Kenya is likely to witness worsening food security, significant disease outbreaks, and further pockets of conflict in 2011, as well as a continuing flow of refugees from Somalia, aid officials say.
“There is a fear of La Niña compromising the (food security) gains made,” said Aeneas Chuma, the UN Resident and Humanitarian Coordinator at the November 30 launch of Kenya’s 2011 Emergency Humanitarian Response Plan (EHRP) appeal.
Most of the $525 million funding requested is expected to meet food security and refugee needs.
At present, the number of food aid beneficiaries has dropped to 1.2 million from a peak of 3.8 million during the 2009 drought due to favourable October to December 2009 short rains and March to May 2010 long rains.
But numbers are expected to rise, with poor rains in Eastern and North Eastern regions, as well as lower levels in western areas.
According to the Assistant minister in the Ministry of State for Special Programmes, Mahmoud Ali, an estimated 250,000 children below the age of five years are affected by moderate malnutrition nationally while 40,000 face acute malnutrition.
“With the La Niña, the drought, and the shortfall of water... cholera outbreaks are also likely,” said Patrick Lavand’homme, deputy head for Kenya of the UN Office for the Coordination of Humanitarian Affairs (OCHA).
Kenya has been struggling with repeat cholera outbreaks since 2006.
Reported cases have declined over the January to October period to 3,000 compared with 8,000 in 2009.
Conflict over water and pasture during the dry spell is also projected to continue in arid parts, with “an estimated 10,000 people… expected to be displaced due to resource-based conflicts, fuelled by proliferation of small arms into the country from the neighbouring countries”, according to the EHRP.
Contingency planning for a likely surge in Southern Sudanese asylum-seekers, as a possible impact of the January 9 referendum, is also necessary, said officials.
“We are talking about probably 20,000 Sudanese asylum-seekers in the first half of 2011 and about 80,000 more in the second half,” said Mr Lavand’homme.
A continued influx of Somali refugees, now estimated at about 4,000 a month, is expected to continue into 2011.
Kenya hosts 412,193 refugees and asylum-seekers and the numbers are projected to rise to 455,000 by the end of 2011, according to the government.
“Given the escalation of fighting in Somalia, a weakened central government, and the proliferation of armed groups, it is envisaged that there will be an increase in the refugee population in Dadaab (refugee camp) of between 60,000 and 100,000 in 2011,” stated the EHRP.
While Kenya’s political situation is expected to remain stable in 2011, aid agencies will be assessing the impact of the recently passed Constitution, such as new county boundaries, and preparations for the 2012 general elections.
The EHRP, dubbed 2011+, will be characterised by longer-term humanitarian projects incorporating disaster risk reduction into 2012-2013.
“We are hoping this will encourage donors to deal with crises on a continuum basis to build on the year-on-year capacity,” said Anne O’Mahony, Kenya director for Concern Worldwide.
Continued humanitarian assistance is vital as Kenya deals with multiple challenges, including a growing population and a lack of infrastructure, said Ms O’Mahony, adding that recurrent drought and flooding had brought about a chronic poverty cycle in the arid areas.
“Chronic poverty also is not very far from our doorsteps as seen in urban slums in Nairobi and Mombasa,” she said.
Every year thousands of Kenyans go without essential medicines because of poor supply chain management, corruption and insufficient funding of the health service, say civil society members.
“The health system lacks the capacity to run effectively. Many health workers are not skilled enough, for example, to request for drugs before they run out,” said Christa Cepuch, programmes director for Health Action International (HAI) Africa.
She noted that according to a 2008 government survey, 42 per cent of people administering drugs in the public health system are untrained.
Under the drug supply system, health centres receive standard kits containing essential drugs from the Kenya Medical Supplies Agency, but this system has been criticised as too rigid and unable to cope with health facilities’ varied needs.
The country is piloting a new “pull” system where drug supply is based on orders from health centres, in the hope that this will improve the ability to provide essential drugs in the quantities required.
“Facilities will only receive drugs based on utilisation and need so that we avoid situations where drugs are stolen or wasted because they were supplied to a facility that doesn’t need them,” Francis Kimani, Kenya’s director of medical services, told IRIN.
But activists say merely changing the drug supply system may not be enough to address the supply problems.
“There is a need to overhaul the system from the ground up, to clean up the whole system,” said Patricia Asero of the East Africa Treatment Access Movement.
The media frequently report drug shortages, with major hospitals sometimes facing lengthy stock-outs of drugs to treat malaria, tuberculosis and HIV, among others.
A 2009 Kenyan study published in the American Journal of Tropical Medicine and Hygiene found that two years after Artemisinin combination therapy (ACT) was introduced as the first-line treatment for malaria, one in four surveyed facilities had none of the four recommended weight-specific ACT treatment packs in stock while three in four were out of stock of at least one of the packs. The shortages sometimes lasted several weeks.
This, according to the authors, caused health workers to prescribe a range of inappropriate alternatives.
Some of the main reasons for the stock-outs were delays in procurement, poor management of stock flows and a lack of funds to purchase new drugs.
According to Dr Kimani, the government was working to improve the efficiency of the national drug supply system.
“The government has recently allowed the Kenya Medical Supplies Agency to purchase drugs directly from local suppliers in a bid to stem shortages, and we hope this will help in reducing stock-outs of essential drugs,” he said.
Ms Asero noted that corruption was a major problem, with drugs frequently “disappearing” from health facility stores.
“Where I come from in Migori, a shipment of drugs might arrive one day and within a week you go to see the doctor and he tells you they are out of stock. In one week? I don’t think so,” she said.
According to HAI’s Ms Redemtor Atieno, many government pharmacists set up private pharmacies to sell stolen government medicines.
The government can ill afford to lose medicines. As it is, the budget for drugs is inadequate to cover national needs and has diminished over the past few years.
Kenya now spends 8.87 per cent of the national health budget on medicines, down from 10 per cent in 2009-2010 and 12 per cent in 2008-2009.
The country spends an average of $14 per person per year on health, less than half the World Health Organisation’s recommended $34.
“That budget works out to roughly Sh56 per person — enough to buy you maybe four Paracetamol,” said HAI’s Ms Cepuch.
The Ministry of Medical Services has, according to Dr Kimani, requested additional funds from the Treasury to purchase essential drugs to prevent further shortages.
However, Ms Atieno noted that more money would not solve the problem of erratic drug supplies until the system was completely overhauled.
“We need to know exactly how to fix the supply chain, we need to address corruption and we need to train health workers — otherwise it’s like we are throwing money away,” she said.