GOK/UNFPA 7 th Country Programme Performance Summary A. Country Information Country name: KENYA Category per decision 2007/42: Current programme period:2009- Cycle of assistance: 7 th Country Programme B. Country Programme Outputs Achievement (please complete for all your CP outputs) Reproductive Health and Rights Output 1: Maternal and newborn health services, including services to prevent and manage fistula, are available, especially for young people and vulnerable groups in selected districts. Indicators Baseline 2009 Target End-line data () Percent of sites offering Basic Emergency Obstetric Care 10% 70% 69% Migori 10% 62% 15% Naivasha 20% 60% 38% Kilifi Number of skilled community midwives recruited, 45 (15 per 315 143 updated and trained district) Number of facilities upgraded to provide fistula services 8 14 16 Number of obstetric fistula clients successfully operated 300 1500 705 Per cent of fistulae survivors re-integrated into community 50% of those operated 50% of those operated 39% (275 out of 705) Key Achievements The establishment and support to model health centers in the focal districts, the training of health service providers, the recruitment and training of community midwives and their provision of services within proximity of the community assisted in addressing issues of access to quality services. Access to services by young people was improved greatly in centers that were functional and linked to a health facility than the youth empowerment centers. The innovation around repair of obstetric fistula (OF) was lauded by the beneficiaries. Output 2: Increased gender-sensitive and culturally sensitive behaviour change interventions for maternal health, including family planning, fistula management, and services to prevent female genital mutilation/cutting Indicators Baseline 2009 Target End-line data Number of clients referred for OF repair by CBOs 150 600 258 (MUMCOP,CDN) 1 Number of community health extension 24 96 143 workers/community midwives providing FP information and services Number of IPs implementing BCC activities 3 13 10 1 This number refers to clients referred (600) for repair and is part of the total repaired (705) and demonstrates the key role of the CBOs in client mobilization. 1 P a g e
Key Achievements The faith based organizations have a comparative advantage in mobilization of obstetric fistula clients, which was demonstrated by the number of clients repaired through their efforts. Revitalization of the family planning programme by the National Council for Population and Development has helped reposition family planning and with the concerted advocacy efforts, the uptake of family planning is bound to increase substantially Output 3: Increased availability of high quality services to prevent HIV and sexually transmitted infections, especially for women, young people and other vulnerable groups Indicator Number of health institutions (sites) providing Youth Friendly Services to prevent HIV and STIs Number of young people and persons Most at Risk (MARPS) (married/discordant couples/ CSWs, MSM receiving comprehensive info& services to prevent HIV&STI per year Baseline (2009) Target End line data None 4 (1 in each 4 (one in each focal focal districts but only 3 districts) fully functional) 15 000 75,000 185,312 Existence of a condom policy and strategy None Condom policy in place Condom policy is in place and operational Number of condoms distributed 4 million 16 million per year 152 million (20 million per month in 2011) Number of young people, persons most at risk (SW) 200 800 6,847 receiving comprehensive HIV/STI services Number of Implementing Partners implementing 3 13 10 Behaviour Change Communication strategies Key Achievements The programme focus on the provision of high quality services to prevent HIV and sexually transmitted infections, especially for women, young people and other vulnerable groups has been successful with targets often exceeded. The support to Sex Workers through business training and loans has been an effective strategy to influence behavior change. Condom programming in particular has benefited from direct procurement of commodities by UNFPA, helping to fill in gaps when necessary as well as the GOK commitment of resources to purchase and distribute condoms. The introduction of DICs in Kilifi under ICRH and FHOK in Nairobi has expanded access to a wider range of services to the extent that the target of 75,000 people to be reached has been exceeded by far. Population and Development Output 1: Improved coordination, monitoring implementation and evaluation of gender-responsive population and reproductive health policies and programs Indicator Percent of 7 th Country Programme implementing partners that continuously comply with the established coordination mechanisms Percent of implementing agencies that continuously comply with the Monitoring and Evaluation system Number of biannual joint review meetings on ICPD and MDGs Number of Medium Term Plan progress reports incorporating PD, RH &GE Number of target districts with functional civil registration system Baseline (2009) Target End line data -2012 30% 58% 72% 30% 58% 86% 0 2 2 (July & December 2012) 1 5 3 0 4 2 (Migori & Kilifi) 2 P a g e
Existence Kenya Youth Dialogue tool 0 Tool developed Existence of a National Population Policy 0 National Population Policy in place Number of individuals from key stakeholders with capacity to integrate population factors into environmental issues Existence of a set of indicators to monitor the linkages between population and environment issues at all levels Tool in Place National policy in place 0 100 120 persons were trained 0 A set of indicators developed Number of individuals with capacity to conduct a microcensus Existence of a tool for micro-census 0 Tool for micro census in place A set of indicators developed as well as a training manual 0 40 40 Tool in place Key Achievements A Monitoring and Evaluation Plan for the GOK/UNFPA 7 th Country Programme was developed, with annual targets to help in programme planning and monitoring. The plan had an elaborate coordination mechanism. The mid-term review and end of country programme evaluation were successfully conducted Programme review and re-focusing was also achieved following joint GOK/UNFPA meetings, 88 district officers trained on E-promise and ICPD beyond 2014 operational review conducted and draft report submitted. Revitalization of vital registration system was kick-started and training is on-going in two of the four districts. Three MTP progress reports incorporating Population Dynamics, Reproductive Health and Gender Equality issues have been produced and disseminated, in addition to other reports such as State of Kenya Population and World Population reports. Intensive family planning advocacy campaigns have been re-launched and the World Population Day celebrations sustained as a critical advocacy platform. The National Leaders Conference was held and the National Population Policy adopted. Following sustained training, there is an increasing level of integration of population issues into national planning. Output 2: Improved systematic collection analysis and dissemination of quality gender-sensitive population and reproductive health data Indicator Baseline 2009 Target Number of public institutions with technical capacity to collect, analyze and disseminate quality gender-sensitive population and RH data The 4 public institutions have limited technical capacity gaps for collection, analysis and dissemination of data NCPD, KNBS, PSRI and PAK strengthene d with technical capacity to collect, analyze and disseminate data Endline data 2012 NCPD, KNBS and PSRI 3 P a g e
Number and type of reports providing data on ICPD related issues Percentage Compliance with census dissemination schedule Census not undertaken Dissemination schedule not developed Census undertaken 12 analytical reports 100% compliance 12 analytical and 4 basic reports published 1 PES report and 1 Census Atlas 4 state of Kenya population reports 1 world population report 1 report on Facts and Figures on population and development 1 report of training on integration of PHE in development programmes 100% compliance No of analytical reports 12 12 12 No of publications supported 0 3 3 (KDHS, KSPA, KAIS) No of socio-cultural, demographic & RH research conducted Number of research papers presented in regional and international meetings 0 1 None has been conducted 0 3 2 papers presented in UAPS and 24 papers presented in the National Leaders conference. Number of biannual national conferences on PD 0 2 1 national conference held No of district access & utilization of IMIS 0 4 2 districts have access to IMIS Existence of an updated database 0 Updated database for NGOs in place Updated database of NGOs in place Key Achievements Over the programme cycle, the 2009 Population and Housing Census was conducted in a most timely manner and 100% compliance to the census dissemination schedule achieved. This culminated into a UN Award for Publicity for Kenya. In addition, KDHS, KSPA and KAIS reports were also finalized, launched and disseminated. Policy dialogue also benefitted immensely from partners participation in regional and international research networks. A total of 12 data sets were successfully uploaded into the Integrated Multi-sectoral Information System, which has led to increased access to quality vital Gender Equality Output 1: Increased access to accurate & appropriate information & services on sexual & GBV including emergency and post emergency situations Indicators Baseline 2009 Target End line data 2012 Existence of database on female and male SGBV survivors - Web-based database in place Web site on GBV in place; www.gbvkenya.org 4 P a g e
Number of community networks whose capacity have been strengthened on gender equality Number of key parliamentary committees sensitized on gender and international human rights instruments 0 4 4 0 4 6 Number of SGBV committees/networks established & 0 6 6 sensitized on SGBV including HIV/AIDS issues in selected districts Number of FBOs participating in promoting gender 0 5 5 responsive programme in the selected district Key Achievements National and community networks comprising of various leaders, local administration, watch groups, GBV working groups and court users committees capacities were strengthened to advocate against gender inequalities, including SGBV. Implementing partners (IPs) developed culturally sensitive behaviour change communication strategies on SGBV and supported the establishment of watch groups, networks and information centres at the community level. Parliamentarians support translated into gender related legislation that address issues of sexual and gender based violence directly or indirectly. The passing of the Abandonment of Female Genital Cutting Act is related to the advocacy efforts Output 2: Enhanced institutional mechanisms to reduce & respond to GBV & discrimination/particularly among marginalized populations & during humanitarian crisis Indicators Baseline 2009 Target Endline data 2012 Existence of a database of existing service providers in 4 target districts No database 4 Mapping of service providers in the 4 focus district, policy Number of law enforcement agents with skills to handle SGBV related issues 0 1000 (200 annually) Existence of a report on an assessment of SGBV services 0 Report on assessment of GBV services in place Number of community networks supported in selected Districts 1 5 (increase of 4) brief in place 1, 400 law enforcement agents trained Assessment report on GBV services in place Working groups: watch groups, GBV working groups, FGM networks and Court Users committees Existence of Gender Responsive Guidelines, frameworks, policies and Acts 0 Responsive guidelines in place The Gender Responsive Budgeting guidelines finalized (awaiting adoption by government) 5 P a g e
Number of projects/programmes in selected districts involving men and boys on SRHR 0 20 7 IPs and affiliate organizations in the focus districts with programmes involving men and boys Key Achievements The focus was on the provision of supportive services to survivors of gender based violence and strengthening of the capacity of institutions, such as the national gender machinery, police and judicial system for the implementation and enforcement of gender responsive laws and policies, support to protective services/social safety nets to reduce gender based violence and effective mainstreaming women s rights and gender equality into national legislation, policies, programmes and budgets. The capacities of national institutions and the civil society organizations to implement the Gender Based Violence response and prevention programme have been strengthened Output 3: Improved advocacy for women & adolescent girls reproductive rights, male participation in Reproductive Health and elimination of harmful practices, particularly FGM Indicators Baseline 2009 Target Number of policy makers including parliamentarians 20 90 sensitized on harmful cultural practices including FGM (increase by 70) Number of girls who undergo ARP in project sites 1,000 2,500 (300 annually; (Increase by 1,500) Frequency of media reports on gender issues 0 60 (I feature per month) End line data 2012 155 policy makers educated on harmful cultural practices including FGM 7 parliamentary committees 586 girls have undergone ARP 35 girls have refused to undergo FGM 13 boys have become champions on FGM 402 6 P a g e
Key Achievements This output on advocacy for women & adolescent girls reproductive rights, male participation in RH & elimination of harmful practices, particularly FGM was implemented within the GOK/UNFPA/UNICEF Joint Programme initiative on Accelerating Abandonment of Female Genital Mutilation (FGM) initiated in 2008. The two UN agencies have created synergy in accelerating abandonment of FGM and acting as a catalyst through building in country partnership to ensure a critical mass of people support the abandonment of FGM. Key achievements include: Support towards the formulation and advocacy for the National Policy for the Abandonment of FGM/C and the passage of the FGM Prohibition Act in 2011. Support to the establishment of District GBV/FGM/C networks and members trained on GBV/FGM/C A policy and legal framework conducive for the promotion of gender equality in line with the UNDAF outcome for improved governance. The following sectoral policies have been developed and include: National Plan of Action for the elimination of FGM (1999-2019), Adolescent Reproductive Health and Development Policy ( 2005-2015), National Advocacy, IEC and BCC Strategy for Population and Sustainable Development (2005-2015), National Youth Policy (2005-2015) The National Gender Policy, its Action Plan, and Sessional Paper No. 2 on Gender Equality (2006) C. National Progress on Strategic Plan Outcomes Start value Year End value Year Comments Outcome 1 Population dynamics and its inter-linkages with the needs of young people (including adolescents), sexual and reproductive health (including family planning), gender equality and poverty reduction addressed in national and sectoral development plans and strategies National development plans (NDPs) and poverty reduction strategies (PRSs) that address population dynamics and its interlink ages with the multiseectrol needs of young people (including adolescents), sexual and reproductive health (including family planning), gender equality and sustainable development and poverty reduction National health policies and plans that have integrated sexual and reproductive health (SRH) services (including family planning) Medium Term Plans for Kenya s Vision 2030 to be developed 2009 Two Medium Term Plans developed with progressive incorporati on of population dynamics, SRH and GE issues 3 2009 5 2012 Resources allocated to ICPD activities in relevant sectors Number of annual reports on vision 2030 with gender disaggregated /sensitive data 3.3% 2009 4.18% 2012 Increasing trend in resources for ICPD indicated Annual reports not prepared 2009 Five Annual Reports of the MTPs prepared with gender disaggregat ed data 2014 7 P a g e
Summary of National Progress The national population policy was adopted and there is sustained effort to integrate population issues and principles of sustainable development into the country s policies and programs. The other policy documents that were developed integrating Reproductive Health and Family Planning include: National RH Policy (2007) ARH&D policy (2003) and its Plan of Action (2005-2010) The National Health Sector Strategic Plan II National Population policy for Sustainable development (2000), Population Policy for National Development (2012) National Health Policy (2012) UNFPA s Contributions Support for capacity building trainings, orientation and sensitization workshops on integration of PHE in development planning, support towards enhancing advocacy campaigns and sustaining dialogue among key stakeholders. UNFPA also supported activities aimed at strengthening programme coordination mechanism, monitoring and reporting. Outcome 2 Increased access to and utilization of quality maternal and newborn health services Maternal mortality ratio (deaths of women per 100,000) 488 2008/09 N/A Births attended by skilled health personnel 44% 2008/09 N/A Caesarean sections as a proportion of all live births 6% 2008/09 N/A Will be available in KDHS 2014 Will be available in KDHS 2014 Will be available in KSPA 2015 Summary of National Progress National health priorities are outlined in the Kenya Health Policy framework (1994, 2012-2030), the National Health Sector Strategic Plan (NHSSP II (2005-2012) and HSSIP (2012-2016). The review of the Road Map for accelerating the attainment of MDGs relating to maternal and newborn health has shown that Kenya is one of the countries that are not making progress in the reduction of MMR (WHO, 2012) 2. In response, the GOK is committed to providing quality care as well as increasing access to services to address MDG 5(a & b). The development of the National Guidelines for community midwifery (2006) within the 6 th CP and the decision to establish and equip model health centres in every constituency with the 7 th CP was in a bid to increase access to and increased utilization of quality health services. The recent announcement by the current government to waive maternity fees in GOK health facilities is likely to enhance utilization of skilled attendance at birth. UNFPA s Contributions The programme supported the establishment of 4 model health centres. The Country Programme targets for increasing the proportion of sites offering Basic Emergency Obstetric Care (BEOC) were district specific. For example available data shows that for Migori district, there was a steady increase in the proportion of facilities offering BEOC from a baseline of 10% in 2009 to 24% (2010), 69% 2011 and 69% in 2012. Strengthening Emergency Obstetric Care (EOC) was addressed through training of health service providers in EOC, including use of the partograph that is critical in the management of labour. Data at the DRH show that 120 health service providers have been trained in EOC. 2 Trends in Maternal Mortality 1990-2010: WHO, UNICEF, UNFPA. The World Bank Estimates (WHO, 2012) 8 P a g e
Outcome. 3 Increased access to and utilization of quality family planning services for individuals and couples according to reproductive intentions Contraceptive prevalence rate (modern methods) 46% 2008/09 N/A /14 KDHS yet to be conducted for end value Unmet need for family planning 26% 2008/09 N/A /14 KDHS yet to be conducted for end value Percentage of service delivery points (SDPs) offering at least three modern methods of contraception 85% for any modern method 2008/09 N/A Kenya Service Provision Assessment yet to be conducted Summary of National Progress The Ministry of Public Health and Sanitation has doubled its efforts towards increasing access to utilization of FP including LAPMs as one of the ways of expanding access to family planning services. To this effect several strategic documents have been developed and include the following: National Reproductive Health Policy 2007 The National Reproductive Health Strategy 2009-2015 Contraceptive Commodities Security Strategy Kenya Comparative Assessment of Long Acting and Permanent Methods Activities (December 2008) The National Road Map for Accelerating the attainment of the MDGs related to Maternal and Newborn Health in Kenya (2010) Strategy for improving the uptake of Long Acting and Permanent Methods of Contraception in the family planning programme (July 2008-June 2010) Community Health worker training Manual (have modules on FP and provides an opportunity to include a module for CHWs to motivate women/community regarding LAPMs and referral) IUD Guidelines for Family Planning Service Programmes Course Notebook for Trainers. JHPIEGO 2006 The Government and Donor commitments were able to procure all contraceptive needs for 2008/2009 and 2009/2010 following national Forecasting and Quantification exercises. Currently there is regular review of forecasted quantities according to changing scenarios and constant monitoring of the contraceptive pipeline both upstream and downstream. UNFPA s Contributions In repositioning of FP, revitalization of family planning was undertaken at facility level and community levels. At facility level, this included training of health service providers in the provision of Long Acting and Permanent Methods (LAPM), procurement of Family Planning commodities and supplies and LAPM kits. At the community level, emphasis has been laid on social mobilization, creation of awareness on available family planning services and provision of FP through outreach camps, the use of youth networks and youth peer educators. NCPD has invested resources in advocacy for revitalization of FP and the details are covered in the PD section of the report. Outcome 4 Increased access to and utilization of quality HIV- and STI-prevention services especially for young people (including adolescents) and other key populations at risk KAIS KAIS 2012 results not HIV prevalence in youth (15-24 years) 3.8% N/A 2007 yet out Percentage of women and men aged 15-49 who had more than one partner in the last 12 months who used a condom during their last sexual intercourse 35% women 62% men KDHS 2008-09 N/A KAIS 2012 results not yet out 9 P a g e
Summary of National Progress The Kenya government is committed on addressing the health needs of youth and MARPs as a vulnerable group. This is outlined in the policy document of 2003 and the revised plan of action of 2012-2015; and is reflected in the support for establishment of youth empowerment centres and advocacy for provision of youth friendly services. At the national level the programme supported policy work focusing on developing of policy documents: Development of Action Plan and programmatic guidelines for Gender mainstreaming action plan in tandem with the KNASP III (2009/10-2012/13); Gender response Human rights manual in the context of HIV and AIDS; Engendering of the Kenya National AIDS Council Bill; The National Condom Policy and the National Condom Promotion Strategy. UNFPA s Contributions The programme focus on these groups recognizes the need to provide services as well as institute behavior change through HIV risk reduction and empowerment of communities, in line with the GOK policy to meet the needs of vulnerable groups and reduction of HIV prevalence. The programme supported the establishment of 4 youth friendly centres and 4 youth empowerment centres that serve as centres for the provision of condoms and HIV counseling and testing has increased access to RH services for youth during the programme period. In terms of capacity building UNFPA supported 2 NPPP positions for MARPS and gender mainstreaming. As a result there is integration of gender dimensions in legislation (KNAC Bill, 2010) and other national HIV strategies/guidelines. National data exists on MARPS and a situation analysis report on SWs while strengthened youth networks are in place. Comprehensive condom programming is in place; enhancing RH/HIV integration and increased use of condoms for control of STIs Outcome 5 Gender equality and reproductive rights advanced particularly through advocacy and implementation of laws and policy Percentage of women aged 20-24 who were married Awaiting KDHS 6.2% 2008/09 2012 N/A or in union before age 18 /14 Number of mechanisms in place to implement laws and policies advancing gender equality and 2 2011 reproductive rights Summary of National Progress The GOK-UN Joint Programme on Gender Equality and Women s Empowerment (JP GEWE) contributed to the national objectives within five inter-related strategic priority areas, namely: Gender mainstreaming (UNWOMEN), Gender-Based Violence (UNFPA), Gender and Governance (UNDP), Economic Empowerment (ILO), UN Coordination and Delivering as One (UNWOMEN). The engagement of members of parliament, particularly, lobbying for support amongst the male parliamentarians drew immense support to the Gender Bills, especially during the enactment of the Prohibition of FGM Act, 2011. Key sectoral policies have been developed which include: National Plan of Action for the elimination of FGM (1999-2019), National Advocacy, IEC and BCC Strategy for Population and Sustainable Development (2005-2015) Youth Policy (2005-2015) National Gender Policy and its Action Plan and Sessional Paper No. 2 on Gender Equality (2006). National Gender and Equality Commission Act, 2011 10 P a g e
UNFPA s Contributions UNFPA supported the establishment of the National Gender and Equality Commission (NGEC) and built its capacity to coordinate and oversee implementation of the GBV Prevention and Response Programme. As a result, GBV working groups were established in the focus districts, coordinated at the district level by the Ministry of Gender, Children and Social Development (MOSGD). UNFPA continues to support the efforts of National Gender and Equality Commission (NGEC) in tandem with Vision 2030. The NGEC has been a great beneficiary of the collaboration that has existed among the gender component partners. This has particularly been in the area of sexual and gender based violence. Outcome 6 Improved access to SRH services and sexuality education for young people (including adolescents) Adolescent birth rate (per 1000 women aged 15-19) 100.2 2008/09 NA Percentage of young people aged 15-24 who both correctly identify ways of preventing the sexual transmission of HIV and reject major misconceptions about HIV transmission Implementation status of comprehensive ageappropriate sexuality education in and out of school 47.6% 2008/09 NA /14 KDHS yet to be conducted for end value /14 KDHS yet to be conducted for end value 0 0 0 0 Advocacy initiative on comprehensive sexuality education initiated at national scale Summary of National Progress The Kenya government is committed to addressing the health needs of young people as a vulnerable group. This is outlined in the policy document of 2003 and the revised plan of action of 2012-2015 and is reflected in the support for establishment of youth empowerment centers and advocacy for provision of youth friendly services and the training of service providers to offer these services. UNFPA s Contributions The programme supported the establishment of 4 youth friendly centers (YFC) and 4 Youth Empowerment Centers (YEC) in each of the focal districts. Working in collaboration with other NGOs and CBOs such as FHOK and MUMCOP, the CP also supported youth activities to increase access to integrated SRH and HIV related services. According to FHOK report (2009-2012), the programme reached 41,092 young people with integrated FP/RH/STI information and services. Between 2009 and 2010, a total of 6,147 young people received HIV counseling and testing; family planning, Pap smear 480, and STI -treatment services-580. The 7 th CP worked in collaboration with the Ministry of Youth Affairs to disseminate various youth policy documents and action plans in all the 8 provinces and the focus districts. These included the following among others: Action Plan for Youth and Health and The Kenya Youth Dialogue tool. 11 P a g e
Outcome 7 Improved data availability and analysis around population dynamics, SRH (including family planning) and gender equality Census completed 2010 round of population and Census Census not done 2009 2012 and disseminated housing census completion status completed as per schedule Number of national household surveys conducted (in the last five years) that allow for the estimation of all MDG 5B indicators 0 2009 3 2012 3 reports finalized, launched and disseminated (KDHS, KAIS, KSPA) Summary of National Progress The Kenya 2009 Population and Housing census was completed within the set time lines thereby leading to the UN award for publicity for Kenya and the level of awareness on population and development issues has increased significantly. UNFPA s Contributions Coordination of resource mobilization from other development partners, support for capacity building and support for pre-census advocacy, data collection, analysis, dissemination and post-enumeration survey. The programme supported the conduct, launch and dissemination of KDHS, KSPA and KAIS E. Country Programme Resources ($): 2009- SP Outcome (for onwards only ) Choose only those relevant to your CP Population dynamics Maternal & newborn health Family planning HIV and STI prevention Gender equality and reproductive rights Young people s SRH and sexuality education Data Programme coordination and assistance Regular Resource (Planned and Final Expenditure) Others (Planned and Final Expenditure) Total (Planned and Final Expenditure) 2,266,028 $ 2,128,773 0 0 2,266,028 2,128,773 5,643,212 5,102,524 2,515,825 1,740,597 8,159,037 6,843,121 3,410,937 3,053,290 1,449,282 944,528 4,860,219 3,997,818 1,313,267 1,205,870 82,688 47,754 1,395,955 1,253,623 2,684,358 2,559,927 760,455 746,598 3,444,813 3,306,525 923,952 923,057 681,597 607,854 1,605,549 1,530,911 3,614,567 3,004,664 3,045,425 2,272,625 6,659,991 5,277,289 7,382,192 7,437,828 0 0 7,382,192 7,437,828 Total 27,238,514 25,415,933 8,535,271 6,359,955 35,773,785 31,775,888 12 P a g e