidence of opportunistic diseases. It is important to note that contraceptive use only refers to condom use as it is assumed that the condom is the only form of contraception that is effective in reducing the spread of HIV. A fourth set of goals and targets are interactive. For example, HIV/AIDS demobilizes immunity against TB. For this reason, the indicators will be analyzed jointly. Overall, however, most of the goals are inter-related and rely on each other for their realization. For example, time spent collecting water (G7) reduces time available for schooling (G2). Finally, some of the indicators are ranked by province. This will assist to develop hypothesis on possible causes and interactions between various indicators. It will also allow for the postulation of linkages in different geographical areas. The idea is to develop a possible set of policy prescriptions to address the achievement of the MDGs in an operational context.

Assessment of the Monitoring Environment The standards used in this report are similar to those used by other country reports. Data gathering capacity is considered “strong” if there is capacity for periodic, regular and endogenous collection of nationally representative data with respect to the MDGs; “weak” if these capacity is lacking and “fair” if inadequate. Quality of recent survey information is “strong” if the most recent data set is evaluated to be valid, reliable, replicable and in consonance with recent allied data sets and trends; “weak” if there is no recent data and “fair” if gaps exist. Statistical tracking capacity is considered “strong” if there is a fairly long standing mechanism, already implemented in at least two episodes, to collect relevant information and to process it in a preliminary manner; “weak” if no mechanism exists and “fair” if this has been done in at least one episode. Statistical analysis capacity is rated “strong” if there is a fairly long standing mechanism, already implemented in at least two episodes, to analyze information and to engage in a multivariable analysis in a sustained manner; “weak” if no mechanism exists and “fair” if this has been done in at least one episode. Capacity to incorporate statistical analysis into policy planning and resource allocation mechanism is rated “strong” if new information and analysis is systematically fed into policy making, planning and resource allocation; “weak” if this does not happen and “fair” if this happens irregularly. Monitoring and evaluation mechanism is rated to be “strong” if a tradition of systematic, information-based review and replanning is a constituent component within a program; “weak” if this tradition is lacking and “fair” if it is inadequate.

Kenya MDGs Progress Report 2003

The analysis of goals and targets that can be specific targets of government policy focuses on the overall trends as a likely indication of the ability to meet the MDGs targets. The analysis of the goals and targets that are largely outcomes rather than specific targets of government policy are supplemented by trend analysis and a brief statement of the contributory factors that are likely to be responsible for the specific outcomes. For example, maternal mortality is dependent on a host of process indicators (e.g. proportion of births attended to by skilled health personnel) and the user rate of the process indicator (including quality and access to such a service) is a more pertinent focus of government policy than the MDG goal itself.

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KENYA: DEVELOPMENT CONTEXT The Political and Socio-economic Situation enya became a multiparty state in 1991. The then ruling party won the two subsequent general elections in 1992 and 1997. However, in December 2002, a coalition of opposition parties, the National Rainbow Coalition, NARC, won the elections, ushering in a new administration which has vowed to rid the country of poor governance. There is now renewed hope that good governance will be restored, relationships with bilateral and multilateral donors will improve leading to increased inflows in development aid and a fresh start towards economic recovery. The government has recently launched the Economic Recovery Strategy for Wealth and Employment Creation, 2003-2007, in the context of Vision 2025.

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Kenya MDGs Progress Report 2003

Kenya’s economy performed remarkably well in the 1960s and early 1970s, registering an average of 6.6% annual growth in GDP during 1964-73. This growth was, however, not sustained mainly due to exogenous factors. During 1974-79, the growth

rate declined to 5.2%, dropping even further to 4.1% over1980-89 and down to 2.5% in 1990-95. The annual growth in GDP has continued to decline. Some of the reasons behind poor economic performance in the recent past include reduced investor confidence, poor governance, institutionalized corruption, poor infrastructure, reduced inflows of donor assistance, and unfavorable weather conditions. Due to economic mismanagement, poor governance and financial infractions, the donor community, including the Bretton Woods Institutions, suspended assistance to the country. The exclusion of donor support from the government budget proposals has continued to adversely affect Kenya's economic performance. The current political and economic situation looks very promising with the new government that has a vision to "work together with all Kenyans to bring about effective economic reforms and growth". In the spirit of the new Economic Recovery Strategy for Wealth and Employment Creation, the Government has pledged to revitalize the country's economy by streamlining economic and financial management as well as harmonizing the mechanisms for implementation. Development partners have an opportunity to support these efforts particularly by strengthening key governance institutions and establishing a rights based approach to development; entrenching a culture of openness, transparency and accountability; enhancing access to basic and quality social services; protecting the environment and promoting sustainable livelihoods. The current situation looks very promising with the new government that has a vision to work together with all Kenyans for effective reforms and growth. Pic: UNICEF

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Donors are expected to resume aid after several governance-related bills, passed in parliament take legal effect.

Demographic and Poverty Situation Kenya has a population of 28.7 million people according to the 1999 national census and is projected to have grown to 31 million in 2002, about 75% to 80% of whom live in the rural areas. The population distribution varies from 230 persons per square kilometres in high potential areas to 3 persons per square kilometres in arid areas. Only about 18% of the land area is high to medium potential agricultural land, and supports 80% of the population. The remaining 20% of the population lives in the remaining 80% of the land which is arid and semi-arid. Over 50% of the population is below 15 years. The intercensal population growth rate has declined from 3.9% per annum during 1969-79 to 2.9% during 1989-99.

line averaged 50%. During the same period, investments in water resource management have shrunk significantly, thereby reducing the ability to increase the percentage of the population with access to potable water. There has also been pressure on environmental goods and services (mainly forest cover), which threatens the sustainability of the little economic growth reported during the period. In the area of health and nutrition, there has been a general decline in the provision of health services. Infant and under-five mortality rates have been on the rise. The HIV/AIDS pandemic has compounded the deteriorating health standards, in some instances reversing the earlier gains. In its wake, the pandemic has caused a steep rise in the number of orphans, growing destitution, and unprecedented levels of poverty.

During the nineties, the proportion of the population living below the poverty

Indicator

Value

Year

28.7

1999

Population growth rate (%)

2.9

1999

Life expectancy at birth (yrs)

46.4

2003

GNP per capita (US $)

1.022

2000

Human Development Index (value)

0.489

2001

146

2001

56

1997

10.1

2002

55

2000

32.5

1999

83

2003

Net enrolment rate in primary education (%)

73.3

2000

Ratio of girls to boys in primary education (%)

74.8

2000

Under-five mortality rate (per 1,000 live births)

100

1999

Maternal mortality rate (per 100,000 live births)

590

1998

Population size (M)

Human Development Index (rank) Percentage of Population below national poverty line Prevalence of HIV/AIDS in adult population aged 15-49 (%) Population without access to drinking water supply (%) Percentage of underweight under-five children Adult literacy rate (%)

Kenya MDGs Progress Report 2003

Key Socio-Economic Indicators

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GOAL 1 ERADICATE EXTREME POVERTY AND HUNGER Target 1: Halve, between 1990 and 2015, the proportion of people whose income is less than 1 dollar a day. The indicators are 1. Proportion of people living on less than $1 per day, 2. Poverty gap ratio (incidence x depth of poverty), and 3. Share of the poorest quintile (20%) in national consumption. Indicator The proportion of people below $1 per day Share of the poorest quintile in national consumption

1990

Year 2000

2015

43.3

51.8

21.7

4.8

4.8

9.6

SOURCE: Welfare Monitoring Survey 1992 & 1994; Population & Housing Census 1999

Status and Trends The Proportion of the Population Below the Poverty Line he proportion of Kenyans living under the poverty line is on the increase with the urban population accounting for the highest proportion of this increment. Between 1982 and 1994, the percentage below the poverty line stagnated at about 47 percent in the rural areas. The current national estimates (2002) are 56 percent. Of great concern is the dramatic increase of the population living under the poverty line in urban areas, as illustrated by a near 90 percent increase between 1994 and 1997. The percentage of people below poverty line is projected to increase to 65.9 percent in 2015 if the current trend continues. Kenya MDGs Progress Report 2003

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The poverty line adopted in Kenya is US$17 and US$36 per month per adult in the rural and urban areas respectively. Behind these increases are a number of factors including primarily low economic growth from 1994 that culminated into a 0.3 per cent contraction in 2000, inflation and rise in consumer prices. Bad governance, inefficient use of public resources, corruption and structural adjustment programs have significantly contributed to the poor economic performance.

Kenya is ranked among the top ten low income economies with a high concentration of income amongst its highest earners (10 percent controlling 35 percent of national income). The share of consumption of the lowest income quintile rose from 4.9 percent to 6.0 percent, while that of the highest income quintile dropped from 56.9 percent to 47.9 percent between 1982 and 1997. The gap between the quintiles is expected to narrow by 2015 but it will still be wide.

CHALLENGES Poverty remains a major impediment to fulfillment of basic needs of Kenyans especially women and children. On the one hand, the high incidence of poverty has greatly undermined the government’s ability to address the pressing needs in such critical sectors as primary healthcare, nutrition, and basic education. On the other hand, poor health and malnutrition serve to entrench poverty due to low productivity. Hence, only a rapid economic growth can lift the country out of this vicious circle of poverty. Governance, corruption, and inefficient use of public resources still remain critical barriers to the achievement of the national targets of poverty reduction. Full and effective implementation of the Food Policy, especially in regions that are prone to perennial drought and starvation. Level of agricultural production and food storage unable to cushion the country during lean seasons.

Eradicating Extreme Poverty: Monitoring and Evaluation Environment Elements of Monitoring Environment

Assessment

Data-gathering capacities

Fair

Statistical tracking capacities

Fair

Statistical analysis capacities

Weak

Capacity to incorporate statistical analysis into policy planning & resource allocation mechanisms

Fair

Monitoring and evaluation mechanisms

Fair

Target two: Halve the proportion of people who suffer from hunger between 1990 and 2015 The indicators are: 4. Prevalence of underweight in children under five years of age, and 5. Proportion of the population below minimum level of dietary energy consumption.

Protein energy malnutrition in Children Under Five Years of Age The indicators of child Protein-Energy Malnutrition (PEM) are (a) underweight (weight-for-age), (b) stunting (heightfor-age), and (c) wasting (weight-forheight). Based on extrapolation from the KDHS surveys, the underweight, stunting and wasting in under-fives was 32.5 percent, 6.2 percent, and 22.5 percent, respectively in 1990. By 2015, this is projected to decrease to about 16.3 percent, 3.1 percent and 11.1 percent, respectively.

PROGRAMMING ENVIRONMENT he government has demonstrated its commitment to reducing the unacceptable high levels of poverty and consequently starvation and hunger through various initiatives:

T

The National Poverty Eradication Plan (NPEP), seeks to strengthen the capabilities of the poor and vulnerable groups. The Poverty Reduction Strategy Paper, 2001, based on the principle of broadbased development, is a consultative process aimed at reducing poverty and links the national budgeting process through the Medium Term Expenditure Framework (MTEF). To address the basic causes of malnutrition, Kenya developed a National Food Policy with the objective of improving food security at the household and national levels. The school feeding program, targeting children in arid and semi-arid areas, has not only supplemented dietary needs of those children but improved their participation and performance in schools.

Indicator 1990

Year 2000

2015

32.52

33.12

16.26

6.17

6.60

3.09

22.50

22.10

11.05

Prevalence of underweight (weight-for-age) in children under five years of age Prevalence of stunting (height-for-age) in children under five years of age Prevalence of wasting (weight-for-height) in children under five years of age

Kenya MDGs Progress Report 2003

The Government has launched Economic Recovery Strategy for Wealth and Employment Creation, 2003 - 2007 to focus attention on specific. deliverable poverty reduction targets.

SOURCE: KDHS 1989, 1993 & 1998

11

Under-five Malnutrition: Monitoring and Evaluation Environment Elements of Monitoring Environment

Assessment

Data-gathering capacities

Weak

Statistical tracking capacities

Weak

Statistical analysis capacities

Weak

Capacity to incorporate statistical analysis into policy planning & resource allocation mechanisms Monitoring and evaluation mechanisms

Proportion Below Minimum Energy Consumption Rural food-poor households, those that spend less on food than what could guarantee a minimum level of dietary consumption, were estimated at 71.8% in 1992, 47.2% in 1994 and 50.7% in 1997. The levels among the urban foodpoor were estimated at 42.6% in 1992, 29.2% in 1994 and 38.3% in 1997. It is important to note that in 1997, there were unfavourable weather conditions that caused a shortfall in agricultural output. Findings from the Food and Agriculture Organization (FAO) show that a big proportion of the population cannot meet the minimum dietary requirements. Over the period 19902000, the aggregate supply of proteins

Fair Weak

per capita per day remained at around 50 grams while that of fats remained at around 45 units. The per capita calorie supply average of 1,924 during 1990 – 2000 is less than the required daily allowance (RDA) of 2,250 calories per day.

RECOMMENDATIONS The government should implement the strategies outlined in the NPEP, PRSP and Economic Recovery Strategy that aim at poverty reduction. Focus should be placed on reversing the poverty trends and its impact amongst the poorer segments of the society. Although the government has stated its commitment to dealing with corruption, mismanagement of national resources among other ills, there is need for more political will and practical action to root out these vices.

Kenya MDGs Progress Report 2003

Investment in agricultural production and access to food storage facilities is recommended. The post-harvest handling warehousing receipt system should be improved to encourage agricultural production. Implementation of the strategies outlined in the Economic Recovery Strategy for Wealth and Employment Creation, in particular, strengthening the National Productivity Centre as a way of nurturing and promoting a productivity culture and mind-set among Kenyans

Findings show that a big proportion of the population cannot meet the minimum dietary requirements Pic: UNICEF

12

GOAL 2 ACHIEVE UNIVERSAL PRIMARY EDUCATION Target 3: Ensure that, by 2015, children everywhere, boys and girls alike, will be able to complete a full course of primary schooling The indicators are: 6. Net enrolment ratio in primary education, 7. Proportion of pupils starting grade 1 who reach grade 5, and 8. Literacy rate of 15-24 year olds. Year 1990

2000

2015

Net enrolment rate in primary education 80.0

73.7

100

Proportion of pupils starting grade 1 63 who reach grade 5 (1986)

81 (2001)

100

SOURCE: MICS 2000, CBS 2001

Status and Trends he national net enrolment rate in Kenya has been declining. It has deteriorated from 80% in 1990 to 74% (MICS 2000). This is likely reverse as the Government of Kenya has introduced free primary education, and it is likely that the goal of universal primary education will be achieved by the year 2015.

T

Current and recent unsatisfactory performances of the primary school system are often linked to Kenya’s previous cost-sharing policy and differential geographic access to educational facilities (Central Bureau of Statistics, 2001). To these factors, the 2002-2008 National Development Plan adds staffing problems and mismanagement of education resources. Budget allocation for primary education declined by 9% between 2000/2001 and 2001/2002, but primary schools still constitute more than half of Kenya’s educational institutions (Central Bureau of Statistics, 2002). Primary school enrolment is still characterized by sharp regional disparities. The highest net enrolment rate reported by the 2000 MICS was 83% for Central and 75% for Nyanza, while the lowest were reported in Coast

CHALLENGES he NARC government’s policy of free primary education in Kenya will substantially contribute to meeting the MDG goal of universal access to primary schooling by the year 2015. Major challenges facing the education sector relate to its financing, regional disparities in access, high wastage rates, relevance and quality, and reducing child labour. Specific challenges include:

T

The infrastructure expansion and human resources implications of the free primary education policy are immense. Although the World Bank and other donors have already made commitments towards its support, resource mobilization (including teacher training) by the Kenya Government remains a challenge. Low rates of primary school enrolment in North Eastern Province, closely linked to the nomadic lifestyle of its local populations. High wastage, repetition and drop-out rates; low transition, all exacerbated by the rising poverty and HIV/AIDS epidemic. The provision of adequate learning facilities at the primary school level, including equipment and human resource capacity, impedes the quality and relevance of the imparted skills to pupils. Child labour has been identified as one of the factors explaining declining enrolment rates in primary school in Kenya (Central Bureau of Statistics, 2001). Inadequate provision of education to children with disabilities owing to the weak identification and assessment mechanisms.

Kenya MDGs Progress Report 2003

Indicator

13

Under-five Malnutrition: Monitoring and Evaluation Environment Elements of Monitoring Environment Data-gathering capacities

Strong

Statistical tracking capacities

Weak

Statistical analysis capacities

Weak

Capacity to incorporate statistical analysis into policy planning & resource allocation mechanisms

Fair

Monitoring and evaluation mechanisms

Fair

(57%), and North Eastern – urban (60%). The rural and urban net enrolment rates were almost identical. During 1986-2001, the proportion of pupils who were in Standard One who reached Standard Five rose from 63% to 81%. The 2000 MICS showed that 89% who enter grade 1 reach grade 5. The highest were recorded in Nairobi (97%),

PROGRAMMING ENVIRONMENT o far the Government has invested substantial efforts aimed at closing the educational achievement gaps between regions and economic classes, especially with declaration of free primary education. Four key programs/activities need to be mentioned, namely:

S

The Children’s Bill, passed into an Act of Parliament in 2002, provides the framework for enforcing universal primary education in the country,

Kenya MDGs Progress Report 2003

followed by Rift Valley (92%), Central (91%), Eastern (89%), Nyanza (88%), Western (82%), and Coast (82%). North Eastern province recorded 90% but the survey only covered urban clusters.

RECOMMENDATIONS Several reforms of the education sector are under way in Kenya. Over the next five years, these will focus on strengthening the free primary education policy, governance and management, curriculum review and development, and staffing arrangements. In addition, achieving universal primary education (UPE) by the year 2015 will require pursuing already existing programmes, especially the textbook and bursary funds and the school feeding programmes. It will also be heavily dependent on the implementation of the Children’s Act in its entirety.

The Textbooks Fund which is a cushion for poor parents from the costs of learning materials; and

Reaching out to communities and sensitizing them on cultural and other practices that hinder school enrolment and retention. Many of these efforts may be supported by enhancing partnership between stakeholders involved in the provision of primary education.

The Bursary Fund, an initiative aimed at improving the transition rates from primary by helping poor students meet some of the costs related to secondary school attendance.

Provision of an all-inclusive education by modifying existing facilities to accommodate children with disabilities as well as training of special education teachers.

The School Feeding Programme which targets mainly the poverty-stricken Arid and Semi-Arid Lands (ASAL);

14

Assessment

GOAL 3 PROMOTE GENDER EQUALITY AND EMPOWER WOMEN Target 4: Eliminate gender disparity in primary and secondary education preferably by 2005 and in all levels of education no later than 2015

Gender disparity in enrolment at various levels, 2000

The indicators are: 9. Ratio of girls to boys in primary, secondary and tertiary education 10. Ratio of literate females to males of 15-24 year olds 11. Share of women in wage employment in non-agricultural sector 12 Proportion of seats held by women in national parliament

Status and Trends he enrolment, retention, completion and progression rates for boys and girls at primary and secondary levels are almost equal in Kenya. The ratio of girls to boys in the primary education cycle during the 1990-2001 period increased from 94.9% to 97.3%. The ratio of girls to boys in secondary school education cycle increased from 74.9% to 89.5%. There is however need to address general enrolment in North Eastern and Nairobi and to focus on gender imbalance in North Eastern Province and Coast where relatively fewer girls enroll in schools.

T

The trends generally show that Kenya is capable of achieving the target on primary and secondary education but the main problem in enrolment is in post secondary tertiary educational Primary School Gross Enrolment Rate by Province and Sex

SOURCE: CBS, 2001

institutions. The ratio of enrolment of girls to boys in tertiary institutions continues to be low although it has recorded some improvement. Enrolment into university improved from 36.1% in 1995 to 48.8% in 2001/02 in the public universities.

CHALLENGES he Government has to address several issues to effectively address gender disparities and thereby promote gender equality and the empowerment of women:

T

Although female to male ratio in primary and secondary school is almost equal, there is a major gap in enrolment in tertiary institutions. To address these disparities, special attention should be paid to improving girls’ performance in science and technical subjects and targeting community and householdbased impediments. The failure to satisfactorily inculcate a modern scientific culture and to equip learners with adequate social skills and values to enhance their performance in the labour market is also a critical factor. It is important for the regional variations in literacy levels to be addressed if the government is to achieve 100% equity between males and females. The involvement of women in positions of decision making both in government and private institutions still remains a big problem yet for effective promotion of gender equality, more women need to occupy such positions.

Kenya MDGs Progress Report 2003

Sex Ratio in Primary, Secondary and Tertiary Education

SOURCE: CBS, 2001

15

Ratio of Literate Females to Males 15-24 years old Literacy ratio for females to males increased from 81.3% in 1989 to 90.5% in 2000. However, these national figures, similar to the gross enrolment, tend to camouflage regional variations that pose a challenge to the national achievements. Although there have been improvements in overall literacy for both males and females and a narrowing of the gap between them, the overall goal of closing the gender literacy gap will not be achieved without focusing attention on the underprivileged regions.

Share of Women in Non-agricultural Wage Employment The involvement of women in nonagricultural sector is quite low. The annual Economic Survey data on wage employment in the modern sector for 1999-2001 shows that it was around 30%. A review of data on civil service employees shows that women made up 24.3% in September 2002 with a majority concentrated in the lowest cadre of employment (job group A-D). The number of women in job groups LZ remains low and yet these are the decision-making positions in the civil service. A host of factors at the household level may account for low progression of women to tertiary education

PROGRAMMING ENVIRONMENT

Pic: UNICEF

he Government has committed itself to mainstreaming gender issues in its legislation, policies and programs. It is also a signatory to international conventions and treaties on women’s rights and empowerment.

Kenya MDGs Progress Report 2003

T

16

The enrolment ratio in mid-level tertiary institutions increased from 22.5% in 1998/99 to 44.2% in 2001/2. There are a host of factors at the household levels (such as premarital pregnancy and early marriage) that may determine the low progression of women from secondary to tertiary institutions; however the choice of subjects and the females’ poor performance at the end of secondary school cycle influence their engagement in the job market. Analyzes of performance in KCSE shows that girls normally perform better than boys in languages while boys consistently perform better than girls in all science subjects.

The Government is in the process of implementing UPE which will increase the number of girls enrolled in primary schools. The Children’s Act passed by Parliament in 2002 provides a framework for equal opportunities for boys and girls. As a signatory to the Convention on the Elimination of all Forms of Violence Against Women, the Government is obliged to provide equal opportunities to men and women. The Government has approved the National Gender and Development Policy and a related Sessional Paper is under discussion.

Proportion of Women in National Parliament Kenya continues to perform dismally in the participation of women in politics. Although there has been marginal increases in the number of women members of parliament from a mere 5 in 1990 to 18 in 2002/3, they only comprise 8% of the total parliamentary membership. In terms of leadership positions, only 7 women serve as Government Ministers compared to 44 positions held by men.

Involvement of women in non agricultural sector is quite low. Pic: UNICEF

Gender Equity: Monitoring and Evaluation Environment Elements of Monitoring Environment

Assessment

Data-gathering capacities

Fair

Statistical tracking capacities

Fair

Statistical analysis capacities

Fair

Capacity to incorporate statistical analysis into policy planning & resource allocation mechanisms Monitoring and evaluation mechanisms

Weak Fair

RECOMMENDATIONS

Improve the quality of education, upgrade facilities and equipment, and avail adequate instructional materials. Motivation of teachers is a crucial element in this endeavour. Expand tertiary institutions and increase enrollment of girls, with special emphasis on their performance in science, technical and professional courses. Reach out to communities and sensitize them on the importance of educating girls and voting for women to leadership positions. Implement the National Gender and Development Policy.

Kenya MDGs Progress Report 2003

The Government should address the regional disparities in enrollment and transition along levels and specifically on girls’ enrollment.

17

GOAL 4 REDUCE CHILD MORTALITY Target 5: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate The aim of this goal is to assist in the formulation of child health policy and the evaluation of programs intended to improve the well-being and survival prospects of young children by year 2015. The indicators are: 13. Under-five mortality rate (probability of dying between birth and the fifth birthday per 1,000 live births); 14. Infant mortality rate (probability of dying before the first birthday expressed per 1,000 live births); and 15. Proportion of one-year old children immunized against measles. Indicator

Infant Mortality Rate

Year 1990

2000

2015

Under-five mortality rate

98.9

111.5

33.0

Infant mortality rate

67.7

73.7

-

Measles vaccine (%)

48

76.1

100

SOURCE: KDHS 1998 and MICS 2000

Status and Trends eath rates, especially during childhood and those related to pregnancy and delivery have long been used to evaluate a country’s level of socio-economic development and quality of life. In Kenya, the recent increase in infant mortality is particularly alarming.

D

Kenya MDGs Progress Report 2003

Under-Five Mortality Rate

18

KDHS 1998 estimated the under-five mortality rate at 112 during the period 1993-1998. Today at least 12 percent of children born alive do not reach age five. The high incidence of child nutrition problems, the large number of persons below the poverty line, the HIV/AIDS pandemic, acute respiratory infections, malaria and diarrhoea, the low quality of health facilities and services are some of the causes.

There has been a reduction in infant and child mortality during the period 1960-1990. From more than 190 deaths per 1,000 live births in the 60’s, the under-five mortality rate decreased to less than 100 deaths per 1,000 live births in the 90’s (Ahmad, 2000; KDHS 1989, 1993 and 1998). This substantial reduction was, to a large extent, made possible through the control of malaria, TB, measles, cholera and other highly communicable diseases. The rate of reduction, however, has gradually decelerated and has now reversed. For the last decade, Kenya has experienced an increase in infant and child mortality.

Similar to the under-five mortality, the infant mortality rate decreased during the period 1960-1990 from more than 100 deaths per 1,000 live births to about 60 deaths per 1,000 live births. For the last decade, infant mortality has increased to reach 71 during 19931998. High infant mortality rates are mainly due to high rates of postneonatal deaths (about two thirds of infant deaths).

CHALLENGES Mortality rates have been on the increase. Levels of under-five and infant mortality are higher in 2000 than in 1990. High infant mortality rates are due to high post-neonatal morbidity related to diarrhoea, acute respiratory infections, malaria and other childhood conditions such as malnutrition. Although tremendous progress had been made in reduction of infant and child morbidity and mortality, which is mostly attributed to the significant improvement in the general immunization status of children, the gains made in child health have in recent years been adversely affected by the HIV/AIDS pandemic. Child survival problems, which are worsened by mal-distribution or lack of access to health services, insufficient resources, poor performance of health system; inappropriate reproductive behavior and low status of women.

Wide Geographic Disparity A lot of behavior that determines survival of young children, such as use of health services, is preconditioned by social and economic factors. KDHS 1998 indicate wide disparity of under-five mortality across the regions with low mortality in the central part of the country, that is, Central, Nairobi, Rift Valley and Eastern provinces and high mortality in the Coast, Western and Nyanza provinces.

Neonatal, postneonatal, infant, and under-five mortality rates

Socioeconomic factors determine health-seeking behavior, which

SOURCE: KDHS 1998

affects child survival.

According to the Ministry of Health (Implementation Plan For National Reproductive Health Strategy, 19992003), the leading causes of morbidity and mortality in Kenya are malaria, respiratory and diarrheal diseases among children, complications associated with pregnancy and Level of under-five mortality by province

Pic: UNICEF

PROGRAMMING ENVIRONMENT The Ministry of Health has ensured the development and sustenance of programs that are currently supporting several components of reproductive health. Notable are the Kenya Expanded Programme on Immunization (KEPI); Control of Diarrhoea Diseases and Acute Respiratory Infections (CDD/ARI); Nutrition; STIs/HIV/AIDS and Maternal and Child Health with Family Planning. All these programs have solid foundations, and some have policy guidelines. The NARC Government proposes to initiate a National Social Health Insurance Scheme, which will ensure access to sustainable proper health care.

SOURCE: KDHS 1998

Kenya MDGs Progress Report 2003

Main Causes of High Mortality

19

Under-five Malnutrition: Monitoring and Evaluation Environment Elements of Monitoring Environment Data-gathering capacities

Strong

Statistical tracking capacities

Strong

Statistical analysis capacities

Strong

Capacity to incorporate statistical analysis into policy planning & resource allocation mechanisms

Fair

Monitoring and evaluation mechanisms

Fair

childbirth, road/traffic accidents and infections associated with HIV/AIDS and most recently tuberculosis. Some of the mentioned infections such as malaria and HIV/AIDS, and other conditions, for example malnutrition, further complicate the outcome of pregnancy and child survival. Besides the disease burden, the poor performance of the economy coupled with the demographic pressures, have affected the overall delivery of health services in Kenya. This is reflected in the diminishing per capita allocations for health over the years. For instance, the per capita recurrent expenditure on health was US$9.50 in 1980/81 Financial Year (KHPF, 1994), which has dropped over the years to only US$4.6 for 1998/99 (MOH, 1998/99).

Kenya MDGs Progress Report 2003

Proportion of One-Year Olds Immunized Against Measles

20

Assessment

The concern for measles immunization coverage is premised on two considerations: measles is the last vaccine within the immunization cycle that should ideally end at the age of 9 months; and it is the commonest vaccination-preventable disease. The Kenya Expanded Programme of Immunization (KEPI) was started in 1980. According to the WHO/UNICEF

Review of National Immunization Coverage 1980-1999, the reported coverage levels using administrative data were high in the eighties and early nineties. KDHS 1993 estimated measles vaccine coverage at 84%. However, KDHS 1998 and MICS 2000 indicated a decline in measles vaccine coverage (79% and 76%, respectively). Measles vaccine coverage is particularly low in Western and Nyanza provinces (58% and 68% in 2000, respectively).

RECOMMENDATIONS Reinforce programs that address the main causes of infant and child mortality with particular emphasis on postneonatal mortality diseases (diarrhoea, ARI, malaria, etc.). Increase access to health services for the treatment and management of childhood diseases and conditions. Appropriate management and advocacy on HIV/AIDS at all levels (community, regional and national). Expand immunization coverage generally, with specific focus on measles.

GOAL 5 IMPROVE MATERNAL HEALTH Target 6: Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio The indicators are: 16. Maternal mortality ratio, and 17. Proportion of births attended by skilled health personnel. Proper medical

Indicator

attention can reduce

Year

Maternal mortality ratio Delivery by skilled health personnel

1990

2000

2015

590

-

147

the risk of complications and infections that can cause death or serious

51

41

illness of either the

100

mother or the baby. SOURCE: KDHS 1998 and MICS 2000

Maternal Mortality Ratio t the national level, the maternal mortality ratio (MMR) was 365 maternal deaths per 100,000 live births for the period 1990-1994. However, the figure for Kenya produced by WHO and UNICEF for 1990, using an estimation process, was 670, which was obviously considerably higher. The recent and reliable source of data on maternal mortality was the Kenya Demographic and Health Survey, 1998, using the sisterhood method (verbal autopsy of surviving sisters).

A

The KDHS 1998 estimated the maternal mortality ratio at 590 maternal deaths per 100,000 live births, applicable to the period 1989-1998. We can assume that this MMR applied also to the year 1990. However, Kenya still lacks a current and reliable picture of regional differentials in maternal mortality. The available multiple data sources reveal a high burden of unsafe motherhood in Kenya, with wide regional differentials. However, the usefulness of these data is limited by the small sample of maternal deaths included, though several of them do provide valuable insights into the factors associated with unsafe motherhood in Kenya.

CHALLENGES The maternal mortality ratio is still high in Kenya. To reduce it by two-thirds, between 1990 and 2015, several challenges related to direct obstetric causes should be addressed including hemorrhage, sepsis, complications arising from unsafe/induced abortion, eclampsia and obstructed labor. Indirect obstetric causes such as malaria, anemia, TB and HIV/AIDS will also exacerbate maternal deaths. Adequate maternity services will be critical in the reduction of direct obstetric causes of maternal mortality. Comprehensive needs assessment exercises carried out since 1997 in several districts by MOH and nongovernmental and donor agencies revealed that many of the obstacles to adequate maternity services are associated with the health system as a whole. During this last decade, no improvement has been noted regarding professional assistance during delivery. In fact, most deliveries in Kenya take place at home. This situation is further aggravated by outdated guidelines for delivery at health centers, which prevent primiparous women and those of parity three or more, who have no complicating factors from delivering in these facilities. In a resource-constrained environment, the challenge to policy and program planners is to maintain a balance of focus, and use every opportunity to integrate services within the primary health care.

Kenya MDGs Progress Report 2003

Status and Trends

Pic: UNICEF

21

The determinants of maternal mortality and morbidity in Kenya are multiple and closely interwoven. The direct obstetric causes of maternal deaths are: hemorrhage, sepsis, complications of unsafe/induced abortion, eclampsia and obstructed labor. Unwanted pregnancies, particularly among adolescents often result in unsafe abortions, which account for up to 35% of maternal deaths. Indirect obstetric causes such as malaria, anemia, TB and HIV/AIDS also play a significant role in maternal and child deaths in Kenya. As regards trends in maternal mortality in Kenya, the availability of a national estimate for the first time in 1994 and 1998 for a similar reference period means that changes over time cannot yet be chartered. However, a number of indicators can monitor progress towards reduction of maternal mortality, e.g. proportion of women who deliver with the assistance of a skilled healthcare provider, access to antenatal and postpartum care, and access to family planning information and service to prevent unwanted pregnancy and unsafe abortion.

PROGRAMMING ENVIRONMENT The Safe Motherhood Initiative, launched in October 1987, has four main pillars: family planning, ante-natal care, safe delivery and essential obstetric care. Post-partum, newborn and post-abortion care are also key components.

Kenya MDGs Progress Report 2003

Under the PRSP, all Districts identified safe motherhood and child survival as priority with reduction of maternal and child morbidity and mortality as the ultimate objective.

22

In the last two decades, Kenya has experienced a dramatic decline on Total Fertility Rate (TFR) from 8.1 in mid 70s, 5.4 in 1993 to 4.4 in 1998. The Government has put in place guidelines on safe motherhood and has designated a department of reproductive health in the Ministry of Health to oversee all reproductive health issues. The new Government’s Economic Recovery Strategy for Wealth and Employment Creation puts strong premium on RH issues.

Proportion of Births Attended By Skilled Health Personnel An important component of efforts to reduce the health risks of mothers and children is increasing the proportion of babies that are delivered in medical facilities. Proper medical attention and hygienic conditions during delivery can reduce the risk of complications and infections that can cause death or serious illness of either the mother or the baby. However, the proportion of births attended to by skilled health personnel has been declining in the last decade, from 51% in 1989 to 45% in 1993 and 44% in 1999. The 1999 data show that only 12 percent of babies were delivered under the supervision of a doctor and 32 percent by nurse or midwife. Trained traditional birth attendants conducted about one in ten (11%) deliveries. In addition, untrained TBAs assisted in the delivery of one in ten (10%) of the births. In 1998, while 92 percent of women reported at least one antenatal clinic visit, only 44 per cent of women were attended to by health professionals during delivery. The difference in utilization rates between antenatal and intra-partum care do, however, give some pointers. In terms of accessibility, there are more service delivery points for antenatal care and thus, in theory, the time and distance involved should be less than for reaching a facility with maternity beds. Another factor may be cost, which is known to affect both uptake and delays in seeking care. The GOK introduced cost-sharing in 1989 for specific services, but excluding promotive and preventive services, which includes antenatal care. The Health Policy Framework proposes the introduction of user fees, and these are already in operation within private and public maternity facilities in Kenya. Evidence from other developing countries indicates a direct decline in utilization of maternity services linked to the introduction of user fees, and this will need to be monitored in Kenya.

Maternal Mortality: Monitoring and Evaluation Environment Elements of Monitoring Environment

Assessment

Data-gathering capacities

Fair

Statistical tracking capacities

Fair

Statistical analysis capacities

Fair

Capacity to incorporate statistical analysis into policy planning & resource allocation mechanisms

Fair

Monitoring and evaluation mechanisms

Fair

RECOMMENDATIONS There is need to improve access and quality of maternal and childcare services, and put in place an effective referral system. In addition, training and updates for health workers and Traditional Birth Attendants is required to enhance essential obstetric care. Enhancing national capacity to implement action: the National Safe Motherhood Task Force should be revitalized. Strengthening maternity services and links with the community: the national guidelines for delivery at health centers should be reviewed.

A more concrete and strategic effort is required to prioritize interventions that make a difference, and apply them gradually and systematically.

Access to antenatal and postpartum care is an important indicator of progress towards reduction in maternal mortality. Pic: UNICEF

Kenya MDGs Progress Report 2003

A policy to reduce MMR has also to deal with both excess fertility and pregnancy safety. High fertility may increase obstetric risk as pregnancy complications are normally associated with the number of children born to one mother and the age of the mother.

23

GOAL 6 COMBAT HIV/AIDS, MALARIA AND OTHER DISEASES Target 7: Have halted by 2015 and begun to reverse the spread of HIV/AIDS The indicators are: 18. HIV prevalence among 15-24 year-old pregnant women, 19. Contraceptive prevalence rate, and 20. Number of children orphaned by HIV/AIDS.

Status and Trends Prevalence Among 15-24 year-old Pregnant Women IV/AIDS is a major health and development problem in Kenya. Since the diagnosis of the first AIDS case in the country in the mid1980s, there has been a steady increase in the proportion of people infected by the HIV virus. The national HIV prevalence rate doubled from 5.1 to 10.4 per cent between 1990 and 1995 and peaked at 13.4 percent in 2000 before declining to 10.6 percent in 2002. The HIV infection rate of all pregnant women aged 15-24 years was 9.8%. In addition to women, about 23 percent of men and women with sexually transmitted diseases tested positive to HIV.

H

Kenya MDGs Progress Report 2003

Trends in National HIV Prevalence Rates

SOURCE: Sentinnel Surveillance, Kenya 1990-2002

24

CHALLENGES Efforts to encourage young people to delay initiation of sexual intercourse are not yielding much success as the median age at first intercourse has largely remained constant in the 1990s, at 16.7 and 16.8 for men and women respectively. A substantial proportion of men and women continue to indulge in risky sexual practices despite awareness of the consequences. There is still strong resistance against use of condoms, especially within marriage. Although there is official recognition of the growing number of orphans in the country, strategies aimed at caring for them and ensuring that they realize their full potential have not been fully implemented. Although access to VCT has improved in the last two years, many rural areas are still underserved. The current cost of ARVs is way beyond the means of the majority of Kenyans living with HIV/AIDS.

HIV prevalence rates among young pregnant women aged 15-24 years has followed the same trend; it increased from 15.6 per cent in 1999 to 18.0 percent in 2000, and then declined to 12.9 percent in 2002. The number of Kenyans living with HIV/AIDS increased from 513,941 in 1990 to over 2.5 million in 2002. Prevalence rates show marked variations across sub-groups of the population. Urban areas are more devastated by AIDS than rural areas; although prevalence rates in rural areas are growing more rapidly than in urban areas. In 2002 prevalence rates were 12.9 percent in urban areas, and 7.7 percent in rural areas. Younger women are particularly more vulnerable than men. For instance, among 20-24 year olds, about 40 and 15 percent of women and men, respectively, were infected. There are also marked differences in HIV prevalence rates by province with Nyanza Province exhibiting the highest rate (22%) while rates for five of the remaining 7 provinces are below 15 percent.

Condom Use and Contraceptive Prevalence Rate Contraceptive use has increased from 26.9% in 1989 to 32.7% in 1993 and 39.0% in 1998. The use of male condom as a form of family planning increased from 0.5% in 1989 to 0.8% in 1993 and

PROGRAMMING ENVIRONMENT The Government, in collaboration with development partners has put in place various strategy papers and guidelines. In particular the National HIV/AIDS Five Year Strategic Plan (2000-2005) developed in conjunction with UNAIDS spells out a multi-sectoral response to the pandemic. The formation of NACC with networks up to the community level is indicative of the government’s commitment. There is a lot of NGO, private sector, and donor goodwill. The Global Fund for HIV/AIDS, Malaria and Tuberculosis provides an opportunity for the government to gain access to funds to allow it implement desired interventions.

1.3% in 1998. The condom use rate was higher for sexually active unmarried women at 8.1% in 1998. For men, 8 and 47 percent of married and unmarried men reported use of condoms for family planning, respectively. It is encouraging, as the chart below shows, that there is a greater resolve to use condoms during sexual interactions with irregular partners. There are, however, various problems with condom use related to the negative perceptions, particularly regarding use within marriage, and inconsistency in use.

Kenya MDGs Progress Report 2003

Use of Condoms During Last Sexual Intercourse by Sex and Type of Partner, 1998

25 SOURCE: KDHS 1998

In terms of condom supply, reports from the Ministry of Health show a marked increase from 41.1 million in 1997 to 90.2 million in 1998 but there was a decline in 2002 to 74.2 million. Availability of condoms in the country is still far below the demand.

Number of Children Orphaned by HIV/AIDS Kenya’s HIV/AIDS orphans were estimated at 1.2 million as at the end of 2002. This number has been growing steadily from 27,000 in 1990, to 257,000 in 1995, and 890,000 in 2001. Orphaned children are susceptible to a whole range of problems, from contracting HIV/AIDS themselves to being forced out of school to support their families. Girls are especially at risk, as they are pulled out of school more readily than boys when someone in the household is ill.

RECOMMENDATIONS Differentials in infections between age groups and among regions highlight the need for concerted efforts to identify and devise special intervention programs for highly vulnerable sub-groups of the population. There is need to increase the supply of condoms and intensify community education to demystify them. Interventions to prevent mother-to-child transmission and to promote VCT and early diagnosis and treatment of STIs should be broadened and enhanced to curtail the spread of HIV. There is need to enhance access to ARVs for infected people. There is need to plan and implement interventions targeting AIDS victims, particularly the highly vulnerable orphans.

HIV/AIDS: Monitoring and Evaluation Environment Elements of Monitoring Environment

Kenya MDGs Progress Report 2003

Data-gathering capacities

26

Assessment Strong

Statistical tracking capacities

Fair

Statistical analysis capacities

Fair

Capacity to incorporate statistical analysis into policy planning & resource allocation mechanisms

Fair

Monitoring and evaluation mechanisms

Fair

TARGET 8: Have halted by 2015, and begun to reverse the incidence of malaria and other major diseases

CHALLENGES Increasing frequency of unpredictable malaria epidemics often due to climate change, population movement, poor development planning, and drug resistance.

MALARIA

Status and Trends

Poor infrastructure in epidemic prone areas which hinder timely intervention and access to healthcare facilities.

M

Indicator Fever cases accessing prompt treatment (%) Coverage of ITN for children below 5 years of age (%) Coverage of ITN for pregnant women (%) Pregnant women accessing prophylaxis (%)

1990

Year 2000

2015

40

60

65

5 4 4

60 60 60

65 65 65

Limited capacity of the healthcare system in vector control, information dissemination, case detection, and provision of adequate prompt treatment.

PROGRAMMING ENVIRONMENT

SOURCE: National Malaria Strategy (2001-2010), GOK/MOH, 2001

malaria which is associated with high case fatalities. According to the National Malaria Strategy (2001-2010), which was drafted following the Abuja Declaration by African Governments in 2000, there is a projection to significantly reduce malaria related morbidity and mortality (GOK, MOH 2001).

Increased political and resource commitment by the Government. Decentralization of health system and resource management as part of the overall re-structuring movement within the public sector. Emphasis in capacity building and service integration for areas where there is an overwhelming need. Increasing donor support as part of the global campaign to fight malaria, tuberculosis and HIV/AIDS.

RECOMMENDATIONS Improved monitoring and evaluation. Private sector partnership in preventive activities, particularly in the supply of ITN. Increased community mobilization in awareness raising and management of fever in malaria endemic areas. Integration of malaria control activities into IMCI and better epidemic preparedness.

Malaria: Monitoring and Evaluation Environment Elements of Monitoring Environment

Assessment

Data-gathering capacities

Fair

Statistical tracking capacities

Fair

Statistical analysis capacities

Weak

Capacity to incorporate statistical analysis into policy planning & resource allocation mechanisms

Weak

Monitoring and evaluation mechanisms

Fair

Kenya MDGs Progress Report 2003

alaria is one of the top development concerns for Kenya as 70% of the total population (20 million) is at risk of infection. Every year, about 34,000 children below five years of age are estimated to die of illnesses related to malaria - about 93 of them each day. Throughout the country, malaria accounts for about one-third of outpatient clinic visits. About 145,000 children below five years of age are admitted to hospital due to malaria. Kenya is also experiencing a reemergence of highland (unstable)

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Tuberculosis: Monitoring and Evaluation Environment Elements of Monitoring Environment

Assessment

Data-gathering capacities

Weak

Statistical tracking capacities

Weak

Statistical analysis capacities

Weak

Capacity to incorporate statistical analysis into policy planning & resource allocation mechanisms Monitoring and evaluation mechanisms

TUBERCULOSIS he annual risk of infection for tuberculosis in Kenya according to the national tuberculin survey in 1995 was about 1.2%. This is equivalent to 325,000 new infections per year. Some sources, e.g. CDC, Kenya 2002, estimate an annual increase of this incidence by up to nine-fold since the onset of the HIV/AIDS epidemic. The incidence increased from 12,000 to 70,000 during 1990 – 2001- an average annual increase by 20%.

T

The interaction between tuberculosis and HIV has implications on the total burden of illness and mortality from both

1990 Expected new cases

Year 2000

2015

350,000 300,000 200,000

No. of notified cases RX Success %

73,000 75

Weak

CHALLENGES

Status and Trends

Indicator

Fair

Need for sustainable economic growth and improved budgetary allocations to fight poverty diseases. Healthcare system’s capacity in management of tuberculosis. The need to improve the health information system.

PROGRAMMING ENVIRONMENT The NARC Government is committed to improve the ailing economy, fight corruption, revamp health services, reduce unemployment and generally reduce poverty. Interested donor community such as the World Bank and IMF to provide long-term loans for healthcare reform activities. Kenya is among the many countries which are expected to receive substantial grants from the Global Fund to fight HIV/AIDS, Malaria and Tuberculosis.

90,000 120,000 80

85

RECOMMENDATIONS

Kenya MDGs Progress Report 2003

SOURCE: National Tuberculosis Survey 1995, CDC Kenya, 2002

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diseases. Adult HIV prevalence estimate for Kenya in 2002 was 13% and the reduction target by the year 2008 is to 9% (GOK/JICC). Currently, the National Program for Tuberculosis and Leprosy Control estimates an annual treatment success rate for Directly Observed Treatment (DOT) at 79%. Tuberculosis notification rate in the year 2001 was 248/100,000 new cases- about 21% of the expected number. Slight reduction in the annual risk of tuberculosis infection is expected due to declining trend in HIV incidence and increased access to anti-retroviral drugs. If all conditions are met (i.e. successful poverty reduction strategy, sustainable economic growth and reduced incidence of HIV/AIDS), the expected number of new cases will

Strengthen disease surveillance system. Improve the skills of the health workers for proper case detection, management and reporting. Wider and continuous availability of free anti-tuberculosis drugs. reduce by about 40% during the next 15 years. Case notification rate will show a three-fold increase if the capacity of health care system in case detection and reporting is significantly improved. Treatment success rate is unlikely to go beyond 85% due to problems related to compliance and drug resistance. Although an immense improvement could be anticipated in the area of tuberculosis control all together, the target set as ‘reversal’ of incidence to ‘pre-HIV era’ is unlikely to be met.

GOAL 7 ENSURE ENVIRONMENTAL SUSTAINABILITY Target 9: Integrate the principles of sustainable development into country policies and programmes and reverse the loss of environmental resources The indicators are: 25. Proportion of land area covered by forest 26. Land area protected to maintain biological diversity 27. GDP per unit of energy use (as proxy for energy efficiency) 28. Carbon dioxide emissions (per capita)

Status and Trends Change in Forest Cover

P

In Kenya, the total area of gazetted forest reserves is 1.64 million ha, of which 1.24 million ha constitute of indigenous forest (about 2% of the land area of Kenya).

Proportion of Land Protected for Biological Diversity This indicator is defined as the percentage of total land area that is designated as national parks, natural monuments, natural reserves or wildlife sanctuaries, protected land and sea scapes, or scientific reserves with limited public access. The protected areas in Kenya include gazetted forests, natural parks (243,170 ha), natural resources (195,970), marine resources or mangroves (28,200 ha) and sanctuary (500 ha).

Environmental degradation contributes to rural poverty that implies overuse and misuse of resources Pic: Shadley Lombard/ Topham Picturepoint/UNEP

CHALLENGES There are significant factors, which continue to put pressure on natural resources and compromise effective implementation of sustainable development strategies, mainly limited government capacity for environmental management; and insufficient institutional and legal framework for enforcement and coordination. Widespread poverty in rural areas leads to over-exploitation of natural resources. Deforestation and unsustainable agriculture is reducing the vegetal capital stock, soils’ water retention capacity and increasing erosion. Despite a strong Government commitment and active programmes against illegal deforestation, large-scale illegal logging, wildlife poaching and trade pose a significant threat to biodiversity. Due to population pressures, forests are increasingly under threat through uncontrolled logging and encroachment. The sector urgently needs interventions such as alternative, non-wood, energy sources to allow sustainable forest conservation and management.

Kenya MDGs Progress Report 2003

roportion of land area covered by forest is the share of forest area, as defined in the FAO Global Forest Resources Assessment 2000, of the total land area. The definition of forests includes both natural forests and forest plantations. It excludes stands of trees established primarily for agricultural production.

29

Environmental Sustainability: Monitoring and Evaluation Environment Elements of Monitoring Environment

Assessment

Data-gathering capacities

Weak

Statistical tracking capacities

Weak

Statistical analysis capacities

Weak

Capacity to incorporate statistical analysis into policy planning & resource allocation mechanisms Monitoring and evaluation mechanisms

Fair Weak

A traditional pit latrine is considered as typically not acceptable sanitation facility in urban areas. Pic: UNICEF

PROGRAMMING ENVIRONMENT he NARC administration has vowed to protect Kenya’s biological diversity and to restore the forest cover. As a matter of priority, the government will revoke the allocation of forestland that had been earmarked for degazettement and individual ownership.

T

RECOMMENDATIONS iodiversity and environment have to be adequately addressed within the PRSP. Environmental degradation is also related to rural poverty that implies overuse and misuse of forests. It is urgent to:

Kenya MDGs Progress Report 2003

B

30

Put in place properly directed pro-poor natural resources conservation program in a manner that ensures sustainability of livelihoods and ecosystem management; Support capacity-building for the implementation of international conventions; Enhance conservation of trans-border conservation areas; and Strengthen the coordination of institutional mechanisms related to the management of the biodiversity in Kenya.

The Government of Kenya has adopted several action plans for Forests and the Environment that makes provision for:

Gazetting and reinforcement of protected areas; Establishment of contractual accountability of logging companies against poaching; Systematic implementation of environmental impact assessments prior to road-works and industrial projects; Involvement of local communities in the management of natural resources; and Coordination of priority actions. The creation of the National Environment Management Authority (NEMA) is expected to bring about significant gains in overall coordination and management of environmental issues.

Target 10: Halve, by 2015, the proportion of people without sustainable access to safe drinking water This target will be monitored through the following indicator: 29. Proportion of population with sustainable access to improved water source Indicator 1990

Year 2000

2015

Access to an improved water source

48

55

74

Access to improved sanitation

84

81

-

SOURCE: Welfare Monitoring Survey 1992 & 1994; Population & Housing Census 1999

Access to adequate water supply is a fundamental

ost frequent diseases related to poor water supply and sanitation are: diarrhoea, intestinal worms, trachoma, and cholera (UNICEF/WHO, 2000).

M

Routine measurement of access to safe drinking water or sanitary means of excreta disposal are not currently within the scope of surveys because monitoring the quality of water consumption or the correct usage of sanitary facilities is not typically covered. Instead, surveys register the presence of water and sanitation facilities of different technology types. WHO/UNICEF Joint Monitoring Program’s (JMP) Global Water and Sanitation Assessment 2000 Report (GWSSA 2000) assumed that certain technologies, those that can be categorized as improved, are inherently safer or more sanitary than others that are considered not improved.

Proportion with Sustainable Access to Improved Water Results from MICS 2000 and KDHS 1989, 1993 and 1998 show that there has been no improvement in access to safe drinking water in the past decade. Most of the Kenyan population drink unsafe water from unprotected wells, springs, etc. However, access to safe water is more a rural than urban problem. The 2000 MICS reports an overall rural access rate to improved water source of 44% compared to 90%

Pic: UNICEF

CHALLENGES Access to adequate water supply is a fundamental need and human right. It also has considerable health and economic benefits to society. On the other hand, lack of adequate water contributes to poor health, especially in children. Thus, access to water is a crucial element in the reduction of underfive mortality and morbidity, in particular in poor urban areas. Access to water also means that the considerable amount of time women and children spend for fetching water could be spent more effectively on other tasks, improving their economic productivity, a key component in poverty alleviation efforts. Lack of sanitation is a major public health problem that causes disease, sickness and death. Highly infectious, excretarelated diseases such as cholera still affect whole communities in developing countries. Diarrhoea, which is spread easily in an environment of poor hygiene and inadequate sanitation, kills many people each year, most of them children under five. Despite the success in reducing child mortality from diarrhoeal diseases, the overall health burden has not decreased over the decade. Improvements in safe water supply, and in particular in hygiene and sanitation, could reduce the incidence of diarrhoea by about one fifth and the number of deaths due to diarrhoea by more than half.

Kenya MDGs Progress Report 2003

Status and Trends

need and human right.

31

Improved Access to Water: Monitoring and Evaluation Environment Elements of Monitoring Environment Data-gathering capacities

Fair

Statistical tracking capacities

Fair

Statistical analysis capacities

Fair

Capacity to incorporate statistical analysis into policy planning & resource allocation mechanisms

Fair

Monitoring and evaluation mechanisms

Fair

in urban areas. At the national level, in 2000, only 48% had access to improved water source.

Target 11: Have achieved, by 2020, significant improvement in the lives of at least 100 million slum dwellers The indicators are: 30. Proportion of people with access to improved sanitation; 31. Proportion of people with access to secure tenure.

Kenya MDGs Progress Report 2003

Access to Improved Sanitation

32

Assessment

The results showed that 84.1% had sanitary means of excreta disposal (flush toilet and pit latrine), comprising a high 94.4% in urban areas and 82.0% in rural areas. The 2000 MICS reported a national access rate of 81.1%, with 76.6% for rural areas and 94.8% for urban areas. However, experts for water and sanitation in urban areas consider a simple or traditional pit latrine as typically not acceptable in urban areas UN-Habitat). If traditional pit latrine was not retained in urban areas as an improved category of sanitation, the urban coverage of improved sanitation will fall to 47%.

Number of Slum Dwellers UN-HABITAT is responsible for monitoring Millennium Development Goal 7 Target 11 to improve the lives of 100 million slum dwellers by 2015. During 2002 UN-HABITAT developed a methodology to make regional and global estimates of slum dwellers. The slum indicator will be a composite index, which combines five dimensions of slum life, as decided by the Expert Group Meeting. These include:

Access to water Access to sanitation Access to secure tenure Durability of housing Sufficient living area The slum population is estimated at 71 % of urban population in Kenya (UNHabitat, 2003).

PROGRAMMING ENVIRONMENT The Sanitation Field Manual for Kenya (1987) gives details of technical specifications for construction of various types of sanitary means of excreta disposal, including the means of excreta disposal that are not considered sanitary from a health standpoint. The sanitary means of excreta disposal include septic tank, ventilated improved pit (VIP) latrine, alternating twin-pit VIP latrine, pour flush; but excludes aqua privy, bucket latrine systems, and composting latrine.

GOAL 8 DEVELOP A GLOBAL PARTNERSHIP FOR DEVELOPMENT

Target 15: Deal comprehensively with the debt problems of developing countries through national and international measures in order to make debt sustainable in the long term. The indicators are: 41. Proportion of official bilateral HIPC debt cancelled, 42. Debt service as a percentage of exports of goods and services, 43. Proportion of ODA provided as debt relief, and 44. Number of countries reaching HIPC decision points and number that have reached their HIPC completion points.3. Share of the poorest quintile (20%) in national consumption.

Rich countries can make a vital contribution by opening markets and

Status and Trends oreign aid consists of all contributions made available to a recipient country in the form of either loans or grants. The importance of foreign aid to a recipient country is normally measured in terms of (a) foreign aid/GDP ratio, aid/investment ratio to measure the importance of external assistance to the overall development effort, and (c) foreign aid/trade balance ratio to measure the importance of foreign aid to a sustainable balance of payments.

providing access to technologies. Pic: APHRC

F

The HIPC debt relief framework designed by the IMF and the World Bank provides debt relief to heavily indebted countries that pursue IMF/World Bank–supported adjustment and reform programs. One of the eligibility criteria is that the Net Present Value (NPV) of external debts/exports must be at least 150%. Kenya has not met the criteria because is has not consistently implemented IMF/World Bank reforms and its NPV of debt/exports is around 110%. Kenya’s domestic debt has risen to unsustainable levels. The withholding of external aid in the last decade has led to increased Government borrowing, which has led to higher servicing costs.

Kenya MDGs Progress Report 2003

In Kenya, there is evidence of declining importance of foreign aid to the economy especially in the last decade. Between 1992-94 and 1998-2000, foreign aid/GDP declined from 7.3% to 1.3%, foreign aid/investment declined from 57% to 6.7%, and foreign aid/trade balance declined from 126% to 14.3%. The decline in the role of aid has been accompanied by a decline in investments/GDP from 19% to 16% over the same period, so that part of the decline in foreign aid may have undermined the country’s growth potential.

CHALLENGES

33

Other Targets:

Status and Trends

16: In cooperation with developing countries, develop and implement strategies for decent and productive work for youth, 17: In cooperation with pharmaceutical companies, provide access to affordable drugs in developing countries, and 18: In cooperation with the private sector, make available the benefits of new technologies, especially information and communication The indicators are: 45. Unemployment rate of 15 to 24-year-olds for each sex and total, 46. Proportion of population with access to affordable, essential drugs on a sustainable basis, 47. Telephone lines and cellular subscribers per 1,000 population, and 48. Personal computers in use per 1,000 people and internet users per 1,000 population.

Telephone Lines and Cellular Subscribers per 1,000 Population he indicators of potential for telecommunications traffic are telephone exchange connections, public call boxes and mobile telephony. The number of telephone exchange connections increased from 261,000 in 1996 to 321,000 in 2001. During the same period, the number of public call boxes increased from 5,932 to 8,346.

T

There had been an overwhelming subscription for mobile phone services after the commissioning of two mobile phone service providers. Consequently, the number of mobile phone subscribers increased from 3,000 in 1996 to 85,000 in 2000 and 668,000 in 2001, to about a million in 2002. Coverage of mobile telephony has expanded to cover urban and rural areas as well as major highways in the country, beyond what landlines can conceivably achieve.

PROGRAMMING ENVIRONMENT

The indicators of potential telecommunications traffic are telephone exchange connections

Kenya MDGs Progress Report 2003

and mobile telephony.

34

Pic: APHRC

Kenya strives to maintain its external debt at sustainable levels. In this context, the Government has strived and managed to keep the ratio of its external debt to GDP at around 45-50% with a preference for concession loans that contain a significant grant element.

Goal 8 is about accountability. While national governments from the developed and developing world have joined together in formulating and ratifying the MDGs, certain negative or static trends, nevertheless, can be observed in several parts of the world on key social and economic indicators, bringing into sharp focus the question of accountability. Both local and national governments, bilateral and multilateral institutions must be held accountable on how their actions potentially undermine the realization of the goals and targets. For instance, are policy measures taken in one institution supportive of the MDGs or do they make the task of achievement harder? Do some policy measures go against the very fabric of the consensus that has been reached? How can this be monitored? What mechanisms should be put in place to censure such governments or institutions? What early warning mechanisms can be identified to ensure there is public scrutiny of retrogressive policy measures?

A recent policy event provides an example: what is the impact of recent increased agricultural subsidies in the USA on the MDGs in sub-Saharan Africa? To be more concrete, what is the impact of US cotton subsidies on rural livelihoods in Coastal Kenya? Since these are substantial and negative, in what way is that national government held accountable for its action? There must be a means by which there is more open discussion of positive and negative measures adopted by nation states and bilateral/multilateral institutions vis-à-vis the MDGs that can be subjected to public scrutiny and debate. By so doing, it should serve to raise awareness and increase accountability of policy makers everywhere towards the progressive realization of the MDGs. In other words, if this goal is ignored, it is hard to imagine the achievement of the other goals.

This report shows what is needed to accelerate progress towards the goals: allocating sufficient funds to the social sector; establishing more girls-friendly schools to encourage more girls to go to school; building more public water supply systems; securing women’s rights to land; investing in agricultural research; improving governance and rooting out corruption. The Government of Kenya must lead the

way in taking these steps, but it cannot take them on its own. The country will need substantial injections of donor financing to invest much more heavily in health, in education, in agriculture, in water supply and infrastructure development: indeed, these core investments will lay the foundation for economic growth leading to poverty reduction.

Kenya MDGs Progress Report 2003

Conclusion

35

REFERENCES Abagi, O., 1997. Status of Education in Kenya: Indicators for Planning and Policy Formulation, Institute of Policy Analysis and Research (IPAR), Kenya.

Kenya, Office of the Vice-President and Ministry of Planning and National Development, 1997. First Report on Poverty in Kenya, Nairobi, Kenya.

Adetunji, J. et al, 2000. Trends in Under-5 Mortality Rates and the HIV/AIDS Epidemic, Bulletin of the World Health Organization, 78(10).

Kenya and UNICEF, 1998. Situation Analysis of Children and Women in Kenya 1998, Nairobi.

Ahmad, O.B. et al, 2000. The Decline in Child Mortality: A Reappraisal, Bulletin of the World Health Organization, 78(10). Albania, 2002. The Albanian Response to the Millennium Development Goals, Report Prepared for the United Nations System in Albania by the Human Development Promotion Centre, May.

Kenya, Central Bureau of Statistics, 1999 Population and Housing Census Volume II: Socioeconomic Profile of the Population, Nairobi.

Kamarck, Andrew M.1976. The Tropics and Economic Development: A Provocative Inquiry into the Poverty of Nations, World Bank Publication, Johns Hopkins University Press, Baltimore.

Kenya, Ministry of Health, 1999. Health Management Information Systems: Report for the 1996 to 1999 Period, Nairobi.

Kenya, National Council for Population and Development, Central Bureau of Statistics, and Macro International Inc, Kenya Demographic and Health Survey 1989. Kenya, National Council for Population and Development, Central Bureau of Statistics, and Macro International Inc, Kenya Demographic and Health Survey 1993. Kenya MDGs Progress Report 2003

Kenya, Central Bureau of Statistics, 1999 Population and Housing Census Volume I: Population Distribution by Administrative Areas and Urban Centres, Nairobi.

Hay, S.I., 2002. The Inter-sectoral Response to the 2002 Malaria Outbreak in the Highlands of Western Kenya, Consultant Report to UNICEF/Kenya.

Kenya, Central Bureau of Statistics, 1979 Population Census: Analytical Report, Nairobi.

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Kenya, National Council for Population and Development, Central Bureau of Statistics, and Macro International Inc, Kenya Demographic and Health Survey 1998.

Kenya, Ministry of Health, 1995. Kenya National Five-Year Plan of Action for Malaria Control 1996-2000, Nairobi. Kenya, Central Bureau of Statistics, 1996. Kenya Population Census 1989: Mortality: Analytical Report Volume V, Nairobi.

Kenya and United Nations Development Programme, 1999. Kenya Human Development Report 1999, Nairobi. Kenya, Ministry of Health, 1999. AIDS in Kenya, Fifth edition, Nairobi. Kenya, Ministry of Finance and Planning, 2000. Second Report on Poverty in Kenya (Volume 1: Incidence and Depth of Poverty; Volume 2: Poverty and Social Indicators), Nairobi, Kenya. Kenya, National Aids Control Council, 2000. Kenya National HIV/AIDS Strategic Plan, 2000-2005, Nairobi Kenya, Ministry of Home Affairs, Heritage and Sports, 2000. Women and Men in Kenya: Facts and Figures, Women's Bureau. Kenya, Ministry of Health, 2001. National Condom Policy and Strategy, 2001-2005, Nairobi.

Kenya, Central Bureau of Statistics, 1996. Kenya Population Census 1989: Education: Analytical Report Volume V, Nairobi.

Kenya and United Nations Development Programme, 2001. Kenya Human Development Report 2001: Addressing Social and Economic Disparities, Nairobi.

Kenya, Central Bureau of Statistics, 1996. Fifth Nutrition Survey 1994, Nairobi.

Kenya and UNICEF, 2001. Midterm Review

of the Country Programme of Cooperation 1999-2003: HIV/AIDS, Nairobi. Kenya, Ministry of Health, 2001. AIDS in Kenya, Sixth edition, Nairobi. Kenya, Ministry of Health, 2002. National Leprosy Tuberculosis Programme: Annual Report 2001, Nairobi. Kenya, Central Bureau of Statistics, Statistical Abstract, Various Issues, Nairobi. Kenya, Central Bureau of Statistics, Economic Survey, Various Issues, Nairobi. Mukui, John T., 1990. Income Distribution in Kenya: A Preliminary Analysis, Report Prepared for USAID/Kenya. Mukui, John T., 1994. Kenya: Poverty Profiles, 1982-92, Consultant Report Prepared for the Office of the VicePresident and Ministry of Planning and National Development, Nairobi, Kenya.

United Nations, 2002. United Nations Millennium Development Goals: Data and Trends, 2002, Report of the Interagency Expert group on MDG Indicators, United Nations Statistics Division, New York, April. United Nations, 2002. Implementation of the United Nations Millennium Declaration: Report of the Secretary General, New York, July. WHO/UNICEF, Joint Monitoring Programme for Water Supply and Sanitation Coverage Estimates 1980-2000, 2001. Access to Improved Sanitation: Kenya. WHO/UNICEF, Joint Monitoring Programme for Water Supply and Sanitation Coverage Estimates 1980-2000, 2001. Access to Improved Drinking Water Sources: Kenya.

Population Services International/Kenya, 2001. Kenya Knowledge, Attitude and Practice (KAP) Survey 2000: Family Planning, Nairobi. Population Services International/Kenya, 2001. Kenya Knowledge, Attitude and Practice (KAP) Survey 2000: Sexual Behavior, HIV/AIDS and Condom Use, Nairobi. Population Services International/Kenya, 2001. Kenya Knowledge, Attitude and Practice (KAP) Survey 2000/01: Malaria Prevention and Control, Nairobi.

United Nations, 1998, Common Country Assessment for Kenya: Final Report, Nairobi. United Nations, 2001, Common Country Assessment for Kenya, Nairobi. United Nations, 2001. Road Map Towards the Implementation of the United Nations Millennium Declaration: Report of the Secretary General, New York, September.

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Sloan, N.L. et al, 2001. The Etiology of Maternal Mortality in Developing Countries: What Do Verbal Autopsies Tell Us? Bulletin of the World Health Organization, 79(9).

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For further information, please contact:

REPUBLIC OF KENYA

The Government of Kenya Ministry of Planning and National Development P.O. Box 30005 - 00100 Nairobi Tel: 254-(0)20-338111 Fax: 254-(0)20-218475 E-mail: [email protected] Web-site: www.kenya.go.ke

The Resident Coordinator Secretariat, United Nations Office in Nairobi, Gigiri, Block Q, Room 315 P.O. Box 30218, GPO 00100, Nairobi, Kenya. Tel: 254 (0)20 624469, Fax: 254 (0)20 624463 E-mail: [email protected] Website: www.un-kenya.org