• Introduction and Overview
• Government Agencies
• Non-Government Organizations
• Demographic Profile
• Social Protection
• Child, Youth and Family Policy Regimes
• Maternity Benefits
• Early Childhood Education
• Child Education
• Child Health
• Special Groups of Children
• Child Labor
• Child Trafficking and Prostitution
• Female Genital Mutilation
• Notes
• References

(Last updated April 2007)

Introduction and Overview

Located in East Africa, the Republic of Kenya is a member of the Commonwealth of Nations. Formerly a British colony, Kenya gained independence in 1963 and has been a republic since 1964. Covering a total land area of 582,646 sq km (224,961 sq mi) Kenya is bounded on the north by Sudan and Ethiopia, on the east by Somalia and the Indian Ocean, on the south by Tanzania, and on the west by Lake Victoria and Uganda. Nairobi is the country’s capital and largest city. The equator passes through the middle of the country. [Encarta Online Encyclopedia, 2006]

In 1964 Kenya became a republic with a president as head of state and government. From 1964 to 1982, Kenya was, for all practical purposes, a one-party state; between 1982 and 1991 it was a one-party state by law – the Kenya African National Union (KANU). In 1991 the Kenyan government allowed for the existence of multiple political parties, and in 1992 the country held its first contested presidential elections.

Independent Kenya’s first constitution, adopted in 1963, provided for a semi federal system with a two-chamber national legislature and regional governments with designated powers. When the constitution was revised in 1964 to provide for a republic with a strong president, most federal features of the government were scrapped. In 1967 the two chambers of the legislature were merged to form the single-chamber National Assembly. The country holds regularly scheduled parliamentary elections, and all citizens age 18 and older are eligible to vote.

Executive:

The executive branch is the most influential branch of the Kenyan government. Kenya’s president serves as both head of state and head of government. The president is elected by the people for a five-year term, and a 1991 constitutional amendment established a two-term limit for the presidency. To become president, a candidate must simultaneously run for president and for a seat in parliament and must win both elections. The president appoints a cabinet of ministers, each of whom heads an executive department of the government, and a vice president, who is also a member of the cabinet.

Legislature:

Kenya’s parliament is a single-chamber body called the National Assembly. Legislation passed by the parliament becomes law after being approved by the president. Elections to the National Assembly are held every five years, unless called earlier by the president or the assembly itself. Following the elections held in 2002, the National Assembly consisted of 210 directly elected representatives (including the president), 12 members nominated by the president, the attorney general, and the speaker of the house.

Judiciary:

Kenya’s judiciary consists of two major courts and a number of lower magistrate courts. The major courts are the Kenya Court of Appeal, with 9 judges, and the High Court of Kenya, with 27 judges. All judges are appointed by the president. Kenya’s legal system is based on English common law, tribal law, and Islamic law. Trial by jury is not used in Kenya.

Between 1982 and 1991 Kenya was a one-party state by law. The ruling party was the Kenya African National Union (KANU), a conservative nationalist party dominated by the interests of President Daniel arap Moi. At the end of the 1980s many Kenyan people began to protest the system of one-party rule, and in late 1991 the government agreed to permit the registration of other political parties. More than a dozen new political parties were legalized in 1997. KANU remained the ruling party of Kenya until December 2002 elections, which were dominated by an alliance of opposition parties called the National Rainbow Coalition (NARC). The main components of NARC were the National Alliance Party of Kenya (NAK) and the Liberal Democratic Party (LDP). Other opposition parties included the Forum for the Restoration of Democracy-People (FORD-People) and the Social Democratic Party (SDP). Ethnicity has long been a main determinant of political party membership. Since 2002, the chief of state has been President Mwai KIBAKI and the Vice-President is Moody AWORI. [Encarta Online Encyclopedia, 2006]

The regional hub of trade and finance in East Africa, Kenya promoted rapid economic growth through public investment, encouragement of smallholder agricultural production, and incentives for private (often foreign) industrial investment after independence. Gross domestic product (GDP) grew at an annual average of 6.6% from 1963 to 1973 (among the highest in sub-Saharan Africa). Agricultural production grew by 4.7% annually during the same period, stimulated by redistributing estates, diffusing new crop strains, and opening new areas to cultivation.

Between 1974 and 1990, however, Kenya's economic performance declined. Inappropriate agricultural policies, inadequate credit, and poor international terms of trade contributed to the decline in agriculture. From 1991 to 1993, Kenya had its worst economic performance since independence. Growth in GDP stagnated, and agricultural production shrank at an annual rate of 3.9%. Inflation reached a record 100% in August 1993, and the government's budget deficit was over 10% of GDP.

Kenya’s slowing economic growth rate and expanding budget deficits caused the government to turn to structural adjustment policies advocated by the World Bank and the International Monetary Fund (IMF) as part of their economic assistance to Kenya. Nevertheless, the Kenyan government has set the ambitious target of achieving the status of industrialized economy by 2020. In 2005 the gross domestic product (GDP), grew by 5.2% and was 16.11 billion.

Services was the highest contributor (65.1%) to the GDP followed by industry (18.8%) and agriculture (16.3%). In 2005, Kenya had a labor force of 11.85 million; three-fourths (75%) of which is involved in agriculture while the remaining one-fourth in industry and services.  The unemployment rate in Kenya was estimated to be close to 40% in 2001 [CIA World Fact Book, 2006]. The ILO estimated in 2005 that some 80 per cent of Kenyans worked in rural areas, mainly in small-scale farming and crop growing and most live in large extended families whose members have worked together for generations on family farms.

The World Bank estimated that in 2004, women constituted 44 percent of the total labor force, the majority working in the agricultural sector. Life expectancy at birth for females was 46.3 years, slightly lesser than that for males – 48.1 years. Adult Literacy Rate for females in 2005 (82 percent) was also lower than that for males (92 percent). The combined gross enrollment ratio in primary, secondary and tertiary education was 50 percent for females and 53 percent for males. In 2005, women held 7 percent of the seats in the lower house, an increase from 1 percent in 1990. [HDR, 2005]

Under the current Kenyan laws, there is no uniform definition of a child. The Children and Young Persons Act defines a child as anyone below 14 years and a young person as between 16 and 18 years. The Department of Children’s Services is the main governing and implementing body on child welfare and child rights.

The Children and Young Persons Act passed in 1963 and the Children’s Bill 2001 are the main legislations addressing the needs of children’s welfare. Both these legislations draw heavily from the UN Convention on Rights of the Child and the African Charter on the Rights and Welfare of the Child. They address all issues related to child rights and welfare including child labor, prostitution, FGM, street children, children in institutions, adoption, education and health.

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Government Agencies

Some of the important government ministries and department in Kenya that are involved in child and family policies and programs  include:

1.   Ministry of Education, Science and Technology: The federal Ministry of Education, Science and Technology is the central governing body in all matters pertaining to education policies and programs. Its mission is to provide, promote and co-ordinate lifelong education, training and research for Kenya's sustainable development. To focus on priority areas within overall education goals, notably towards attaining "universal primary education" by 2005, within the context of the wider objective of "Education for All (EFA)" by 2015.

2.   Ministry of Health: The federal Ministry of Health is the central governing body in all matters pertaining to health policies and programs. Its mission is to promote and participate in the provision of integrated and high quality preventive, curative and rehabilitative health care services.

3.   Ministry of Gender, Sports, Culture and Social Services: The federal Ministry of Gender, Sports, Culture and Social Services is the central governing body for all policies and programs related to gender, social welfare and adult education. Its mission is to create and develop a well-defined social services delivery infrastructure as a channel for harnessing people’s participation in all national and sectoral development programs. The Department of Gender within the Ministry of Gender, Sports, Culture and Social Services is responsible for improving the efficiency and effectively integrating gender dimensions in policy formulation, planning and implementation. The Department of Social Services under the Ministry of Gender, Sports, Culture and Social Services coordinates social welfare programs aimed at mitigating socio-economic problems with special focus on the vulnerable groups. The categories of vulnerable groups targeted by the Department include: people with disabilities and aged persons.

4.   Department of Children’s Services: The Department of Children’s Services which falls under the federal Ministry of Home Affairs is the central governing body for all policies and programs related to child welfare. Its mission is to safeguard the well-being of the child and assist in the establishment, promotion, co-ordination and supervision of services and facilities designed to advance the rights of the child. 

5.   Child Labor Division: The Child Labor Division, which falls under the federal Ministry of Labor and Human Resource Development, is the central governing body in all matters pertaining to child labor policies and programs.

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Non-Governmental Organizations (NGOs)

The first known non-government agencies or civic organizations in Kenya were during the colonial period. Since freedom of association was not promoted, there were mainly two kinds of organizations – religious/philanthropic organizations (mainly Christian charitable organizations), and people’s organizations (which broadly included women’s groups and professional associations). After independence, the number of NGOs  in Kenya increased significantly facilitated by the government’s support for NGOs. Estimates on the growth of non-government agencies in Kenya range from 100 percent between 1977 and 1987 to 229 percent between 1974 and 1988.

The growth of NGOs in the 1980s and 1990s was linked to the economic and social problems including an escalation in poverty, internal conflict and displacements, and the breakdown of the socio-economic and political systems. Many NGOs diversified their activities to include providing basic social services to the public. In 1990, the government passed the NGO act, which was the first main institutional and legislative framework to govern NGOs in Kenya. It is estimated that by the end of the 80s, indigenous NGOs in Kenya had grown by over 150 percent in a ten-year period. This increase can also in part be attributed to the fact that the government permitted new political parties for the first time, encouraged the right to association and promoted institutional democracy in Kenya.

The activities of non-governmental agencies in Kenya cover a range of issues including: environment, energy and conservation measures, health, food and nutrition, water and sanitation, population matters, shelter, relief services, programs for disabled persons, children, youth, women, destitute persons, and religion, communication, the informal sector, and education.

The main government department that deals with administration of non-governmental agencies is the Department of Social Services under the Ministry of Gender, Sports, Culture and Social Services. Non-governmental agencies are required to be registered either as societies (under the Societies Act), trusts (under the Trusts Act), a company (under the Companies Act), or with the Ministry of Gender, Sports, Culture and Social Services. Most large organizations with a national presence and broad objectives are registered under as societies or trusts.

Some of the problems usually faced by non-governmental agencies in Kenya include lack of autonomy, government interference, inefficiencies in functioning because of a lack of democratic method in the internal governance of NGOs, lack of accountability, and financial constraints. [Kameri-Mbote, 2002]

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Demographic Profile

Kenya is one of the most populous countries of the African continent. Kenya’s population at the time of the 1999 census was 28,686,607. In 2006 the population was estimated at 34,707,817. Kenya experienced very high population growth rates in the 1970s and 1980s, but by 2006 the rate of increase had declined to 2.6 percent. In 2006 Kenya’s birth rate was estimated at 40 per 1,000 and its death rate at 14 per 1,000. The fertility rate has declined almost by half since 1980, though it is still high at 4.9 in 2006. The average life expectancy at birth (49 years) has also declined due to inadequate health services and the AIDS epidemic. The low life expectancy and years of high birth rates have combined to give Kenya a young population: 43 percent of the people were younger than age 15 in 2006.

Eighty percent of the population is concentrated in the 17% of land area comprising high, medium and low potential regions; the remaining 20% is sparsely scattered in the semi-arid or arid regions that make up 83% of the territory.

Nearly all Kenyans are black Africans, divided into more than 40 ethnic groups belonging to three linguistic families: the Bantu, the Cushitic, and the Nilotic. Language traditionally has been the primary characteristic of ethnic identity in Kenya. Bantu-speaking Kenyans are divided into three different groups: the western group (Luhya); the central, or highlands, group (including the Kikuyu, the Kamba, and other subgroups); and the coastal Bantu (Mijikenda). Among Kenya’s Nilotic speakers, the major groups are the River-Lake, or Western, group (Luo); the Highlands, or Southern, group (Kalenjin); and the Plains, or Eastern, group (Masai). The Cushitic-speaking groups include the Oromo and the Somali. The Kikuyu are Kenya’s largest ethnic group.

For much of Kenya’s history, its ethnic groups were loose social formations, fluid and constantly changing. In the late 19th and early 20th centuries British colonial rule solidified ethnic identities among Kenya’s people. Colonial administrators associated ethnic groups with specific areas of the country by designating areas where only people with a particular ethnic identity could reside. This pattern of ethnically based settlement has persisted in Kenya since it became independent, even though economic and political development has increased mobility and urbanization among the country’s inhabitants. Thus, the majority of Kikuyu live in south central Kenya, the majority of Luhya in western Kenya, the majority of Luo in southwestern Kenya, the majority of Kamba in east central Kenya, and the majority of Kalenjin in west central Kenya. Ethnicity also has been an important factor in Kenyan politics.

Kenya’s official languages are English and Swahili; both are widely used for communication between members of different ethnic groups. Nearly all of the African ethnic groups in Kenya also have their own languages, making for considerable linguistic diversity within the country. Many Kenyans thus speak three languages: the language of their particular ethnic group, Swahili, and English.

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Social Protection

Kenya’s social security system largely follows the ILO framework of a three-tier structure, also followed by its east African neighbors Uganda and Tanzania. The first tier constitutes provision of services such as primary health care, primary education, water, food security, relief for disasters and calamities, and other services. Financing of such services is by government budgetary allocations, non-governmental organizations, and donors and UN agencies. The second tier comprises compulsory and contributory schemes financed by both employer and employee during the working life for terminal and short-term benefits. Kenya has one contributory social security institution for the country – the National Social Security Fund (NSSF). The schemes under the third tier include personal savings, cooperative and credit societies occupational pension schemes and private schemes. Employers, professional bodies, community-based organizations and financial institutions manage these schemes.

Though there are various forms of social protection in Kenya, the NSSF is the main institution in terms of social security provision. The NSSF covers all workers in the formal sector including the government and private sector employees. The NSSF contribution rate is 10 percent of the insured persons earnings shared equally by the employer and the employee at a rate of 5 percent. However, the maximum amount payable is 400 Kenya shillings (US$ 6).

Other schemes include the government sponsored pension schemes for senior civil servants, the armed forces, prisons, etc. The Workman’s compensation act under the Ministry of Labor also provides social protection through compensation of salaried employees (in the government and private sectors) injured in their normal working environment but whose wages do not exceed 4000 Kenya shillings (US$ 53).

The National Hospital Insurance Fund is a health insurance scheme where all formal sector workers contribute a proportion of their wages depending on their salary bracket. The minimum payable amount for an employee with a basic salary of 1000 Kenya shillings (US$ 14) is 30 shillings (US$ 0.4) per month and the maximum for those earning a basic salary of over 15,000 shillings (US$ 207) is 320 shillings (US$ 4.4) per month.

It was estimate that 1in 2003, 10.6 percent of the total population was covered under the governments two main schemes – the NSSF and the civil service pension scheme. Main contingencies covered and benefits paid are: age benefit (any person who is 55 years or more), survivors benefit, and invalidity benefit. All benefits are paid as a lump sum or as pension for those entitled.

The social security programs do not cover the informal sector, which forms the bulk of the labor force in Kenya, and is limited even in the formal sector. Firms employing five or fewer persons remain uncovered because the employers are not registered as contributing. In addition, most of the benefits are not linked to the cost of living. (SSA, 2006))

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Child, Youth and Family Policy Regimes

Maternity Benefits

The law that governs maternity benefits in Kenya is the 1976 Employment Act. A woman is entitled to two months of maternity leave with full pay. However a woman who takes maternity leave is required to forfeit her annual leave for that year.

An amendment to the employment act has currently been filed in the parliament which recommends that the maternity leave be extended to three months excluding the annual leave. It also seeks to extend maternity benefits to both. (SSA, 2006)

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Early Childhood Education

Early Childhood Development (ECD) in Kenya concerns the holistic development of children between 0+ and 5+ years old.23 ECD is under the responsibility of the

MOEST. The only policy framework that directs the MOEST’s provision of ECD is the Partnership Policy. The Children’s Act of 2001 safeguards the rights and welfare of children from early childhood to adolescence.

 Though early child education centers existed during the colonial period, they were segregated and stratified. In 1954, UNICEF started supporting early childhood development and education in Kenya. Its focus was support for the health of mother and child. In later years, UNICEF expanded beyond the goals of child survival to include development and education.

The greatest expansion in early childhood programs came shortly after Kenya's independence in 1963, in response to the late President Jomo Kenyatta's call for Harambee ("pulling together"), which promoted community participation for accelerated education development. The motto of Harambee has been evident ever since in the development of many self-help projects, including community-funded, community-built preschools and other services. Such community-supported preschools still far outnumber those built by the government or donors; approximately 80 percent of Kenyan preschools are run by local communities.

This received further impetus in the 1970s which saw the increasing participation of Kenyan women in the labor force, a growing number of female-headed households, and changing family structures and child-rearing practices which created new demands for external support. The community alone could no longer be the primary provider of nutrition, health care, and education for preschool children.

Initially, the preschools for African children were intended to be non-academic, non-teaching, child care settings. This view persisted until 1970. Many parents, however, favored academic instruction and school preparation in the nursery school. A rapid expansion of preschool education was brought about by the joint efforts of communities, government, welfare organizations and private enterprise.

The first survey to document the number of children enrolled in preschool was carried out in 1969 through the University of Nairobi, showing that 200,000 children were enrolled in 4,800 centers nationally. Most of the 5,000 teachers were untrained. In 2003, there were 26,463 preschools enrolling 1,107,276 children. About one third of the children under 6 years old were enrolled in preschool; there were 42,609 preschool teachers, just under half of whom are formally trained.   

Seven key early childhood services can be identified in Kenya. They are broadly called “ECD Centres”. Among them, Nursery School is the most common early childhood service in the country and central to the MOEST’s early childhood planning.

Source: UNESCO, 2005

One of the strengths of the ECCE program in Kenya is its partnership policy which encourages the participation of various partners, including parents and local communities, local authorities, voluntary organizations, religious bodies, companies, the Ministry of Education and other ministries, and NGOs, several of which have sponsored a number of early childhood intiatives (e.g. the Bernard van Lerr Foundation, UNICEF, and the Aga Khan Foundation). Parents and local communities are the most important partners in the ECCE program in Kenya. They have started and manage over 75% of the preschools in the country. These schools were started on a Harambee (community self-help) basis mentioned earlier. Through "harambee," the parents and the local communities provide land and funds for the construction and maintenance of physical facilities. They also provide furniture, materials, and labor, and pay teachers' salaries. In some preschools, parents and local communities have initiated community-based feeding programs and growth monitoring and promotion (CBGMP) activities. (Swadener and Kabiru, 1995)

The MOEST is the central ministry responsible for the country’s ECD programs and involves other ministries (e.g., the Ministries of Health, Home Affairs, Gender, Sports, Culture and Social Services, and Local Government) for planning and implementation. 

Within the MOEST are three concerned sections at the national level: (1) the ECD Unit of the Directorate of Basic Education in the MOEST Headquarters, responsible for the formulation of policy guidelines, registration of preschools, coordination of data collection, funding, donors and other partners, and provision of trainers; (2) the ECD Unit of the Division of the Directorate of Quality Assurance and Standards, responsible for the inspection of preschools and training institutions, administration of preschool teacher trainee examinations and preschool teacher certificates; and (3) the National Centre for Early Childhood Education (NACECE), housed in the Kenyan Institute of Education (KIE), responsible for preschool curriculum and material development, training of and professional support to District, City and Municipal Centre for Early Childhood  Education (DICECE, CICECE, MUCECE) trainers, and coordination of research, monitoring and evaluation.

The Government, parents, communities and the private sector (e.g., religious organizations, private companies, NGOs and CBOs, individuals) are the main sources of ECD finance and support. The largest source of external assistance in recent years has been the World Bank’s ECD loan project of 1996/7-2003/4, targeting disadvantaged children aged 0+-8 and their parents.

The Education Sector Strategic Plan and Implementation Matrices 2003-07 (ESSP), Kenya’s key education policy implementation document, states the following objectives for ECD: (1) enhance access and participation in ECD, notably raising the GER to 70% by 2007; (2) improve the quality of ECD services at all levels by 2007; (3) implement ECD alternative complementary approaches (e.g., home-based and employer-provided care, programs for pastoralist and Islamic communities) by 2005; and (4) enhance ECD management and service delivery. These objectives are aligned with those contained in the country’s Education for All (EFA) plan.

One of the major gaps in the ECD services in Kenya is the lack of services for children under three years of age. The ESSP also does not explicitly address the needs of children under three and most parents have to visit health centers frequently to monitor children’s growth and for immunization. Psychosocial development of children in this age group is largely neglected. The second major gap is an excessive emphasis in ECD centers on literacy and numeracy skills rather than holistic development. Parents also largely focus on children’s early acquisition of learning skills. Though the MOEST has developed training manuals and programs that focus on the multidimensional aspects of children development, implementation is a major issue primarily because ECD is perceived as a stage for preparing children for formal schooling. [UNESCO, 2005]

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Child Education

Established in the 1980s, formal schooling in Kenya consists of eight years of primary education, four years of secondary education and four years of university education, referred to as the 8-4-4 system. Basic education is defined as 12 years of primary and secondary education. The Government is trying to include Early Childhood Education for ages 4+ and 5+ as part of basic education. Children are expected to start formal schooling at age 6+. Since 2003, primary education has been free but not compulsory. Extraneous costs of education including the cost of uniforms, books, supplies, and school-related fees have to be met by pupils. Examinations taken at the end of the 8th and 12th grades determine whether students will be admitted into high school and university. 

Parallel to the formal system are non-formal education programs catering for disadvantaged populations in arid and semi-arid regions and urban slums. Programs teaching literacy, vocational and other skills are provided by NGOs, religious organizations and local communities. However, after the introduction of the Free Primary Education (FPE) policy, the MOEST began providing some financial support to non-formal schools offering the national primary education curriculum under the 8-4-4 system. [UNESCO, 2005]

Although 92 percent of school-age children attend the first years of primary school, factors such as cost, examination performance, and inadequate facilities eliminate large numbers from secondary and university education. Kenya has made great progress with adult literacy since independence. [Encarta Online Encyclopedia, 2006]

The gross enrolment ratio (GER) in pre-primary education in Kenya was about 40% in 2001, superior to the median of developing (35%) and sub-Saharan African (5.8%) countries. Kenya’s net enrolment ratio (NER) in primary education stood at 70% in 2001, lower than the weighted average of 83% for developing countries. Its NER in secondary education was 24% in 2001, which was below the weighted average of 48.5% for developing countries.  

Kenya has a relatively low percentage of private enrolment in pre-primary, primary and secondary education. In particular, private enrolment in pre-primary education, at 10.4%, is far inferior to the world median (40.1%) and that of developing countries (55.5%).

According to the government's 2005 Economic Survey data, the government's Free Universal Primary Education Program, which began in 2003, raised primary school enrollment from 7.2 million in 2003 to 7.4 million in 2004. The 2003 figure constituted about 78 percent of the primary school age group. The 2004 figure represented 81.1 percent of the primary school age group. Some NGOs, however, claimed that there were still one million children not attending school.

Most citizens welcomed tuition‑free education; however, the program also resulted in overcrowded classes due to insufficient teachers and an inadequate budget. To enhance access to free primary education, the government supported non formal education schools to cater especially to children in urban slums. About 79 percent of enrolled children completed the 8‑year primary school education cycle. The school drop‑out rate declined from 5 percent in 1999 to 2 percent in 2004. The law mandates compulsory schooling for all children through grade 12, but fewer than half of primary school graduates went on to secondary school. During the year the gross enrollment rate for the secondary school age population was 22.2 percent. In 2004, 86 percent of secondary school students completed the four‑year secondary cycle.

Although the number of boys and girls in school approximately was equal at the primary level, boys substantially outnumbered girls in higher education. Rural families were more reluctant to invest in educating girls than in educating boys, especially at the higher levels. According to FIDA, 8 thousand to 13 thousand girls drop out of school each year due to pregnancy.

In 2004, 77 percent of females were enrolled in primary schooling, 89% completed their schooling and 73 percent of those who progressed to grade 5 were females.

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Child Health

In 1994, the Government of Kenya (GOK) approved the Kenya Health Policy Framework (KHPF) as a blueprint for developing and managing health services. It spells out the long-term strategic imperatives and the agenda for Kenya’s health sector. The above policy initiative aimed at responding to the following constraints: decline in health sector expenditure, inefficient utilization of resources, centralized decision making, inequitable management information systems, outdated health laws, inadequate management skills at the district level, worsening poverty levels, increasing burden of disease, and rapid population growth.

According  to the 2003 Kenya Demographic and  Health Survey (KDHS 2003), more married women are using modern contraceptive methods. The prevalence rate has risen from 18 percent in 1989 to 27 percent in 1993, 32 percent in 1998, and 33 percent in 2003.There has been a steady decline I the fertility rates from 8.1 in 1978 to4.9 in 2003.

Overall morbidity and mortality remain high, particularly among women and children. An infant mortality rate (IMR) of 62 in 1993 increased by 12 percentage points to 74 in 1998 and further declined to 59 in 2006. The under-five mortality rate also rose from 110 deaths per 1,000 live births in the period 1993-1998 to 115 in the 1998-2003 period. Maternal mortality in 2003 was estimated to be 414 maternal deaths per 100,000 live births, which is a decline from the 590 deaths estimated for 1998.

The World Health Organisation (WHO) estimates that over 10 million children under 5 years of age die annually from preventable diseases in Kenya. According to WHO, many sick children who are brought to see a health provider do not receive adequate assessment and treatment. It is not uncommon for a provider to treat the symptom that is most evident, without conducting a full assessment of the child’s health status and acting to prevent further diseases. For this reason, WHO and other agencies developed the Integrated Management of Childhood Illnesses (IMCI) strategy. This strategy promotes using every visit to a health care provider as an opportunity not only to conduct a full assessment of the child’s current health and possible underlying problems, but also to provide preventive interventions such as immunization and growth monitoring (for early detection of faltering growth) to prevent or minimize progression to illness.

In 2003, full immunization coverage declined to under 60 percent (from 65 percent in 1998 and 78 percent in 1993), with the percentage of children receiving no vaccinations at all increasing from 3 percent in 1998 to 6 percent in 2003. The major causes of this decrease in coverage were the declining availability, access to, and quality of public health services; the increasing level of poverty is a main underlying factor. In addition, because fewer people are dying from immunisable diseases, the focus on immunization services has reduced, and funding has decreased.

Malnutrition is an underlying factor in about 70 percent of the illnesses that cause death among children under five. It was estimated that in 2003 about a third of children under five in Kenya were stunted or too short for their age. Specifically, 30 percent were stunted, 11 percent were severely stunted, and 20 percent were underweight. It was also estimated that among children suffering from fever and/or symptoms of acute respiratory infections, only 46 percent were taken to health facility/provider for treatment.

Health services in Kenyan facilities are relatively integrated; about 8 in 10 facilities offer basic child health services including preventive and curative care and immunization services. In 2003, Childhood immunization was provided in 83 percent of facilities (com-pared with 86 percent in 1999), growth monitoring in 81 percent (compared with 90 percent in 1999), and outpatient curative care for sick children in 97 percent (compared to 88 percent in 1999).

The health sector comprises the public system, with major players including the MOH and parastatal organisations, and the private sector, which includes private for-profit, NGO, and FBO facilities. Health services are provided through a network of over 4,700 health facilities countrywide, with the public sector system accounting for about 51 percent of these facilities.

The public health system consists of the following levels of health facilities: national referral hospitals, provincial general hospitals, district hospitals, health centers, and dispensaries.

Only some hospitals, health centers, and maternities are expected to offer the full range of basic services (outpatient services for sick children and for STIs, temporary methods of family planning, antenatal care, immunisation, and child growth monitoring). In general, 57 percent of facilities offer the full range of services, with hospitals (66 percent) and health centres (65 percent) more likely than dispensaries (55 percent) and  maternities (52 percent) to provide these services.

Over the past decade, real financing allocations to the public sector have declined or remained constant. Reviews of public expenditures and budgets in Kenya show that total health spending constitutes about 8 percent of the total government expenditure and that recurrent expenditures have been consistently higher than the development expenditures, both in absolute terms, and as a percentage of the GDP. The per capita expenditure falls short of the Government of Kenya’s commitment to spend 15 percent of its total budget on health, as agreed in the Abuja Declaration. The under-financing of the health sector has thus reduced its ability to ensure an adequate level of service provision to the population.

The health budget allocation is also skewed in favor of tertiary and secondary care facilities, which absorb 70 percent of health expenditures. Yet primary care units, being the first line of contact with the population, provide the bulk of health services and are cost effective in dealing with the disease conditions prevalent in communities. [KSPAS, 2004]

HIV/AIDS:

Kenya faces a severe, generalized HIV/AIDS epidemic that continues to have a devastating impact on all sectors of society. National estimates indicate that the adult HIV prevalence rate in 2005 was 6.7%. In 1999, Kenya declared HIV/AIDS a national disaster and public health emergency. An estimated 1.2 million people are living with HIV/AIDS in Kenya. An estimated 1.5 million people have died from AIDS since 1984. More than 1.6 million children younger than 15 years (3.7% of the total population) have been orphaned through the death of their mother. At least 180 000 people die from AIDS annually. The prevalence is still high but appears to be decreasing. The Ministry of Health reported an adult prevalence of 13.5% in 2001, and surveillance figures suggested that the prevalence had declined to 10.2% in 2002.

Vulnerable groups include AIDS orphans, pregnant women and rural populations living in areas with a high burden of disease. Girls and young women are particularly vulnerable to infection. Women 15–24 years of age are more than twice as likely to be infected as men this age. The prevalence of HIV is higher in urban areas: about 10% among pregnant women.

The National AIDS Control Council has developed the Kenya National HIV/AIDS Strategic Plan 2005–2010; its overriding theme is social change to reduce HIV/AIDS and poverty. The Sessional Paper No. 4 of 1997 provides a policy framework to guide all partners in Kenya’s response to the challenges of HIV/AIDS. Other supportive policies include a policy on condom use, national guidelines on voluntary counseling and testing, guidelines on national home-based care programs and services, guidelines on blood safety, guidelines on antiretroviral therapy and guidelines on preventing mother-to-child transmission. National treatment guidelines have been developed, and a new policy on diagnostic testing and counseling was recently finalized and disseminated.

The government established the National AIDS Control Council in November 1999 to lead the multisectoral response to HIV/AIDS. The Council developed the Kenya National HIV/AIDS Strategic Plan 2000–2005 to provide a policy and institutional framework to guide the response and ensure that the multisectoral policies and strategies are integrated into core government-wide processes, including the implementation of the Poverty Reduction Strategy Paper. The strategic approach to control the epidemic, outlined in the Kenya National HIV/AIDS Strategic Plan 2000–2005, consists of prevention of new infections; treatment, care and support for those infected and affected by HIV/AIDS; mitigation of the impact of the epidemic on social and economic development efforts; monitoring and evaluation; and management and coordination.

The health sector response to HIV/AIDS is addressed primarily through the National AIDS and STDs Control Program (NASCOP) located within the Ministry of Health. The National Health Sector Strategic Plan 2005–2010 guides the health sector response. In January 2002, the NASCOP established a National Antiretroviral Therapy Task Force to guide the way forward to scaling up the provision of antiretroviral therapy across the country. The policy involves both the private and public sector. Kenya has made significant progress in institutionalizing care and treatment and has opened a total of 288 comprehensive care centers, of which 167 are in government facilities, including all provincial hospitals, all district hospitals, most sub district hospitals and some health centers. The Ministry of Health also has a reasonably well-developed programs for preventing mother-to-child transmission using nevirapine. In addition, all regions of the country now have access to some facilities for voluntary counseling and testing, but these are still inadequate and tend to be concentrated in urban areas. A program to scale up the provision of voluntary counseling and testing services is being implemented, and guidelines have been developed. Training programs are being implemented in providing antiretroviral therapy, preventing mother-to-child transmission and voluntary counseling and testing. Nongovernmental organizations, bilateral donors, private providers and the corporate sector complement the government’s efforts.

One of Kenya’s main bottlenecks to scaling up HIV prevention and care is the acute shortage of trained health workers, especially in rural areas. Kenya also has inadequate health system infrastructure and lacks the resources to improve it. Several areas need to be developed further, including aligning and coordinating partners around the national response, developing a national human resource plan to support scaling up, developing an operational research agenda for antiretroviral therapy and further developing protocols on antiretroviral therapy adherence. Sustainability of the available funding for antiretroviral therapy from partners, including the Global Fund to Fight AIDS, and the United States President’s Emergency Plan for AIDS Relief, is not assured. Treatment literacy is very low, which is associated with very high levels of stigma among health workers and the general population. The cost of drugs and laboratory tests remain high and out of reach for most people. Training curricula need to be harmonized among various implementing partners. Systematic monitoring and evaluation systems are lacking. [WHO, 2005]

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Special Groups of Children

Child Labor

The law proscribes slavery, servitude, and forced and bonded labor, including by children; however, forced labor is a major problem. The employment in industry of children under the age of 16 is illegal, but the law does not apply to the agricultural sector, where approximately 70 percent of the labor force is employed, or to children serving as apprentices under the terms of the Industrial Training Act. Child labor is a problem, particularly in the informal sector. The Children's Act of 2001 prohibits all forms of child labor that are exploitative, hazardous, or would prevent children under age 16 from attending school.

The Ministry of Labor and Human Resources Development officers nominally enforce the minimum age statute, and the government works closely with COTU and the ILO's International Program for the Elimination of Child Labor to eliminate child labor. The government's Free Universal Primary Education Program has resulted in the return to school. In 2003, it was estimated that approximately one million children who formerly were working and more than one million children believed to be still working returned to school.

Children work primarily in the informal sector, mostly in family businesses and usually assist parents on family plots; they also often work as domestic servants. A significant number of children work in family units on tea, coffee, sugar, and rice plantations. Deteriorating economic conditions and the effects of the HIV/AIDS pandemic have given rise to more child labor in the informal sector, which is difficult to monitor and control. In addition a large number of underage children are active in the sex industry. In view of the high levels of adult unemployment and underemployment, the employment of children in the formal industrial wage sector in violation of the Employment Act is less common.

The law establishes definitions of child labor, and in June 2004 the government prepared a National Plan of Action to Eliminate the Worst Forms of Child Labor; it has not yet been implemented. A practical guide to labor inspection was developed, and the government trained labor inspectors and occupational health and safety officers to report on child labor. Many NGOs are also active in child labor issues and assist in the return to school of child laborers.

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Child Trafficking and Prostitution

The law does not explicitly prohibit trafficking in persons, and there are reports that persons are trafficked to, from,  and within the country. Internal trafficking is also a problem. Various laws can be used to prosecute trafficking‑related offenses. The penal code prohibits detaining females against their will for the purposes of prostitution as well as child labor, the transportation of children for sale, and the commercial sexual exploitation of children. Fines are limited and jail time is rarely enforced.

The Anti‑Human Trafficking Unit of the Police Service (KPS) has primary responsibility for combating trafficking. The Criminal Intelligence Unit of the KPS, the Ministry of Labor, and the Ministry of Home Affairs are also involved in curbing human trafficking.

Victims are trafficked from South and East Asian countries and the Middle East and transited in the country to European destinations for sexual exploitation. Asian nationals, principally Indians, Bangladeshis, and Nepalese, are trafficked into the country and coerced into bonded labor in the construction and garment industries.

Trafficking in children is a problem, as is child prostitution. Child prostitution has grown considerably due both to economic contraction and to the increase in the number of children orphaned because of the spread of HIV/AIDS. According to the International Labor Organization (ILO), approximately 30 thousand girls under the age of 19 years are engaged in prostitution in the country.

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Female Genital Mutilation

Kenya is one of the 28 countries in Africa where Female Genital Mutilation (FGM) is widely practiced. The Children's Act of 2001 explicitly protects the girl-child from early marriage or forced FGM. The act prohibits all forms of FGM, and any person found circumcising a girl under the age of 18 is liable to be charged and imprisoned for one year or fined 50,000 Kenya shillings (US $710), or both.

Some estimates indicate that 38 percent of Kenyan women have undergone FGM and that the figure soars to 80 or 90 percent for girls in some of the more rural districts. The practice is known to be more common among ethnic groups in northeastern Kenya, where it is estimated that almost 98 percent of girls are subjected to FGM. Some ethnic groups in western Kenya including the Luo and Luhya do not practice FGM.

Kenya's refugee population is affected as well. The country hosts over 240,000 refugees, mainly from Sudan and Somalia, but also from Ethiopia, Eritrea, and other neighboring countries. Dadaab refugee camp houses thousands of Somalis, who, according to the UN's Refugee Agency (UNHCR), practice FGM on girls as young as six. UNHCR has a gender-based and sexual violence program that targets all communities practicing FGM in refugee communities across the country.

Complications arising from the practice are common in Kenya, as most procedures are performed without an anesthetic, using rudimentary tools in unsanitary conditions. Studies show that up to 48 percent of women who undergo FGM suffer short-term complications, including hemorrhage, infection and urine retention and up to 30 percent suffer longer-term complications, such as difficulties during childbirth, vesicle vaginal fistula, low libido and depression. Another chilling threat posed by FGM is the risk of contracting HIV/AIDS. Traditionally, a single instrument is used to cut several girls in quick succession, increasing the risk of contracting the virus.

The UN's Beijing Declaration (1995), to which Kenya is a signatory, underscores the obligations of governments to combat violence against women - including FGM - as a priority. Kenya has also signed the African Union's Maputo protocol, which requires parties to use legislative measures to prohibit and condemn all forms of FGM.

Despite the legislation, FGM remains widespread in Kenya and the law is rarely enforced against practitioners, or parents forcing their daughters to undergo the procedure because it is considered part of the tradition rituals. According to NGOs actively campaigning to end the practice in Kenya, a slow but steady decline is being noted due to greater public awareness of the dangers of FGM. Education and westernization in urban centers have meant that the practice remains much more prevalent in rural areas than in urban areas, where people’s cultural priorities are no longer match those of their rural counterparts.

The Kenyan government has made significant strides in its struggle to eradicate FGM. It is working with its international partners and several NGOs in Kenya. The issues are being addressed in three ways: public awareness and education campaigns, policy and legislation, and alternative rites (this approach involves retaining the rites of passage, but eliminating FGM). While these efforts have yielded some results, many communities still practicing FGM remain adamant that they will perpetuate their traditions - including cutting their young girls. [IRIN News, 2005]

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Notes

 

* Research and Reported by Manita C. Rao
 

References

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IRIN News; Kenya: A Case Study of Modern Legislation against Cultural Identity (2005); IRIN News.org, UN Office for the Coordination of Humanitarian Affairs; Retrieved from the World Wide Web at http://www.irinnews.org/report.asp?ReportID=45979&SelectRegion=East_Africa

Kameri-Mbote, Patricia (2002); The Operational Environment and Constraints for NGOs in Kenya: Strategies for Good Policy and Practice; International Environmental Law Research Center; Retrieved from the World Wide Web at http://www.ielrc.org/content/w0002.pdf#search=%22ngos%20in%20kenya%22

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Social Security Administration (SSA) (2006); International Update: Recent Developments in Foreign Public and Private Pensions; Social Security Administration, Office of Policy, Office of Research, Evaluation and Statistics, Washington D.C.; Retrieved from the World Wide Web at http://www.ssa.gov/policy/docs/progdesc/intl_update/2006-08/2006-08.pdf

Swadener, Beth Blue and Kabiru, Margaret (1995); Does the Village Still Raise the Child? A collaborative Study of Changing Child-Rearing and Community Mobilization in Kenya; Retrieved from the World Wide Web at http://www.acs.appstate.edu/orgs/afcab/swadener.htm

UNDP; Kenya: Human Development Indicators (2005); United Nations Development Program; Retrieved from the World Wide Web at http://hdr.undp.org/statistics/data/countries.cfm?c=KEN

UNESCO; Policy Review Report: Early Childhood Care and Education in Kenya (2005); UNESCO Early Childhood and Family Policy Series N11-2005; Retrieved from the World Wide Web at http://unesdoc.unesco.org/images/0013/001390/139026e.pdf

US Department of State; Country Report on Human Rights (2005); Bureau of Democracy, Labor and Human Rights, US Department of State; Retrieved from the World Wide Web at http://www.state.gov/g/drl/rls/hrrpt/2005/61575.htm

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