Global Conference on Gearing

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Oct 28, 2013 (3 years and 8 months ago)

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NATIONAL AIDS CONTROL COUNCIL

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REPUBLIC OF KENYA


Global Conference on Gearing
Macro
-
Economic Policies To
Reverse the HIV Epidemic

Presentation by:

John Kamigwi

Deputy Director, NACC Kenya

in Brasilia, Brazil, 21st November 2006

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Kenya Country Profile


Kenya is on the East Coast of Africa, bordering
Tanzania, Uganda, Sudan, Ethiopia, Somalia and the
Indian Ocean


Population (2005 Est.): 33.4 million


Fertility Rate: 4.9


Infant Mortality Rate per 1,000 (in 2005 Est): 77


Under 5 Mortality Rate per 1,000 (2005 Est.): 115


Maternal Mortality Rate 100,000 (2003 Est): 414


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Kenya Country Profile cont.


Economic growth had stagnated in 1990s but has
picked up since 2003


GDP growth rate in 2005 was 5.8% compared to 4.9%
in 2004 (and 4.5% for African Continent and 4.3 for
Global Economy).


Agriculture contributes close to 25% of GDP and is a
major employer.


Other key sectors include Tourism and Manufacture


Poverty levels are high, with over 50% of population
living below poverty line (US$1 per day).

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HIV and AIDS Trends &
Impacts


HIV and AIDS is a major development issue


a
recent study estimates that high morbidity and
mortality could result in up to 14.5% loss in
GDP.


Since 1990s, HIV and AIDS has reversed many
of the gains previously accrued


HIV and AIDS affects all MDGs.

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HIV and AIDS Trends &
Impacts


Over 1.5 million people have died as a result of
HIV and AIDS since the 1
st

case in 1984


Almost 1.3 million people are living with HIV


HIV and AIDS has resulted in over 1 million
orphans, and the number is growing by the day
with long
-
term implications for all sectors

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HIV and AIDS Trends &
Impacts


About 263,000 people need ART


Currently, about 90,000 people (or 34% of those
in need) are on ART


HIV and AIDS has a major gender dimension:
about twice as many adult women being infected
compared to men


HIV and AIDS has to be dealt decisively if
women development has to be achieved

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National Response and
Challenges


Like in many countries, in 1980s and early 1990s there
was general denial and epidemic was considered just a
medical issue.


In 1999, HIV/AIDS was declared national disaster.


Multi
-
sectoral response was adopted, bringing together
all stakeholders coordinated by National AIDS Control
Council under Office of President


The first multi
-
sectoral strategic plan covered 2000 to
2005



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National Response and
Challenges



Funding of Stakeholders, incl. Civil Society, using public funds
was initiated.


A major challenge was restructuring Government financing
mechanisms to effectively handle multi
-
sectoral response.


M&E to ensure efficiency and effectiveness of interventions was
another major issue.


The ``Three Ones Principle” is being implemented incl. One
M&E Framework.


Capacity of various stakeholders to effectively participate is being
built on ongoing basis, incl. Planning, financial management and
M&E.



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General Public Finance


Structural Adjustments


From mid
-
1980 Kenya started implementing Structural
Adjustment Programs (SAPS) led by IMF


Between 1986 to 2000, Social Sector, including Health
and Education, was targeted for reduced government
spending


User fees became a major source of additional
resources in the socio
-
sector. However, though a noble
idea, poverty limited access in many cases.


Investment in Health and general socio
-
sector was
drastically reduced despite rising population, and in
many cases was dependent on user fees.

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General Public Finance


Structural Adjustments Cont.


Wages in public sector, including health, remained low


Absorption of newly trained health personnel from
Medical Colleges was drastically reduced, and many
doctors and nurses migrated to developed countries


To further reduce the government wage bill,
retrenchment was carried out from 1990s
-

initially on
voluntary basis

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General Public Finance


Structural Adjustments Cont.


Retrenchment often led to the most experienced
personnel (incl. nurses) leaving the service, thereby
seriously affecting service delivery.


Though some room was provided in health,
recruitment was generally frozen leading to major
staffing shortages and succession gaps.


Grants and staffing that used to be provided by Govt
to non
-
public health facilities, especially in very needy
areas stopped, weakening the non
-
public sector.


All these developments set the stage for serious
personnel and infrastructural gaps resulting from HIV
and AIDS and TB epidemics from late 1990s.

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General Public Finance


Structural Adjustments Cont.


To qualify for IMF programmes (and attract
funding by other partners) the government has
over
-
time aimed at:


Inflation target below 5%.


Low Budget Deficits or Surpluses



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General Public Finance


Structural Adjustments Cont.


Inflation has been
contained below 12%
(see figure).


The budget has virtually
been balanced.


Exchange Rates have
been stable for a long
time



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General Public Finance


Structural Adjustments Cont.



In FY2004/5 the budget surplus on commitment basis was 0.3%
of GDP, while in FY 2003/04 deficit was
-
0.4% of GDP.


External funding has been unreliable and covers limited
timeframes


and hence cannot be relied on.


The Government is therefore avoiding factoring external pledges
into the annual budget, and thereby heavily depending on tax
revenue


Mainly through increased tax revenue (which has rapidly
increased since 2003), total government revenue and grants
increased by 11.5% from US$4.26 Bill in FY2004/05 to US$4.75
bill in FY 2005/06.


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General Public Finance


Structural Adjustments Cont.


As a result of heavy dependence on tax revenue
there has been difficulties in expanding the
socio
-
sector infrastructure (including health) to
effectively deal with HIV and AIDS epidemic


Furthermore, previous low capacity building in
socio sector/health e.g. in personnel is
continuing to affect service delivery.

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HIV and AIDS Financing


Second Strategic Plan was developed & estimates that annual
funding requirement would increase from US$338 million in
FY2005/06 to US$605 million by FY2009/10


Four priorities set with relative resource requirements as follows:
(1) Prevention 24%; (2) Improved Quality of Life/Treatment
29%; (3) Mitigation of Socio
-
economic Impact 30%; and (4)
Support Services 17%.


Specific vulnerable groups incl. women and youth are prioritised
for intervention.


At the moment, only about half of the funding is available.


There is heavy dependence on external project oriented and off
-
budget funding including PEPFAR




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HIV and AIDS Financing



Existence of large off
-
budget amounts results in serious
coordination problems of aligning programme activities to
national priorities.


This compromises the participatory planning and budgeting
-

MTEF processes, since key stakeholder do not participate.


This creates inefficiencies in planning and budgetary processes.


Tentative Resource Tracking findings indicate that relative to
other priorities Quality of Life/Treatment is highly financed
while Mitigation of Socio
-
economic Impacts is highly under
-
financed.



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Intervention Outcomes &
Impacts


Outcomes and Impacts:


Despite all the challenges. positive changes have been observed.


HIV/AIDS Prevalence has been fallen from 10% in 2000 to
5.9% in 2005.


Behavioural changes that reduce infection rates have been
observed.


Kenya is one of very few countries where this is happening.


There is however an urgent need to strengthen both prevention
and treatment.


In addition, mitigation of socio
-
economic impact is critical.


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Public Finance Cont.


The government has increased allocations to the
health sector and education (incl. free primary
education).


ART drugs are free in public facilities.
However, additional capacity and resources are
needed to meet the needs.


Mainstreaming of HIV and AIDS in various
sectors within the Planning and Medium Term
Expenditure Frame (MTEF) is attracting
additional resources within public sector and line
ministries.

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New ways of doing things



More needs to be done to address socio
-
economic impacts
including the rapidly escalating challenge of orphans.


New financing approaches are needed. For example, a 1.8%
budgetary deficit would be enough to provide the resources
required to implement the National HIV/AIDS Strategic Plan.


Mainstreaming work will have to continue


both in public and
private sectors.


The MTEF process should include all donor resources to be
more effective. Pooling of resources is called for.


Long
-
term and sustainable financing is needed.


M&E needs to be strengthened.

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Thank You

God Bless You