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Period Poverty: An Epidemic Among Poor Women and Girls

by Laura Darcey

Period poverty refers to the lack of access to menstrual hygiene products, education, facilities and proper sanitation during menstruation.  Women and girls can’t afford or access basic menstrual products like pads, tampons, or menstrual cups, and many don’t have access to adequate sanitation or safe facilities to manage their periods hygienically. Rising inflation is perpetuating these issues. In 2020 a pack of seven to ten pads sold for an average of KSh50 in major Kenyan supermarkets.  In 2023 they retail for KSh85[i].

The absence of proper resources places women and girls at significant risk, affecting their physical health and well-being, alongside their access to education.

An estimated 65% of women and girls in Kenya can’t afford the basic necessities to manage their menstruation, leading them to use alternatives such as rags, blankets, pieces of mattresses, tissue paper, cotton wool or chicken feathers[ii].

Also, fundamental to a dignified menstruation is access to hygiene resources. Yet many women do not have in-home plumbing and must use outdoor facilities – preventing access to clean water, to clean sanitation systems and increasing their chances of physical assault. Schools often compound this problem.  Only an estimated 32% of rural schools have a private place to change their feminine hygiene products[iii].

Ultimately, poor menstrual hygiene can pose serious health risks, like reproductive and urinary tract infections which can lead to future infertility and birth complications[iv].

School attendance and social stigma

Period poverty has a serious impact on girls’ school attendance. In 2021, the Ministry of Education estimated that girls lose an average of four days of school each month due to their period which, over a full school year, translates to missing two months[v].  A study also found that 70% of female students reported menstruation as having a negative impact on their grades, and over 50% said it was forcing them to fall behind in school[vi].

Going to school while menstruating without adequate sanitary products puts girls at risk of severe teasing and taunting from male students and teachers. Girls are often afraid of leaks and soiling their uniform and will stay home, foregoing their education, to avoid the judgement. In 2019, a 14-year old Kenyan school girl took her own life after experiencing excessive period shaming and humiliation from a teacher who called her ‘dirty’ for staining her uniform[vii].

These challenges are exacerbated by a societal stigma surrounding menstruation in which discussing menstrual health remains taboo. A 2014 study by Alexander Kelly found only 50% of Kenyan women openly discuss menstruation at home and only 12% of girls were comfortable receiving menstrual information from their mothers[viii].

Sex for menstruation products and sexual violence

Covid-19 caused huge disruptions to Kenyan life, exacerbating existing financial hardships, and cutting girls off from resources upon which they previously relied.

After schools closed in March 2020, access to basic hygiene requirements such as water, soap, and menstrual products diminished even further than prior levels. This created a ‘shadow pandemic’ where Kenyan girls were preyed on by older men with spare cash, and exchanged sex for money to buy period products. By 2021, 10% of 15-year old girls had traded sex for period products. In addition, within the first three months of lockdown more than 152,000 girls became pregnant in Kenya[ix].

Girls who are out of school are more likely to get pregnant and more likely to be victims of sexual assault[x]. Teen motherhood is rife with issues in any culture and in Kenya, if a student has a child, it is difficult for them to continue with their education. Formula and child care are expensive, and it is almost impossible to attend school as a nursing mother[xi].

Sexual violence is also prevalent where there is a lack of access to adequate hygiene facilities. Women often won’t visit toilets at night as they do not view them as safe spaces. In Kenyan informal settlements, the majority of sexual violence occurs within the context of using a toilet, bathing or managing menstrual hygiene[xii].

Providing women and girls with reusable menstrual pads has been seen as an important solution for period poverty, but these products only work for girls and women who have access to clean water and a private and safe environment in which to manage their menstruation.

Faltering Progress  

In 2004 Kenya repealed its VAT on pads and tampons to lower the price consumers paid for products, and in 2016 the government went even further, removing tax on the raw materials used to manufacture sanitary pads. But despite these reforms, menstrual products remain squarely out of reach for many, and some tax cuts have benefited retailers and manufactures more than consumers. ALWAYS – the product dominating the Kenyan pads market – didn’t change the price of its product following the removal of VAT, instead absorbing the tax cuts into their product margins[xiii].

In 2017 the government made the commitment to “provide free, sufficient and quality sanitary towels to every girl child registered and enrolled in a public basic education institution who has reached puberty and provide a safe and environmentally sound mechanism for disposal of the sanitary towels”[xiv].

But budgetary allocations have not been enough to sustain this ambitious policy. In the 2012/13 financial year, Sh300 million was set aside for the programme, but this had fallen to Sh260 million by 2018/19 despite rising inflation. The programme has also been hit with integrity queries over payments, as well as concerns of corruption[xv].

In addition to inadequate funding, menstrual products have not been reaching the girls who need them the most. There is no process used to track the distribution of pads and female teachers have been known to steal the pads for themselves. Male teachers are often in charge of distributing the pads, which girls find humiliating[xvi].

Support from NTS

NTS believes that all students should be able to confidently attend school and therefore ensure that period poverty is a thing of the past for our female students.

NTS works with our partner, AFRIpads, who provide reusable sanitary products, discrete ways of carrying the products, and culturally-relevant training and education to both educators and students about sexual health and menstruation.  Upon beginning their education with NTS, students are given 2 pairs of underwear, reusable pads (1 heavy, 1 light, and 3 for day time) and a carrying kit that keeps dirty and clean pads separate. NTS also has extra uniforms for female students so if anyone has an accident, it can be dealt with quickly and discreetly.

We also teach female students about their reproductive cycle and how to avoid pregnancy, how to embrace their bodies without fear, and when to seek medical help. NTS offers basic health and reproductive education to all of our students. In the future NTS hopes to expand to provide more in-depth education about their bodies and reproductive systems, including consent, STIs, HIV, birth control, and family planning.

School toilets are modern and have separate entrances that are not close to each other.  In addition, they are monitored at breaks by the NTS security guard, further ensuring safety.  During classes, students do not use toilets unless there is an emergency.  In this way, safety is further assured for all students.

At NTS, female students are able to independently manage their period and can confidently attend school while menstruating.  As a result, their performance at school, and on their NITA exams, is on a par with their male peers.  At NTS, period poverty is a thing of the past.

References

[i] Nation, Menstrual Health: Breaking the silence on menstrual struggle, https://nation.africa/kenya/news/gender/menstrual-health-breaking-the-silence-on-menstrual-struggle-4247566

[ii] Buckner, What is period poverty and why should people care?, https://www.buckner.org/kenya/blog/what-is-period-poverty-and-why-should-people-care/#:~:text=65%25%20of%20females%20in%20Kenya,access%20to%20feminine%20hygiene%20products

[iii] Buckner, A Kenyan female’s perspective on period poverty, https://www.buckner.org/blog/a-kenyan-females-perspective-on-period-poverty-world-health-day/

[iv] WHO, Menstrual Health and Hygiene, https://www.worldbank.org/en/topic/water/brief/menstrual-health-and-hygiene

[v] Aljazeera, ‘I wish I was a boy’: The Kenyan girls fighting period poverty, https://www.aljazeera.com/features/2020/2/24/i-wish-i-was-a-boy-the-kenyan-girls-fighting-period-poverty

[vi] BBC News, Period poverty: African women priced out of buying sanitary pads, https://www.bbc.co.uk/news/world-africa-66423981

[vii] Catalyst, A look at the impact of period poverty on girls in Kenya, https://catalystmcgill.com/a-look-at-the-impact-of-period-poverty-and-period-shame-on-girls-in-kenya/

[viii] UNFPA Kenya, Period poverty: the weak link in ending gender based violence, https://kenya.unfpa.org/en/news/period-poverty-weak-link-ending-gender-based-violence-dr-olajide-unfpa-representative-ms-mbugua

[ix] Catalyst

[x] Munala, The impact of covid-19 on girls from low income urban and rural areas in Kenya, https://assets.researchsquare.com/files/rs-1594640/v1/ea2df3c4-cf2f-4410-898c-be61066a25ff.pdf?c=1652561510

[xi] Otieno Onyango, Challenges of school re-entry among teenage mothers in primary schools in Muhoroni district, https://healtheducationresources.unesco.org/library/documents/challenges-school-re-entry-among-teenage-mothers-primary-schools-muhoroni

[xii] Abrahams, Intersections of sanitation, sexual coercion and girls’ safety in schools, https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-3156.2006.01600.x

[xiii] Reuters, How the fight against the tampon tax failed to fix period poverty, https://www.reuters.com/article/idUSL1N34I248/

>[xiv] Borgen, Addressing period poverty in Kenya keeps girls in school, https://www.borgenmagazine.com/period-poverty-in-kenya/

[xv] Nation

[xvi] NPR, What Kenya can teach the US about menstrual pads, https://www.npr.org/sections/goatsandsoda/2016/05/10/476741805/what-kenya-can-teach-the-u-s-about-menstrual-pads

Female Genital Cutting: Safeguarding Kenya’s Young Women

by Laura Darcey

Female genital cutting (FGC) is a practice that involves the complete or partial removal of the external female genitalia for non-medical reasons. It is frequently practised on young girls and is a deeply entrenched tradition in many communities marking the transition from girlhood to womanhood.

In 2021, it was estimated that 21% of Kenyan women aged 15-49 had undergone FGC. Breaking down the most recent data by age group, however, shows that the prevalence for women aged 45-49 is 40.9%, while for the youngest age group it has fallen to 11.9%. This demonstrates that progress has been made in recent years, but FGC remains prevalent in Kenya.

FGC has been classified as a human rights violation by the United Nations . It can range from Type 1 – the partial or total removal of the clitoral glans, and/or the clitoral hood, to Type 3 – infibulation, the narrowing of the vaginal opening through the creation of a covering seal, which is formed by cutting and repositioning the labia minora or labia majora, sometimes through stitching.

There are no medical benefits associated with FGC, but many dangers. Immediate consequences of FGC can include excessive bleeding, swelling, fever, infection, urinary problems, shock and death. Long term complications can range from menstrual problems, sexual challenges, and psychological issues to an increased risk of childbirth complications, including fistula and new-born death .

Girls who have undergone FGC experience physical trauma and health complications that can make school attendance and learning difficult. In addition, FGC reinforces patriarchal structures, positioning young girls as prospective wives and mothers, rather than autonomous individuals. Following FGC, many girls become withdrawn as they face the short and long-term health complications associated with the procedure .

A Cultural Expectation

In some Kenyan communities, FGC is part of a larger coming-of-age ceremony wherein girls establish their identity and indicate that they are ready to be wed. The practice is driven by families who want their daughters to be accepted in the community and married into good families who can support them.

FGC is also performed for cosmetic reasons, as some men prefer the physical aesthetic of a woman who has been circumcised. A woman who has not undergone the procedure is sometimes viewed as ‘unclean’. Religious doctrine is also frequently used to justify the practice, although many religious scholars and international organisations maintain that FGC is endorsed by neither Christianity nor Islam.

The pressure to undergo the cut can be immense. An uncircumcised woman can be seen as devalued, unclean and cowardly. Women risk losing their social standing in the community, their prospects of finding a husband, and their worth as a bride. This can lead to women being marginalised and becoming both socially and economically vulnerable.

Surprisingly, the greatest supporters of the practice are often female elders. These women, who were circumcised as children, hold real political power. They are both practitioners who derive major income from performing the cutting , and are those who uphold the rituals and teachings associated with the practice. It is not uncommon for an elder to overrule the FGC preferences of a girl or those of her mother.

Poverty, Marriage and School Holidays

Financial shocks can increase the prevalence of FGC. If a family is undergoing financial hardship, they may look to marry off their daughter in exchange for a dowry, requiring her to undergo FGC in preparation. Currently, climate change is exacerbating these issues, creating more desperate families who are not willing to risk foregoing FGC, despite the waning popularity of the procedure .

The Covid-19 pandemic demonstrated that economic and social disruption can also lead to an increase in FGC. First, the usual processes to protect girls from FGC were halted during the pandemic, leaving girls vulnerable. Then, schools which have historically been a source of protection for school-aged girls at risk of FGC, were closed. Girls are most commonly cut during the Christmas holidays, which is the longest vacation of the year and allows them time to heal from the procedure without scrutiny from teachers or school administrators. During Covi, this school year protection disappeared. Data gathered by UNICEF in nine Kenyan counties shows a 121% increase in the number of FGC cases between January and November 2020 compared to the same period in 2019. The number of girls rescued from FGC dropped from 1,073 in 2019 to 994 in 2020 .

Additionally, pandemic-related travel restrictions prevented government officials, law enforcement, and humanitarian workers from travelling in regions with high FGC prevalence to implement child protection programmes.

Criminalising FGC

FGC was banned in Kenya in 2001 through the Children’s Act which stated “no person shall subject a child to female circumcision, early marriage or other cultural rites, customs or traditional practices that are likely to negatively affect the child’s life, health, social welfare, dignity or physical or psychological development”.

In 2011, Kenya criminalised FGC and set the goal of eliminating the practice by 2022, passing more explicit legislation – the Prohibition of Female Genital Mutilation Act, which imposed harsh penalties or perpetrators of FGC, including a minimum fine of 200,000 KSH (equivalent to $1,800), or three years imprisonment, or both . The Kenyan government also established an “Anti-Female Genital Mutilation and Child Prosecution Unit” with 20 prosecutors based in FGC practicing communities around the country to deal exclusively with eradicating the practice .

Yet, superstitions around FGC have been passed down from generation to generation, and indicate a certain way of life and belief system. The interference of government officials from far-off Nairobi, and aid workers from even further away in Europe and America, are distant and foreign compared to deeply rooted customs that permeate the everyday lives of the people and tribes that practise FGC .

The criminalisation of the practice has pushed it underground, making it harder for police officers and local officials to identify, arrest and prosecute those practising it. Additionally, many Kenyans, including law enforcement officials are unwilling to report FGC t in their communities. Often, it is their own grandmothers who are doing the cutting .

Education as Protection

FGC acts as a barrier to girls’ education, particularly when it serves as a precursor to child marriage. But education can also be a way to help girls escape FGC.

Accessing education creates a ‘network effect’ for girls, providing them with the life skills and the social space to introduce new concepts and giving room for the exchange of ideas. Education strengthens the agency and ability of girls to understand and exercise their rights. School-based interventions such as teacher training and curriculum on the risks of FGC as well as wider gender equality, raises girls’ awareness and strengthens their decision-making capabilities. School attendance can also protect girls from FGC. In countries where FGC is practised, 54% of women with no education report they have undergone FGC, compared to 19% of women who have some level of secondary education .

Access to education also has the potential to affect girls’ decisions when they have children of their own. Of women who underwent FGC, 85% of those who completed primary education believe the practice should stop, compared with 35% of those with no education . According to a report by the International Centre for Research on Women, women’s support for FGC decreases as her level of education increases. Education can protect the next generation of girls from FGC .

How Does NTS Help Combat the Practice?

NTS provides girls with an alternative path, empowering girls so that marriage is not their only option. By earning a professional degree, young women can secure their own financial future and get married once their careers are established and have reached personal financial stability. The professionals in our community model this for our female students, showing them what it looks like to be an empowered woman.

NTS also takes great care to ensure students are well-informed. We teach students about the dangers of FGC in reproductive health classes. In civics lessons, we cover students’ constitutional and legal rights, including the fact that FGC is illegal in Kenya. And our child safeguarding policy ensures all students are aware of their rights to physical and emotional safety. Additionally, gender equality lessons help to break down some of the patriarchal assumptions that can contribute to FGC.

Structurally, NTS has only short holidays. This means students are not exposed to long breaks from school, therefore reducing the chance they are whisked away for an FGC procedure. And other opportunities, as they arise, will be incorporated into the curriculum and general community social structure.

References

[1] Health and Human Rights Journal, Eradicating Female Genital Mutilation / Cutting https://www.hhrjournal.org/2018/08/eradicating-female-genital-mutilation-cutting-human-rights-based-approaches-of-legislation-education-and-community-empowerment/

[2] WHO, Female Genital Mutilation https://www.who.int/news-room/fact-sheets/detail/female-genital-mutilation

[3] WHO

[4] WHO

[5] Vice, Female Genital Cutting is on the rise during COVID in Kenya https://www.vice.com/en/article/xgzm83/female-genital-cutting-is-on-the-rise-during-covid-in-kenya 

[6] ICRW, Leveraging Education to end female genital cutting worldwide https://www.icrw.org/wp-content/uploads/2016/12/ICRW-WGF-Leveraging-Education-to-End-FGMC-Worldwide-November-2016-FINAL.pdf 

[7] Pulitzer Centre, Climate Change pushes girls in Northern Kenya back to early marriage and FGM https://pulitzercenter.org/projects/climate-change-pushes-girls-northern-kenya-back-early-marriage-and-female-genital 

[8] Vice

[9] Vice

[10] Vice

[11] UNAA, Why is female genital cutting practised, and what is being done to eliminate it? https://www.unaa.org.au/2021/02/06/why-is-female-genital-cutting-practised-and-what-is-being-done-to-eliminate-it/ 

[12] Pulitzer Centre, Some Anti-FGM activists say law is not enough to end practice https://pulitzercenter.org/stories/some-anti-fgm-activists-say-law-not-enough-end-practice 

[13] Orchid Project, Intersection between female genital cutting and education https://www.orchidproject.org/wp-content/uploads/2021/07/Intersection-Between-Female-Genital-Cutting-and-Education.pdf 

[14] UNICEF, The power of education to end female genital mutilation https://data.unicef.org/wp-content/uploads/2022/02/The-power-of-education-to-end-FGM_2022.pdf 

[15] ICRW

Why Math?

by Natali Chinchaladze, NTS teen blogger

Why is math important?  It has been a key area of study even before formal schooling began. But what role does it play in the development of the human mind particularly during childhood?

At Stanford University, researchers have identified that there are three regions of the brain that predict improvement in math learning. Evidently, even the simplest math tasks “lit up” multiple regions of the brain simultaneously. Tanya Evans, the lead researcher, said, “It’s not just a math part of the brain; it’s a network of regions”. [1] This means that the whole brain is “awake” while concentrating on math solutions.

Now, what happens to adolescents who don’t receive or stop receiving education in math?  Researchers from the Department of Experimental Psychology at the University of Oxford and Loughborough University experimented on 133 students ages 14–18 and found a decrease in certain brain chemicals in a brain area that supports math, memory, learning, reasoning, and problem-solving. [2] This means that key functions never develop to their fullest, leaving minds under-developed in critical areas such as: problem-solving, organizing chaotic thoughts, rational thinking, critical thinking, logical reasoning, and the ability to order activities in steps.

In Kenya, this shows up in employer responses to surveys.  While most employers report being satisfied with the knowledge of graduates in different disciplines, they consistently report deficiencies problem-solving skills.  Problem-solving involves an ability to plan ahead and look at the consequences of different potential decisions.  If this critical skill isn’t learned in early years through math education, it becomes much harder to teach in later years and can lead to a stunted career future.

Nyamboyo’s Technical School is combatting this in our three years of intensive vocational training.  Students learn math in their studies. In addition, NTS is developing algebra and financial literacy programs that will be required of all students within the next year.  Our goal is to provide students with a training that opens their minds and gives them skills beyond math, using math as a tool for brain development.   

[1]https://www.bostonglobe.com/ideas/2015/09/17/this-your-brain-math/WMrjRMIyyBmtJCLhb5m2FM/story.html#bgmp-comments

[2]https://www.lboro.ac.uk/news-events/news/2021/june/lack-math-education-affects-brain-development/

Is Healthcare Equity Possible in Kenya?

by Megha Rana

As mentioned in Part 2, a large portion of Kenyan healthcare financing comes from out-of-pocket (OOP) payments. OOP healthcare payments worldwide are estimated to push over 100 million people into poverty annually.  Kenya can ill afford this – with a population of 25.5 people living at some level of poverty, this means a sick nation unable to reach its potential.

 In fact, the economic burden that results from OOP payments is inversely related to income level. In other words, the poorest are often the ones who have the highest OOP fees, spending on average 10-15% of their budget for proper health. This is not only a form of catastrophic health spending (i.e., when the amount a household pays out of pocket is greater than the capacity of the share kept for healthcare purposes), but also creates several barriers to receiving proper healthcare.

Government spending on healthcare in Kenya is one of the lowest in Africa with only 9.1% of the government’s budget allocated towards the healthcare sector. This contrasts the 2001 Abuja Declaration on healthcare in Africa, that all governments must allocate at least 15% of their budget to healthcare sectors. In 2020, Kenya’s health expenditure per capita (i.e., the amount a country spends on health) was $83 or KES 11,806. This compares to Eygpt’s $151 or KES 21,478, Equatorial Guinea’s $237 or KES 33,711 and South Africa’s $490 or KES 69,698.

While other African countries are increasing their funding for the healthcare sector, Kenya is lagging. Although taxes and tax revenues are increasing (one Kenyan recently complained that soon the air will be taxed), the public healthcare sector is not benefitting.  The political and economic danger here is if the poor and middle class are seeing less income because of increased taxes but still squeezed with OOP healthcare payments, the financial burden on those in need will only increase.  Again, those needing care will not have the means to access it.

In essence, health equity can only be achieved in Kenya when there is a greater investment into healthcare sectors to provide support for those unable to care for themselves. An investment in healthy citizens means an investment in a healthy economy and greater political stability.

References:

https://www.who.int/data/gho/indicator-metadata-registry/imr-details/4989#:~:text=Catastrophic%20health%20spending%20occurs%20when,to%20pay%20for%20health%20care.

Chuma, J., Okungu, V. Viewing the Kenyan health system through an equity lens: implications for universal coverage. Int J Equity Health 10, 22 (2011). https://doi.org/10.1186/1475-9276-10-22

https://blogs.worldbank.org/africacan/remaining-ahead-curve-what-should-kenya-do-achieve-its-universal-health-coverage

Barasa, E.W., Maina, T. & Ravishankar, N. Assessing the impoverishing effects, and factors associated with the incidence of catastrophic health care payments in Kenya.Int J Equity Health 16, 31 (2017). https://doi.org/10.1186/s12939-017-0526-x

Salari, Paola et al. “The catastrophic and impoverishing effects of out-of-pocket healthcare payments in Kenya, 2018.” BMJ global health vol. 4,6 e001809. 24 Nov. 2019, doi:10.1136/bmjgh-2019-001809

Mwenda, Ngugi et al. “What Drives Outpatient Care Costs in Kenya? An Analysis With Generalized Estimating Equations.” Frontiers in public health vol. 9 648465. 22 Sep. 2021, doi:10.3389/fpubh.2021.648465

https://www.who.int

 

 

 

 

 

 

The Status of Healthcare in Kenya Today

by Megha Rana

Since the early 2000’s, Kenya has made great progress in reducing child deaths, improving access to maternal healthcare, and expanding healthcare coverage. After many failed attempts, as discussed in our earlier blog, the Kenyan government has been working toward developing a healthcare system that can effectively provide high-quality care to the entire population. In 2017-2018, it was estimated that 72% of all county-level public health systems were more than 80% efficient. In other words, these systems were more than 80% successful in using their allocated resources for positive health outcomes of patients.

However, universal healthcare coverage, meaning all people have access to healthcare services when and where they need them without financial worry, is still out-of-reach.  To-date, 50% of Kenya’s population or 25.5 million people do not have access to essential and affordable health services.  It is an inequity leading to deep discontent among Kenyans.

What has created this inequity?

Current healthcare is Kenya is affected by exploitation for financial gains, creating inaccessibility to public healthcare services for poor and marginalized communities. A report completed and shared by the Global Initiative for Economic, Social, and Cultural Rights (GI-ESCR) analyses how strengthening public healthcare sectors has been disregarded in favor of strengthening private systems. Figure 1 illustrates the division of health facilities by public facilities, non-governmental organizations, faith-based institutions, and private practices.

Private practices take the largest share of health facilities in Kenya.  The authors note that healthcare provided in private facilities is very expensive because private providers, who operate for-profit clinics and hospitals only provide treatment where they have revenue opportunities. This is compared to NGO and faith-based programs where revenue is low to non-existent.

Despite recent efforts, the Kenyan government is struggling to balance the need to generate earnings from patients while still making sure there are no barriers to healthcare access. In public healthcare settings, government funding is limited and, as a result, the main source of funding comes from user fees.  This means that patients, a majority of whom live at or just above the world poverty level, are without health insurance and must pay out-of-pocket. This leads to millions of Kenyans ignoring health needs because they cannot afford care.

Stay tuned for Part 3

References:

Healthcare in Kenya remains elusive due to commercialization

Moses MW, Korir J, Zeng W, et al

Performance assessment of the county healthcare systems in Kenya: a mixed-methods analysis

BMJ Global Health 2021;6:e004707.

https://www.netherlandsandyou.nl/latest-news/news/2022/11/30/trade-mission-kenya

Mohajan, Haradhan. “Improvement of health sector in Kenya.” (2014): 159-169.

Moses, Mark W et al. “Performance assessment of the county healthcare systems in Kenya: a mixed-methods analysis.” BMJ global health vol. 6,6 (2021): e004707. doi:10.1136/bmjgh-2020-004707

Kenya’s Healthcare Reform – A Brief History

by Megha Rana

Since Kenya’s independence in 1963, a national focus has been on building a healthy working country, with “healthcare for all” as a centerpiece. The first developmental plan for Kenya was released in 1965, with the purpose of designing a healthy state of growth for the nation and developing social/economic relations. Called the “Sessional Paper”, it emphasized the elimination of disease, poverty, and illiteracy. While noble, it did not succeed in managing the healthcare needs of a growing and diverse population.

It was not until 1994, that the government approved the Kenya Health Policy Framework (KHPF) for developing and managing health services. The policy focused on four areas: sustainable, accessible, and affordable quality healthcare; sharing of resources; participation and working with others; and the consistent involvement of the government.

To bring this policy into action, in 1996, the Ministry of Health (MOH) developed the Kenya Health Policy Framework Implementation Action Plan and established the Health Sector Reform Secretariat (HSRS) to track the progress of the implementation process. However, this plan soon failed because it lacked the necessary infrastructure.  A new plan called the National Health Sector Strategic Plan was created in its place.  Controlled by the central government, it offered free universal healthcare.

However, by the early 2000’s, with the population growing at a rate faster than the expansion of the healthcare system, a supply crisis emerged.  A lack of funding and clinics meant few citizens could access basic healthcare.  This led to another radical change in the healthcare system, putting greater emphasis on private sector healthcare and the government’s role in regulating preventative health. Like many countries, politics remained a real driver of health reform in Kenya.

In 2008, the Ministry of Health was split into two branches, creating a redundant system with duplicated efforts, difficulty in sharing resources and unreliability in assigned responsibilities. New health reforms were needed to provide equitable, accessible, and affordable healthcare to all.

Stay tuned for Part 2.

References:

https://dhsprogram.com/pubs/pdf/spa8/02chapter2.pdf

Wamai, Richard G.. “Administration and Reforms in Post-Colonial Kenya and Challenges for the Future.” (2009).

Meet Natali – NTS’ Official Teen Blogger!

Today, it is our honor to introduce NTS’ teen blogger, Natali Chinchaladze. Natali discovered NTS through the website VolunteerMatch.  We have worked together for nearly a year and her work is remarkable by any standards – most particularly for someone so young, who speaks English as a second language.  Rather than tell you about her, it is our pleasure for you to meet Natali in her own words:

It is a pleasure to meet the NTS school community.  I am 15 years old and from Kutaisi, Georgia – the Republic of Georgia not the US. I am in the 11th grade and study at Niko Nikoladze School.

School is my great love.  There are millions of things I like and admire about my school. Even walking in the gate makes me cheerful and instantly lifts my mood. My priority is to study and I am different this way from many teens my age.  I am lucky to be in a school where the teachers make the school environment welcoming and open, they respect my love for learning, and I feel I can truly be and grow into my best self. I am specifically so grateful to my mathematics teacher, who has taught me since 7th grade.  He was the first math teacher who made me look at the subject differently, and through his help, I became quite interested and fully committed to the subject. He is the portrait of the ideal teacher, who puts in a lot of extra hours to make our education really count.

Academic achievement is the fuel that keeps me going and motivated. I know that education is the key to a better, brighter future. I know that all of this hard work won’t go to waste and may lead me to my dream university. But these characteristics of mine—dedication, aim for results, seriousness of purpose — do separate me from other teens.  So, when friendships are hard to make, I turn to books which take me to worlds where I am independent and free and where there are a million possibilities.

And while I disappear into others’ tales, I know I am building my own.  In addition to school, I love volunteer activities. I have taught children the English language online in India and, am proud to be NTS’ teen blogger. I love writing about diverse topics that concern millions of people.  And this experience has taught me a lot about the world and its many challenges.  It has helped me to realize what “work” means.

In life, I adore every hardworking person who has put, as poets would say, “blood and sweat” into becoming their present self. And kindness, I think, is one of the greatest things to appreciate in life. It is beautiful to see even the smallest gestures of kindness.

And since NTS is about helping teens build futures, let me tell you about my hopes for my future career.  I want to be a political scientist where I will have the chance to change people’s lives for the better and debate things of international value. Challenging these great problems makes me stronger, and I always remember John Kennedy’s speech at Rice University where he said, “We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard”.

The Essence of Food

By Natali Chinchaladze, NTS teen blogger   

From the beginning of humanity to today, the search for food has always been a prime survival instinct. As our scientific understanding of the nutritional requirements of humans, at all stages of development has grown, so has the centrality of food.

Today, 162 countries, including Kenya, are committed to 17 Sustainable Development Goals of the United Nations, one of which is Zero Hunger, This noble idea means eradicating hunger completely by 2030.  This is a grave challenge, particularly during this era of radical climate change and food shortages.

Here’s a key question: what happens to adolescents who are not provided with adequate nutrition?

The official page of UNICEF Kenya states: “In Kenya, more than a quarter of children under the age of five, or two million children, have stunted growth. Stunting is the most frequent form of under-nutrition among young children. If we do not address this issue, it will have devastating long-term effects, including decreased mental and physical development. In addition, 11 percent of children are underweight, which is related to increased and preventable deaths among young children.”

Nutritional inadequacy during childhood and adolescence not only delays growth but also creates a high risk of chronic diseases in adulthood. Children who experience stunting (defective growth and development from poor nutrition) or wasting (causing a person or a part of the body to become progressively weaker) are also likely to suffer diseases such as weak immunity and a lower response to vaccines, making them more exposed to various long-term health issues.

Furthermore, adolescents with histories of malnutrition have been documented to suffer from inattention, behavior problems, aggression toward peers, depression, school failure, and reduced IQ. Many of these adverse outcomes continue into adulthood and can even persist into the subsequent generation. Additionally, these outcomes are not limited to cases of growth stunting or protein–calorie malnutrition, but also include iron and other micronutrient deficiencies during early childhood that similarly impact brain, behavior, and cognition in adolescents.

According to a UNICEF survey, 11 percent of children in Kenya are underweight (2,624,000), with 4 percent (105,000) wasted. Nationwide, 26 percent of children under the age of five (250,000 children) are stunted. This rises to 46 percent in the Kitui and West Pokot countries.

The cause of poor nutrition is quite simply, poverty.  Fifty percent of Kenyans or 25.5 million people live with food insecurity.  In 2023, skyrocketing food prices have seriously exacerbated the problem and famine may be looming in some regions.

This is where NTS comes in, providing students with three fully balanced, nutritional meals daily. In a region where food shortages are common, NTS students (and staff) are served a well-balanced 2,000-calorie diet, receiving the daily nutrition and calories necessary to grow healthy bodies and minds. What’s more, students are even taking nutrition lessons, so they learn to create healthy food combinations and how to buy and prepare locally affordable foods.

And, as everyone at NTS is learning, food education is a long-term investment in healthy families and vibrant communities.

Sources:

https://www.unicef.org/kenya/nutrition#:~:text=Nutrition%20in%20numbers,doses%20of%20vitamin%20A%20supplement.

https://nyamboyotechnical.org/what-we-do/support-programs/

https://www.ohchr.org/sites/default/files/Documents/Publications/FactSheet34en.pdf

https://www.powerofnutrition.org/the-impact-of-malnutrition/

https://www.ncbi.nlm.nih.gov/books/NBK525242/#:~:text=Undernourished%20adolescents%20have%20commonly%20experienced,pancreatic%20cells%20that%20produce%20insulin.

https://data.unicef.org/how-many/how-many-children-under-18-are-there-in-kenya/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5374755/

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Meet Lisa Van Dyke – When a Volunteer is MUCH more

You never know what an ad on VolunteerMatch will bring.  For those who don’t know the organization (www.volunteermatch.org), it’s a nonprofit dedicated to matching nonprofits with willing volunteers.   Through VolunteerMatch, NTS has worked with over 50 volunteers, all people who have donated their time and talents to help our school succeed.

In early 2021, NTS desperately needed a book illustrator for our new English As A Second Language (ESL) books.  We were searching for someone able to create a visual style our Kenyan students could relate to.  This was particularly tricky.  Most volunteers through the site come from the US and Europe and aren’t familiar with Kenya.  Also, we have 12 books, which meant a LOT of illustrations!

I’ll never forget the first time I met Lisa, which was by email.  She wrote a beautiful email, presenting herself modestly as a book illustrator who had left the workforce and was dedicating her time to helping nonprofits through her art skills.  She was so professional – submitting a
portfolio and showing, through the variety of her work, that she was willing to learn anything.

But what really struck me was how Lisa had a fresh perspective with every project. Lisa is, by choice, a whimsical designer.  I was fascinated by how her view shifted with each project, maintaining a beautiful sense of whimsy and fun.  Somehow, Lisa is able to mold her style to fit the words and stories she is illustrating.  

Over the almost two years we’ve worked together, Lisa has brought the characters in our ESL books to life.  We’ve begun to see them as real people in ways we never imagined possible as we created the texts. ESL text can often be dry, but as new illustrations arrive, they always lead me to reread the book and find the nuances that Lisa has revealed.

So, I started tell you about a volunteer.  But really, Lisa is much more.  She is an essential member of the NTS team.  When we think of NTS staff, Lisa is always among us.

Please join everyone at NTS by thanking and celebrating Lisa Van Dyke whose work and presence is a grand part of making NTS so much more, every day.

 


Welcome, Madame Irene!

We are thrilled to announce the appointment of Irene Kwamboka, called Madame Irene by her students, as NTS’ Lead Instructor of Hairdressing.  Madame Irene joined NTS in June 2021 as an assistant teacher and has led our students through their first NITA exam.  We are delighted to see her take the big step of leading the Hairdressing Program!

Prior to joining NTS, she worked as a hair braiding specialist at Komina Salon in Kisii Town. She has also volunteered in the Hairdressing Department at Entanke Polytechnic. 

Madame Irene, who is an advocate for women’s menstrual health rights, will lead our AFRIpads program in 2023. AFRIpads is an award-winning social enterprise, founded on the belief that menstrual health is a human right.  NTS is partnering with AFRIpads to provide our students with reusable menstrual pads and reproductive education. 

Madame Irene is a graduate of Kisii Polytechnic where she earned her Hairdressing and Beauty Therapy Diploma.