Conversations in Kenya have started around the upcoming 2022 presidential elections. Elections in Kenya tend to be highly contentious and there is often concern that, in some places, violence may erupt.

Political violence has a long history in Kenya. It extends back to the British colonial state’s use of violence to control people, expropriate land, and suppress dissent.

In independent Kenya, the regimes of Jomo Kenyatta and Daniel arap Moi continued to use violence as a way to control land and intimidate political rivals.

With the reintroduction of multi-party elections in 1992, politicians used violence to shape electoral outcomes. In the 1992 presidential elections, around 1,200 people were killed and 300,000 people were displaced from their homes. Following the 1997 elections, between 300 and 1,000 people were killed and about 10,000 were displaced. And in the 2007 general elections, Kenya experienced its most violent election to date: around 1,500 people were killed and another 600,000 displaced.

Studies of political violence tend to focus on how the electoral incentives of political leaders shape the use of violence. But the occurrence of violence is often a joint production between political elites and ordinary citizens.

The participation of ordinary citizens was particularly stark after Kenya’s 2007 general elections. People set fire to homes and farms, burned tyres in the roads, and in some cases, killed and raped.

Violence escalated when the incumbent candidate, Mwai Kibaki, was announced as the president reelect. The main opposition party, the Orange Democratic Movement (ODM), disputed the results and party leaders encouraged members to mobilise. Protests quickly turned violent and escalated across the country.

Importantly, however, there was significant local variation in the sites and scale of violence. This raised questions that are central to my new book, “Political Violence in Kenya: Land, Elections, and Claim-Making”. Specifically, I ask: how do leaders organise political violence, and more so, why do ordinary citizens participate?

I carried out several years of fieldwork for the book. This included hundreds of interviews and a household survey with residents across the Rift Valley and Coast regions. I found that electoral violence is most likely to escalate where there is:

1) Moderate (rather than significant) inequality in land rights between two nearby and ethnically distinct groups.

2) Salient and contentious narratives around land between these two groups.

3) A strong leader who can use these land narratives to convince or compel ordinary citizens to participate in violence.

Election violence tended to happen where a group believed that their participation in violence would advance their personal interests, or those of their community.

The book highlights the importance of land tenure reform as a key policy tool to mitigate and prevent violent conflict in Kenya. It can also help to explain or anticipate patterns of election violence based on local inequalities, for instance over land, jobs, or other resources.

It’s about land

In Kenya, and many other agrarian-based economies, control and ownership over land shapes identity, livelihood, and power. Yet land tenure institutions are often weak and highly politicised. This can give rise to certain narratives that elites and citizens can use to coordinate the use of violence.

In Kenya, for example, the belief that “outsiders” have invaded the ancestral land of “insiders” has justified violent evictions, often during elections.

I compared areas where ethnically-distinct farming communities border one another. I selected several cases from Nakuru County, in the central Rift Valley, where predominantly Kalenjin farming communities bordered Kikuyu communities. Political leaders have long pitted these communities against one another in struggles over access to land and political representation.

Many Kalenjin have come to view the Rift Valley as their ancestral land and see Kikuyu as ethnic outsiders. Many Kikuyu, meanwhile, argue that because they have purchased the land and hold title deeds, they are the rightful claimants.

For instance, after the results of the 2007 elections were announced, violence erupted when Kalenjin residents from Mauche crossed into the neighbouring area of Likia and burned property belonging to Kikuyu residents.

However, a short distance away in Ogilgei, where Kalenjin residents border the mostly Kikuyu community of Kerma, violence never escalated.

A key difference between these two cases is the degree of land tenure security, and specifically, what I describe as “moderate land inequality”.

Residents in Likia and Mauche are small-scale farmers. But in 2007, most Kikuyu residents in Likia held title deeds while most Kalenjin farmers in Mauche did not. For many Mauche farmers, this lack of tenure security shaped a defensive logic: “evict them before they can evict us”.

By contrast in Ogilgei, both Kalenjin and Kikuyu residents held title deeds. Neither side linked the election outcome with their tenure security, and thus had few reasons to engage in violence.

Coastal dynamics

In another example, I ask why many communities in the coastal counties of Kwale and Kilifi experienced far less violence than those in the Rift Valley.

I find that a key mitigating factor was the significant land inequality between a small, but powerful group of “landlords”, alongside a large population of landless “squatters”.

Landlords tend to be of Arab, Indian, or European descent, while most landless identify as Mijikenda. The main cleavage line tends to be class, rather than ethnicity.

Though the Mijikenda are the electoral majority, such significant land inequality means that their own local leaders tend to remain beholden to the interests of the landed elite, rather than their land-poor constituents.

Hence, while there are contentious land narratives, many citizens tend to see their elected leaders as weak: unwilling or unable to alter land rights in their favour.

This means that elections are far less high-stake than in the Rift Valley where many believe that the outcome determines who gets evicted and who can remain.

Broader implications

While the dynamics of violence that I describe in the book draw specifically from the case of Kenya, there are a number of broader implications. The book can help explain or anticipate patterns of election violence. This dynamic has played out in countries such as Zimbabwe, Cote d’Ivoire, the Democratic Republic of Congo, Indonesia, and Bangladesh.

It also highlights the importance of strengthening land tenure institutions so that a citizen’s access to land does not hinge on a particular electoral outcome.

Finally, it provides insights into how political elites use particular appeals to divide populations, consolidate political support, and in some cases, incite violence.

In order to prevent or mitigate violence, there needs to be a better understanding of how and why particular narratives – built around identity, rights, and citizenship – gain resonance compared to others.The Conversation

 

Kathleen Klaus, Assistant Professor, University of San Francisco

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Tanzania banned Kenya's national airline from entering the country effective Saturday, in the latest move in a deepening row triggered by Tanzania's controversial handling of the coronavirus pandemic.

Tanzania said Kenya Airways flights were being banned "on a reciprocal basis" after Kenya decided against including Tanzania in a list of countries whose passengers would be permitted to enter Kenya when commercial flights resumed on 1 August.

"Tanzania has noted... its exclusion in the list of countries whose people will be allowed to travel into Kenya," Tanzania Civil Aviation Authority director general Hamza Johari said in a letter sent to Kenya Airways on Friday.

"The Tanzanian government has decided to nullify its approval for Kenya Airways (KQ) flights between Nairobi and Dar/Kilimanjaro/Zanzibar effective August 1, 2020 until further notice," Johari wrote.

"This letter also rescinds all previous arrangements that permit KQ flights into the United Republic of Tanzania."

Kenya Airways chief executive Allan Kilavuka said Saturday he was "saddened" by the letter and hoped the situation would soon be resolved.

Tanzania has taken a controversially relaxed approach to tackling the coronavirus pandemic and began reopening the country two months ago.

President John Magufuli's refusal to impose lockdowns or social distancing measures, and to halt the release of figures on infections since late April, has made him a regional outlier and caused concern among Tanzania's neighbours and the World Health Organization.

Magufuli declared Tanzania free of coronavirus in June, thanking God and the prayers of citizens for the disease's defeat disease.

The diplomatic spat between Kenya and Tanzania erupted soon after the outbreak of the pandemic in East Africa, when Kenya blocked Tanzanian truck drivers from entering the country, fearing they would spread the disease.

 

The COVID-19 pandemic has revealed the extent of Africa’s reliance on imports.

As global supply chains and the flows of manufactured goods around the world have been disrupted by lockdown restrictions, African countries have faced the prospect of mass unemployment and curtailed economic growth in a way which more self-reliant developed countries have not, as noted by the African Union in its research paper titled Impact of the Coronavirus on the African Economy.

As leaders globally consider the trade-off of permitting sectors of their economies to operate while still minimising the risk of transmission of the virus, the imperative of long-term, sustainable economic development in Africa through coordinated initiatives has never been clearer. Investment in industrialisation is a key lever to moving the economic growth needle over the long term, as demonstrated by the last few decades of economic growth trends globally.

Those countries that have industrialised and exported manufactured goods have become the most resilient and diversified economies. In the wake of global supply chain disruption, Africa faces a golden opportunity for governments to provide incentives for industrialisation and the development of local value chains. Industrialisation cannot happen in a vacuum: governments need to work hand in hand with development finance partners who can provide the funding that manufacturers and suppliers require to scale up production and manufacture appropriate goods to meet market demands.

Joel Jackson, CEO of Mobius Motors, based in Nairobi, Kenya, says during COVID-19-induced lockdown Mobius has continued to focus on testing and development of a new vehicle model which will be uniquely tailored to the African environment, but once restrictions are lifted and economic activity can resume in full, will scale up production and distribution of its vehicles to the wider African market.

“With a vehicle designed for African operating conditions and sold at an unparalleled price point, Mobius is driving down the cost of vehicle ownership; playing an important role in catalysing economic development in Africa, on two fronts. First, the pandemic and subsequent lockdown have shown how profoundly important mobility is to a fully functioning economy and healthcare system. Second, vulnerabilities of global supply chains to pandemics have highlighted the importance of localisation and self-reliance to build resilience in national and regional manufacturing ecosystems” he says.

Jackson says African economic recovery will require doubling down on industry potential and working with development funders who recognise the benefits of greater self-reliance in Africa’s future growth story.

“This kind of event fundamentally undermines global supply chains and import-dependent markets, making it even more crucial for African countries to build their long-term resilience through a stronger and more localised supplier landscape in the manufacturing sector. Governments need to expand incentives to companies and business models that have the potential for a disproportionate impact on job creation and up-skilling.”

Mobius is currently in discussions with the Kenyan government about incentives for local industrialisation and skills development. “The more we invest in industrialisation, the more we enable a self-fuelling flywheel of economic growth and consumer market development,” Jackson says.

He cites a recent research paper by McKinsey, Reopening and Reimagining Africa: How the COVID-19 crisis can catalyze change, which states that Africa cannot rely on business as usual to come back from the brink. In recovering from the crisis, Africa has the potential to create a reshaped and more resilient manufacturing sector, “provided that governments and businesses tackle long-standing barriers to industrialisation and cooperate to seize new opportunities”.

“We estimate that, for every dollar of manufactured product, Africa imports approximately 40 cents in inputs from outside the continent—higher than most other regions in the world. Over five years, a serious push to reduce reliance on global supply chains could add an initial $10-20 billion to the continent’s manufacturing output if 5 to 10 percent of imported intermediate goods can be produced within the region. In addition to supply-chain resilience, the shift could also benefit exporters in countries experiencing devaluation, if they could capture the upside of increased export attractiveness with less burden of more expensive imported inputs,” the report says.

No African car brand has been able to establish a presence in local markets at scale, and Jackson says a coordinated effort with governments and funders can overcome structural challenges to scale up local production and content. Mobius was founded in 2011 and has focused on manufacturing a multi-use transport platform that can “plug in” a range of different modules to enable a myriad of transport applications – something imported vehicle models are unable to do in meeting African challenges.

“There is a clear and significant gap in the market: durable and affordable vehicles, offering the versatility consumers want. We have donated two of our first-generation Mobius II vehicles to the Kenyan government for the COVID-19 community relief effort, and the advantages of a locally tailored vehicle platform are demonstrable. The next step is to progressively scale our next-generation Mobius 2 vehicle across the continent and drive positive and sustainable socio-economic change,” Jackson says.

Pakistan overtook Uganda to become the biggest buyer of Kenyan goods in the first five months of the year after supplies to Kampala were largely slowed by coronavirus-induced delays at the border.

Earnings from exports to Pakistan, predominantly tea, bumped 19.37 percent to Sh24.13 billion($224m), pushing the world's fifth most populous country back to the summit of top importers of Kenyan products for the first time since 2017, official data shows.

The data collated by the Kenya National Bureau of Statistics (KNBS) shows supplies to the land-locked Uganda, Kenya’s largest overall trading partner, dropped 5.65 percent to Sh20.22 billion, largely hurt by delays in April and May due to a requirement for truckers to have Covid-free certificates.

That slowed delivery of goods – including vegetable oils, fuel, iron and steel as well as paper and paperboard– to Kampala, pushing the country down to third biggest buyer of Kenya’s after being leapfrogged by the United Kingdom (UK).

Revenue from exports to the UK, the former Kenya’s colonial master, grew at the fastest pace of 30.06 percent to Sh21.49 billion on increased demand for fresh farm produce such as fruits, cut flowers and vegetables.

Kenya Flower Council, the lobby for large-scale flower farms, said demand for Kenyan fresh produce in Europe and other key destinations has been rising since April at about 30 percent of targeted sales to current levels of nearly 75 percent.

Delivery has, however, been hurt by erratic freight services with most airlines prioritising medical supplies in the fight against contagious Covid-19, KFC chief executive Clement Tulezi said on phone.

“The biggest challenge we have at the moment is freight. It is only the UK which has remained open for the longest even when we were in the heat of Covid shocks two months ago,” said Mr Tulezi.

“Our hope is that as Europe and other markets start to open, and increased demand and less supplies comes in, we should be able to attract more freighters into Nairobi.”

Overall, Kenya’s exports rose 6.73 percent (or Sh16.98 billion) in the January-May 2020 period to Sh269.13 billion, spurred by increased sale of tea and horticultural products.

Tea earnings jumped 18.90 percent to Sh58.62 billion, cut flowers by 4.23 percent to Sh51.14 billion, while income from sale of fruits surged 78.91 percent to Sh11.09 billion.

 

Business Daily

A key objective of Kenya’s agriculture growth and transformation strategy and the Big Four Agenda is increasing smallholder productivity and incomes.

The strategies also aim to enhance value-addition and agro-processing, which could create employment in agricultural value chains. The overall goal is to transform rural economies into commercially viable concerns.

But the government sometimes pursues policies that undermine these objectives.

Sorghum farming is a case in point. In Kenya, sorghum is mainly grown in areas characterised by low rainfall and high temperatures. For decades, there was little incentive to grow the crop because production costs were high, market integration low, and yields consistently low at about 0.7 tons per hectare. Ethiopia has consistently attained a national yield of 2.5 tons/ha. Farmers were unable to break even. Production was mainly for domestic consumption.

But thanks to the government policy supporting the use of sorghum for commercial beer brewing in 2004, through waiver of the excise duty, demand for sorghum increased, giving smallholder farmers an opportunity to transform their agriculture and livelihoods.

First, sorghum beer processing provided a stable market. Contracts entered between the main brewer and farmers guaranteed farmers a market and stable prices. Farmers responded by increasing their production. Some attained up to 3.3 tons/ha, which translated to an increase in incomes of about 220%.

Contract farming for sorghum beer processing expanded from three counties in 2010 to the current ten counties, with four more in the pipeline. During this period, the number of farmers has grown from 2,300 to 48,000 and farm-gate price per kilogram from 23 to 37 KES. Yield has improved due to better agronomic services and inputs provided on credit by the industry.

Second, researchers have been given an incentive to support the industry and responded by doubling the number of improved varieties from 20 in 2012 to 40 in 2017. These improved varieties are higher yielding, drought tolerant, pest and disease resistant and tailored for specific soils, rainfall and temperature.

Third, the policies on flour blending provide additional uses for sorghum in agro-processing. Despite this growth, Kenya remains a net importer of sorghum.

But the sorghum value chain, which is now years in the making, faces severe disruption. The National Treasury now seeks to reduce the excise duty waiver for beer made from locally grown sorghum, millet or cassava or any other agricultural produce from 80% to 60%. This measure is of course intended to increase tax revenue for the government.

But this policy will likely result in increased prices for the end consumers. This will in turn force the processor to cut down on production, and thereby reduce demand for the raw material. It is important to note that the main objective of changing the policy in 2004 was to fight illicit brews by making sorghum beer more affordable for people with low incomes.

Reduced demand will not only lower sorghum prices but increase costs for farmers forced to invest in storage and management of unsold produce. And more jobs will be lost along the value chain as economic activity scales down.

Learning from past policy failures

Existing evidence shows that such a policy move is counterproductive. In 2013, a similar proposal was implemented when a 50% excise duty was introduced. As a result, the price of sorghum beer increased as the added tax was passed on to consumers. The demand for sorghum plummeted as the beer processors scaled down processed volumes and also cancelled contracts for farmers.

This had a negative impact not only for farmers, but for others in the value chain, like input sellers, grain aggregators and transporters. Instead of the government raising revenue, it actually lost Ksh 2 billion in forgone tax revenue due to losses accruing to the sorghum beer processors and others in the chain.

The policy measure was rescinded in 2015.

The new regulation is ill-timed. This year, the agriculture sector has suffered several shocks. From December 2019, the desert locust invasion affected most of the arid and semi-arid lands. Also, excessive rainfall has been experienced in most parts of the country. Although the former did not pose a severe threat to sorghum farming, the latter posed a significant threat to productivity arising from flooding and waterlogging.

The COVID-19 pandemic has disrupted the economy in a way never experienced before. The demand for sorghum beer was already depressed following the closure of bars, restaurants and hotels in March 2020. Curtailing the industry during such economic shocks can only lead to worse effects for the economy.

Inconsistent policy choices

The adverse policy also contradicts other government’s policies and investments. The government, through support from development partners such as the World Bank and European Union, has also invested heavily in the sorghum and millet value chains through the projects like Kenya Climate Smart Agriculture Project, the National Agricultural and Rural Inclusive Growth Project and the Kenya Cereal Enhancement Programme. Several counties have prioritised sorghum as an essential food and commercial crop.

The president opened a Ksh 14 billion plant in Kisumu County two years ago which is serving as a key market for farmers in the western region. Another processing plant is being set up in Nakuru County. These investments have been made as a result of a stable and predictable policy environment that has existed in the past.

Across the value chain various players have invested and continue to do so with the expectation that this environment will persist and guarantee them a return on their investments. These actors include seed breeders working on sorghum varieties, seed companies, grain processors and investments in post-harvest storage and management.

The proposed regulation will be a disincentive to such investments, especially by the private sector, and possibly lead to capital flight.The Conversation

 

Timothy Njagi Njeru, Research Fellow, Tegemeo Institute, Egerton University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Kenya has overtaken Angola as the third-largest economy in Sub-Sahara Africa, International Monetary Funds’ (IMF) fresh estimates released Friday has shown.

The East Africa’s largest economy, that has been the fourth largest economy in the Sub-Sahara Africa, has surpassed Angola to become third-largest economy in dollar terms.

Kenya now is behind Nigeria (1) and South Africa.

Bloomberg reports that Angola has contracted every year since 2016 as oil output declined, and the kwanza was devalued in 2019 while Kenya’s shilling held steady.

The coronavirus pandemic and restrictions to limit its spread will probably see Angola’s gross domestic product contract 1.4 percent in 2020, while Kenya’s is projected to grow by one percent, according to the IMF report.

According to IMF, Angola, an oil dependent country, recently had its national assembly approve a package of revenue and expenditure measures to fight the COVID-19 outbreak in the country and minimize its negative economic impact.

Additional health care spending, estimated at $40 million (Sh4billion) was announced. Tax exemptions on humanitarian aid and donations and some delays on filing taxes for selected imports were granted.

While Kenya has earmarked Sh40 billion (0.4 percent of GDP) in funds for additional health expenditure and funds for expediting payments of existing obligations to maintain cash flow for businesses during the crisis, among other tax relief incentives.

 

Read More: Daily Nation

To control the spread of coronavirus, the Kenyan Ministry of Health COVID-19 Taskforce implemented initial prevention and mitigation measures. These included encouraging the public to wash their hands, wear face masks and stay home.

But not everyone will be able to adhere to these because they rely on a daily wage and cannot afford to stay home. Many of these people live in Nairobi’s low income settlements which are overcrowded and where sanitation and social distancing measures are near impossible to maintain. COVID-19 would spread rapidly under these conditions.

To make sure this doesn’t happen, health authorities need timely data to design policies and interventions that are easily understood and relevant to the lives of urban slum inhabitants.

Along with our colleagues at the Population Council (an organisation dedicated to carrying out research on critical health and development issues), we worked with the government’s taskforce committees to do just that. We used rapid phone-based surveys to collect information on knowledge, attitudes, practices and needs among 2,000 households in five Nairobi urban slums. The survey will be conducted every 2 to 3 weeks over the coming months as the pandemic unfolds in Kenya.

Some of our key findings so far are that prevention methods are being adopted by most, but people are starting to struggle: many are missing meals, have lost work and say that the cost of living is going up.

It’s vital to have this information as it will help to inform prevention, control and mitigation measures during epidemics. A recent example is from the Ebola response, where surveys identified the prevalence of misconceptions about Ebola transmission and prevention, the need to prevent stigmatisation of Ebola survivors, and to foster safer case management and burial practices.

What people are saying

One of our key findings so far was that most people are adopting prevention practices, including social distancing, hand washing and wearing face masks. For instance participants reported that – compared to before COVID-19 – they: saw less of family (56%), saw less of their friends (87%), avoided public transportation (76%) and stayed at home more (85%).

But staying at home is proving more difficult. In the day before the survey, 79% had left the house; 37% left once, 24% left twice, 39% left three times or more. Of those that left home, 34% travelled outside of the slum where they live, suggesting significant travel around Nairobi.

When it came to wearing face masks, 89% said they had worn one in the last week, 73% said they always wore the face mask when outside of the home. Of those who did not always wear a face mask, the reasons were mainly that they were uncomfortable (57%) and unaffordable (19%).

Hand-washing was also a widely adopted practice: 95% said most public spaces have hand-washing stations, 76% said they washed their hands more than seven times a day, and 88% said they always used soap. Only 5% of participants say they wash their hands between 1 and 3 times per day. Barriers to regular handwashing were a lack of access to water at home (25%) and that they couldn’t cannot afford (32%) extra soap or water.

Hand sanitisers were used far less: 40% of participants said they don’t use them because they’re too expensive (83%) or not available in shops (24%).

Skipped meals

The pandemic is clearing having a negative impact on people’s health and economic and social status.

Most people who responded to our survey (68%) said they had had skipped a meal or eaten less in the past two weeks because they did not have enough money to buy food. Only 7% had received any type of assistance – such as cash, vouchers, food and soap – and only half said the assistance given was enough to cover their households’ most important needs.

Participants expressed their single biggest unmet need was food (74%) followed by cash (17%). This may be related to 77% of participants reporting increased food prices and 87% noting household expenditures increased, as well as more than 4 out of 5 participants reporting complete or partial loss of income or employment.

Women may be disproportionately affected with increased time spent on chores (67% vs 51% of men) and more women reported a complete loss of income or employment compared to men.

When it came to how well-informed people are of the illness, we found a big majority knew that fevers (83%) were a symptom. But less knew about difficulty breathing (48%) and coughs (52%).

We also found that young people were less likely to think they were at high risk of becoming infected compared to older people. We identified two other persistent myths: 27% thought that coronavirus was a punishment from god and 13% thought it could not spread in hot places.

Recommendations

Based on our findings, we recommend that the Kenyan government continue its public education campaigns, with a focus on:

  • Clarifying that everyone can be infected with COVID-19 and pass on the virus to others, even if they themselves are not at high risk from severe illness.

  • Recognise that people are starting to be flooded with information on COVID-19 from all sources. This suggests that messaging can be refocused toward accurate prevention measures and accessing social protection.

  • Given the high rates of people forgoing food, and experiencing a complete or partial loss of income, assistance must be provided so as to avoid a secondary humanitarian crisis. It is particularly important that assistance gets into the hands of women to help them cope with these challenges.

  • Current assistance efforts are reaching less than 10% of the participants and should be ramped up in a coordinated way.The Conversation

Karen Austrian, Senior Associate in Kenya, Population Council and Timothy Abuya, Senior Analyst, Population Council

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Kenya is facing a double burden of communicable and non-communicable diseases. Clustering of infections (such as HIV or TB) and noncommunicable diseases such as diabetes or hypertension is now common. This is putting pressure on the overstretched healthcare system.

In spite of this, many individuals with noncommunicable diseases remain undiagnosed for a number of reasons. These include unfamiliarity with symptoms, lack of testing equipment, and costs associated with the tests.

Recent statistics show that just over half a million adults were living with diabetes in Kenya in 2019. About 40% were unaware of their condition. Deaths from cancer are estimated at 7% while cardiovascular diseases account for 13%.

Overall, almost half of hospital admissions and about 55% of deaths in Kenya are associated with noncommunicable diseases.

This leaves countries like Kenya in a particularly vulnerable position when it comes to the severity of COVID-19. Globally, evidence shows people with underlying medical conditions such as cardiovascular disease, hypertension, diabetes or cancers are at a higher risk of COVID-19.

Is the health system in Kenya prepared?

Even before the COVID-19 pandemic reached Kenya, access to chronic care, especially for noncommunicable diseases, was challenging. This is worse for patients with more than one chronic disease.

Kenya’s health system is fragmented and largely designed to manage individual diseases rather than managing patients with multiple diseases. This is partly due to health system challenges such as staff shortages, inadequate or dysfunctional medical equipment, drug stock-outs and unskilled providers.

Unlike HIV, tuberculosis and malaria, access to care for most noncommunicable diseases such as diabetes is a major problem especially among the poor. Findings from our study at Mbagathi district hospital in Nairobi revealed some of these challenges.

A 52-year-old female patient said:

My HIV/AIDS care is provided free of charge but other diseases such as diabetes I pay for.

Another 58-year-old male patient said:

Every time I use KSh.1500 (US$15); consultation fee is KSh.300 ($3); I buy drugs for three months and that costs KSh.300 ($3).

During the COVID-19 pandemic, access to care may be even more difficult due to overwhelmed health systems, lockdown and curfews as well as fear of infections. Currently, preparations are being made to prevent or manage COVID-19 cases. But little is said about protocols to manage patients with chronic conditions.

It’s important to strengthen the healthcare system in Kenya to offer integrated care that addresses not only the COVID-19 pandemic but also chronic illnesses.

Recommendations

Management of COVID-19 should take account of other conditions. The current funding such as the $50 million provided by the World Bank should provide horizontal treatment and care. It should address all conditions rather than only prioritising COVID-19 cases.

Integrating care means that individuals could get access to testing and medical care for COVID-19 as well as other conditions such as diabetes or hypertension.

The Kenyan government must also provide healthcare workers with adequate personal protective equipment and address staff shortages by hiring more unemployed doctors and nurses.

And healthcare providers with chronic conditions must be relieved from being at the frontline in managing COVID-19 cases. If this is not possible, providers must be well protected to avoid being infected.

Collaborating with communities and local administrations will help in reporting and tracking cases or deaths, and citizens who defy government laws. Community health workers can sensitise community members and individuals at risk of COVID-19 on preventive measures.

Finally, the police force in Kenya should be made aware that, even during the COVID-19 pandemic, patients with chronic diseases need constant engagement with hospitals. Lockdowns or curfew measures should be sensitive to these populations.The Conversation

 

Edna N Bosire, PhD Candidate and Associate Researcher, Developmental Pathways for Health Research Unit (DPHRU)., University of the Witwatersrand

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Kenya has started negotiating a withdrawal from Somalia by 2021. The country is set to leave as Ethiopia’s influence continues to rise.

Kenya has achieved a lot since it intervened in 2011. Its intervention was a “game changer”, contributing to a momentum that led to al-Shabaab losing all major Somali cities. But it has fallen short of its goals to subdue al-Shabaab and end terrorism in Kenya. And it will leave a Somalia where its rivals are gaining power and challenging Kenyan national interests.

The intervention

Kenya’s public motive for intervening in 2011 was self-defence. Its defence forces moved into Somalia to stop al-Shabaab attacks and improve the country’s internal security. Since then, al-Shabaab has lost territorial control over all of Somalia’s larger cities. In 2012, Kenya reclaimed Kismayo. In the same year, it convinced Ethiopia to join the fight.

The combined forces of Kenya and Ethiopia were redeployed under the African Union Mission to Somalia. This was crucial in containing al-Shabaab between 2012 and 2016. This combined force weakened the terror group to the point that it is now unable to hold territories within Somali cities.

But this still does not mean that the intervention was successful. Since it began, al-Shabaab has launched three large attacks in Kenya. In 2013, it attacked Westgate Mall in Nairobi. In 2015, it attacked Garissa University in northeastern Kenya. And last year it attacked the Dusit Hotel complex, also in the capital.

By late 2019, al-Shabaab’s infiltration in Kenya’s northeast intensified, and locals are increasingly accommodating their presence.

The situation in the area around the coastal town of Lamu is similar. Al-Shabaab is taking advantage of animosities between the Muslim Bajunis and the Christian elite who settled in the area in the 1970s.

Broadly speaking, Kenya has managed to curtail al-Shabaab activities in trouble spots in Kilifi and Mombasa. The country also managed to return a large number of foreign fighters to Somalia without much blow-back. Yet the intervention of 2011 failed to keep Kenya completely safe.

Nor did it fully vanquish al-Shabaab. The group is still strong, despite having lost much of its territory. It is richer than ever, propelled by its efficient taxing of the Somali business community, tolled checkpoints and investments, including some in the agricultural sector. Its leadership structure remains intact, with many key officers having served more than four years.


Read more: Al-Shabaab's attacks come amid backdrop of West's waning interest


Kenya’s dilemmas

Kenya’s withdrawal from Somalia will have its own drawbacks. For one, it will abandon its long-time allies inside Somalia. Thus, it will lose leverage with both Addis Ababa and Mogadishu.

The government of Somalia’s president, known as Farmajo, has increasingly been at odds with Kenya. The two countries are currently in a diplomatic row over their shared maritime border.

Second, Farmajo’s agenda to place his preferred candidates in political office in Somalia’s regional states has challenged Kenya’s allies in Somalia and especially the regional state of Jubaland.

It has become clear that Farmajo is willing to draw Ethiopian forces as well as the Somali National Army into his quest to consolidate power by appointing political allies. This has pitched Ethiopia against Kenya, and created tension. Ethiopian forces have recently intervened in support of the Somali government in Mogadishu, targeting the enemies of the Farmajo government. That government has been increasingly willing to use military force against the opposition (as well as the Somali media, and against the regional state of Jubaland, led by Kenyan ally Ahmed Mohamed Islam “Madobe”.

Kenya leaves a Somalia where neighbouring Ethiopia plays an increasing role, and also works against Kenya’s former allies. Also, there are stronger totalitarian tendencies on the part of the Somali presidency than before.


Read more: Western countries take sides in Kenya's maritime row with Somalia


Its withdrawal will leave Ethiopia with a dominating position in the African Union Mission to Somalia. As Ethiopia’s alliance with Farmajo is strong, this is bad news for the Somali opposition, including allies of Kenya.

By withdrawing, Kenya has also let its allies down. It has shown that it cannot be trusted to stay the course. Yet the withdrawal follows a wider pattern in Kenyan politics, wherein the 2011 intervention was the exception.


Read more: Kenya and Somalia row over offshore rights is rooted in the carve up of Africa


Kenya’s foreign policy strategy has traditionally been passive and restrained. It has held back from the more aggressive politics of all of its neighbours. In the past, this strategy served Kenya well, and the country avoided much of the turmoil that plagued neighbouring countries like Uganda, Sudan, South Sudan, Somalia, and even Tanzania. A Kenyan withdrawal is thus a return to Kenya’s traditional foreign policy, and saves Kenyan lives and resources.


Read more: How Moi put foreign policy at the centre of his presidency


Kenya’s relationship with Ethiopia has been the cornerstone of its regional foreign policy, and a Kenyan withdrawal can repair the relationship. But that will be done on Ethiopia’s terms, enhance Ethiopian power in Somalia and leave Kenya with fewer allies within Somalia.

This is the dilemma faced by Kenyan decision-makers today, and their choices will have far-reaching consequences.The Conversation

Stig Jarle Hansen, Associate Professor of International Relations, Norwegian University of Life Sciences

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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