Kenya Country Briefing
Section 1: Economy and Business Climate
– Capital: Nairobi, is the second largest capital city in Africa after Cairo and when combined with Mombasa, houses over 70% of the Kenyan population.
– The prevalence of HIV/AIDS has curbed population growth and is reported by the UN to infect 7-8% of the population.
– The current life expectancy is 57 years -The average family is reported to have 3-5 children.
– Kenya reports a literacy rate of 85% (high compared to its neighboring countries of Uganda and Tanzania)
-Kenya is characterized as having a very diverse ethnic and religious population composed of over 40 tribal affiliations.
– Kenya straddles the equator and covers the 583,000 sqkm (about the size of Texas)
– Kenya has a very diverse landscape consisting of mountains, flat lands, landscapes and coastlines.
– Within its boarders, are The Great Rift Valley, Lake Victoria, Lake Turkana, Mount Kenya, Mount Elgon, and Mount Kilimanjaro, and the Nzoia, Yala and Gori rivers.
Kenya’s macro-economy can be divided into two significant periods: The first period between 1963- 1980, which is characterized by strong economic growth and huge gains in social outcomes. The second less illustrious period has lasted between 1980’s and the present. During these times there has been slow if not negative growth of the economy, losses in social welfare, mounting macroeconomic imbalances, rising poverty, and falling life expectancy.
Since the 1970’s, the Kenyan government became a dominating and noticeable influence in the economy. The government increased it expenditures by nearly 60% to instigate the economy yet this insurgence ultimately led to trade-shocks, inflation, and macroeconomic collapse.
Kenya has had reputably weak policy response to economic downturns. Failures to embrace export-oriented solutions in the agriculture and oil industries ultimately led the country to a balance of payments crisis as well as multiple debilitating oil shocks.
Fiscal indiscipline has been the largest threat to the Kenyan economy. The government has yet to implement policy that can control or compensate for this tendency. Kenya still runs a large trade deficit, and a budget deficit despite its unique ability to finance much of its expenditures and deficits domestically.
Agriculture: Kenya has been dependent on agriculture to minimize imports, strengthen local communities, and generate potential exports. Corn is the staple crop, and wheat production can satisfy 70% of the domestic demand. Coffee is an important export, but falling prices have crippled the sector. Kenya is the world’s second largest producer of sisal and forth largest exporter of cut flowers.
Industry: Government attempted to support industrial development by implementing import substitution. This gave rise to over-regulated, over concentrated, and uncompetitive industrial structure. The public sector has become monopolistic and overextended. This has led to a 70% drop in investment efficiency over the past two decades. Transparency International’s corruption perception index ranks Kenya at the very top of its corruption scale (following its neighbor Uganda).
Tourism: Tourism has become a pillar of economic development in Kenya. Revenue reportedly tripled between 1980 and 1994 and has continued to grow since. Periods of civil unrest have posed threats to this industry; however, it currently seems to remain healthy, yet not thriving.
The State and the development of the Private Sector in Kenya. www.tulips.tsukuba.ac.jp/, 2001
1.4 Regulatory environment
The Kenya National Biosafety Authority is under the Ministry of Higher Education Science & Technology. They proactively share, identify, and communicate with other regulatory agencies and government organizations. Additionally, they are responsible for implementing the Cartagena protocol on Biosafety in order to address safety for the environment and human health in relation to modern biotechnology as well act (National Biosafety Office)
The Cartagena Protocol on Biosafety to the Convention on Biological Diversity is an international treaty governing the movements of living modified organisms (LMOs) between countries. Several meetings lead up to the development of this treaty including a few meetings held in Narobi. It was entered into force on September 11, 2003. (Cartagena Protocol)
Current debates are being held with respect to biosafety legislation. These debates are mainly focused on controlling biophysical risks associated with biotechnology, such as transgenic crops, instead of the socio-economic or ethical concerns. Legislation could largely affect Kenya’s primary crop, maize. Maize is a cross-pollinated crop and more likely to be composites than pure varieties, which has potentially serious implications for biosafety regulation. (Future Agricultures)
The Capital Market Authority is the regulatory body for capital markets in Kenya. It was set up through an Act of Parliament in 1989, and then constitute and inaugurated on March 7th, 1990. Their mission is to promote market confidence, protect investors, and ensure access to financial services within capital markets in Kenya through effective regulation and innovation. investor protection and access to financial services within capital markets in Kenya and the region through effective regulation and innovation. Capital markets provide a gateway to Kenya for global and foreign portfolio investors, which is critical in supplementing the low domestic saving ratio.(Capital Markets)
(n.d.). Retrieved 02 14, 2011, from Future Agricultures: http://www.future-agricultures.org/index.php?option=com_content&view=article&id=7429:biosafety-regulation-in-kenya&catid=81:fac-news&Itemid=472
(n.d.). Retrieved 2 14, 2011, from Cartagena Protocol: http://bch.cbd.int/protocol/background/
(n.d.). Retrieved 2 15, 2011, from Capital Markets: http://www.cma.or.ke/index.php
National Biosafety Office. (n.d.). Retrieved 02 14, 2011, from http://www.biosafetykenya.co.ke/frontpage.php
1.5 Regional comparisons
Kibera is a large slum in Nairobi comprised of 13 villages that span about 2.4 square kilometers. There has been recent controversy regarding the slum’s purported size: while some estimates claim it is home to over 1 million residents, making it the largest slum in Kenya and second largest urban slum in Africa, the most recent census in December 2010 brought this number down to 220,000. http://www.newsfromafrica.org/newsfromafrica/articles/art_11595.html
The British founded the settlement in 1918 for Nubian soldiers. After Kenyan independence in 1963, Nubians began renting out their properties to a large number of tenants. However, Kikuyas have informally controlled the settlement for the past 30 years. (Source: Lonely Planet: Kenya, 7th Edition, p. 116)
Today Kibera faces the same problems that exist in slums around the world: extreme poverty, poor access to healthcare and education, unemployment, clean water shortage, and lack of electricity. The slum is heavily polluted and contaminated with human and animal feces thanks to its open sewer system. Kibera also faces tension due to the multi-ethnic and multi-tribal nature of its population. 12-15% of the population is estimated to be infected with HIV/AIDS. (Source: http://cfk.unc.edu/about-kibera.php)
Kipkaren & Western Kenya
Living Room International is based in the village of Kipkaren, 30 miles west of Eldoret and home to 12,000 residents. Like other villages in this fertile region, the local economy is rooted in agriculture: the primary assets are land and livestock, and the sources of income include maize, cows, sheep, chicken and goats. Most of the population participate in subsistence agriculture, and many receive income only once yearly, when maize is harvested in late summer. Household income in this region is lower on average than across Kenya overall.
While a majority of the population own mobile phones, access to electricity and clean water is limited. The Kipkaren community is predominantly Christian, and there is a strong network of missionary-related NGOs and schools operating in the area. An estimated 6-8% of the local population is infected with HIV/AIDS.
Source for all info on Kipkaren: “Empowering Lives in Kenya: The Chebaiywa Clinic” (Cassleman, LaFountain, Newkirk, Thobhani; MIT Sloan, August 2009) https://mitsloan.mit.edu/MSTIR/GlobalEntrepreneurship/EmpoweringLivesKenya/Documents/09-094%20ELI%20case%20Sastry.pdf
Section 2: Health
2.1 Stats about Health in Kenya
Kenyans live on average 54 years, comparable to their East African neighbors (World Bank). Diseases causing morbidity include malaria, HIV, TB, tropical diseases and diseases of the respiratory system. The following table lists the prevalence rate for several main diseases found in Kenya.
|Disease||% of population affected (2007)||Number of patients affected (2007)||Number of patients treated (2007)|
|· Malaria||31||11.7M||≤ 5M|
|· Intestinal worms||4.5||1.7M||NA|
|· Filariasis||15-25 (2006 data)||7.6M||NA|
|· Trachoma||5.4 (2003 data)||2.0M||NA|
As can be seen from the table, malaria is the single biggest disease in Kenya in terms of affected population. Roughly 12 million people, or 31% of the population carry this disease. HIV and worms are the next largest, with around 1.5 million affected people for each.
 Note: all prevalence data except when noted, is extracted from “Vision 2030: Strategic Thinking in Relation to Pharmacy” presentation
 WHO Epidemiology Fact Sheet on HIV and AIDS, 2008
 Calculated based on market size and estimated ART prices
 WHO World Malaria Report, 2009
 WHO Global Tuberculosis Report, 2009
 Wamae, Njenga, Kisingu, Mthigani, and Kiiru, 2006
 WHO Global Health Atlas, 2003
2.2. Overview of the health system
The chart below summarizes the relationships between the different key players in the healthcare market in Kenya.
Simplified mapping of the players in the industry
· World Health Organization (WHO): provides technical advice to the Ministry of Health on several areas including the development of clinical guidelines for disease treatments, tailoring the essential drugs list to country-specific needs and pharmaceutical product assessment.
· Pharmacy and Poisons Board (PPB): equivalent of the US FDA regulatory body. PPB licenses and regulates the local pharmaceutical industry.
· Ministry of Health (MoH): government body that makes and oversees health policies in Kenya. The MoH forecasts demand and orders products based on the WHO essential drugs list. MoH is also in charge of revising clinical guidelines for disease treatment in Kenya.
· Aid organizations: Key aid organizations in the Kenyan health care industry include Bill and Melinda Gates Foundation, the Clinton Health Care Initiative, PEPFAR and the Global Fund. These organizations play a large role is supplementing government funds in medicine procurement.
· Manufacturers: 28% of the market share of the pharmaceutical industry belongs to local manufacturers (Hasan and Wanyanga, 2010). These local producers manufacture mostly over the counter generic drugs. The rest of the market is divided among multinational pharmaceutical companies (est. 40% market share by UNIDO) and Indian and Chinese manufacturers (est. 32% market share by UNIDO).
· Insurance: National Hospital Insurance Fund (NHIF) is a governmental body that provides insurance coverage to Kenyans who are employed in the formal sector. About 20-25% of the Kenyan population are currently covered under this insurance. These individuals tend to be part of the wealthy population (est 2-3% of the Kenyan population).
· Distributors: There are three distinct channels: public (KEMSA), faith-based (MEDS) and private. Each channel serves different points of care, as can be seen in table below.
2.3 Implications in terms of delivering health care in Kenya
There are five main current health issues in Kenya (not in any particular order):
· Infrastructure: Access to clean water and sanitation facilities, poor road structure and the cost of electricity all cause major problems for health in Kenya. Only 42% of the Kenyan population uses improved sanitation facilities and a mere 49% of the rural population uses improved drinking water sources (UNICEF). On the other hand, people in urban areas are 85% of the population has access to drinking water. This infrastructure problem causes many tropical diseases such as intestinal worms. Poor road infrastructure leads to long delays in medication delivery and can sometimes cause medication stockouts in rural areas.
· Lack of Financing: The Kenyan government spends very little on healthcare (4.3% of GDP) while external organizations spend 15.3% of the Kenyan GDP on Kenyan healthcare needs (World Development Indicators, 2006). Many of the government healthcare facilities run out of medicine because KEMSA doesn’t deliver the full order to the facilities. This is the cause of lack of funding and not lack of demand planning.
|Country||Health Expenditure % of GDP||Health Expenditure % of GDP||Public Expenditure % of GDP||Private Household % of GDP||External Sources % of GDP|
· Access to care in rural areas: The major gap in access to health care is not between rural and urban areas, but between private and government clinics. Patients who have capital in urban and rural areas have the access to any medicine at any time without stock outs. However, patients without many means often experience a shortage of medicines in the government hospitals they frequent (G-Lab experience).
All of these problems are further perpetuated by cultural norms:
· Price and affordability of medicines: people in the bottom of the pyramid visit government hospitals that are supposed to be free. However, all services must be payed for. For example, while medications might be free, patients pay a fee to see a physician and a fee for lab tests. This causes many people to self medicate and visit a pharmacy shop without a real diagnosis.
– Politics: One of the biggest challenges to deliver health care in Kenya is the ability to gather all the key stakeholders. Many parties (Pharmacy & Poison’s Board, Ministry of Health, USAID, Ministry of Finance, Vision 2030, KEMSA, MEDS, etc) have a stake in this, and the challenge lies in mobilizing them and keeping them functional. & procurement
2.4 Points of healthcare access in Kenya
Quoted directly from the case “Empowering Lives in Kenya: The Chebaiywa Clinic” (Cassleman, LaFountain, Newkirk, Thobhani; MIT Sloan, August 2009)
“The majority of Kenya’s citizens received healthcare through a multi-level system of government-run
facilities. In general, patients received primary care from their nearest government health facility,
usually a dispensary or health center, and were referred to more sophisticated facilities when
necessary. Government health facilities included:
• Dispensaries. Staffed by a registered nurse. Diagnosed and treated mild malaria and flu, and
provided simple outpatient services.
• Health Centers. Led by a clinical officer and run by a staff of nurses, technicians and other
administrators. Provided outpatient and limited inpatient services, laboratory testing, maternal
health services and minor surgery.
• District Hospitals. Served as a referral center for lower-order facilities. Provided a wide range of
inpatient and outpatient services, including surgery.
• Provincial Hospitals. There were eight provincial hospitals in Kenya.
• National Hospitals. Kenya had two national hospitals: Moi Teaching and Referral Hospital in
Eldoret and Kenyatta National Hospital in Nairobi.
In addition to these government facilities, communities were also served by private, for-profit clinics and pharmacies (chemists) and also by non-profit clinics like the Chebaiywa Dispensary. Some larger towns and cities had hospitals run by missionary organizations, or specialist institutions such as the Sabatia Eye Hospital situated halfway between Eldoret and Kisumu. As in other developing nations, non-governmental organizations (NGOs) had set up disease-specific programs and infrastructure in parts of the country to treat patients for HIV/AIDS, tuberculosis, and certain other diseases. The city of Eldoret was the base for one such NGO, AMPATH (Academic Model Providing Access to Healthcare), a collaboration between the Indiana University School of Medicine and Moi University School of Medicine that had grown to treat some 70,000 HIV-positive patients at 18 sites in urban and rural western Kenya.”
Section 3: History, culture, and society [team Kibera]
There are over 70 distinct ethnic groups in Kenya, ranging in size from about seven million Kikuyu to about 500 El Molo. Kenya’s ethnic groups can be divided into three broad linguistic groups: Bantu, Nilotic and Cushite. While no ethnic group constitutes a majority of Kenya’s citizens, the largest ethnic group, the Kikuyu, makes up only 20% of the nation’s total population, The five largest – Kikuyu, Luo, Luhya, Kamba and Kalenjin- account for 70%.
Kenya’s ethnic diversity has led to disputes at various times throughout its history. Interethnic rivalries and resentment over Kikuyu dominance in politics and commerce have hindered national integration.
The Kenyan coast had served host to communities of ironworkers and communities of subsistence farmers, hunters and fishers who supported the economy with agriculture, fishing, metal production and trade with foreign countries. Around the 6th or 9th century CE Kenya switched to a maritime-based economy and began to specialize in shipbuilding to travel south by sea to other port cities such as Kilwa Masoko and Shanga along the East African coast. Mombasa became the major port city of pre-colonial Kenya in the Middle Ages and was used to trade with other African port cities, Persia, Arab traders, Yemen and even India.
In the centuries preceding colonization, the Swahili coast of Kenya was part of the east African region which traded with the Arab world and India especially for ivory and slaves.
Swahili, a Bantu language with Arabic, Persian, and other Middle Eastern and South Asian loanwords, later developed as a lingua franca for trade between the different peoples.
The colonial history of Kenya dates from the establishment of a German protectorate over the Sultan of Zanzibar’s coastal possessions in 1885, followed by the arrival of the Imperial British East Africa Company in 1888. Incipient imperial rivalry was forestalled when Germany handed its coastal holdings to Britain in 1890. This followed the building of the Kenya–Uganda railway passing through the country. This was resisted by some tribes — notably the Nandi led by Orkoiyot Koitalel Arap Samoei for ten years from 1895 to 1905 — still the British eventually built the railway. The Nandi were the first tribe to be put in a native reserve to stop them from disrupting the building of the railway. During the railway construction era, there was a significant inflow of Indian peoples who provided the bulk of the skilled manpower required for construction.
During the early part of the 20th century, the interior central highlands were settled by British and other European farmers, who became wealthy farming coffee and tea. By the 1950s, the white population numbered 80,000.
From October 1952 to December 1959, Kenya was under a state of emergency arising from the Mau Mau rebellion against British rule. It involved a Kikuyu dominated anti-colonial group called the Mau Mau and elements of the British Army, auxiliaries and anti-Mau Mau Kikuyu. The conflict later widened to become a generalized civil war and set the stage for Kenyan independence.
The first direct elections for Africans to the Legislative Council took place in 1957. Despite British hopes of handing power to “moderate” African rivals, it was the Kenya African National Union (KANU) of Jomo Kenyatta that formed a government shortly before Kenya became independent on 12 December 1963, on the same day forming the first Constitution of Kenya.
On 12 December 1964 the Republic of Kenya was proclaimed, and Jomo Kenyatta became Kenya’s first president. At Kenyatta’s death in 1978, Daniel arap Moi became President. Daniel arap Moi retained the Presidency, being unopposed in elections held in 1979, 1983 and 1988, all of which were held under the single party constitution. The 1983 elections were held a year early, and were a direct result of an abortive military coup attempt on 1 August 1982.
In 2007-2008 Kenya experienced political, economic, and humanitarian crisis that erupted after incumbent President Mwai Kibaki was declared the winner of the presidential election held on December 27, 2007. Supporters of Kibaki’s opponent, Raila Odinga of the Orange Democratic Movement, alleged electoral manipulation. This was widely confirmed by international observers.
In addition to staging several nonviolent protests, opposition supporters went on a violent rampage in several parts of the country, most noticeably in Odinga’s homeland of Nyanza Province and the slums of Nairobi, part of his Langata constituency. Police shot a number of demonstrators, including a few in front of TV news cameras, causing more violence directed toward the police.
Targeted ethnic violence (as opposed to violent protests) escalated and at first was directed mainly against Kikuyu people – the community of which Kibaki is a member. This violence peaked with the killing of over 30 unarmed civilians in a church near Eldoret on New Years Day. Tensions in the Rift Valley have caused violence in several previous Kenyan elections, most notably in the 1992 Kenyan Elections. Some of the Kikuyu also engaged in violence against groups supportive of Odinga, primarily Luos and Kalenjin, especially in the areas surrounding Nakuru and Naivasha.
The slums of Nairobi saw some of the worst violence, some of this ethnically-motivated attacks, some simple outrage at extreme poverty, and some the actions of criminal gangs. The violence continued sporadically for several months, particularly in the Rift Valley.
Former UN Secretary General Kofi Annan arrived in the country nearly a month after the election, and successfully brought the two sides to the negotiating table. On February 28, 2008, Kibaki and Odinga signed a power-sharing agreement called the National Accord and Reconciliation Act, which establishes the office of prime minister and creates a coalition government.
Traditional music in East Africa is based mainly on drumming and singing, though sometimes accompanied by lyres and flutes. Different communities have different musical practices, such as Akamba’s percussive emphasis, and Maasai’s polyphonic singing, and Luhya’s drumming. Perhaps a little surprisingly, guitar has been historically popular in Kenya even before the twentieth century, incorporating complex native rhythms as well as “borrowed” ones such as from cavacha in Congo. In the region near Lake Victoria, Benga music, which first evolved from Nairobi in the 1940’s, has also become quite popular. In popular music, Kenya is heavily influenced by Congo: for example, both genres of Swahili sound and Congolese sound originated from Congolese soukous, a dance music similar to rumba. Other familiar musical styles, such as hip hop, reggae, rock, also receive substantial popularity in Kenya. Notably, many Kenyan songs have lyrics in a mix of English, Swahili, and other local tribal languages (Wikipedia, 2011).
Because there are many communities within Kenya, and because some of these communities may extend to other neighboring countries, the food scene in East Africa in general consists of several varieties. The universal staple is probably the ugali (also known as posho in Uganda), a dough usually made from cornmeal, and frequently accompanied by a sauce or stew. Given that a large part of the population cannot afford meat frequently, various vegetables—such as kale, spinach, cabbage—are commonly in use, particular as stews, perhaps the most famous of which is sukuma wiki, made mainly of collards and kale, and kachumbari, made of various chopped vegetables (KenyaInformationGuide, 2011). For lovers of roasted meat such as beef and goat, nyama choma is also considered a popular dish. Food also varies amongst regions depending on availability: for example, while the Maasai people in southern Kenya relies heavily on cow and goat products, fish stews are abundant near the shores of Lake Victoria (AdvaMeg, 2011). Because of a population of recent Indian and Pakistani immigrants, Kenya has also adopted its version of the chapati, sometimes topped with an omelette, and samosas. Tropical fruits such as mangoes, papayas (“papaws”), and pineapples, are abundant. Furthermore, many Kenyans enjoy drinking tea—sometimes even more so than water—and Tusker is a well-known brand of Kenyan beer.
Social and cultural considerations in health
The Kenyan society is marked by large gaps between the rich and the poor, with the richest quintile holding more than half of the country’s total income (Earthtrends). and this situation is reflected in many pertinent health issues. For example, field studies in Nakuru conducted by Muchukuri and Grenier, revealed that the most important factors to unevenly affect health in the poorest population include: “water supply, sanitation, solid waste management, food environments, housing, the organization of health care services and transportation” (2009). In slum areas, additional social problems including crime, violence, drug use, and prostitution further complicates the matter. Since health is often related to so many other social issues, many health delivery enterprises, such as Carolina for Kibera, attempt a holistic approach to communities, by not only providing health care alone, but also by empowering the communities through capacity-building activities such as education and workshops.
Another cultural barrier is associated with limited awareness. Many people may not be in a position to effectively judge when to seek care. In some cases, underlying health problems (such as constant low-grade diarrhea resulting from water contamination) are so prevalent that people may not recognize those as problems. In the specific case of HIV/AIDS, even as the disease afflicts about 6% of the population (USAID, 2011), there is sometimes a strong social stigma associated with the disease. This will affect patients’ willingness and ability to seek AIDS-related care.
Gender imbalance exists in Kenya and sometimes victimizes women, who may be more susceptible to rape, prostitution, lack of education, and lack of reproductive information (CFK, 2011). In providing health care, organizations should be aware of and address these issues, as promoting women’s well-being not only raises her health and productivity, but also encourages the well-being of the next generation.
Furthermore, many people in Kenya place a large emphasis on traditional medicine, sometimes over western medicine. In fact, about 80% of Kenyans utilize traditional medicine as their primary care, and some even view western medicine negatively (Turin, 2010). Therefore, as long as people are satisfied with the outcome from traditional medicine, it may be difficult for a clinic to make entry into the community, as there exists not only competition, but also barriers associated with behavioral change.
Finally, one important, but often ignored issue, is the local perception on the delivering enterprise. In many places in Kenya, people experience long queues and medicine stock-outs in existing clinics, and surveys have shown that these situations are widely viewed negatively. An aspiring health delivery enterprise should therefore take extra care in these aspects, for new customers tend to compare their experiences (Turin, 2010). Words from a single negative report about a clinic can spread quickly in a community, which could have an immediate negative effect on people’s willingness not only to visit the particular clinic, but to seek health care in general.
Carolina for Kibera (CFK). <http://cfk.unc.edu/binti-pamoja.php>, 2011.
Earthtrends. Economic indicators: Kenya. Country Profiles, 2000.
East Africa Living Encyclopedia. African Studies Center, University of Pennsylvania. <http://www.africa.upenn.edu/NEH/kethnic.htm>, 2011.
Muchukuri, E., and Grenier, F.R. Social determinants of health and health inequities in Nakuru (Kenya). Int J Equity Health 8:16, 2009.
Wikipedia. “Music of Kenya”. <http://en.wikipedia.org/wiki/Music_of_Kenya>, 2011.