Imbalances in development undermine Kenya’s potential

The Kenya National Bureau of Statistics (KNBS) recently released the 2022 Kenya Demographic and Health Survey Data (KDHS).

The media reporting of the data focused on what could sell. The media paid attention to findings that cause huge public excitement. These include findings on counties where men and women tend to have relations outside marriage and the extent of promiscuity.

The development policy import of the survey data was lost in this report. Issues such as declining fertility rates and reduced household sizes in both rural and urban areas are some of the findings reported but what this implies for the well-being of households has not received attention.

The findings also reveal huge differences in the performance of counties in relation to many indicators. The counties in the marginalised regions of the country lag in many aspects. Those in Northern Kenya and the Coast perform poorly in almost all reported indicators.

For instance, the percentage of children under the age of five who are stunted is high in almost all historically marginalised counties. Kilifi at 37 per cent and West Pokot at 34 per cent lead in this respect. That is to say that in Kilifi, 37 per cent of the children under the age of five and 34 per cent in West Pokot are stunted.

Other counties in Northern Kenya and the Coast are not any better. Samburu has 31 per cent; Turkana 23 per cent; Mandera 21 per cent; and Kwale 23 per cent. This means that there are counties in this country where about one-third of the population is poorly nourished.

And poor nourishment of children at this age means that they will not have the full potential to develop their human capacities. Stunting will undermine their abilities in many other ways, including poor performance in education.

One-third of the population could be wasted because of poor child nutrition status. And of course, poor nutrition status is a factor of poverty at the household level, which in turn is resulting from the state of underdevelopment in these counties.

Teenage pregnancy is also high in poor counties. The percentage of women aged 15-19 who have ever been pregnant is high in Samburu (50 per cent), West Pokot (36 per cent), and Marsabit (29 per cent). It is lowest in Nyeri and Nyandarua at five per cent each. There are well-off counties where these figures are higher than 10 per cent, but all the marginalised counties are performing poorly on this indicator.

Child mortality

But there is good news too with regard to raising children. Child mortality is on the decline. Child mortality has declined steadily since 2003. It has declined from about 115 deaths per 1,000 live births in 2003 to 41 deaths in 2022.

That is, in the period around 2003, about 115 out of 1,000 children faced the probability of dying before age five. Only 41 out of 1,000 children faced this probability in 2022, meaning a significant improvement. But 41 out of 1,000 is not anything to be happy about. It is not anything to be happy about especially given that even those alive tend to be stunted because of poor nutrition.

The KDHS findings also reveal that education and wealth matter in the well-being of households. 

Poor households perform worse in a majority of the indicators compared to well-off households. For example, health insurance is important in terms of providing households and individuals with access to health services. The findings show that about a quarter (about 26 per cent) have some form of health insurance.

The National Hospital Insurance Fund (NHIF) is the most common type of insurance; about 24 per cent are covered under NHIF. This is an improvement on the 2014 findings; only under 16 per cent had any insurance cover in 2014. Again NHIF at 14 per cent was the most common insurance cover for many households.

The wealth of households is an important determinant of whether the households have health insurance or not. Health insurance coverage increases with wealth; such that the poorer the household, the poor the possibility of getting insurance cover.

Of the 24 per cent covered under NHIF, half (50 per cent) are under the highest wealth group of households. Only 4 per cent of the poorest group of households have any insurance (3.6 per cent have NHIF). This, of course, means that the poorer the household, the more the challenges of accessing health services.

It is noteworthy that poor counties lag in terms of health insurance coverage. Although the report has no findings for county-specific health insurance coverage, poverty levels in the marginalised counties would certainly constrain households from obtaining even NHIF cover.

Now that we know wealth determines whether a household has a cover or not, we are confident that poor households in marginalised counties (historically disadvantaged counties) have no insurance cover.

Again the findings reveal that the level of education determines how a household performs in terms of the various indicators. For example, the use of family planning methods is more common among educated women than among those without education. Overall, only 25 per cent of women with no education use any contraception. On the other hand, more than 60 per cent of women with education (from primary education and above) use contraception.

Inequalities 

These findings add more value when read together with the 2019 Kenya Population and Housing Census. The census findings again reveal a stark reality of imbalances and inequalities in development. There are many households without access to clean drinking water next to their dwellings.

For instance, in 2019, only 10 per cent of households had piped water in their dwelling and 14 per cent had piped water within the compound. The counties performing poorly in terms of the provision of drinking water to households include those in the marginalised counties. For instance, in Wajir, only 1.4 per cent had water piped to their homes, Mandera (one per cent) and Tana River (2.9 per cent). In Kwale, only 4 per cent of households had water piped to their homes. Another 5.5 per cent had piped water near home.

Back to KDHS findings. There is some good news. Delivery care has improved in the country. There are more deliveries assisted by skilled health providers compared to the past. The percentage of live births delivered by skilled providers has increased from 43 per cent in 1999 to 89 per cent in 2022.

On this one may argue that devolution and specifically devolving health functions to the counties has helped. There are more health facilities in many counties today where people can be attended to compared to the past. Healthcare workers are now found in some of the most remote places in the country and under the supervision of county governments.

All the same, there are many counties without an adequate number of health facilities and health workers to give support to the population. The disparities in access to health facilities and other basic services contribute to these differences revealed in KDHS 2022 report.

Overall, the 2022 KDHS reveals county-level imbalances in all indicators that matter for the well-being of a people. Unless the country is proactive in giving attention to the development of the counties left behind, the country’s potential will remain untapped. These counties are part of the ‘whole’ that is Kenya. Failure to address the developmental challenges that they face has implications for the development of the ‘whole’.

And the challenges can only be addressed by making devolution work. This means more funds to the counties to address county-specific developmental needs as envisaged in the constitutional provisions on the Equalisation Fund. It also highlights the need for the national government to provide conditional funds to help counties address some of the critical indicators such as the immunisation of children.

Prof Kanyinga is based at the Institute for Development Studies (IDS), University of Nairobi, [email protected], @karutikk