By Susan Anyangu-Amu and Joshua Kyalimpa
NAIROBI and KAMPALA, Sep 30 2010 (IPS)

Regina Namukasa has been twice dispossessed – first when her husband died and his clan left her out when dividing up his estate, and again when she was denied a share in her father’s land. But this time she’s fighting back.

When Namukasa’s husband died fifteen years ago, she did not struggle with his relatives for a share of his estate; she moved back to her own family’s home in central Uganda’s Luwero district with her three children to start a new life.

But when her father died, his sisters decided only her younger brother was entitled to a share in the land, and asked her to leave.

Uganda’s constitution grants women equality and legal protection against discriminatory traditional practice, but there have been no reforms to the law and the constitutional provision has had little impact.

Across sub-Saharan Africa, customary law is hindering efforts to reform land tenure and increase women’s access to and ownership of land.

“Far fewer women own land than men,” says Fatou Diop Sall, “and often have access to land only through male family members, marking them as dependent mothers, wives or daughters. In cases where couples divorce, or a man dies, women often run the risk of losing their entitlement to land.”

Sall is the coordinator of a research project on gender and society at the University of Gaston Berger in Senegal.

Sall says Senegalese law stipulates that men and women have equal access to land. But just as in Uganda, the reality on the ground is markedly different. Women’s representation on village land councils, for example, is limited; when it comes to inheritance, women are also often excluded.

“Despite what the law says, women are blocked from land control by cultural and economic factors. Most women do not have the financial might required to purchase a piece of land. When families are sharing out pieces of land, women are not allocated portions,” Sall says.

Namukasa’s grandfather originally gave the piece of land in question to her father, and her aunts ruled it belongs to the clan; having been married, they say, Namukasa must look to her deceased husband’s family.

“It’s because of culture which dictates that girls are worthless and should get their share where they get married,” Namukasa told IPS.

She has turned to the courts to defend her rights. “I approached the resident district commissioner for Nakawa, Fred Bamwine, who helped me by taking [the case] to court.”

Namukasa is a defiant exception to the rule in Uganda and elsewhere.

Magadelena Ngaiza, a senior lecturer at the University of Dar es Salaam, says ignorance of their rights is still blocking women from land ownership.

In her native Tanzania, legal provisions to address land rights inequalities between men and women have not yet had the desired effect.

“The majority of women are not aware of what the law states with regard to land ownership. They are not informed that they have such rights and must demand for them. Most do not even consider themselves landowners and actually are surprised by such a suggestion,” she says.

She says attempts at improving women’s access to land must begin with massive awareness creation, educating women on existing land laws and policies.

Women must also be empowered economically to ensure they can access land and not just be tied to be small scale farmers.

“Any discussion towards improving women’s land rights must go beyond empowering them at a small scale. We must visualise a situation where they become large scale producers and this requires them to own large tracts of land. Financial might is what will make a difference here,” Sall says.

Back in Luwero district, Namukasa is sad that her own relatives have turned against her. “Imagine: it’s women mistreating a fellow woman. My father must be turning in his grave.”

“This government should help us women becasue they say that they are helping us but why should they look on when women are mistreated?”

Namukasa’s case is being heard in Nabweru court, and she is convinced she will get justice.

“I will not rest until I get my share, in fact even your very own brother can deny you a share because a girl should not not inherit property this is unfair,” she says.

Excerpt:

The number of pregnant women being tested for HIV and accessing treatment in Sub-Saharan Africa has shown significant progress – indicating that virtual elimination of mother-to-child transmission of the virus by 2015 is possible.

According to a new report Towards Universal Access, the proportion of pregnant women in Sub-Saharan Africa who received an HIV test increased from 43 percent in 2008 to 51 percent in 2009. The report by the World Health Organisation (WHO), the United Nations Children’s Fund (UNICEF) and the Joint United Nations Programme on HIV/AIDS assessed HIV/AIDS progress in 144 low- and middle-income countries.

It found an estimated 24 percent of the approximately 125 million pregnant women in these countries received an HIV test in 2009, an increase from 21 percent in 2008 and eight percent in 2005. Fifty-four percent of HIV-positive pregnant women in Sub-Saharan Africa received antiretroviral drugs to prevent transmission to their children in 2009, up from 45 percent in 2008.

Speaking to IPS during the launch of the report in Nairobi on Sep.28, UNICEF regional director Elhadj As Sy said the progress made in the prevention of mother-to-child transmission is testimony of the fact that virtual elimination by 2015 is achievable.

“What we need is strong political leadership, funding, good programs and activism. If we build on the progress and with renewed commitment we are well on our way to achieving virtual elimination by 2015,” Sy said. However, despite the progress there are still challenges with disparities between regions and within countries.

Despite the marked progress, countries in Eastern and Southern Africa fared better than their counterparts in West and Central Africa. In Eastern and Southern Africa, 50 percent of pregnant women received HIV testing and counselling, an increase from 43 percent in 2008. In Western and Central Africa, coverage increased from 16 percent to 21 percent between 2008 and 2009.

“While the figures in Western and Central Africa are low, this does not mirror failure on their part. The burden of HIV/AIDS has leaned heavily on Eastern and Southern Africa and this is where most interventions have been directed. Western and Central Africa are just beginning to pick up the problem and their burden of the epidemic is lower,” said Dr. David Okello. Okello is director, HIV/AIDS, Tuberculosis and Malaria Cluster at the WHO regional office for Africa.

Seven countries including Nigeria, Angola, Democratic Republic of Congo (DRC) and Ethiopia provided HIV tests to less than one third of pregnant women. “Knowing and accessing treatment is very crucial. Greater investments are needed to increase HIV testing and counselling among pregnant women in order to effectively prevent mother-to-child transmission of HIV,” Okello said.

Nigeria, DRC, Ethiopia and Uganda are still far from attaining the UNGASS target. These four countries contributed to 50 percent of the global gap in reaching the UNGASS target. The global gap is the difference between the current number of pregnant women in need who have access to ARVs and the estimated number who must be reached to achieve the UNGASS goal. Nigeria alone accounts for almost one third, 32 percent of the gap.

The number of children receiving antiretroviral therapy in Sub-Saharan Africa rose from 224,100 to 296,000. However, the total coverage among children in the region is still low at 26 percent compared to adults at 37 percent. “Too many children are still dying in this time and era when we can test and treat. We need to do more to reach the 10 million who still need treatment,” Sy said.

Among infants and children exposed to HIV, access to early testing, care and treatment is still a challenge. More than 90 percent of children living with HIV are infected through mother to child transmission during pregnancy, around the time of birth or through breastfeeding. The challenges facing Sub-Saharan Africa include weak integration of services, persistent drug stock-outs and little follow up of patients started on treatment.

“To address these challenges, countries need to strengthen health systems, improve integration of services and bring facilities closer to the people,” Okello said.

Integration of services means having related areas close together such as child and maternal health, tuberculosis and reproductive health services. “We need to develop strategies to reach out to every woman and child especially those in marginalised areas, the poor and those living in rural areas. We need to counter stigma and discrimination and the risk of violence against women particularly,” Sy said.

Countries need to develop mechanisms to engage communities as partners and establish links between health facilities and the local people. Address challenges that keep people away from health facilities such as financial barriers and user fees. Strong follow-up systems are needed to monitor and ensure identified needs are actually being met. Many infants and pregnant women who test HIV-positive are lost to follow up.

However, Sub-Saharan Africa which greatly relies on donors for its HIV interventions, faces tough times in the future, with the announcement that funding is steadily declining. “Funding for HIV has flat-lined for the first time in 15 years. In 2009 we had 8.7 billion dollars, now we have 7.7 billion (dollars), the funding gap has increased to about 10 million dollars,” Okello said.

African governments are being urged to increase national budget allocation to healthcare. “Countries must live up to the Abuja declaration of 15 percent of national budget going towards health. With good governance structures and accountability, these monies can be put to good use. The advantages of increased investment in healthcare are immense,” he said.

The platform at the Global Fund replenishment conference in New York in October will be used to appeal to governments to reduce the funding gap.

The number of women dying from pregnancy related causes around the world is falling. Sub-Saharan Africa remains one of the most dangerous place for pregnant women, despite recording a 26 percent reduction in maternal mortality rates.

Government hospital in Makeni, Sierra Leone: reaching women in rrual areas and poor households is key to continued progress. Credit: Nancy Paulus/IRIN

The statistics in the “Trends in Maternal Mortality” report released by the World Health Organisation. on Sep. 15 cover the period from 1990 to 2008, revealing that maternal mortality fell from 540,000 deaths worldwide in 1990 to 358,000 in 2008 – a 34 percent decline.

Several reasons are cited for the reduction in number of maternal deaths, including improvement in health systems to assist pregnant women and increased education of women, raising awareness of the importance of delivering with skilled help.

Around the world, more midwives are also being trained. The proportion of deliveries attended by skilled health personnel rose from 53 percent in 1990 to 63 percent in 2008. The proportion of women who attended a pre-natal clinic at least once during their also rose from 64 percent to 80 percent.

The use of contraceptives by women aged 15-49 also rose: East Asia which experienced the greatest reduction in maternal deaths has a contraceptive prevalence rate of 86 percent. Sub-Saharan Africa, where contraceptives are used by just 22 percent of women, recorded one of the lowest declines of maternal mortality.

Sub-Saharan Africa and South Asia still account for 87 percent of global maternal deaths.

Nearly two thirds of all maternal deaths take place in just eleven countries – Afghanistan, Bangladesh, the Democratic Republic of Congo, Ethiopia, India, Indonesia, Kenya, Nigeria, Pakistan, Sudan and Tanzania.

South Asia recorded an overall maternal mortality rate of 280 deaths per 100,000 live births. Sub-Saharan Africa had a rate of 640 per 100,000. Afghanistan, Chad, Guinea-Bissau and Somalia all recorded maternal mortality rates over 1,000 per 100,000 live births.

The rate of progress recorded in the U.N. figures is less than half of what is needed to achieve MDG target for reducing maternal deaths, translating into an average annual decline of 2.3 percent since 1990. To meet MDG target five an annual decline of 5.5 percent is required.

Reacting to the release of the numbers by the U.N., Kenyan reproductive health expert Joachim Osur said the decline must be concentrated elsewhere in the world, because the situation in sub-Saharan Africa continues to be bad.

Osur says a lack of funding for the health sector, and particularly reproductive health, is at the heart of the problem.

“Most governments – almost all of them in Africa – depend on international donors for funding for maternal health. In the case of Kenya, we cannot survive without external help. Budgets do not fund the health sector fully. If you want good services, especially in reproductive health, you must pay for this,” he says.

Osur says community education is lacking in most rural areas and he argues that in the case of Kenya, the situation was actually better in the 1990s.

“In the early 1990s, there was increased awareness on family planning but this went down in the 2000s. The hype has gone down, supplies in hospitals are lacking. The reality here is markedly different from the global reduction on the rate of maternal deaths,” he says.

In a statement released to the press, the executive director of the United Nations Children’s Fund, Anthony Lake, said that to achieve the goal on improving maternal health and to save women’s lives, government initiatives must reach those most at risk.

“This means reaching women in rural areas and poorer households, women from ethnic minorities and indigenous groups and women living with HIV and in conflict zones,” he says.

The U.N. report calls for donors to help governments implement plans to improve access to reproductive health services.

Campaigners for increased health financing welcome the commitment by African Union member states to direct more resources to health. But the needs of the continent seem to dwarf available budgets.

A busy clinic in Malawi Credit: Claire Ngozo/IPS

Africa, is home to 12 percent of the world’s population, yet accounts for 22 percent of the total global disease burden. More than 68 percent of the people living with HIV/AIDS are also found in Sub-Saharan Africa.

About 4.5 million children under five die each year due to malnutrition, diarrhoea, pneumonia, malaria and HIV.

During the 15th Summit of the African Union heads of state in Kampala in July, African leaders committed to mobilise more resources for the health sector in addition to the allocation of 15 percent of national budgets.

National resources insufficient

Dr Thomas Kibua says even if every African states were to increase allocation to the health sector to 15 percent, none of the three health-related millennium development goals will be achieved.

“States would have to increase allocation to health care to 45 percent if they are to achieve MDGs by 2015. This is untenable because that is almost the entire national budget going towards health,” he says.

Kibua directs health policy and systems research at the African Medical and Research Foundation (AMREF) a development organisation that seeks to improve people’s access to health care.

“Countries will have to increase their health spending per person to reach the World Health Organization-recommended $40,” says Rotimi Sankore of APHA, a non-profit organisation promoting health development and financing across Africa.

And even this may not be enough: the WHO’s recommendation assumes basic levels of nutrition, and access to clean water and sanitation. “For this to be worthwhile, governments will have to make separate investments in other sectors within the economy such as human resource and infrastructure,” says Sankore.

The gulf between that level of investment and the status quo is daunting. More than half of Africa’s 53 governments invest $14 or less per capita, with some investing as little as $1 to $4 per capita on health. “Such miniscule amounts can hardly balance gaps,” says Sankore.

Building from a low baseline

Poor health in Africa has been perpetuated by a lack of health workers and poor distribution of those who are available.

Seventy percent of women in Sub Saharan Africa have no contact with health workers during childbirth. This is a major contributing factor to high maternal mortality rates.

In countries such as Chad, Madagascar, Burkina Faso, Nigeria, Cameroon and Mali, fewer than five percent of women have access to skilled care during birth.

Fifty percent of people in Africa do not have access to essential drugs.

Several countries are trying to provide free or very low cost maternal and childcare, while others are training additional workers for remote areas.

Malawi has trained health surveillance assistants to deliver services to the community.

Mozambique is upgrading skills of existing health workers to address chronic shortages of trained staff. Nurses and outreach workers can now provide medications and surgeon assistants can perform caesarian sections where no obstetrician is available.

With only a fraction of African states meeting even the 15 percent target for spending on health, finding extra resources to train health workers will be an uphill task.

As additional health workers become available, many more health centres will be needed for them to work in.

Without coordinating efforts by the health, education, labour and human resources sectors, the removal of user fees for pregnant women and children will only mean more people will turn up to access non-existent services.

Recommendations

To improve access to essential drugs, countries will have to improve their capacity for production of drugs – including storage and efficient distribution channels.

This will require investment in training of skilled scientists, technicians and engineers. This will also require improved manufacturing and industrial investment and necessary negotiations and laws for trade and related aspects of intellectual property rights, argues APHA.

To make the most of limited funding, governments will have to ensure gender equity and also include adolescent and youth health facilities. Sankore says if countries break down the population and prioritise women of childbearing age, they can prevent HIV transmission.

“If you apply a gender lens, you can deal with problems that cost hundreds of millions each year,” Sankore says. Focusing on preventing mother-to-child transmission of HIV, for example, will reduce the number of children born with HIV and thus reduce treatment costs.

While donor funding makes up a large part of spending on Africa’s public health, Sankore says over time this should be reduced.

“In some countries 50 percent or above of their budgets is from foreign aid. This is just not sustainable,” he says.

He asserts that the focus should be on ensuring that countries can survive beyond the timelines set for donor funds. Once the aid is stopped, countries should have policies in place that will ensure programmes can be sustained by domestic resources.

*Chris Stein in Johannesburg contributed to this report.

By Susan Anyangu-Amu
NAIROBI, Sep 13 2010 (IPS)

When a doctor instructs a patient to take one tablet three times a day, she often has no way to ensure the instructions are followed.

TB patient in a Kenyan hospital. Credit: Siegfried/IRIN

Daniel Ngetich and Patrick Kipngetich are presently cooling their heels in a government of Kenya prison; unless a court orders otherwise, they will remain there for eight months until they finish their TB treatment.

Henry Ngetich, who was also arrested for defaulting on his treatment, was lucky enough to end up in hospital because he is in critical condition.

The move by the Kenyan government to arrest and incarcerate TB sufferers has been castigated by human rights organisations who term it a violation of their rights.

“Everyone has a right to quality medical care and this must be provided with dignity and respect,” said Pascaline Kang’ethe the national coordinator, rights to health and HIV/AIDS at ActionAid International Kenya. “This is a case of discrimination and the move is bound to cause others in need of treatment to shy away fearing arrest.”

Nelson Otwoma, the chief executive officer of Network of Persons Living with HIV/AIDS, said the two men are being held in prison in deplorable conditions and do not have access to the proper nutrition that is required for TB treatment.

“When we visited, we found them being held in the same room as other prisoners. They were not in isolation. To make matters worse they are being treated like common criminals and are handcuffed and under armed guard,” Otwoma said.

Speaking to IPS, the head of the National Leprosy and TB control programme, Joseph Sitienei defended the government’s action, saying they had acted to safeguard the interest of others after receiving complaints from family members.

“The public health officer in that region acted within law under the public health Act section 27 – which authorises him to take necessary action including detaining infectious patients to prevent the spread of a disease,” Sitienei said.

A 2008 World Health Organisation estimate is that 5,000 people around the world die from TB every day.

Several other countries have also considered incarceration to control the spread of TB. When research uncovered the presence of a highly-fatal extremely-drug resistant TB in South Africa’s KwaZulu-Natal Province, health authorities

In 1994, Israeli health authorities initiated legal proceedings seeking compulsory isolation of a homeless person with infectious MDR-TB who was failing to take medication.

In South Africa in 2007, the discovery of highly-fatal and extremely-drug resistant (XDR) TB in prompted debate over compulsory isolation. The decision was taken to quarantine drug-resistant TB sufferers at facilities like Cape Town’s Brooklyn Chest Hospital.

“There are challenges without answers,” Simon Moeti, medical superintendent of the facility told the South African Press Agency. “There are people who are refusing treatment, people who want to abscond.”

Otwoma said the incarceration of the two men in Kenya’s Rift Valley has sent the wrong message and caused panic among other TB patients who have stopped taking their medicine.

“In fact when we visited the home of Daniel… his wife indicated that their last-born child has been coughing however, she is afraid to go for tests fearing she will be incarcerated alongside the child to facilitate treatment,” he said.

Under the public health act, safeguarding the safety of others supersedes an individual’s right to comfort. Patients who are found to have infectious diseases may be isolated to prevent spreading and this should essentially be in specific wards in government hospitals.

But Allan Ragi, the executive director of Kenya AIDS NGOs Consortium, says government hospitals do not have such facilities.

“Under the round five of the Global Fund, Kenya got $19 million to construct an isolation ward at Kenyatta National Hospital. Five years down the line, this is yet to be completed,” Ragi said.

He said rather than concentrate on arresting defaulters, the government should invest in creating awareness about tuberculosis and its treatment.

“This country is at risk of a multi-drug resistant TB epidemic because we do not have the capacity to test everyone and follow up on treatment. The government should invest in awareness creation and train TB champions who will work in the community to educate others on the fact that TB is curable but one must adhere to treatment,” Ragi said.

The government has indicated that the two who have been incarcerated have drug-resistant TB, but this is refuted by human rights activists who say tests to confirm have not been conducted.

At the close of 2009 Kenya had 110,065 cases of TB. The default rate on treatment is at five percent and the government is working to reduce this to three percent.

By 2009 Kenya had 500 cases of MDR-TB. Oonly 117 are on treatment. MDR-TB is resistant to two of the most powerful first-line anti-TB drugs. It can, however, be cured with long treatments of costly second-line drugs, which have more adverse effects. Treating a single case calls for drugs worth more than $16,250. Kenya is 13th on the UN World Health Organisation’s list of high-burden TB countries.

Excerpt:

By Susan Anyangu-Amu
NAIROBI, Sep 9 2010 (IPS)

Though it is relatively easy to prevent, obstetric fistula continues to have devastating effects on the lives of millions of women globally. A regional policy document has been developed to address the root causes of fistula in East, Central and Southern Africa.

Obstetric fistula is caused by extended pressure of the child’s head against the soft tissue in the mother’s pelvis during childbirth.

The tissue eventually dies from the lack of blood supply, and a hole develops between either the rectum and vagina or between the bladder and vagina.

According to Dr Odongo Odiyo a reproductive health specialist, fistula leaves a woman unable to control the flow of urine or faeces.

“These women are stigmatised in the community. Their husbands and families often abandon them. They are unable to work and have to rely on a family that shuns them,” he says.

The factors that contribute to fistula arise from overlapping areas of inequality for women. Very young women or girls face a higher risk of fistula because their bodies have not fully developed; the continuing practice of early marriage in many parts of the continent, and the frequent absence of family planning place women at risk.

“Obstetric fistula is essentially a burden of the girl child. Deprived of her right to basic education and proper nutrition, the innocent girl child is plunged into an arranged marriage for which she is neither physically nor mentally prepared,” Odiyo says.

Women’s low status means the decision to spend precious money on fees for medical care – or even transport to the nearest facility – is deferred as long as possible. Many women across Africa give birth at home, and the absence of a skilled attendant increases the risk that the danger signs of obstructed labour will be missed, and there will be no one to take appropriate emergency measures.

Odiyo manages family and reproductive health programmes for the East, Central and Southern African Health Community (ECSA-HC) – an organisation that fosters and encourages cooperation in health in the three regions. The organisation estimates that there are at least 100,000 women with fistula in rural areas of Ethiopia alone, many of them developing the condition at an early age.

Odiyo says in Uganda, where the average distance to a health facility is 20 kilometres, a lack of good roads means women are unable to reach medical care when they need it.

Another tragic cause of fistula is sexual violence, such as in the conflict zones of the Democratic Republic of Congo (DRC) or in Kenya’s post election upheaval in 2007/2008

According to United Nations Population Fund estimates, there are two million women in developing countries with untreated obstetric fistula. At least 50,000 to 100,000 new cases occur each year. Reliable data is thin due to shame and stigma, but fistula is said to be most common in poor communities in sub-Saharan Africa and Asia where access to medical care during pregnancy and childbirth is limited.

Before the 20th century, fistula was also common in Europe and the United States. Today, it is almost unheard of in high-income countries or those where obstetric care is widely available.

ECSA-HC has formulated a regional policy document to address the causes of fistula. The policy document will be presented to health ministers ahead of the upcoming summit in Zimbabwe in October.

“The overall goal of the regional policy on fistula is to provide a framework for leadership and coordination of the countries’ responses to fistula,” says James Watiti, who steers research, information and advocacy at ECSA-HC.

Odiyo says the continuing incidence of fistula points to a failing in the health care system. The hope is that the new policy will offer guidance to governments on what should be done to prevent the condition.

The policy document calls on governments to focus on building of roads to ensure people can reach hospitals easily. Hospitals must have the necessary drugs and equipment as well as enough qualified staff.

Governments are also urged to ensure there is appropriate information to educate the public on the importance of seeking medical care from skilled healthcare workers. Cultural practices such as early marriages, female genital mutilation should be outlawed.

Countries are also encouraged to set aside dedicated funds towards reproductive health and child health: like poverty, the disease burden falls disproportionately on women and children, and funding should reflect this.

Governments will also need to focus on the poor and concerns of malnutrition. While corrective surgery is available for survivors of fistula, ECSA-HC recommends more attention should be on addressing the causes.

Dr Iteerswaree Thacoor, a gynaecologist/obstetrician working for the Mauritian ministry of health, says governments must address the issues that force women to deliver at home, on lack of education among girls and poor nutrition.

“In Mauritius we are doing well with regards to maternal health because most women deliver in hospital. This is because the government has concentrated on bringing health facilities closer to the people,” Thacoor told IPS.

“Treatment for pregnant women and their newborn babies is 100 percent free in government facilities. The government also encourages corporate organisations to contribute at least two percent of their profits to social ventures particularly in the health sector.”

The policy also calls on governments to focus on gender based violence and child sex abuse because they also lead to fistula.

Excerpt:

By Susan Anyangu-Amu
NAIROBI, Sep 8 2010 (IPS)

“Herding goats is tough with the thirst, sun, loneliness and hunger each day. And it can last forever. You herd as a girl, then as a wife, as a pregnant woman, as a mother and even as a grandmother,” says Rukia Ibrahim whose 13-year-old younger sister was married off to a herdsman.

A young girl from Kenya's North Eastern Province. It is a province where a high level of apathy towards girls' education exists. Credit: Ann Weru/IRIN

But a life of herding goats is not what Ibrahim wants. And in order for her and other disadvantaged children around the world to have a better future, governments and aid agencies need to invest first in the poorest and most disadvantaged children and their communities.

This is according to two global reports on the state of the children released by the United Nations children’s agency (UNICEF) on Sep. 7. The report states that countries can achieve the Millennium Development Goals (MDGs) for children quicker this way.

The UNICEF reports titled Narrowing the Gaps to Meet the Goals and Progress for children: Achieving the MDGs with Equity, unearthed glaring disparities among children born in poor families compared to those from richer families in sub-Saharan Africa and South Asia.

The reports state these widening disparities will derail the achievement of MDGs and governments will need to refocus their investment priorities to focus on those who need it most in order to change the odds facing the world’s most disadvantaged children.

Ibrahim is one of those children able to benefit from such an investment that will lift her from the cycle of poverty. She is a beneficiary of a scholarship program for bright and needy girls.

The program, started in 2006 by UNICEF and the ministry of education, aims to address the low performance of girls in schools in North Eastern Province. Since its inception, the scholarship program has admitted 300 girls, thus increasing the transition rate of girls from primary to secondary school.

While between 1991 to 2005 only two girls from North Eastern Province joined regular degree programs at state universities, of those who sat for final year school exams in 2009, 59 percent scored a grade of C+ and above – which is the requirement for joining a state university.

For Ibrahim, the opportunity to receive an education has been profound difference. She says seeing her sister get married at such a young age gave her a clear picture of what her destiny would be like if she did not have an education. “Education has an end which could lead to better livelihood…so I have decided to give my very best to books (studying) to change my future,” the grade 10 pupil says.

But a stronger commitment from governments is needed in order to effect change. Hellen Tombo, Pan African advocacy advisor for Plan International – a children’s organisation working with communities in 48 developing countries to alleviate child poverty – says in sub-Saharan Africa a lack of political will and bad governance is hindering the achievement of MDGs aimed at children.

“Heavily rooted, biased, traditional attitudes on age and gender are delaying the emancipation of children and women and our governments are not responding well,” Tombo says. Edward Ouma, chief executive officer of Children’s Legal Action Network – a non-governmental organisation working to promote high quality legal aid services that improve the lives of children, agrees. He says governments in sub-Saharan Africa have focused on the wrong priorities such as heavy spending on military to the detriment of the health sector, education and infrastructure such as roads and hospitals.

“Countries in sub-Saharan Africa need to invest heavily in the education sector. This is in order to increase access to all children, especially the poor. They also need to invest in poverty reduction and come up with initiatives such as direct cash transfers to vulnerable families,” Ouma says.

Tombo says national budgets, plans and policies need to cater for the MDGs that still lag behind, like maternal health. “We need girl-friendly schools with safe learning environments and gender-sensitive curriculums. Countries such as Rwanda and Ghana have been very strategic and prioritised women empowerment and gender equality…they have outlawed child marriages and enforced compulsory school attendance,” she says.

For example, Tombo says, additional meals have been provided in schools in Rwanda and Ghana. Costs like examination fees and uniforms have been scrapped. Special schools have been set up for children from marginalised communities like the mobile schools for pastoral communities in Northern Kenya and Uganda.

Ethiopia has also focused on its health sector by increasing the number of community health workers to 30,000, says Michael Klaus the regional chief of communications UNICEF Kenya.

Excerpt:

By Susan Anyangu-Amu
NAIROBI, Aug 23 2010 (IPS)

During every year that ends in an even number, the month of August is a special occasion for young men in Kenya’s Western Province. During this month thousands of boys aged between 10 and 18 undergo male circumcision – something that is seen as an important rite of passage into manhood among their communities. But it is also a time were nearly half the young men circumcised will have to fight for their lives.

Ayub Alulu entertains the crowd after young initiates were circumcised in Kakamega in Kenya's Western Province on Aug. 19. Credit: Benjamin Sakwa/IPS

According to Dr. Nicholas Muraguri the head of National AIDS/STD Control Programme in Kenya, this year the Bukusu community plans to circumcise about 20,000 young boys in traditional ceremonies – without the assistance of trained medical staff or even properly sterilised equipment. Muraguri says out of the total young men to be circumcised, statistics indicate that 40 percent will end up with complications, some of which will be life-threatening and could lead to death. And the Bukusu are just one of the many communities currently conducting circumcision rites in Kenya’s Western Province.

While safe voluntary male circumcision for men as a key strategy of HIV prevention, Muraguri says some of the cultural practices are likely to increase the risk of HIV transmission and may reverse the potential benefits. This includes instances where one knife is used to circumcise several boys or where boys are encouraged to engage in sexual intercourse soon after the procedure.

According to David Alnwick a senior adviser of HIV/AIDS at the United Nations Children’s Fund, the focus has been to encourage male circumcision among communities that previously did not have the practice. However, parents are encouraged to circumcise their sons shortly after birth. Where neonatal male circumcision is done in medical settings it is rare and unusual that complications will arise.

But adult male circumcision performed by untrained individuals in unhygienic conditions and without proper follow-ups means the complication rate can be high, and severe, potentially life-threatening complications may occur. These often include severe bleeding, bacterial infections, gangrene and mutilation of the penis. Muraguri says there are concerns about the safety of the procedure carried out by traditional circumcisers who have no formal training.

Dennis Kuloba is a traditional circumciser from the Bukusu community. For him it is simple. If a man is not circumcised he is not truly a man. “Men who are not circumcised are not respected in the community and are not allowed to eat on the same table as their circumcised counterparts,” Kuloba says.

But the passage to manhood comes at a steep price. The Bukusu community does not use trained medical staff for the procedure. Instead traditional circumcisers like Kuloba, who acquire the skill of circumcising through apprenticeship, use a traditional double-edged knife called a ‘lutembe’ to perform the circumcisions.

Kuloba says he uses a special mix of clay soil and ash to sterilise the ‘lutembe’. The boys are not put under local anaesthesia to numb the area and instead are expected to be courageous and not show any sign of pain while Kuloba removes their foreskin. But, Kuloba adds, he uses only one knife per boy to safeguard against HIV infection. According to him, those who seek the services of traditional circumcisers are driven by a need to identify with their community’s beliefs which has serious implications for their standing and acceptance in the community.

But Muraguri and his team are trying to find a way to allow young men to hold on to their culture without having to place their lives at risk. “While we respect the cultural aspect of the procedure, we cannot guarantee the safety when done by the traditional circumcisers and what we are promoting is health facility based circumcision,” he says.

It is why government is now offering the service at a drastically reduced price to initiates in the Western Province. In Kenya, the cost of circumcision in a medical facility ranges between six and 12 dollars. This cost is prohibitive for many rural parents who are unemployed and try to make their living selling the produce they plant.

“We have reduced the amount to 200 Kenyan shillings (two dollars and fifty cents) in Bungoma and Kakamega districts during this circumcision period. For those living in far-flung areas away from medical facilities, we are holding medical camps throughout the circumcision period. Here the procedure is done at no cost,” Muraguri said.

He said his team had been successful in persuading parents that it was safer to have their sons circumcised by medical professionals in a sterile environment. So now some of the young men meant to undergo initiation are being circumcised at medical facilities. Later they are instructed on their initiation by their uncles or grandfathers.

Alnwick hopes that soon traditional circumcision will be widely discouraged. “It is our hope that through male circumcision policies developed by various ministries of health, they will discourage traditional circumcision. While we acknowledge it is part of tradition and important to that regard, some of the circumcisers do a very poor job ending up in botched cases that lead to infection and at times death,” Alnwick says.

But Muraguri is optimistic. Through working closely with communities during circumcision periods he argues that it also provides the perfect opportunity to access adolescent boys and counsel them on sexual reproductive health and gender issues.

Excerpt:

Kenyans are still euphoric over the referendum endorsing a progressive new constitution; but the heat generated by its opponents around their main rallying point – abortion rights – is a reminder of the wide gap between law and implementation in Africa, particularly when it concerns women’s rights.

Article 26, clause 4 reads: “Abortion is not permitted unless, in the opinion of a trained health professional, there is need for emergency treatment, or the life or health of the mother is in danger, or if permitted by any other written law.”

Those opposed to Kenya’s new constitution, including the National Council of Churches in Kenya and some prominent serving and retired politicians, were united on the premise that the clause is an assault on family and morality.

Abortion was not mentioned in the draft constitution until the No Campaign scored an early, pyrrhic victory in persuading the Parliamentary Select Committee to add text defining life as beginning at conception, and limit abortion to cases where a physician feels the mother’s life is in danger.

The Committee of Experts charged with the final drafting sighed, and delicately expanded the definition in line with the country’s commitments under the 2003 Maputo Protocol, the African Union treaty dealing with women’s rights.

It came into force in November 2005, after the required 15 member states ratified it, but to date only 28 of the continent’s 53 states have completed ratification. Kenya’s twin objections are a good indicator of the reasons for the delay elsewhere.

In Sudan, a broad spectrum of government and civil society actors are opposed to sections of the protocol.

“Some provisions of the protocol such as the issue of equality, equality before the law and in inheritance, control of fertility are still debatable among legislators, religious leaders and policy makers. Even some women groups are having some reservations,” said Sidiga Washi, a former president of the Babiker Badri Scientific Association for Women Studies, which works for the empowerment of rural women in Sudan.

Washi supports ratification, saying the delay affects the work of Sudanese women’s organisations, particularly on reproductive health rights, legal discrimination and violence against women.

“It also contributes to lowering the visibility of the women’s rights issues provided for in the Protocol and discourages women who are willing to seek justice [from doing so].”

In Mali – which has ratified the Protocol – conservative Muslim clerics organised mass protest against a new family law that granted women and men equal inheritance rights (in Mali’s Muslim tradition, a woman is entitled to only half the share given to her brothers).

The new law also entitled Malian women to work without requesting their husband’s permission and removed references to wives obeying their husbands, replacing this, attractively, with the statement that, “Spouses owe each other fidelity, protection, relief and assistance. They commit themselves to the community of life on the basis of affection and respect.”

Rwanda shares Kenya’s reservations over the Protocol’s Article 14 on reproductive rights.This is seen as opening the door to “encouraging immoral behaviour”.

“It would be a tragedy to officially legalise activities which involve the termination of a pregnancy,” the permanent secretary in the ministry of health, Agnes Binagwaho, told IPS.

“Endorsing the right to abortion in the case of rape has several risks as regards to the family planning in Rwanda,” she said, without specifying these.

Zaina Nyiramatama, the executive secretary of Haguruka, a local NGO advocating the rights of women and children, told IPS the focus must be on greater use of family planning.

“It is important to emphasise the use of contraceptive methods rather than abortion, in order to avoid the risk of unintended pregnancy,” she said.

Family planning vital

But Kenyan advocates of expanded access to abortion agree. “We are not proponents of abortion,” Dr Koki Muli-Kinangwa, a member of the Kenya Medical Women’s Association, told a July press conference.

Kenya’s obstetricians and gynecologists agree that the focus should be on preventing unwanted pregnancy and expanding family planning services. But pointing to a 2004 study estimating that 300,000 abortions take place in Kenya every year, they are trying to avoid 20,000 women ending up in hospital after who end up hospitalised after seeking an illegal abortion.

“Abortion cannot be alleviated through punitive action or denial of proper healthcare services and education,” said Muli-Kinangwa.

Dr Joachim Osur, a Kenyan reproductive health expert, says those who see the Protocol’s – or the constitution’s – provisions as merely expanding access to abortion are missing the broader picture.

“People seem to think the health of a woman is not a priority. While Kenya signed the Protocol, it is clear they have no intention of ratifying it, which is a backlash against women’s rights,” says Osur.

He says the Protocol seeks to address a broad range of problems women face.

Grace Maingi the executive director of Federation of Women Lawyers-Kenya, says the Protocol is the first African treaty which specifically addresses the issues of the contemporary African woman, including conflict, displacement, land rights and inheritance, but she fears its ratification by Kenya is still some way off.

“Based on the fierce resistance that was witnessed and the heightened temperatures when debating those issues [in the constitutional context], those pushing for the country to ratify the Maputo Protocol have an uphill task,” Maingi says.

By Susan Anyangu-Amu
NAIROBI, Aug 17 2010 (IPS)

“My daughter had repeatedly tried to describe to me what her step-father would do to her when I was not home,” says Wanza*, a 28-year-old mother resident of Nairobi’s Mathare slum. “On this particular night I pretended to be asleep and watched as he left our bed and went for my eight-year-old daughter.”

Sexual violence is endemic in Nairobi’s slums, says Michael Njuguna. He works in a gender-based violence clinic run by humanitarian group Médécins Sans Frontières in Mathare.

The majority of the victims are children and women; the perpetrators of violence almost invariably men, frequently well-known to their victims.

“In Kenyan slums, the way of life is weighing down on most of the men who are breadwinners in their families,” says Alfred Makabira, national secretary of Men for Gender Equality Now.

“And when they realise they cannot live up to societal demands, they become frustrated and vent it on the next person which is often the women and children in their lives.”

Boys from a young age learn to believe that violence is part of being manly, Makabira says; both genders are also socialised to believe that women are property of men.

Drug and alcohol abuse – especially of traditional brews – contribute further to the high levels of violence in the informal settlements.

The geography of the slums amplifies gender inequality. A July 2010 report by Amnesty International, “Insecurity and Indignity: Women’s Experiences in the Slums of Nairobi”, draws attention to how the lack of basic amenities such as toilets and bathrooms, exposes women and children to danger when they venture out to use communal facilities.

When night falls, the 100 or 300 metres to the nearest latrine are charged with danger.

“We had just finished having dinner and it was about 7.30 pm when my eight-year-old son left our one-roomed home to go and relieve himself. Within minutes, a neighbour knocked on my door and asked me to go and fetch my son who had been sodomised by another neighbour,” Mathare resident, Irene* told IPS.

Fear of assault is one of the reasons residents resort to relieving themselves in plastic bags, which they then dispose of in the open – the infamous flying toilets of Nairobi. Many women recount the indignity of relieving themselves or bathing in a single room shared with other family members.

But the women also said that the greatest threat of violence came from within their own homes. Watching horrified from her bed, Wanza chose silence over reporting the crime of the father of her two other children.

“I lay there recoiling in disgust, hurt and betrayal and watched the man whom I call husband, rape my daughter. It was the most painful ordeal… but I was powerless because he is the sole bread-winner in the home.”

In addition to often being economically dependent on the men who assault them, poor women in Nairobi say there is little or no police presence in the slums, and they do not believe rape survivors will get any justice from the legal system. And so many remain silent, for fear of reprisals by perpetrators.

Improved policing is among the principal recommendations by Amnesty International.

To help victims of crime seek justice, the report also recommends improving awareness through civic education on legal rights and provision of legal aid to support women seeking justice. The government is also urged to institute measures – including speedy attention – that will improve the confidence of the people in the justice system and policing so that it is easier to report crimes.

Observers acknowledge that economic independence for women is key to addressing gender-based violence, underlining the importance of reducing poverty through improved access to education, jobs, credit for women’s businesses.

For MEGEN’s Alfred Makabira, there is a need to change society’s attitude by transforming the understanding of gender roles.

“The central idea is to educate boys from the earliest age that violence against anyone is wrong, and that the traditional definition of what makes a ‘man’ in society is not the only alternative, and that even though they are physically different, girls are entitled to the same rights and opportunities as men,” Makabira says.

He says this can be achieved through both genders working on awareness creation and education which will change the mindset and promote values that encourage communication and equality between men and women.

*Names have been changed to protect privacy.

Excerpt:

Kenyans can now save towards the cost of childbirth at the country’s largest maternal hospital thanks to a medical smart card system.

Approximately five percent of Kenyans have medical insurance according to Samuel Agutu, the managing director of Changamka Microhealth Limited, the company behind the smart card.

Kenyans employed in the formal sector pay for mandatory health coverage, but 11 million adults working in the informal sector and their dependants – representing the most vulnerable segment of the population – have no such insurance.

“Without medical cover, meeting maternity costs becomes a challenge for most people in Kenya and despite government hospitals charging very modest fees, families cannot pay the charges. Thus, women continue to deliver at home with the help of inexperienced people and most die when emergency situations present,” Agutu says.

A normal delivery costs the equivalent of $42 at Pumwani Maternity Hospital; a caesarean costs $75. Hospital management say it is forced to waive fees to the tune of nearly $19,000 every month.

Kenyan government statistics show that 56 percent of women give birth at home, putting mother and child at risk. When the data is broken down geographically, it emerges that 63 percent of deliveries in rural areas and informal settlements take place at home.

Avoiding a costly visit to the hospital is a contributing factor.

“My sister recently delivered her third child at Pumwani Maternity Hospital,” says Judith Ayuma, a domestic worker in Nairobi’s Pipeline Estate.

“She had hoped to deliver at Makadara health centre where the cost is 30 Kenyan shillings (a bit less than 40 U.S. cents), but since her labour pains came at night [when the health centre was closed] she had to be rushed to Pumwani where the cost of delivery is higher. She checked into the hospital but had no idea how she would pay the bill.”

When it was time to be discharged, Ayuma’s sister was detained at the hospital until relatives raised the $42 fee.

Agutu says the idea behind the smart card is to encourage families to develop a culture of saving for childbirth as well as for their other health needs.

“We are simply telling families that health care is as essential as food and other basic necessities. Just as they save up for other needs, they need to save for medical care,” Agutu says.

“While we acknowledge that there is a cadre of women who cannot spare even 30 shillings a day, we also know that women are innovative and belong to various savings groups popularly known as ‘chamas’. We are telling women to take part of this money they receive from the ‘merry go round’ and upload some of it into the smart card to cater for their families’ medical needs,” he says.

Changamka launched a smart card in September 2009, offering discounted rates at participating medical centres to see a doctor, have tests done or purchase medication.

“We have negotiated with particular health care providers who have agreed to charge a modest fee of 450 shillings ($5.50) when card holders visit their clinics. In return we promise health facilities an increase in the number of patients who are smart card holders,” Agutu explains.

Building on its success, the company is now extending coverage to maternal care. The smart card scheme offered by Changamka – a Swahili word meaning ‘get excited’ or ‘awaken’ – could be an important complement to the subsidy offered by the voucher scheme.

Agutu says that since early July, 500 maternity smart cards have been purchased. His company is negotiating to expand the number of medical providers who accept the card.

He is confident that uptake will be strong, suggesting that an intelligent combination of a convenient means to save and discounted services available at a wide range of health points could offer a large number of uninsured Kenyans access to essential medical services.

Dr Geoffrey Kasembeli says he worked almost seven years without a day off: that’s how severe the shortage of obstetricians and gynaecologists in Kenya is. A similar situation prevails across the continent, a symptom of the weakness of reproductive health care in Africa.

Until the end of 2009, Paul Mitei was the only doctor specialising in reproductive health at the Kisumu Provincial Hospital, handling all referrals for an entire province. A second gynaecologist has joined him at the hospital – working pro bono – but he says the workload is still very heavy.

“Wow, I am not sure how many patients I see in a day, after a while I lose count,” he told IPS. “They are simply too many, almost overwhelming.

“I used to literally go for several months without being off-duty because I was the only gynaecologist in the hospital. While other doctors and the mid-wives can help, there are essential specialised services that must be attended to by a gynaecologist, so this meant I had to be at the hospital for long hours and days on end.”

Across Africa, there is an acute shortage of specialists in women’s reproductive health.

“We are not enough, that’s why there is now a situation where general practitioners are performing caesareans, taking advantage of the critical shortage, fuelling chances of complications during the operation,” he said. “We are stretched, and are always fully booked. I am already fully booked until the end of October and this disadvantages patients.”

Kenya has only 340 registered gynaecologists serving a population of 38 million. Karanja says the shortage of these highly-qualified personnel is exacerbated by the uneven distribution of the few who are available.

“With so few specialists, it means women in rural and peri-urban areas have no access to a gynaecologist because the few who are available are concentrated in urban areas and they are expensive,” Karanja says.

Only a tiny proportion of African women have access to skilled medical care for a wide range of reproductive health issues including cervical and uterine cancer, problems with fertility, or reconstructive surgery for conditions like fistula.

The shortage also impacts on reducing maternal and infant mortality rates – in most countries, the women most likely to develop complications and need high-level intervention are also those unlikely to have timely access to such care.

In Windhoek, Dr E W Lisse told IPS, “We don’t have enough gynaecologists in the country, especially at state hospitals. In cases of emergencies, patients have to be transferred long distances to get treatment. The impact is mostly on the indigenous population who also don’t have medical aid and can’t afford gynaecologists in private practice.”

Where clinical officers, midwives and nurses are unable to offer the necessary care, they have to refer women to higher-level facilities. Time is of essence, for example when a labouring or post-partum woman is haemorrhaging, but too many never make it to a distant referral hospital.

The hospitals themselves are typically understaffed at all levels – Kenya’s health ministry estimates that 17,000 more nurses are needed in that country – and there is typically just one resident obstetrician/gynaecologist.

“In cases of emergency, you need to have providers who can quickly spot danger signs and know exactly how to react. Some of the cases that are brought to the referral hospital often end in death but had the right decision been made from the on-set, the life of the woman would have been saved,” Mitei says.

The shortage of healthcare workers is a global phenomenon. While wealthy Europe and the U.S. can afford to lure staff with lucrative pay, African countries often cannot compete and lose the limited numbers of trained personnel. Those willing to work for government hospitals such as Mitei and Kasembeli face long hours for much lower pay than is offered in the West or the private sector.

If governments are serious about achieving development goals on maternal mortality and women’s reproductive health, they will have to find ways to improve the numbers and distribution of skills in the public health service.

Karanja agrees with the view of the Kenya Obstetrical and Gynaecological Society that government will need to step up its effort to train clinical officers and midwives so they are able to perform many procedures that were previously the preserve of ob/gyns to improve reproductive healthcare.

*Patience Nyangove in Windhoek contributed to this report.

By Susan Anyangu-Amu
NAIROBI, Aug 6 2010 (IPS)

A day after Kenyans voted to accept a new constitution, women across the country speak about their hopes and expectations.

The case of Elizabeth Chazima could stand for the story of millions of women in Kenya who have been robbed of their financial contributions to matrimonial assets.

Speaking to IPS from her modest grocery store in Jericho Estate, Nairobi, Chazima recounts how in the early 1990s, her husband sold the house they had bought together without her knowledge.

“My husband and I owned a modest home which we had bought from the city council. But one frosty morning, my six children and I woke up to loud bangs by rowdy youth who had been hired to evict us from the house.

“To my shock I was informed my husband and had sold the family home without my knowledge. Nor I had seen the money he received from the sale,” she recounts.

Attempts to seek redress proved futile because she had no legal claim to the family home since she had no proof of her contribution to buying the house.

The new constitution provides for the elimination of gender discrimination in law, customs and practices related to land and property.

“My mother who is sick took time to travel and go and vote,” says women’s rights activist Ann Njogu. “She said that finally, with the new constitution, she would have the ability to own land and have her rights in marriage whether during the union or after divorce.”

New dawn for women’s rights

Njogu is the chair of the Centre for Rights Education and Awareness (a non-governmental organisation aimed at confronting the low awareness of women’s real needs and rights in society). She says the new constitution will protect women’s rights to matrimonial property.

Under Kenya’s previous law, inheritance was governed by customary law, often preventing women from inheriting property from their parents or laying claim to joint assets when their husbands’ died.

“This is a historic moment for the women of this country who have for years battled with their in-laws in succession cases,” Njogu says.

A new Bill of Rights also provides that all marriages shall be registered under an Act of Parliament. This means that even customary law marriages will be certified, protecting women’s interests in disputes between a widow and her in-laws over property.

Currently, in the case of customary marriage it is the in-laws who attest to the existence of the union since they are the ones who oversee the traditional wedding. When embroiled in a succession dispute with such in-laws, it is highly unlikely they will assist the widow and her children.



In the new dispensation, all marriages will be officially registered. Women will also be protected from claims by other women who turn up following a man’s death, claiming to have been married to the same man under customary law and demanding a share of his estate – a common occurrence.

Representation in decision-making

According to Njoki Ndung’u, a member of the Committee of Experts which drafted the new constitution, Kenyan women to this point have been treated as second class citizens – the largest historically marginalised group in Kenya.

“Despite being 50 percent of the population, women’s needs are rarely reflected in the overall national policy because they do not feature in key decision making positions that distribute power and resources nationally,” Ndung’u says.

“With the new constitution, this will change because there are over 40 benefits ranging from simple gender-neutral language to those that are life-changing, like the non-discrimination clause outlawing bias on the basis of sex, pregnancy or marital status,” Ndung’u told IPS.



On Aug. 4, Kenyans went to the poll and an overwhelming 67 percent voted for the new Constitution. Ndung’u notes with approval that a third of elected and appointed posts in public office are now reserved for women.


Currently women constitute less than 10 percent of Parliament and occupy an even smaller proportion of posts in Cabinet and elsewhere in government.

Gendered budgets

Ndung’u, who steered the landmark Sexual Offences Act through an overwhelmingly male parliament in 2006, says this has meant issues that affect women are rarely given priority in policy and budgeting.

The new structure of devolution should also benefit women as national budgets are brought closer to the people: a minimum of 15 percent of the national budget will now be allocated at a local level. Currently only the Constituency Development Fund and the Local Authority Transfer Funds are controlled at the county level – representing just three percent of the national budget.

Ndung’u says the increased funding allocation will ensure more economic growth and opportunities for local businesses to grow.

“Women, who form the majority of the informal sector and small and medium business, will gain tremendously from this injection of funds into the counties. This means an overall well-being of the country, because if you invest in women, you invest in the whole nation.”

Accessible justice

Thanks to the new Bill of Rights, women discriminated against on any grounds can challenge it in court or complain to the National Human Rights and Equality Commission. Such cases will not be subject to court fees, making access to justice much easier for all, especially women.

There is also a provision for class action, allowing a person to institute proceedings in the interest of a class of person.


Harmful traditional practices have also been outlawed under the new constitution, meaning female genital mutilation and wife inheritance will be a thing of the past.

Excerpt:

By Susan Anyangu-Amu
NAIROBI, Aug 5 2010 (IPS)

Jubilant supporters say it is a new dawn for Kenya. Sixty-seven percent of votes cast endorsed a new constitution more than two decades after reform was first raised.

Speaking to IPS soon after the results were announced, Senior Counsel Paul Muite, a former member of parliament, expressed joy at the victory, equating it to the jubilation experienced when Kenya attained independence in 1963.

“This is the rebirth of the state of Kenya in the sense that expectations of independence in 1963 were never realised. Those who took over then stepped into the shoes of the colonial masters and the socio-economic benefits ended up in the hands of a few, Muite said.

“This is a dream come true for Kenya. It is the reason the Mau Mau went to war.”

The new constitution has been heralded by many as a progressive document, second only to that of South Africa in terms of the rights it protects.

According to Commissioner Omar Hassan of the Kenya National Commission on Human Rights, the proposed Constitution has the most progressive Bill of Rights in the Continent.

“As a Commission we are very proud of the broad human rights benefits that Kenyans will enjoy. The Bill of Rights will protect and empower Kenyans,” Hassan said.

The new Constitution guarantees the rights to security, housing, food, life, freedom from discrimination and freedom of expression, among others.

Certain provisions in the proposed Constitution will dramatically alter the status of women in Kenya.

The executive director of Kenya’s Federation of Women Lawyers, Grace Maingi, said the new constitution includes affirmative action to achieve gender parity in parliament. Women are guaranteed a minimum of one-third of elected and appointed posts in government.

“Under the proposed Constitution, 47 special seats have been set aside for women in Parliament,” Maingi told IPS. “When political parties are nominating 12 members to the August House, they will have to pay special attention to gender parity – an obvious departure from what has been the norm.”

Dr Joachim Osur, a reproductive health expert, says the proposed Constitution will guarantee better health for the people of Kenya and women in particular.

“Health services have been centered in the urban areas. And with devolution that comes with the proposed Constitution, services will be moved closer to the people, through the creation of Counties which will have their own budgets including a health budget,” Osur said.

“We expect better deployment of health workers in all parts of the country, better nutrition and provision of health services. We expect more women to deliver in hospitals and a sharp improvement of family planning services.”

While most Kenyans are jubilant, Muite warns vigilance will be needed to ensure laws are formulated to implement provisions of the proposed Constitution.

“We now need to shift gears and focus on the truthful implementation of the proposed Constitution. Kenyans need to keep Parliament under watch to ensure they enact the 50 or more legislations that are required to operationalise the new Constitution,” Muite said.

While Parliament is expected to immediately begin passing legislation to give practical force to the new constitution, he warned that Kenyans should not expect immediate results. The full implementation of the new Constitution will be spread over a period of five years.

The first step is for the president to declare the proposed Constitution the new law of the land. This is expected to happen in the next 14 days.

Politicians opposed to the new Constitution, led by Higher Education Minister William Ruto, conceded defeat and lauded the Interim Independent Electoral Commission for having done fairly well. However, others in the ‘No’ camp, such as the clergy, said the vote was marred with malpractice.

Canon Peter Karanja, the secretary general of National Council of Churches of Kenya, called for consultations over the proposed Constitution on specific contentious issues.

The NCCK opposed the draft constitution on the basis of Article 26 on the right to life. Of particular concern to the churches is clause four, which states that abortion may be carried out when, in the opinion of a trained health professional there is a medical emergency, or the life or health of the mother is in danger.

The church also opposed the recognition of the kadhi’s courts jurisdiction over questions of Muslim law. Muslims may now choose this parallel court system to resolve matters of personal status, marriage, divorce or inheritance.

For the moment, Kenyans are engulfed in a spirit of celebration anticipating a better future.

Excerpt:

Precious Nabwire nearly died giving birth to her fourth child. If Kenyan gynaecologists have their way, a drug to control bleeding after childbirth will be licensed, offering greater protection to tens of thousands of women facing similar danger.

Her daughter – named Chausiku, “she of the night”, in honour of her arrival just past midnight – was born in Nabwire’s home.

“My labour began in the night and getting to Pumwani Maternity Hospital was out of question because I would have had to use a taxi and this would have cost a tidy sum of 1,000 Kenyan shillings ($12.50 U.S.),” Nabwire recounts.

She sent for a traditional birth attendant who lived nearby. Nabwire was sure the delivery would be as smooth as her first three.

“How wrong I was. The labour, as I predicted, took a short time but then the placenta did not come out. I started getting severe pains but the TBA assured me once the placenta was out they would subside,” Nabwire says.

“Luckily the placenta gave way and the bleeding subsided. I was able to wait until morning before going to hospital. However, by the next day I was very weak and had to be admitted into hospital for one week.”

Postpartum haemorrhage – bleeding after delivery – is one of the top five causes of maternal deaths in Kenya. Across Africa, it is responsible for a third of maternal deaths, according to statistics from USAID.

The Kenya Obstetrics and Gynaecological Society of Kenya (KOGS) is pushing for the registration of the drug known as misoprostol, often referred to by the brand name Cytotec, which they argue could be very effective in controlling postpartum haemorrhage, particularly in limited-resource settings.

According to the last national demographic health survey, released in 2009, 57 percent of women in Kenya give birth at home. Obstetrician and gynaecologist Dr Omondi Ogutu told IPS that were misoprostol made available in community health centres, this drug would help save the lives of millions of women.

“Currently misoprostol is registered for treatment of stomach ulcers but our push is to have the policy on its use expanded to allow for it to be used for gynaecological purposes. This inexpensive drug which retails across the counter for as little as 240 shillings (roughly $3) will help save the lives of many women who die from post-partum bleeding or unsafe abortions,” Ogutu said.

Dr Joachim Osur, a reproductive health expert with Ipas (a non-governmental organization dealing with protection of women’s health), says 20 percent of maternal deaths in Kenya are directly linked to bleeding after delivery. Failure to deliver the placenta like in Nabwire’s case is often fatal.

Research done on the safety and efficacy of misoprostol has shown that it stops the bleeding immediately while helping the uterus expel placenta.

“Misoprostol is a very effective drug; however, controversy surrounding its use to procure abortions has clouded its merits,” says Osur. “Those focusing on its use as an abortion drug are misguided and in the process are causing women of this country to miss out on its many beneficial roles.”

The fears of those reluctant to make the drug more widely available are illustrated by the Namibian experience, where misoprostol is widely known to be used to induce abortions.

Much like in Kenya, abortion in Namibia is restricted to cases of rape, incest or when the life of the woman is in danger. Osur warns that restrictive abortion laws do little to deter women who are keen on obtaining one. An estimated 800 women die from botched abortions in Kenya every day; many dying from haemorrhaging which the drug in question could stop.

“We have no policy surrounding the use of misoprostol because those in the ministry of health who should formulate the policy are jittery based on the issue of abortion. The fear has been that misoprostol will be misused for purposes of procuring abortions,” Osur explains.

He argues that the health ministry should come up with guidelines expanding the approved use of the drug while ensuring it can only be obtained from health facilities, including community clinics where the need is greatest.

“With controlled use, this drug will not necessarily be misused. The reality is if a woman who has delivered takes this drug she faces no risk of bleeding to death. This will be very beneficial for women in far-flung areas who die on the way having been referred from smaller health facilities to larger hospitals for medical attention,” Osur says.

In February, Nigeria became the first African country to register misoprostol for obstetric use. However, the government restricted its use to professional health practitioners in medical centres, ironic in a context where 75 percent of women give birth at home with the help of traditional birth attendants.

Advocates are pushing for the drug to be made available at much lower levels of the public health system, in order for it to have an impact on reducing maternal deaths.

By Susan Anyangu-Amu
NAIROBI, Aug 3 2010 (IPS)

An arrow points the way from a busy street along a rough pathway; visitors clutch their bags more closely. The door is open: sachets are displayed on the table with labels indicating treatment for ulcers, diabetes, hypertension, fibroids. But not the contraceptive pill IPS is looking for.

Thirty-five-year-old Sophie – she didn’t want her surname used – came here for six months for a herbal contraceptive.

She says she gained a lot of weight and suffered severe bleeding in connection with the injectable contraceptive she was getting at a government health facility, so she turned to this alternative, oblivious to official warnings that it has been linked to serious health problems.

“I stopped using conventional family planning pills because a friend of mine told me about this particular herbal pill which has no side effects. I used it for a period of six months with no side effects except not having my monthly period for that duration,” she says.

But gynaecologists have alerted the Pharmacy and Poisons Board – whose mandate is to investigate the composition of all drugs in the Kenyan market – that a number of women who were using herbal contraceptives were suffering serious problems.

“This particular herbal contraceptive was being distributed by a Chinese clinic and the packaging was in Chinese,” says Board legal counsel Dr Joseph Yano.

“The side effects being reported by the women included pain and swelling in the legs. Children as young as three years whose mothers were using this pill during breastfeeding were reported to have developed enlarged breasts and uterus.”

Investigations by the Board found that the pills contained high levels of the hormones levonorgestrel and quinestrol.

Yano says loopholes in the country’s legal system are creating an avenue for people to sell unlicensed drugs as “herbal remedies”. The herbal classification requires an import and distribution license only from the Ministry of Culture, which has no capacity to test the products.


”Our law on traditional medicines did not envisage a time when we would have herbal remedies imported from abroad. So they come in through the Ministry of Culture while the Ministry of Health has no idea about them. As a result, all manner of concoctions are being brought into the country and being sold under the guise of being herbal remedies,” Yano says.



Professor Joseph Karanja, an obstetrician and gynaecologist, says due to a combination of difficulties accessing standard family planning and a degree of ignorance of their proper use, many women in Kenya are being exploited by unscrupulous people selling “herbal” alternatives.

“Some of these herbalists are not qualified and their claims to treat all manner of diseases are actually not based on any evidence. These people are simply preying on women’s desperation to avoid pregnancy and are exploiting their ignorance and making money.

“Women need to stay away from such clinics because the products contain high doses of unknown hormones which could have very serious side effects,” Karanja says.

Canny operators

Calls for attention at the back alley dispensary go unanswered; a group of people seated across from the door chat on undisturbed.

Suddenly a voice from across the street says the attendant has stepped out and advises us to call the number displayed on the wall.

When IPS dials and asks about the herbal family planning pill, the person who answers hurriedly says the pill is out of stock and promises to call back when it is available. With that, the phone goes dead.

The people running dispensaries like this one are cautious: According to Sophie, clients are not allowed to take the pills off the premises; instead they come to the clinic once a month and swallow the tablet on site. A helpful call from the operator reminded her when it was time to come in for a next dose.

“You only need to take one pill in a month and they will remind you in good time. It is only 200 shillings (about $2.50) and no one ever needs to know what you are up to,” Sophie says. “Even your husband will have no idea that you are using this pill since you do not take it home with you and have to swallow it everyday like the conventional pills.”


As far as Sophie is concerned, the herbal family planning pills did her no damage – she came off the contraception to have a baby – and she intends to return to using it after she delivers, as she does not want any more children.

National health policy suggests safe family planning methods should be readily available in government hospitals for free or at a heavily subsidised rate. The reality is persistent stock-outs.

“Kenya faces chronic contraceptive stock-outs because the budget allocation towards the health sector is low and that of the family planning division is even lower,” says Dr Charles Ochieng, a gynaecologist at Marie Stopes in the eastern city of Kisumu.

As a result, he says, women are often told that their chosen contraceptive is unavailable and are forced to seek an alternative.

He concedes that conventional family planning methods sometimes have side effects, and these can be worse if one keeps changing from one method to another. Ochieng says this is an important reason why women turn to alternatives of unknown composition, but not the only one.

“Staff attitude in hospitals might also be to blame. There is a misconception that women who want family planning methods are promiscuous and thus they are stigmatised. This can force women to seek services from herbalists.”

Excerpt:

The government of Kenya has been encouraging women to deliver in hospital. Home deliveries by traditional birth attendants are considered to be a major contributor to maternal deaths.

Kenyan maternity clinic: less than half of births take place in facilities like these. Credit: Kenneth Odiwuor/IRIN

TBAs are said to be ill-equipped to notice danger signs that could be fatal. The government has proposed banning traditional midwives altogether.

According to the last demographic health survey, released by the government in 2009, Kenya has one of the highest maternal death rates in the world at 448 per 100,000 live births. Home deliveries are believed to be a major contributor.

“When a woman goes into labour in the middle of the night in Mathare slums,” Elizabeth Sibuor, a traditional birth attendant in Nairobi, “the option of getting a taxi is out of question due to the cost and insecurity.

“Such women end up delivering with the help of TBAs. Pregnancy and labour is a matter of life and death, I will not sit back and let a woman and her baby, die if I can offer assistance.”

The 2009 demographic health survey shows less than half of women deliver under the care of a skilled attendant in Kenya. Fifty seven percent give birth at home with 28 percent assisted by a traditional birth attendant.

She often remains unpaid by her clients; of those who do, many settle their bill in small installments or in kind through gifts. Some cannot afford to make any payment, but she says she turns no one away.

Dr Isaak Bashir, the head of Reproductive Health in Kenya’s Ministry of Public Health and Sanitation, is emphatic the government should not recognise TBAs and that women should give birth with support from medical practitioners.

“For anyone to be recognised as a qualified birth attendant they must have commensurate papers from a recognised medical training college. The country is not short of qualified nurses and midwives. Institutions of higher learning are churning out enough candidates, what needs to be done is hire new people,” Bashir says.

But Monica Ogutu the executive director of Kisumu Medical and Education Trust (K-MET) says the health system has failed the women of Kenya.

“No woman wants to deliver at home. The health system is failing women. When a woman is in labour, she needs someone to listen to her and offer comfort. One midwife attending to 10 women at once will not have time for such a woman. This is one of the various reasons why women are opting for the services of traditional birth attendants,” says Ogutu.

While the government’s ban on TBAs may be well-intentioned, Ogutu says the move is dangerous.

Instead of demonising them, Ogutu argues the government should reinvigorate previous efforts to train TBAs as a bridge between the community and the public health system.

“For hundreds of years, TBAs have helped birth our nation and they are highly regarded in some communities, especially rural areas. Banning them will not make women who seek their services go to give birth in hospitals,” Ogutu says.

Sibuor insists that government – and women – have nothing to fear from traditional birth attendants.

“I have lost count of the number of women I have assisted during delivery in my over 20 years experience and no woman has died under my care,” she says. “When I notice danger signs, I accompany the woman to the nearest health centre.

“I encourage the women to attend clinic and also take their children for vaccination. I also insist they must get tested for HIV and if they are positive, I do not agree to deliver – they must go to a health facility.”

Sibuor says women such as Okoth will continue to rely heavily on TBAs. Instead of being perceived as incompetent, she wants the government to identify credible TBAs and help them to improve their service.

“The reality for a woman in Mathare slums is different from that of a woman in an affluent background. Because labour comes at anytime and could progress very fast, the woman in Mathare will continue needing my services. I will continue birthing this nation.”

The Kenyan government, like other African governments, is wrestling with the challenge of extending adequate services to meet its commitment to reduce maternal mortality by two thirds by 2015 compared to 1990 levels. The government acknowledges the important role played by TBAs, says Dr Bashir, and is in the process of coming up with a charter to re-orientate them as birth companions.

It will be essential to accurately assess the quality of care given by women like Sibuor, and find an appropriate place within the country’s public health system.

By Susan Anyangu-Amu
NAIROBI, Apr 1 2010 (IPS)

Pregnant mothers who are HIV-positive could soon find it challenging to access life-saving HIV drugs because Kenya was denied 270 million dollars in funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria.

An estimated 6 percent of pregnant women in Kenya are HIV-positive; administrative rivalries have hurt effective use of donor funds for treatment. Credit: Kenneth Odiwuor/IRIN

According to James Kamau, coordinator of Kenya Treatment Access Movement, jostling between the ministry of medical services and that of public health over who should handle donor money is already affecting the smooth functioning of the health sector.

“Already, due to the confusion and competition between the two ministries on who should control the money, procurement of essential drugs for public hospitals has not been done leading to shortages,” Kamau says.

Dr John Ong’ech, a HIV specialist at the University of Nairobi, states the funding shortfall will worsen access to lifesaving treatment following the move by the World Health Organisation (WHO) to introduce new treatment guidelines.

In 2009 the WHO recommended new guidelines on antiretroviral therapy (ART), calling for an earlier start to treatment and urging HIV-positive mothers and their infants to take ARVs while breastfeeding to prevent transmission.

“Under the new guidelines, WHO raised the CD4 count (measure of immunity to ascertain when HIV positive persons should begin treatment) from 200 to 350. What this means is that more people than was the case in the past will require to be put on treatment.

“This is obviously a challenge considering we were already facing drug shortages in trying to treat people with CD4 count below 200,” Ong’ech says. Approximately 600,000 people will now require treatment.

The new guidelines called for HIV-positive mothers to begin treatment at 14 weeks – up from the previous recommendation of 28 weeks – to prevent mother-to-child transmission. They further urge seropositive mothers and their infants to continue taking ARVs up to 12 months after giving birth. Of the 1.5 million women in Kenya who fall pregnant each year, 100,000 test positive for HIV.

Ong’ech says the new line of treatment recommended by WHO will require more funds, a challenging scenario in light of the reduced funding.

In its report denying Kenya’s appeal for the cash, the Global Fund raised concern over duplication of roles between the two health ministries and the existence of a huge unjustified and unsustainable workforce. The government proposals were also said not to be clear on how they would implement the projects they were sourcing funds for.

The Global Fund has denied Kenya two consecutive rounds of funding (eight and nine) and Kamau says the issues that led to the funds being held back persist. He says the Global Fund has in the past raised queries over Kenya’s absorption capacity for the monies which they request.

“Civil society exhausted its part of the allocation but the cash with the government, which should have been used to buy drugs and other services has never been used,” Kamau says.

Kamau raises concern whether a new application for round 10 monies will sail through unless things change drastically.

Kamau now warns that unless alternative funds are sourced for it remains unclear how the government will continue to provide free HIV drugs since money from the Global Fund constitute a huge component of the total expenditure of the HIV sector.

“Approximately 300,000 people (with low CD4 counts) in need of life-saving antiretroviral (ARVs) drugs are now not sure of continued access to medication. These 300,000 HIV-positive people also include pregnant mothers and HIV-positive children,” Kamau says. There are currently 1.4 million HIV-positive people in Kenya.

He says the situation is further aggravated by the fact that the Clinton Foundation, which also funds HIV/AIDS projects is set to stop at the end of 2010.

“It means more HIV-positive people will join the list of those who cannot access treatment,” he says.

Sarah Oluoch, an HIV-positive resident of Kibera slums, told IPS that public health facilities are already experiencing erratic supply of ARVs and other drugs.

“I am not sure what is going on, but lately we keep getting different brands of ARVs every time we go to the hospital and this is causing confusion. In fact one of my friends with a newborn recently confused her medication taking one of the drugs twice because she is not accustomed to the changing brands,” Oluoch says.

Currently, the government allocates 6.6 million dollars for each financial year towards fighting HIV, a far cry from the estimated 133 million dollars spent annually in previous years.

According to Kamau, the government allocation has only been enough to provide for 25,000 people, with monies from U.S. President Emergency Plan for AIDS Relief (PEPFAR) catering for slightly over 100,000 people and the Global Fund paying for another over 100,000 people.

Kamau says after 2010, there will be no drugs as the stocks purchased in previous years will run out at the end of the year. He says the remaining nine months in the year is not adequate time to source funds because of the bureaucracy involved.

Excerpt:

By Susan Anyangu-Amu
NAIROBI, Mar 23 2010 (IPS)

Gideon Lepalo describes growing up in Loiyangalani, 20 kilometres from Lake Turkana, as magical. However, he fears the building of Gilgel Gibe III dam in Ethiopia, upstream of the Omo River, will soon mean that his childhood memories of the lake will be exactly that – memories.

According to an independent environmental impact assessment (EIA) done by the Africa Resources Working Group (ARWG), a cluster of eight scholars and consultants from the United States, Europe and Eastern Africa, the building of Gibe III upstream of the Omo River will cause a radical reduction of inflow of water into Lake Turkana in Kenya.

This is because the Omo River provides up to 90 percent of the total water flowing into Lake Turkana. The assessment states that up to 500,000 people living around the lake will be adversely affected by the building of the dam.

The result of this will be increased salinity conditions in the lake waters, rendering them unfit for human and livestock consumption. Also facing risk of destruction will be hundreds of aquatic species, which are unique to Lake Turkana and which residents rely on for food.

“There will be a drop in the lake level of up to 10 to 12 metres. Even a slight drop of as little as five metres would cause cessation of flooding, leading to a reduction in the lake’s water which will result in rising salinity. This will cause a destruction of significant commercial interests around the lake which include fishery and tourism,” the ARWG report estimates.

“Residents of Kalokol town on the southern side neighbouring Lodwar area are already feeling the impact of the damming upstream, the lake has gone up to three kilometres inside. As for my ethnic group the El Molo, we used to be close to the lake but now the water is moving inside,” Lepalo the executive director of Save Lake Turkana Project says.

Lake Turkana is considered the largest desert lake in the world, measuring about 7,000 square kilometres and it is fed by three rivers; the Omo of Ethiopia, the Turkwel and the Kerio. The Turkwel and the Kerio are largely seasonal rivers and Lake Turkana almost entirely depends on water from the Omo River where construction of the Gibe III dam started in 2006. Almost 30 percent of the work is complete.

Despite the economic viability of building the dam for Ethiopia, with 500 MW (slightly over a fifth of the country’s electricity needs) expected to be sold to Kenya, critics of the dam including environmentalist Dr Richard Leakey argue the plan is flawed.

The Ethiopian government says they need the dam as it will provide 1,800 MW of electricity, which will provide more than double the country’s current electricity-generating capacity. It will solve the country’s energy crisis and allow a surplus for export. However, Leakey argues the dam will produce far more electricity than the country is capable of consuming, and most will be exported to neighbouring countries of Sudan, Kenya and Djibouti.

“I think that this project is fatally flawed in terms of its logic, in terms of its thoroughness and in terms of its conclusions. It looks to me like the EIA was an inside job that has come up with the results that they were looking for to get the initial funding for this dam,” Leakey states.

Critics of the Gibe III dam state the EIA commissioned by the Ethiopian Government and done by Agriconsulting of Italy, was released in April 2008, two years after work on the dam had already began. They argue that this clearly indicates due process was not followed as an assessment should have been conducted prior to any construction.

According to the EIA commissioned by the Ethiopian Government, the dam will not cause any significant harm. The report states that the dam is necessary in order to preserve Lake Turkana and restore the region’s biological integrity and diversity. The report further states there are no people or ethnic minorities around the dam and reservoir area whose traditional lifestyles could become compromised through the implementation of the project.

However, Leakey says the building of the dam will produce a broad range of negative effects, some of which will be catastrophic to both the environment and the indigenous communities living downstream of the Omo River. The immediate consequence he foresees will be the aggravation of armed conflict between communities over the shrinking natural resources (water and pasture).

Lepalo agrees: “Communities living along the Ethiopian, Kenyan and Sudan borders are armed and continuously fight during the dry spells. Should the reprieve offered by the lake be tampered with, this is bound to explode into serious inter-border conflict.”

Leakey argues that evidence from independent EIA reports by scientists disputing the building of the dam should be reason enough to stop the project.

In February during an African Union conference, Kenya’s president Mwai Kibaki and Ethiopia’s Prime Minister Meles Zenawi signed a deal for a power-grid connection that would enable Kenya to benefit from the surplus electricity generated by the Gibe III dam.

In December 2009, Kenya’s Minister of Energy, Kiraitu Murungi, said Kenya is willing to import between 200 to 400 MW of electricity from Ethiopia. He expressed government’s commitment to the completion of Gibe III project.

“We want a clear report from the government why they have silently approved this onslaught on Lake Turkana. Why has the National Environment Management Authority (NEMA) not done an independent environmental impact assessment and choose to rely on a report produced by the Ethiopians?” Lepalo asked.

Speaking to IPS, the acting corporate communications manager of NEMA, Wangari Kihara said the authority plans to carry out an independent EIA on the building of Gibe III on Lake Turkana after realising that the initial report may have been flawed.

Lepalo sees the move by NEMA as coming too late when 30 percent of the work is complete and deals between the two countries have already been signed. He argues Kenya has other viable opportunities of generating electricity from wind power technology and this is where the government’s focus should be.

“The government should concentrate on expanding the Lake Turkana Wind Power project which on completion will produce a third of Kenya’s electricity. This project can be expanded to serve domestic users and even export power,” Lepalo says.

The Spanish government has recently offered to finance the 150 million dollar wind power project in Lake Turkana. Once completed the project will produce 300 MW (20 percent of the national power production), which will represent a fifth of Kenya’s power generation capacity.

Lepalo and others on the campaign to save Lake Turkana warn they will embark on a 75-day trek from Nairobi to Addis Ababa in Ethiopia to petition the African Union to intervene on the issue to force the two governments to re-evaluate the environmental impact of building the dam.

Excerpt:

By Susan Anyangu-Amu
NAIROBI, Mar 15 2010 (IPS)

Margaret Atieno, a 38-year-old mother of six, says she wanted to avoid her last pregnancy. But consistent stock-outs of contraceptive devices at her health care centre in rural Siaya, western Kenya, gave her no choice but to fall pregnant once again, albeit the fact that she did not want another child.

“My husband, who is polygamous and has two other wives, does not want any of his spouses using contraceptives. So a community health worker told me that if I had the intra-uterine contraceptive device (IUCD) inserted, my husband would never suspect anything. But when I visited the health centre on three occasions, I was told IUCDs were out of stock,” said Atieno.

On her fourth visit, IUCDs were finally in stock, there were no gloves – as a result, health workers could not insert the device. Atieno conceived before her next visit to the health centre.

Atieno says she did not want more children because her husband, who is a cobbler, already struggles to provide for the 13 children he has with his three wives. Living in a traditional, rural community, she is not privy to how much money her husband earns, and although they hardly manage to make ends meet, Atieno and the other wives are not allowed to work to contribute to the household income.

“My two eldest children, who are aged 17 and 15 years, would have been in secondary school, but they had to drop out due to lack of funds. It is a daily struggle finding money to feed and clothe my children, let alone send them to school,” she complained.

Social experts have recognized that lack of family planning is one of the key reasons for an increase in poverty throughout Kenya. A November 2009 report by United States Agency International Development (USAID) warns that Kenya will not be able to foster national development at the current rate of population growth.

If the country wants to achieve universal primary education, food security, primary healthcare for all and reduction in maternal and infant deaths, couples have to have smaller families, USAID researchers noted.

The country’s government has also taken notice of the tight link between poverty and population growth. Dr Boniface K’Oyugi, chief executive officer of the National Coordinating Agency for Population and Development (NCAPD), cautioned that Kenya’s rapid population growth of three percent per year, needed to be reduced by at least a third.

“In developed countries, people are having one or two children, but here, one woman is having five children and more. If we want to be as developed as other countries, we urgently need to reduce our population growth,” K’Oyugi said at a meeting at Nairobi’s Hilton hotel in February.

He called for improved health care provision that includes family planning services, to help couples to better manage their reproductive health and pregnancies.

“The decision of the number of children is a personal one. But smaller families will lead to benefits at the individual, household and national levels,” he explained.

K’Oyugi believes the Kenyan government can learn from Asian countries, such as Thailand, Malaysia, South Korea, Taiwan and Singapore, which managed to strengthen their economies by actively reducing population growth rates.

It is, however, important to note that population growth is only one of numerous factors hampering Kenya’s development. Through the national poverty reduction strategy 2003-2007, government made clear that good governance, primary education, gender equality and HIV prevention, as well as high levels of corruption are other major stumbling blocks to economic growth.

Still, the size of a country’s population dictates how much budget is available for services per capita.

According to the Central Bureau of Statistics, Kenya had 38 million people in 2008 – an increase of a third since 1999. USAID projections warn that if this growth rate persists, the number of Kenyans will increase to 82 million by 2040.

“More people means more pressure on the environment, as demands for food, land, clean water and energy resources escalate. With reduced resources, there is a real danger of civil strife arising as people squabble for the scarce resources,” K’Oyugi warned.

An increase in the number of people will also boost rural-urban migration, according to USAID. This will increase the pressure on urban facilities, in turn creating slums and poverty. Already, Kenya’s informal settlements are characterized by over-crowding, inadequate shelter, lack of clean drinking water and adequate sanitation, insecurity, exploitation and abuse.

The NCAPD is now pushing for family planning to take a central role in the government’s policy agenda to reduce poverty and transform the country into a middle-level income country with a high quality of life and secure environment, as the country’s Vision 2030 policy envisions.

“The aim is to rejuvenate the family planning campaign to the level where it was in the 1980s, during which time the fertility rate dropped from 6.7 children per woman in 1989 to 5.4 in 1993 and 4.7 in 1998,” said NCAPD media liaison officer David Kinyua.

He promised that, in the next financial year starting in June, increased budgets will be allocated for family planning, but was unable to explain how much additional money will be spent and where.

Excerpt:

By Susan Anyangu-Amu
NAIROBI, Mar 11 2010 (IPS)

Lillian Mutuku, a 34-year-old mother of three, describes her home in Katine area, in Kenya’s Eastern province Tala, as a harsh place to live. The soil is poor, she says, the sun beats down mercilessly and vegetation is sparse.

“People here face a daily struggle to make ends meet and to find water and food for their families. During the dry season it is worse, as the few crops we plant die, making food expensive,” she complained. “Women have to walk many miles a day in search of that precious liquid – water.”

The fact that Kenya’s political parties have been struggling to rewrite the country’s Constitution since February 2008 in an effort to end post-election violence and improve justice means a lot to Mutuku, despite the fact that she fails to understand the document’s legal jargon. She believes the new Constitution will oblige government to ensure her family’s access to food, shelter, water and health care.

“The issues that preoccupy my mind are the daily struggle to provide food for my family and for my children to go to school. While there is free primary education, there are not enough teachers in our area, and so parents are forced to pay 100 Kenyan Schilling ($1.3) per month for private teachers,” Mutuku says.

This is a lot of money for Mutuku, a domestic worker, and her husband, who works as a casual labourer. Between the two of them, they earn about $100 a month, which is hardly enough to sustain their family.

If the Parliamentary Select Committee (PSC), which was established to manage the Constitution review process, has its way, Mutuku’s family will never be able to hold government accountable for access to their basic human rights.

The PSC has been castigated by various women’s rights organisations for diluting the language in the draft document, prepared by a Committee of Experts (COE). The initial COE document guaranteed social and economic rights through the Constitution, but the PSC changed the language of the Bill of Rights, leaving the onus of ensuring those rights to parliament.

The PSC deleted numerous sentences referencing basic human rights, including the right to social security and right to health, including health care services, reproductive health care and emergency treatment. It excluded Kenyan’s right to education, inclucing the right to free and compulsory pre-primary and primary education as well as available and accessible secondary and post-secondary education. Rights to housing, food and water were also taken out of the document.

Lawyer Catherine Mumma terms this as a particularly big loss for Kenyan women who often bear the burden of providing for their families: “The chapter on the Bill of Rights as drafted by the COE was one of the major gains for the women of this country. (A) woman who walks for many hours in search of a hospital and collapses with her baby on the back due to lack of food does not care about the legal jargon in the Constitution. She wants to hear that the government will ensure she has access to basic human rights.”

Speaking at a one-day workshop – organised by several women’s organisations in Nairobi in February to review the COE and PSC drafts – Grace Maingi-Kimani, acting executive director of non-profit organisation Federation of Women Lawyers Kenya said the PSC overstepped its mandate by reviewing the Bill of Rights.

“The PSC did the unthinkable and recommended the deletion of the state’s obligation to domesticate international human rights instruments. They also deleted the provision on social and economic rights and relegated to parliament the sole power to decide through legislation when and how the rights and standards can be applicable in national context,” Kimani explained.

Pricilla Nyokabi, executive director of women’s rights group Kituo cha Sheria, agreed that parliament should be left no option but to reinstate the rights in the draft.

“Entrenching these rights in the constitution would obligate the government to ensure equal provision to all citizens. Should the Constitution state that every person has the right to these services, one can enforce the right where they are not provided for,” noted Nyokabi.

PSC chairperson Mohammed Abdikadir, however, says constitutions should be lean documents that cover the broad principles and values that guide a state. Additional details should be formulated as statutes.

Human rights activists remain skeptical. “Can we really leave (our human rights) to members of parliament who are always bickering? No, we cannot trust them with such fundamental rights,” stated women’s rights activist Miriam Wanjiku.

Currently, the latest draft of the Constitution is reviewed parliament, which has 30 days to debate the document and decide if it will be passed. Parliamentarians need a two thirds majority to alter the wording of the draft.

To prevent the document from being passed as is, a grouping of women’s rights organisations, including FIDA Kenya, Urgent Action Fund, Centre for Rights Education and Awareness, Africa Woman and Child Feature Services, have handed a memorandum to parliament, demanding that the initial document drafted by the COE be retained.

“The women of Kenya demand explicit recognition of their rights in the regional and international human rights instruments that Kenya has ratified,” the memorandum states.

(IPS/

Excerpt:

The droughts in the Turkana region were less severe when she was growing up, says Laura Letapalel, and pastoralists could still find some grass and water for their animals. Now, she laments, the droughts are longer and there is nothing to eat.

Watering camels from a hand-dug well in Turkana. Credit: Anthony Morland/IRIN

Andrew Mude, an economist with the International Livestock Research Institute (ILRI), says drought is the greatest hazard encountered by herders.

“This is particularly true for northern Kenya, where more than three million pastoralist households are regularly hit by increasingly severe droughts. In the past 100 years, northern Kenya has recorded 28 major droughts, four of which occurred in the last 10 years,” Mude explains.

“In our community the size of one’s herd is what signifies his status economically. However, of late we have noticed drastic weather patterns that have left our herds dead, turning once rich men into paupers,” says Letapalel a pastoralist in the Turkana area of Kenya.

Esekon Longuramoe, another pastoralist from Turkana, says erratic climatic conditions have changed his fortunes.

“After losing almost all my livestock, I have become so poor that I cannot compare myself to the way I used to be. Even if I wanted to move, I do not have a donkey to carry my possessions, I would have to borrow one,” he says.

The question of how to cushion pastoralist communities against the devastating effects of drought has been a headache for the government of Kenya.

A new project launched by ILRI and its partners promises to help pastoralists.

“Thousands of herders in Marsabit District, a remote, arid area in northern Kenya, will be able to purchase insurance policies for their livestock, based on a first-of-its-kind programme in Africa that uses satellite images of grass and other vegetation to indicate whether drought will put their camels, cows, goats and sheep at risk of starvation,” Mude says.

The programme will use satellite images to assess the state of grazing land. This information will be matched against records of livestock deaths collected over the past decade to calculate stock losses for insurance purposes. This index-based insurance system eliminates the need to verify the individual deaths of animals.

The Marsabit district – adjacent to Turkana – has been divided into two clusters based on risk. It will cost 5.5 percent of the value of livestock to insure animals in Maikona and North Horr divisions; in Laisamis, Loyangalani, Central and Gadamoji, it will cost 3.25 percent.

“We believe this programme has potential because it has the elements insurers need to operate: a well-known risk (drought) and an external indicator that is verifiable and cannot be manipulated, in this case satellite images of the vegetation,” says James Wambugu, managing director of UAP Insurance, which is providing the risk cover.

Sales of the insurance scheme began across the district in January. The premiums can be paid at branches of Equity Bank in Marsabit, or to Point of Sale agents under the Hunger Safety Net Programmes – a scheme that provides regular cash grants to 300,000 vulnerable households in arid districts of northern Kenya and has a presence in most of the major communities in Marsabit.

According to Mude, Marsabit district currently supports about 86,000 head of cattle and some two million sheep and goats which depend on naturally growing vegetation for survival. The livestock in Marsabit alone is estimated to be worth 67 million dollars, though animals are rarely sold or slaughtered.

Given the complexity of the insurance project, a simulation game was developed to help the local communities understand the key features of the insurance policy. Mude says many of the herders who played the game became intensely involved in the simulation.

“The simulation helps them understand how insurance can protect them against losses. They also appear to simply enjoy playing the game itself, which generates a lot of animated discussion,” he explains.

The insurance is valuable even without the deaths of livestock triggering payments.

The policy can be used to obtain credit with which to buy feed or drugs that could help animals survive tough conditions. Expanding herds may also be made easier; private creditors will be more willing to lend if the risk of losing new animals to drought is insured against.

Mude says the pilot project will last three years, during which studies will be carried out to establish the commercial sustainability of the product. If it proves successful, extending it to parts of Uganda, Southern Ethiopia, West Africa and even Asia will also be explored.

By Susan Anyangu-Amu
NAIROBI, Feb 2 2010 (IPS)

The threat by influential Christian leaders to mobilise a vote against Kenya’s draft constitution if it does not explicitly prevent any expansion of abortion rights appears to have succeeded.

Thousands of young women risk their health procuring abortions each year: will a new constitution entrench restrictive laws on termination? Credit: Ann Weru/IRIN

Canon Peter Karanja of the NCCK told IPS, “Life is sacrosanct. The definition of life must be stipulated in the supreme law of the land, the Constitution. Life must be defined as starting at conception and ending at natural death.”

The parliamentary committee has completed deliberations on the draft, and decided to define life as beginning at conception.

Phrases guaranteeing everyone the right to health care (including reproductive health care) and stating that no one may be refused emergency medical treatment have been deleted; added is a phrase ruling out abortion “unless in the opinion of a registered medical practitioner the life of the mother is in danger”.

The changes have raised an uproar, with professional associations of medical practitioners saying it will have negative effects on Kenya’s attempt to reduce maternal deaths.

“As health care providers, we are familiar with both the human impact of unsafe abortion and the public health burden it represents. Including prohibition against abortion in the constitution and defining life as beginning at conception will fail to prevent incidences of abortion,” says Dr Otieno Nyunya, chairman of the reproductive health committee of the Kenya Medical Association.

Grace Maingi-Kimani, the acting executive director of Federation of Women Lawyers Kenya (FIDA), says the move by the PSC is disheartening and will serve to limit access to choice for women and young girls who are raped and end up pregnant.

“The PSC was not thinking about the hundreds of women who were raped during the post-election violence and were forced to have children sired by men who violated them and possibly killed their husbands. The PSC was not thinking of young girls who are abused by their teachers and forced to cut short their education due to unwanted pregnancies,” Kimani says.

“It is the poor women and teenage girls who die at the hands of quacks,” says Professor Joseph Karanja, an associate professor of obstetrics and gynaecology at the University of Nairobi.

He says wealthy, well-educated women are able to find safe ways to terminate pregnancies; ignoring international commitments Kenya has made guaranteeing the right to health, he charges, the PSC, has created a platform that puts the most vulnerable at still greater risk.

On its part, the Church is happy with the prohibition of abortion and definition of life as beginning at conception, and has again warned it will reject anything less.

“We should not victimise the innocent unborn children, who do not have a say in this matter. Even in the case of rape and incest, the life in the womb of the woman is innocent,” says Father Paulino Wondo of the Holy Trinity Catholic Mission in the Nairobi slum of Kariobangi.

Members of the Kenya Medical Association, FIDA, Kenya Obstetrical and Gynaecological Society, Family Health Options Kenya and the National Nurses Association of Kenya, have written a protest note to the PSC, the Committee of Experts and Parliament, calling for the controversial phrases to be reviewed.

Currently, abortion is permitted in Kenya only to save the life of the mother. Despite this, every year large numbers of women seek assistance to terminate pregnancies wherever they can find it.

Dr Joachim Osur, an advisor with reproductive health rights organisation IPAS – a member of the RHRA – argues that opponents of expanded abortion rights in Kenya have their heads buried in the sand.

“Despite termination of pregnancy being restricted in Kenya, induced abortions remain common. In Kenya it is estimated that 300,000 spontaneous and induced abortions occur annually, about 29 abortions for every 100 live births,” says Osur.

“Unsafe abortions contribute a significant margin to the maternal deaths in this country at 30 percent. It is estimated that 2,000 women die annually from unsafe abortions.”

Dr Otieno Nyunya, chairman reproductive health committee of the Kenya Medical Association says research done by his association alongside IPAS and FIDA in 2004 found 316,560 spontaneous and induced abortions occurred that year.

Nearly 21,000 women are admitted each year to Kenya’s public hospitals for treatment of complications from incomplete abortions, either spontaneous or induced.

The study further shows that 800 unsafe abortions are performed every day and 2,600 women die from unsafe abortions in Kenya each year, representing 30 to 40 percent of Kenya’s total maternal deaths, according to Kenya Obstetric and Gynaecological Society and Kenya Medical Association.

Nyunya says that 60 percent of the beds in the gynaecological ward at Kenyatta National Hospital, the largest referral hospital in East and Central Africa, are occupied by patients suffering from abortion complications.

He says a conservative estimate of the cost to the state for the management of these cases is approximately four million dollars a year.

The cost to women’s lives is much higher.

Excerpt:

The testimonies of women who survived sexual violence during post-election conflict in 2008 should be heard, say advocates. The magnitude of the crimes committed against women because of their gender must be recorded and prosecuted to prevent such violence from occurring again.

“We have realised there is no political intention to ensure the perpetrators of gender-based and sexual violence are brought to book, says Patricia Nyaundi, executive director of the Federation of Women Lawyers Kenya (FIDA).

In presenting its findings, the Waki Commission of Inquiry into the Post-Election Violence described rapes committed against women, children and some men; carried out by gangs of thugs, by neighbours and by the security forces. The Commission states that the evidence it collected represented a tiny fraction of the full extent of gender-based violence – just 31 women came forward with testimony of this nature.

Tip of the iceberg

A single facility, the Gender Violence Recovery Center at the Nairobi Women’s Hospital, reported attending to over 650 cases of sexual violence during the chaos. Anecdotal evidence suggests thousands of other women across the country survived similar violence.

“By documenting these testimonies, we are taking this opportunity to give women who underwent horrific ordeals a chance to tell their stories, to create historical evidence that this actually happened.

“This kind of evidence will force this country to move from denial and accept what happened during that period,” says Nyaundi.

Amplifies distrubing trend

“Violence against women has been systematic and entrenched in our society, but the post-election period saw an unprecedented number of women subjected to widespread sexual violence,” says Rosemary Okello.

“Many women were sexually assaulted, gang raped or sodomised. Many of these acts of sexual violence occurred in the presence of the women’s spouses, children or parents causing trauma, humiliation and stress suffered by the survivors and their families.”

Okello is executive director of another partner in the documentary project, the African Woman and Child Feature Service (AWCFS), which promotes diversity, gender equity, social justice and development in Africa through media, training and research. Also participating are the NGOs Centre for Rights Education and Awareness and Women Fighting Against AIDS in Kenya.

The documentation project is supported by the Urgent Action Fund (UAF-Africa), which has wide experience working in the Democratic Republic of Congo, Northern and North Eastern Uganda, Liberia and Zimbabwe, providing rapid response grants to women and human rights organisations.

“Women survivors become guiltier than the perpetrators of the violence,” says UAF executive director Jessica Nkuuhe.

“The women fear to share what they have been through because they are afraid of stigma and being deserted by their families, especially their spouses. They thus shut down and unfortunately this ordeal eats at their very existence, giving rise to depression and eventually some lose the will to live and die miserable.”

Testimony part of healing

Nkuuhe says the documentary project is an off-shoot of similar endeavours in northern and northeastern Uganda, Liberia and Zimbabwe through which survivors of sexual and gender-based violence have been able to share their experiences with each other.

“We brought together survivors of sexual violence to a conference. Before that most of these women had kept their experiences silent. When they met other women who had been through similar horrific ordeals, they were able to open up and share. Sharing their stories provides an avenue for the survivors to seek help to heal after such a traumatising ordeal,” Nkuuhe says.

Kenyan member of parliament Millie Odhiambo says unless women speak out, sexual offences committed in times of conflict will go unpunished.

As Kenya takes account of what happened in 2008 and prosecutes perpetrators, the gender-based violence dimension must be brought into focus.

“As a country, we were not prepared for the level of gender-based and sexual violence that was witnessed. By documenting this, it shall provide a basis for our government to develop policies on preparedness to handle such scenarios. The evidence will also act as shock therapy for Kenya and we shall never forget what happened to these survivors,” Odhiambo says.

Prosecution

Judy Waguma of AWCFS says despite the existence of legislation such as the Sexual Offences Act, there has been minimal prosecution of sexual offences during the post-election chaos.

“During situations of crisis – as evidenced by the post-election violence – the government response to sexual violence is very limited, and it is usually the civil society organisations that have to step in to design and implement responses. Therefore there is a marked lack of access to justice for survivors of sexual violence.”


Odhiambo says the project to document testimonies comes at an opportune time, ahead of the entry of International Criminal Court investigators who will carry out a fact-finding mission Kenya’s post-election violence, after the government failed to act on findings and recommendations of the Waki Commission.

ICC prosecutor Luis Moreno-Ocampo will be gathering evidence for prosecutions of those “most responsible” for the violence. The documentation project should be an important part of making sure responsibility for gender-based crimes is not neglected.

When Nairobi was founded in 1899, it took its name from what the Maasai called the place: Ewassi Nyirobi, “cool waters.” A century later, the river has something stuck in its throat: millions of plastic bags threaten to choke it.

People, pigs and marabou stork sift through the garbage at Dandora Park. Credit: Isaiah Esipisu/IPS

According to Robert Orina, chief enforcement officer at Kenya’s National Environment Management Authority (NEMA), only about 25 percent of the 1,500 tonnes of solid waste generated in Nairobi each day is collected. In slum areas, where 60 percent of Nairobi residents live, there is no formal garbage collection.

“The result is there is garbage strewn all over the place and most of this is stuffed into plastic bags which remain in the environment for many years,” Orina says. “The situation in Nairobi is not unique but rather is replicated across the country.”

He says residents and manufacturers of plastic bags are both to blame for the environmental challenge the country is facing. According to him, residents take little care in disposing of their rubbish, while manufacturers of plastic bags have resisted a ban imposed by the government on the use of flimsy plastic bags thinner than 30 microns.

According to research done by NEMA and the Kenya Institute for Public Policy Research and Analysis (KIPPRA) in 2005, 100 million plastic bags are handed out annually in Kenya by supermarkets alone, the vast majority destined to end up in the environment, clogging sewers and drains, polluting soil, posing a danger to marine life and causing death to livestock when inadvertently consumed.

Orina says, “Millions of plastic bags are dished out annually in supermarkets. Most are so flimsy that they can only be used once and thus they end up being thrown out into the environment where they take hundreds of years to decompose posing a danger.”

Pieces of these plastic bags mix with soil and prevent rainwater from soaking into the ground, contributing to the formation of standing pools of water, the breeding ground for all manner of waterborne diseases.

Orina warns that the practice of burning plastic to dispose of it is not not a viable solution. He argues plastics contain substances which when burned release toxic chemicals, including dioxins, which have been linked with cancer.

While there are companies recycling plastic in Kenya, Geoffrey Okora, of Ramji Haribhai Devani Limited says narrow profit margins mean there are only a handful of other enterprises like the one he manages.

“We buy plastics for recycling, however, the existing organisations are not able to absorb the huge amount of plastics in the environment. Furthermore the profit margin gained from recycling plastic is minimal compared and most organisations would rather not venture in this area. And when they do, they prefer to limit themselves to hard plastics as opposed to the flimsy plastics,” Okora says.

But attempts to rid Kenya’s environment of plastic bags have been met with resistance from manufacturers and consumers alike.

Nearly five years ago, NEMA recommended a ban on plastic bags; the government slapped a 120 percent tax on manufacturers producing thin, single-use plastic bags.

However, this move met resistance from Kenya Association of Manufacturers who pleaded for a transitional grace period. They warned that imposing such a tax would mean an increase on prices for basic commodities such as milk, bread and sugar, Orina says.

Evans Githenji, the spokesperson for Kenya’s plastics industry, confirms that manufacturers felt the 120 percent tax was too high and appealed to the government to review it downwards to 50 percent.

“What we further recommended was that instead of collecting it as a tax levy which ends up at Treasury and is used in other sectors such as health and education, we recommended it be categorized as a specific levy and the proceeds should go towards handling of plastics at the recycling level.”

Orina says he’s not sure what happened to the policy, since the flimsy bags are still on the market, and the 50 percent levy does not appear to have ever been collected.

One solution gaining ground in Kenya is to make bags out of oxo-biodegradable plastic. This involves producing plastic with an additional chemical that enables it to quickly break down when dumped in a natural environment.

“Oxo-biodegradable plastic decomposes more quickly than straw and twigs and much more quickly than ordinary or recycled plastic. It is intended for plastic which gets out into the open environment and cannot realistically be collected. It will automatically self-destruct, but ordinary or recycled plastic will blow or float around for decades,” says Michael Stephen, director of UK-based Symphony Environmental Technologies.

But Symphony’s claim that its plastic is broken down as naturally as grass clippings or twigs has been challenged in other places where it has been introduced.

Orina and Githenji express doubt over the completeness of decomposition, arguing small particles of the degraded matter may find its way into the food chain. The solution for Kenya, they both agree, is to take a diverse approach.

NEMA is promoting replacing plastic with durable, re-usable bags to reduce the sheer volume of plastic in circulation, says Orina.

“What has been lacking is government will to carry out a proper campaign on dealing with the plastics environmental menace. What is needed is for the government to set up clear mechanisms on the collection of the 50 percent levy. This money should then be put in a consolidated fund which should go towards recycling of plastics and the general improvement of the environment,” Githenji says.

Organisers of a protest march against the expulsion of Muslim cleric Sheikh Abdullah El Faisal say Kenyan police have arrested up to 400 people and are interrogating them to prove their nationality and try to uncover links to terrorism.

A Jan. 16 march protesting efforts to deport El Faisal ended in violent confrontation in Nairobi’s central business district. Police say property worth more than 150,000 U.S. dollars was damaged in violence that left six officers injured and two Muslim youths dead.

Members of the public, mainly traders from shops being damaged in the clash, joined police and hurled stones at the demonstrators.

Kenyan security forces in full combat gear responded soon afterwards with aggressive raids in the predominantly Somali neighbourhood of Eastleigh – commonly known as “Little Mogadishu” – seeking undocumented migrants along with anyone suspected of links with Somalia’s Al-Shabaab group, which is fighting to overthrow the government in Kenya’s northern neighbour.

As many as 16 members of Somalia’s Transitional Federal Government were among those detained.

“For the last two days, police have raided residential areas where most Muslims reside,” says Farouk Machanje, who was one of those who organised the march.”They have carried out raids in Kibera and Eastleigh areas, and indications are similar swoops are being carried out in Mombasa in the Coast province.”

Machanje is an officer of the Muslim Human Rights Forum (MHRF), a group working to defend people detained unlawfully in connection with the U.S.-led “war on terror”.

The police response has drawn the attention of the Kenya National Commission on Human Rights (KNCHR) which issued a statement strongly condemning the raids, terming them an attempt by police to intimidate members of a certain faith.

“Muslims everywhere in this country are angry. While we appreciate the fact that the country must keep its borders safe and control influx of illegal immigrants, what is happening is an undesirable attempt at instilling fear among a group of people,” says Hassan Omar Hassan, a commissioner with KNCHR.

Hassan argues police had no reason to stop demonstrators who were within their legal rights to protest. Kenya’s immigration ministry claims El Faisal, who is on an international travel watch list, should not have been allowed into the country. Immigration Minister Otieno Kajwang’ says he must leave Kenya because of his UK conviction and jail term.

But Machanje contends that El Faisal has not committed any offence in Kenya, nor is he a wanted criminal and thus his deportation is unwarranted. The Forum filed suit at the High Court to block the expulsion, and secured a stop order against the deportation.

Omar says the police action is evidence of a calculated strategy to attack Somalis and Kenyan Somalis.

“For a long time the police have been complacent in curbing the influx of illegal immigrants. Suddenly they have created a public image of elements of Al-Shabaab and terror groups being in the country to elicit public sympathy. This is an archaic strategy that used to be employed by past regimes to instill fear and send shockwaves among the population to manipulate the feelings of Kenyans.”

When IPS visited Eastleigh two days after the police action, attempts to interview residents were met with weary looks and anger.

“When there is one spoilt mango in the sack, it does not mean all mangoes are bad,” said Mariam Ahmed, a Kenyan-Somali and resident of Eastleigh.

“Following Friday’s demonstrations all Muslims have suddenly become suspects and we are being subjected to midnight raids by security forces apparently in search of Al-Shabaab elements,” she said angrily.

“Our sons, who are Kenyan by birth and have a right to be in this country, are now being frog-marched in the middle of the night, being subjected to intimidation in a bid to prove their nationality. Just because they have Muslim names and happen to belong to the Kenyan-Somali tribe they are suspected of being Al-Shabaab. This is humiliating and it may actually prompt them to resort to the unthinkable,” says Ahmed.

For Machanje, the attempts to deport El Faisal are merely a pretext to continue harassing and discriminating against Muslims in Kenya. The country’s Muslim population has often faced suspicion in the past – following the 2002 bombing of the Paradise Hotel in Kikambala, a number of Muslims were detained for a long period despite an absence of proof of their involvement.

Kenyan Somalis routinely have difficulties obtaining national identification papers, forced to undergo strict and unusual background checks to prove they are not from neighbouring Somalia. During periodic crackdowns like the one under way presently, police have been known to deport people carrying valid Kenyan identification to Ethiopia or Somalia.

Support for the radical cleric is not universal among Muslims. One section of the Supreme Council of Kenya Muslims has distanced itself from the protest. Garissa branch chairman Abdullahi has attributed the demonstrations to a few hooligans, and appealed to Muslims not to participate in further demonstrations.

Machanje says despite intimidation, the MHRF will continue to demand just treatment for all Muslims.

“We organised peaceful demonstrations to protest the impending deportation of El Faisal who has not been given a fair hearing. Muslims had no intention of turning violent and they only did so when provoked by the police who started shooting from all directions and in the process two Muslim youths were killed.”

Further public protest has been announced for Jan. 22 in the coastal city of Mombasa. With the minister for internal security, George Saitoti saying that intelligence reports connect foreign forces linked to Al Shabaab with the protests, the response from the government could be harsh.

By Susan Anyangu-Amu
NAIROBI, Jan 14 2010 (IPS)

A harmonised draft constitution has now been handed over to Kenya’s Parliamentary Select Committee. Influential Christian leaders are warning that the question of abortion could derail the constitutional review process.

Thousands of young women risk their health procuring abortions each year: will a new constitution entrench restrictive laws on termination? Credit: Julius Mwelu/IRIN

Church leaders are adamant that any ambiguity that could see abortion rights in Kenya expanded is unacceptable.

Canon Peter Karanja of the NCCK told IPS, “Life is sacrosanct. The definition of life must be stipulated in the supreme law of the land, the Constitution. Life must be defined as starting at conception and ending at natural death.”

When the expert committee heard submissions from the public on the draft in 2009, the clergy and other anti-abortion campaigners took issue with the fact that the document did not reinforce Kenya’s current law and clearly outlaw abortion, except where a mother’s life is in danger.

During hearings in July, emotions ran high, with church leaders literally shouting down speeches by the Reproductive Health Rights Alliance (RHRA), warning that legalising abortion would “make or break” the constitution review process.

The vice chair of the committee, Atsango Chesoni had to intervene. “I am asking my Christian brothers and sisters, if you had been born a woman or a girl and had the misfortune of being raped, what would you want and what are the choices you would want available to you?”

Currently, abortion is permitted in Kenya only to save the life of the mother. Despite this, every year large numbers of women seek assistance to terminate pregnancies wherever they can find it.

Dr Joachim Osur, an advisor with reproductive health rights organisation IPAS – a member of the RHRA – argues that opponents of expanded abortion rights in Kenya have their heads buried in the sand.

“Despite termination of pregnancy being restricted in Kenya, induced abortions remain common. In Kenya it is estimated that 300,000 spontaneous and induced abortions occur annually, about 29 abortions for every 100 live births,” says Osur.

“Unsafe abortions contribute a significant margin to the maternal deaths in this country at 30 percent. It is estimated that 2,000 women die annually from unsafe abortions.”

Nerida Nthamburi, executive director of Kenya’s Centre for Legal Information and Communication, says the experts’ decision to resist the call to define the right to life in line with the churches’ demands is a victory – at least for now – for women’s rights.

“It is commendable that the COE considered the issue of abortion as resolvable. Failure to take such a positive position could result in restrictions whose tragic results are most often felt by vulnerable women, among them the young, poor, those living in rural and marginalised areas,” Nthamburi says.

“Having witnessed firsthand the devastating effects of laws and policies that fail to protect women’s lives and health, such as the existing restrictive abortion law, the draft will have a great impact on reducing maternal deaths in Kenya.”

But the churches are furious, threatening to mobilise against a ‘yes’ vote in the eventual referendum on the constitution.

“Should the harmonised draft remain as it is without defining when life begins, we shall explore legitimate options as stipulated under the Kenya Constitution Review Act, 2008 to seek amends. What is clear is that this issue needs to be taken seriously as it will definitely take centre-stage with regards to the referendum,” says Karanja.

Presented with statistics on deaths resulting from unsafe abortions, the canon was adamant. “It must be understood that pregnancy is God’s design, results from sexual contact between a man and a woman. God, therefore, holds the man and woman responsible to control themselves and engage in sex as a husband and wife. In any case, that a pregnancy results, it is not the problem of the unborn child. Why kill the innocent, helpless human life when it has resulted from the behaviour of adults?”

In a memorandum to the COE, the alliance states that the way the draft constitution presently guarantees a right to life, without further definition, is consistent with that adopted by other states and by major international human rights instruments.

The Reproductive Health Rights Alliance views the recommendations by the church as being tantamount to imposing Christianity on all citizens – other religious communities have largely steered clear of this debate in the constitutional review process.

The select committee will spend 21 days working to resolve “contentious issues” before a draft is submitted to the National Assembly for approval. To more forcefully intervene in this stage of the process, a group of pastors went to court in December seeking clarification of what formally qualifies as a “contentious issue”.

The COE identified the type of government (parliamentary, presidential or hybrid), the devolution of powers away from central government, and how a new constitution should be brought into effect. These questions will be the central work of the Parliamentary Select Committee between now and the end of January; church leaders want abortion, among other issues, to be elevated to the same level.

As the debate continues from the pulpit, in the media, and in court, University of Nairobi obstetrician and gynaecologist Joseph Karanja offers a timely reminder.

“Those arguing for the restriction of abortion in the Constitution are misguided and refuse to accept the reality. Whether it is put in the Constitution or not, hundreds of women will continue dying from unsafe abortion every year,” says the professor.

“The solution is to address the source of unwanted pregnancies in the first place instead of expending energies on arguing about including it in the Constitution.”

Excerpt:

In early November, a group of explorers set out to map a blank space in Africa’s map. Twelve youths armed with global positioning system (GPS) devices made the rounds of the Nairobi slum of Kibera.

While Kibera remains a blank spot, its limited resources, traffic patterns, and housing layouts remain invisible to outsiders and residents alike. Credit: OpenStreetMap

The teens are working with an organisation called OpenStreetMap to create a public map of their neighbourhood, seven kilometrs southwest of the city centre. It is the second-largest informal settlement in Africa, after South Africa’s Soweto township.

UN-HABITAT estimates its population at 500,000 to 700,000, with a density of more than 2,000 people per hectare. The settlement is divided into 10 villages, Lindi, Soweto (East and West), Makina, Kianda, Mashimoni, Gatuikira, Kisumu Ndogo, Laini Saba and Siranga.

Despite being home to about one million in a densely populated area, Kibera remains a blank spot in Kenya’s map. The area lacks basic services like toilets and running water.

“While Kibera remains a blank spot, its limited health and water resources, traffic patterns, and housing layouts remain largely invisible to the outside world, and to residents themselves,” Mikel Maron of OpenStreetMap explains.

“Though many organisations have collected data on Kibera, the information is not yet shared as a resource for all to use. Map Kibera will fill in this gap by producing free, open-sourced digital map data, using the techniques of OpenStreetMap, a user-edited map of the world. This information can easily be accessed and used by non-governmental organisations and private and public companies working in the area.”

The young mapmakers took part in a two-day workshop on geographic information systems before setting out to map important landmarks within the settlements. These images will then be scanned and placed in the geographic information system (GIS), and later uploaded into the internet and made available to everyone.

They are not qualified surveyors but ordinary youths who have been taught to use GPS technology. Partner organisations in the technology industry will help train and network with the Kibera community on the project.

Maron says the map will point out landmarks such as churches and mosques, schools, businesses, restaurants, the premises of organisations working in the area and government administrative offices. He says the project is not aimed at collecting demographic data, but rather consolidating information on public infrastructure.

“Very little is known about what exactly goes on in the various villages. Indeed, people in Kibera may not be aware of all the facilities available, such as health centres and charitable organisations. The information we will consolidate will help those who wish to access Kibera know exactly where a particular place is, and what kind of service they provide.

“That way it is easy for organisations wishing to work in Kibera to ascertain what extra services may be required,” Maron says.

The project is spearheaded by the humanitarian OpenStreetMap team in collaboration with JumpStart International, and other partners including Jubal Harpster of WhereCampAfrica, the Social Development Network, Pamoja Trust, Hands on Kenya and Carolina for Kibera.

OpenStreetMap creates free editable maps of the whole world, which provide geographical data to anyone who wants them. The maps are uploaded on the internet and can be edited by anyone to provide additional information.

“There has been a general lack of accountability on the projects going on in Kibera. With this kind of information available, it will be easy to know exactly which organisations are working in Kibera, including available services and facilities,” Maron says. Besides mapping, the team will include details of landmarks.

Sheikh Ramadhan, a resident of Kibera, says the area has been turned into a cash cow for organisations claiming to work in the informal settlement, but many would be hard-pressed to show a tangible contribution.

“Kibera is the only informal settlement in this country where we have more than 100 NGOs operating in this small area. But this has done very little to improve the lives of residents, and we still live in mud-corrugated structures with lack of basic facilities such as functional sewer systems and clean water,” Ramadhan says.

Once the map is complete, the raw data will be available at no charge to upload into collaborative mapping platforms, for organisations that may need specific data on the area, including local authority and national government. The map will be updated as conditions change. Maron says it will operate in a way similar to the Wikipedia encyclopaedia, where anyone with additional information can add the data.

“With this kind of knowledge it will be possible to speak from an informed point of view regarding planning of the area in terms of infrastructure. For instance we can flag how many health centres are available, where they are and what needs to be added,” Maron explains.

Dr Siddharth Agarwal, executive director of the Delhi-based Urban Health Research Centre, says that rapid urbanisation and the growth of slum settlements poses a serious challenge to city planning. He says that in most of the world, including his native India, the majority of these areas remain. Spatial mapping, in his view, has not been used optimally for city planning to provide basic facilities such as health and sanitation.

“One of the main obstacles to effective urban planning is a lack of up-to-date, comprehensive and sufficiently detailed information about urban areas. This lack of information is a major reason behind the failure of urban municipalities to include informal settlements in city-wide planning and urban development,” Agarwal said.

In the absence of information about and understanding of slums, these settlements were typically considered to be chaotic masses rather than coherent urban areas, and thus are ignored or subject to planning aimed at them as slums to be eradicated rather than understood as an integral part of the city.

The European Commission Humanitarian Aid Department (ECHO) has raised a red flag over the worsening food security situation in the Horn of Africa.

Karel De Gucht, European Commissioner in charge of development and humanitarian aid, attributes the disastrous situation to the terrible potential of climate change.

“Large parts of the Horn of Africa have had less than 75 percent of normal rainfall this year, having already endured a series of severe droughts. The population can no longer cope with such extreme and protracted hardship which often comes on top of conflict situation. As a result, more than 16 million people desperately need help,” he said in a statement released by ECHO.

Initial optimism occasioned by forecasts of El Niño rains were thwarted when November proved largely dry. El Niño refers to a periodic warming of temperatures in the Pacific Ocean, far from East Africa’s shores but with impacts on the country’s rainfall and weather patterns.

Samuel Mwangi, acting assistant director of Kenya’s national weather forecasting services explains that El Niño has been linked with greater rainfall during the annual “short rains” in East Africa, between October and December.

ECHO regional information officer Daniel Dickinson told IPS, “In the face of the unfolding drought situation, ECHO is providing 50 million euros in humanitarian aid to vulnerable drought-affected people in Somalia, Ethiopia, Kenya and Uganda. The rains have failed and people have exhausted the coping mechanisms which they had and urgently need help.”

Kenya’s minister for special programmes, Naomi Shaban, issued a similar warning in mid- December over the worsening food security situation across the country.

Speaking as she flagged off relief food worth $80,000 donated by Telkom Kenya and World Vision Kenya, Shaban said ten districts across the country are facing an imminent crisis in relation to food insecurity.

“Unfortunately, the country has experienced another season of failed rains which is expected to increase the current levels of food insecurity. Although Kenya’s food security is still on the borderline, many districts are at risk of sliding into an acute food and livelihood crisis. This situation is made worse by high food prices,” Shaban explained.

In Kenya, Dickinson says it is estimated 3.8 million people currently rely on humanitarian aid and the situation is worsening. with acute malnutrition above 20 percent in five districts.

The government of Kenya has increased its monthly spending on relief food to $1.3 million per month to assist those facing starvation. In early 2009, the government declared the unfolding food security situation a national disaster, stating that 10 million Kenyans were unable to access food.

In Ethiopia, ECHO reports indicate with several consecutive crop failures, the nutritional situation in that country has deteriorated badly and is expected to worsen further.

The story unfolding in Somalia is similar, with the situation aggravated by ongoing conflict. In Uganda, ECHO indicates 2.2 million people in northern Acholi and Karamoja regions face food insecurity.

According to Famine Early Warning Systems Network (which issues alerts on food insecurity) poor rains in November have revised prospects for widespread food security improvements that were expected to manifest toward the end of December in Kenya.

Those set to be adversely affected include pastoral households who already face unrelenting prices for food, an outbreak of cholera and heightened conflict over limited pasture and water in drought conditions.

However, Mwangi says sections of the country have experienced increased rainfall as predicted, which means good harvests will be recorded in certain areas.

“It must be pointed out that the poor performance of rainfall is not widespread across the country. There are areas that will still record good harvests from the rainfall received during the season.

In Coast, Northeastern, Eastern and Central Provinces, the rainfall was characterised by heavy storms in the second half of the month. This significantly enhanced the total rainfall amounts recorded in these provinces,” Mwangi says.

It is not clear whether good harvests in these areas will cover the predicted shortfalls in the rest of the country.

By Susan Anyangu-Amu
NAIROBI, Dec 29 2009 (IPS)

Kenya’s Parliament finally passed the Proceeds of Crime and Anti-Money Laundering Bill in December. But while the passing of the bill is viewed as a highlight of the Tenth Parliament, many fear it may just be a gimmick by the government to appease international partners.

George Kegoro, the executive director of International Commission of Jurists – Kenya Chapter, says while the legislation is good, he doubts there is political will to completely stamp out money laundering in Kenya.

“The existence of the legislation is not sufficient to deter the vice neither are the stiff penalties that are recommended in the bill,” he says. “There is need for genuine support from the government to enact this law. We need a good set of people to be put in place to interpret the legislation.”

Kegoro, whose organisation undertakes advocacy and policy work aimed at strengthening the role of lawyers and judges in protecting human rights and the rule of law, argues that while the bill was government-sponsored, Kenya’s track-record on corruption is poor and he doubts the genuineness of the political class.

It is the fourth attempt since 2004 to pass a bill to prevent the concealment of large profits from drug trafficking and other organised crime, and even this time around it faced resistance from members of parliament who believed the bill was a sly back-door re-introduction of an Anti-Terrorism Bill which had been quashed.

When the bill was tabled in November, an assistant minister in defiance of his own government, strongly opposed the tenets of the Bill. The assistant minister for public service, Aden Sugow, opposed the Bill saying it was an attack on the Muslim community. He argued implementing the Bill would be bowing to the interests of external interests and said that Kenya currently has adequate laws in place to deter money laundering.

While supporting the bill, defence minister Yusuf Hajji warned of a general feeling among the Muslim community that the legislation was targeting them. The Bill went forward after assurances from Prime Minister Raila Odinga that the government had no such intentions.

Once signed by the president, the law will establish a Financial Reporting Centre to assist in the identification of the proceeds of crime. An Asset Recovery Agency will be charged with tracing and recovering ill-gotten assets.

According to Job Ogonda executive director of international corruption watchdogs Transparency International, this would mean millions of dollars stashed in off-shore accounts swindled from Kenya could be recovered.

But Ogonda doubts the passage of new legislation will improve Kenya’s standing as a corrupt state internationally.

“At the moment it is embarrassing to be a Kenyan. Nigeria is improving with regards to corruption because they have shown tangible commitment of doing something about graft. However, the same cannot be said for Kenya,” he says.

“We have previously had good pieces of legislation which would have helped fight graft, however, nothing has been done. How many ministers or former ministers have ever gone to prison because of corruption?” Ogonda wonders.

Ogonda is referring to anti-corruption legislation such as the Public Procurement and the Public Officers Ethics Act which require all public office holders to declare their wealth and origin of the same: this older legislation has had no noticeable effect.

Kenya’s record internationally as a corrupt state has for many years been bad and in the bribery and corruption index released by Transparency International, the country has kept the company of states such as Nigeria, Russia and Zimbabwe. Currently, Kenya is position 147 out of 180 on the global index of corruption.

Indeed the passing of the anti-money laundering bill comes in the wake of the release of a U.S. State Department report saying 93 million dollars of earnings from drug trafficking are laundered in the country’s financial system annually.

Another equally damning report by a UK firm, Kroll Associates, hired by the Kenyan government to track wealth acquired corruptly, revealed an estimated $1.7 billion is currently stashed in off-shore accounts. While the results of this 2004 report have remained confidential, the document was leaked: no action has been taken against any of the prominent figures named in its 110 pages.

But all the right noises were made when the bill was moved in Parliament by deputy Prime Minister Uhuru Kenyatta, who said that in view of the magnitude of the problem to the economy, the debate should focus on the quality of the legislation to ensure it was stringent enough.

Seconding the bill, Raila said, “The country risks becoming a pariah state unless the legislation is passed. We have suffered from the effects of money laundering especially in the property sector whose value has been skyrocketing due to the money being brought from the acts of piracy off the coast of Somalia”.

A boom in property prices in Nairobi is preventing a majority of Kenyans from buying real estate, and in some cases even pricing locals out of the rental market. Media reports are linking the boom with profits from Somali pirates who seized numerous vessels during 2009, extracting handsome fees from their owners before releasing ships and crew members. In certain Nairobi neighbourhoods, Somalis are willing and able to pay rent up front for periods of even up to two years.

Ogonda states that for many years, Kenya has been a hub of money laundering with illegally acquired cash from Europe, South Africa, South America, Democratic Republic of Congo, Sudan, Rwanda, Burundi, Uganda and Tanzania finding its way into local financial markets.

“Due to our porous borders and poor implementation of legislation, people have simply walked in with huge amounts of cash, hired a lawyer to front for them who in turn invest the cash, especially in property,” Ogonda says.

He says despite moves to assure the independence of the new watchdog agencies’ leadership, and fresh monitoring requirements for the banking system, the version of the bill which is now awaiting presidential assent does not demand greater accountability from lawyers whose lawyer-client privileges remain intact.

Kegoro notes that the prescribed penalties are fairly high – jail terms of two to five years, with fines of up to $65,000 for individuals, and corporate penalties set as high as $330,000 or the value of the property. But, he argues, it is not the severity of the penalty that will make people fear it. It is the certainty of being caught, hence the need for genuine political will to implement the law.

Ogonda is in agreement. “Application of the bill is what will be the determining factor. The structure of governance has to support the law and if it remains the same the legislation can exist and nothing will change.”

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By Susan Anyangu-Amu
NAIROBI, Dec 21 2009 (IPS)

Kenya’s new Anti-Counterfeit Act will be challenged on Mar 8 next year in the country’s Constitutional Court on the basis that it violates the right to health. The petitioners, three people living with HIV, argue that the law confuses generic and fake medicine. This could cause a health crisis as generics constitute 90 percent of medicines used in Kenya.

James Kamau says wrong interpretations of the law by customs officials could cost many lives. Credit: Wambi Michael/IPS

HAI Africa is part of a global network working to increase access to life-saving medicines.

The issue is of life-and-death importance as generics, which are between 70 and 90 percent cheaper than their brand-name counterparts, have enabled poor people in developing countries to get the necessary treatment.

International donors that fund drug distribution, including the U.S. President’s Emergency Plan for AIDS Relief (Pepfar) and the Global Fund to Fight AIDS, Tuberculosis and Malaria, also source from generics manufacturers.

James Kamau, co-ordinator of the Kenya Treatment Access Movement, an activist organisation advocating access to anti-retrovirals, has previously pointed out that the Anti-Counterfeiting Act of 2008 contains ambiguities which could lead to misinterpretation, undermining the government’s efforts to ensure access to essential medicines for all Kenyans.

Christa Cepuch, director of programmes at HAI Africa, adds that the act, which is aimed at cracking down on fake batteries, pens, drugs and cosmetics, “contains a vague definition of counterfeiting which could be read to include generic drugs”. She describes generic medicines as legitimate, effective and exact copies of brand-name products.

The law makes the manufacturing, importation or sale of “counterfeit goods” a criminal offence rather than a civil matter, which is the usual way in which disputes over intellectual property rights are resolved.

The onus to verify whether goods are fakes or not has been put on customs officials and police officers. “We’ll have Kenya Revenue Authority officials trying to figure out if drugs are fakes or not. This increases the risk of products being labelled fakes,” Cepuch says.

“The law further gives these officials excessive powers, making the process difficult and expensive. Moreover, the onus to prove the products are not fakes lies with the accused, a price many will not be willing to pay.”

Activists such as Kamau argue that the existing Pharmacy and Poisons Board should be in charge of combating counterfeit medicines as it has the necessary technical expertise to deal with such issues – which customs officials don’t. The latter could “imagine” something is counterfeit and cost the lives of many.

The idea that essential medicines could be delayed for months at ports of entry is not far-fetched, based on what has happened in Europe where 22 seizures of perfectly legitimate generic drugs destined for developing countries have taken place in the recent past.

“The risk is simply too high and will potentially keep away generics manufacturers and importers. This is also because the cost of the whole process, should the products be confused for counterfeits, will be too high,” Munyi cautions.

The Kenyan law seems to be serving as a template for similar policies at regional level in East Africa and in neighbouring Uganda. Health advocates fear an “anti-counterfeiting” agenda is being pushed by actors who do not have the interests of poor people at heart.

Suspicion has also been raised by the speed at which the Kenyan bill was passed and acceded to.

“Parliament was under immense pressure to pass bills that would change Kenya’s political dispensation (after the election violence in 2008). However, they somehow found time to deal with this less urgent bill at the time. And no sooner had it been passed when the commencement notice was published by the minister — despite earlier indications that there was no budget allocated to effect the bill,” Munyi says.

He is referring to the minister for industrialisation publishing a notice in the government gazette on Jul 24, 2009 that backdated commencement of the legislation to Jul 7, 2009, a day before the suit was launched in the Constitutional Court.

“We believe the government should combat counterfeiters and counterfeit goods, including medicines, some of which have been seized in the Kenyan market. However, this should not be done at the expense of the health of millions of Kenyans and their right of life,” according to Cepuch.

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