national aids control council 1 republic of kenya global conference on gearing macro-economic...

1NATIONAL AIDS CONTROL COUNCIL

REPUBLIC OF KENYAREPUBLIC OF KENYA

Global Conference on Global Conference on Gearing Macro-Economic Gearing Macro-Economic

Policies To Reverse the HIV Policies To Reverse the HIV EpidemicEpidemic

Presentation by:Presentation by:John KamigwiJohn Kamigwi

Deputy Director, NACC KenyaDeputy Director, NACC Kenyain Brasilia, Brazil, 21st November 2006in Brasilia, Brazil, 21st November 2006


Kenya Country ProfileKenya Country Profile

Kenya is on the East Coast of Africa, bordering Kenya is on the East Coast of Africa, bordering Tanzania, Uganda, Sudan, Ethiopia, Somalia and Tanzania, Uganda, Sudan, Ethiopia, Somalia and the Indian Oceanthe Indian Ocean

Population (2005 Est.): 33.4 millionPopulation (2005 Est.): 33.4 million Fertility Rate: 4.9Fertility Rate: 4.9 Infant Mortality Rate per 1,000 (in 2005 Est): 77Infant Mortality Rate per 1,000 (in 2005 Est): 77 Under 5 Mortality Rate per 1,000 (2005 Est.): 115Under 5 Mortality Rate per 1,000 (2005 Est.): 115 Maternal Mortality Rate 100,000 (2003 Est): 414Maternal Mortality Rate 100,000 (2003 Est): 414


Kenya Country Profile cont.Kenya Country Profile cont.

Economic growth had stagnated in 1990s but Economic growth had stagnated in 1990s but has picked up since 2003 has picked up since 2003

GDP growth rate in 2005 was 5.8% compared GDP growth rate in 2005 was 5.8% compared to 4.9% in 2004 (and 4.5% for African to 4.9% in 2004 (and 4.5% for African Continent and 4.3 for Global Economy).Continent and 4.3 for Global Economy).

Agriculture contributes close to 25% of GDP Agriculture contributes close to 25% of GDP and is a major employer.and is a major employer.

Other key sectors include Tourism and Other key sectors include Tourism and Manufacture Manufacture

Poverty levels are high, with over 50% of Poverty levels are high, with over 50% of population living below poverty line (US$1 per population living below poverty line (US$1 per day).day).


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Economic Growth Rate (%)

0

2

4

6

8

2001 2002 2003 2004 2005

Year

Gro

wth

Rate

Econ Growth Rate


HIV and AIDS Trends HIV and AIDS Trends & Impacts& Impacts

HIV and AIDS is a major HIV and AIDS is a major development issue – a recent study development issue – a recent study estimates that high morbidity and estimates that high morbidity and mortality could result in up to 14.5% mortality could result in up to 14.5% loss in GDP.loss in GDP.

Since 1990s, HIV and AIDS has Since 1990s, HIV and AIDS has reversed many of the gains reversed many of the gains previously accruedpreviously accrued

HIV and AIDS affects all MDGs.HIV and AIDS affects all MDGs.



Over 1.5 million people have died as Over 1.5 million people have died as a result of HIV and AIDS since the a result of HIV and AIDS since the 11stst case in 1984 case in 1984

Almost 1.3 million people are living Almost 1.3 million people are living with HIVwith HIV

HIV and AIDS has resulted in over 1 HIV and AIDS has resulted in over 1 million orphans, and the number is million orphans, and the number is growing by the day with long-term growing by the day with long-term implications for all sectorsimplications for all sectors



About 263,000 people need ARTAbout 263,000 people need ART Currently, about 90,000 people (or 34% Currently, about 90,000 people (or 34%

of those in need) are on ARTof those in need) are on ART HIV and AIDS has a major gender HIV and AIDS has a major gender

dimension: about twice as many adult dimension: about twice as many adult women being infected compared to menwomen being infected compared to men

HIV and AIDS has to be dealt decisively HIV and AIDS has to be dealt decisively if women development has to be if women development has to be achievedachieved


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Table 2.1: HIV Prevalence by Age and Sex (KDHS 2003)

0

2

4

6

8

10

12

14

15-19 20-24 25-29 30-34 35-39 40-44 45-49

Pe

rce

nt

Women Men


National Response and National Response and ChallengesChallenges

Like in many countries, in 1980s and early Like in many countries, in 1980s and early 1990s there was general denial and epidemic 1990s there was general denial and epidemic was considered just a medical issue.was considered just a medical issue.

In 1999, HIV/AIDS was declared national In 1999, HIV/AIDS was declared national disaster.disaster.

Multi-sectoral response was adopted, bringing Multi-sectoral response was adopted, bringing together all stakeholders coordinated by together all stakeholders coordinated by National AIDS Control Council under Office of National AIDS Control Council under Office of PresidentPresident

The first multi-sectoral strategic plan covered The first multi-sectoral strategic plan covered 2000 to 20052000 to 2005


National Response and National Response and ChallengesChallenges

Funding of Stakeholders, incl. Civil Society, using Funding of Stakeholders, incl. Civil Society, using public funds was initiated.public funds was initiated.

A major challenge was restructuring Government A major challenge was restructuring Government financing mechanisms to effectively handle multi-financing mechanisms to effectively handle multi-sectoral response.sectoral response.

M&E to ensure efficiency and effectiveness of M&E to ensure efficiency and effectiveness of interventions was another major issue.interventions was another major issue.

The ``Three Ones Principle” is being implemented The ``Three Ones Principle” is being implemented incl. One M&E Framework.incl. One M&E Framework.

Capacity of various stakeholders to effectively Capacity of various stakeholders to effectively participate is being built on ongoing basis, incl. participate is being built on ongoing basis, incl. Planning, financial management and M&E.Planning, financial management and M&E.


General Public General Public Finance – Structural Finance – Structural

AdjustmentsAdjustments From mid-1980 Kenya started implementing From mid-1980 Kenya started implementing

Structural Adjustment Programs (SAPS) led by Structural Adjustment Programs (SAPS) led by IMFIMF

Between 1986 to 2000, Social Sector, including Between 1986 to 2000, Social Sector, including Health and Education, was targeted for reduced Health and Education, was targeted for reduced government spendinggovernment spending

User fees became a major source of additional User fees became a major source of additional resources in the socio-sector. However, though a resources in the socio-sector. However, though a noble idea, poverty limited access in many cases.noble idea, poverty limited access in many cases.

Investment in Health and general socio-sector Investment in Health and general socio-sector was drastically reduced despite rising was drastically reduced despite rising population, and in many cases was dependent on population, and in many cases was dependent on user fees.user fees.


General Public General Public Finance – Structural Finance – Structural Adjustments Cont.Adjustments Cont.

Wages in public sector, including health, Wages in public sector, including health, remained lowremained low

Absorption of newly trained health Absorption of newly trained health personnel from Medical Colleges was personnel from Medical Colleges was drastically reduced, and many doctors and drastically reduced, and many doctors and nurses migrated to developed countriesnurses migrated to developed countries

To further reduce the government wage To further reduce the government wage bill, retrenchment was carried out from bill, retrenchment was carried out from 1990s - initially on voluntary basis1990s - initially on voluntary basis


General Public General Public Finance – Structural Finance – Structural Adjustments Cont.Adjustments Cont. Retrenchment often led to the most experienced Retrenchment often led to the most experienced

personnel (incl. nurses) leaving the service, personnel (incl. nurses) leaving the service, thereby seriously affecting service delivery.thereby seriously affecting service delivery.

Though some room was provided in health, Though some room was provided in health, recruitment was generally frozen leading to recruitment was generally frozen leading to major staffing shortages and succession gaps.major staffing shortages and succession gaps.

Grants and staffing that used to be provided by Grants and staffing that used to be provided by Govt to non-public health facilities, especially in Govt to non-public health facilities, especially in very needy areas stopped, weakening the non-very needy areas stopped, weakening the non-public sector.public sector.

All these developments set the stage for serious All these developments set the stage for serious personnel and infrastructural gaps resulting personnel and infrastructural gaps resulting from HIV and AIDS and TB epidemics from late from HIV and AIDS and TB epidemics from late 1990s.1990s.



To qualify for IMF programmes (and To qualify for IMF programmes (and attract funding by other partners) attract funding by other partners) the government has over-time aimed the government has over-time aimed at:at: Inflation target below 5%.Inflation target below 5%. Low Budget Deficits or SurplusesLow Budget Deficits or Surpluses



Inflation has been Inflation has been contained below contained below 12% (see figure).12% (see figure).

The budget has The budget has virtually been virtually been balanced.balanced.

Exchange Rates Exchange Rates have been stable have been stable for a long time for a long time

Rate of Inflation

0

5

10

15

2001 2002 2003 2004 2005

Year

Rate

(%)


General Public Finance General Public Finance – Structural – Structural

Adjustments Cont.Adjustments Cont. In FY2004/5 the budget surplus on commitment basis In FY2004/5 the budget surplus on commitment basis

was 0.3% of GDP, while in FY 2003/04 deficit was -was 0.3% of GDP, while in FY 2003/04 deficit was -0.4% of GDP.0.4% of GDP.

External funding has been unreliable and covers External funding has been unreliable and covers limited timeframes – and hence cannot be relied on. limited timeframes – and hence cannot be relied on.

The Government is therefore avoiding factoring The Government is therefore avoiding factoring external pledges into the annual budget, and thereby external pledges into the annual budget, and thereby heavily depending on tax revenueheavily depending on tax revenue

Mainly through increased tax revenue (which has Mainly through increased tax revenue (which has rapidly increased since 2003), total government rapidly increased since 2003), total government revenue and grants increased by 11.5% from US$4.26 revenue and grants increased by 11.5% from US$4.26 Bill in FY2004/05 to US$4.75 bill in FY 2005/06.Bill in FY2004/05 to US$4.75 bill in FY 2005/06.


General Public Finance General Public Finance – Structural – Structural

Adjustments Cont.Adjustments Cont. As a result of heavy dependence on tax As a result of heavy dependence on tax

revenue there has been difficulties in revenue there has been difficulties in expanding the socio-sector expanding the socio-sector infrastructure (including health) to infrastructure (including health) to effectively deal with HIV and AIDS effectively deal with HIV and AIDS epidemicepidemic

Furthermore, previous low capacity Furthermore, previous low capacity building in socio sector/health e.g. in building in socio sector/health e.g. in personnel is continuing to affect service personnel is continuing to affect service delivery.delivery.


HIV and AIDS HIV and AIDS FinancingFinancing

Second Strategic Plan was developed & estimates that Second Strategic Plan was developed & estimates that annual funding requirement would increase from annual funding requirement would increase from US$338 million in FY2005/06 to US$605 million by US$338 million in FY2005/06 to US$605 million by FY2009/10FY2009/10

Four priorities set with relative resource requirements Four priorities set with relative resource requirements as follows: (1) Prevention 24%; (2) Improved Quality of as follows: (1) Prevention 24%; (2) Improved Quality of Life/Treatment 29%; (3) Mitigation of Socio-economic Life/Treatment 29%; (3) Mitigation of Socio-economic Impact 30%; and (4) Support Services 17%.Impact 30%; and (4) Support Services 17%.

Specific vulnerable groups incl. women and youth are Specific vulnerable groups incl. women and youth are prioritised for intervention.prioritised for intervention.

At the moment, only about half of the funding is At the moment, only about half of the funding is available.available.

There is heavy dependence on external project There is heavy dependence on external project oriented and off-budget funding including PEPFARoriented and off-budget funding including PEPFAR


HIV and AIDS HIV and AIDS FinancingFinancing

Existence of large off-budget amounts results in Existence of large off-budget amounts results in serious coordination problems of aligning serious coordination problems of aligning programme activities to national priorities. programme activities to national priorities.

This compromises the participatory planning and This compromises the participatory planning and budgeting - MTEF processes, since key stakeholder budgeting - MTEF processes, since key stakeholder do not participate. do not participate.

This creates inefficiencies in planning and This creates inefficiencies in planning and budgetary processes. budgetary processes.

Tentative Resource Tracking findings indicate that Tentative Resource Tracking findings indicate that relative to other priorities Quality of Life/Treatment relative to other priorities Quality of Life/Treatment is highly financed while Mitigation of Socio-is highly financed while Mitigation of Socio-economic Impacts is highly under-financed. economic Impacts is highly under-financed.


Intervention Outcomes Intervention Outcomes & Impacts& Impacts

Outcomes and Impacts:Outcomes and Impacts: Despite all the challenges. positive changes have Despite all the challenges. positive changes have

been observed.been observed. HIV/AIDS Prevalence has been fallen from 10% in HIV/AIDS Prevalence has been fallen from 10% in

2000 to 5.9% in 2005.2000 to 5.9% in 2005. Behavioural changes that reduce infection rates Behavioural changes that reduce infection rates

have been observed. have been observed. Kenya is one of very few countries where this is Kenya is one of very few countries where this is

happening.happening. There is however an urgent need to strengthen There is however an urgent need to strengthen

both prevention and treatment.both prevention and treatment. In addition, mitigation of socio-economic impact is In addition, mitigation of socio-economic impact is

critical.critical.


Public Finance Cont.Public Finance Cont. The government has increased allocations The government has increased allocations

to the health sector and education (incl. to the health sector and education (incl. free primary education).free primary education).

ART drugs are free in public facilities. ART drugs are free in public facilities. However, additional capacity and However, additional capacity and resources are needed to meet the needs.resources are needed to meet the needs.

Mainstreaming of HIV and AIDS in Mainstreaming of HIV and AIDS in various sectors within the Planning and various sectors within the Planning and Medium Term Expenditure Frame (MTEF) Medium Term Expenditure Frame (MTEF) is attracting additional resources within is attracting additional resources within public sector and line ministries.public sector and line ministries.


New ways of doing thingsNew ways of doing things More needs to be done to address socio-More needs to be done to address socio-

economic impacts including the rapidly economic impacts including the rapidly escalating challenge of orphans. escalating challenge of orphans.

New financing approaches are needed. For New financing approaches are needed. For example, a 1.8% budgetary deficit would be example, a 1.8% budgetary deficit would be enough to provide the resources required to enough to provide the resources required to implement the National HIV/AIDS Strategic Plan.implement the National HIV/AIDS Strategic Plan.

Mainstreaming work will have to continue – both Mainstreaming work will have to continue – both in public and private sectors.in public and private sectors.

The MTEF process should include all donor The MTEF process should include all donor resources to be more effective. Pooling of resources to be more effective. Pooling of resources is called for.resources is called for.

Long-term and sustainable financing is needed.Long-term and sustainable financing is needed. M&E needs to be strengthened.M&E needs to be strengthened.


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Thank YouThank You

God Bless YouGod Bless You

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