Kenya

Abstract

Even before the pandemic, there were inequalities showing that health and ill-health were not equally distributed in the country. History has shown that public health emergencies such as Covid-19 can disproportionately impact communities that are already disadvantaged. Drawing from these existing structural issues documented in the literature and media reports, qualitative interviews were conducted to examine the impacts of Covid-19 mitigation measures on sectors and vulnerable segments of the Kenyan society. We highlighted that insufficient attention paid to existing inequalities and the needs of vulnerable and marginalized groups subjected them to a higher risk of infection and undermined the broader Covid-19 response. We also shed light on the impacts of the pandemic on the health sector and access to health care. We argue that the mitigation measures were inadequate to protect vulnerable groups from harm; therefore, the responses exacerbated their socioeconomic status and health.

Introduction

The Covid-19 pandemic across the world has raised many debates about the implications of structural inequalities and Covid-19 responses on vulnerable populations. In Kenya, these debates present an opportunity to examine the existing structures that posed severe ramifications for both response and mitigation measures. According to the 2019 Kenya Population and Housing Census, young people constitute the largest segment of the population of 47.5 million in Kenya. 19.5 million of the population are classified as poor, with 14 million, 1.3 million, and 4.2 million living in rural areas, peri-urban and core-urban and informal settlements, respectively.¹ Poverty is also feminized. The 2015/2016 Kenya Integrated Household Budget Survey (KIHBS) results show that 30.2% of female-headed households are poor compared to 26.0% of their male counterparts.²

Kenya’s Gini coefficient of 44.540 is above the 2013 Sub-Saharan African average of 43.841, indicating higher than average wealth inequalities in Kenya. The latest KIHBS results show that nationally, more than half (59.4%) of total expenditure is controlled by the top quintile, while the bottom quintile controls a mere 3.6% of expenditure. Pre-pandemic, the KNBS estimated that unemployment stood at 14.2% among youth aged 20–24. Women comprise 70% of low-wage earners. Most are employed in the informal sector or run micro and small enterprises. Daily wages characterize this sector, with limited social protection measures or savings, making women particularly vulnerable.³

Covid-19 hit Kenya with an already weak health system with frequent health worker strikes and unequal distribution of health facilities. The country also had very low health worker-to-population ratios. Regarding critical care facilities, only 22 of the 47 counties had at least one intensive care unit. There were 537 ICU beds, three-quarters of which were in Nairobi or Mombasa, and only 58% of hospital beds nationally were in hospitals with an oxygen supply.⁴ The cost of health care is also prohibitive. Although the National Hospital Insurance Fund (NHIF) was introduced in 2004 to facilitate cheaper access to services, in 2019, the Ministry of Health reported that this scheme covered only 11% of Kenyans. Furthermore, with 70% of the Kenyan workforce working in the informal sector, most are ineligible for the NHIF or unable to afford its premiums. Most Kenyans pay out of pocket to access health services, which means that they delay care-seeking, if possible, which, in the context of Covid-19, has dire consequences.⁵

All of this raised concerns about the ability to mount an effective biomedical response to the pandemic, and the fear that necessary public health measures such as physical distancing, handwashing, and wearing facemasks might also be challenging to implement, particularly among specific populations, including the poorest of the poor. This chapter explores Kenya’s national legal and policy response to Covid-19 with particular attention to human rights and equity. It encompasses issues such as civil society participation in the response and the unequal impact of the response on different populations. This work has been guided by a socio-ecological framework whereby individuals’ experiences are shaped by a range of nested, interrelated factors around them, from seemingly ‘distant’ factors such as laws and policies down to more ‘proximal’ factors such as their immediate living situation. The interplay of these factors, mainly the range of laws, policies, and regulations relevant to Covid-19 and how they impact different populations, is explored.

Methodology

This mixed-methods study includes policy, quantitative and qualitative research, and a joint analysis to combine all these different data types. We reviewed web-based search engines such as Google and Google Scholar for the legal and policy analysis. Searches were limited by date range of publication and were restricted to the year 2020. Data were assessed for relevance and systematically extracted based on their direct or indirect implications for vulnerable communities. The data were organized thematically and categorized according to date, issuing body, and type of measure issued to create a timeline of the national response. In addition, we relied on secondary literature sources on the theme. The study also used media reports compiled during the period. The data generated were tabulated, indicating the date, the main issue, and reference. Organizations actively engaged in the Covid-19 response in Kenya were identified from the media analysis, including UN organizations such as the WHO, UNDP, UNICEF, WFP, FAO, UN Women, as well as civil society organizations including Amref Health Africa, The Red Cross, the Population Council, KELIN Kenya, and Amnesty International. Their latest reports on areas of interest were reviewed, and data relevant to answering the study’s research questions were systematically extracted. The information was drawn from their research findings, programmatic reports, and experiences of the realities encountered in their programme implementation.

Key informant interviews were conducted with ten participants using a semi-structured interview guide. This included four representatives of government (governance, health, education and gender, and culture), three parastatal organizations, and three civil society organizations (working across health, law, and inequalities). These interviews took place at the national and county levels in Homa Bay County as an example of how the Covid-19 response has been implemented sub-nationally. Interviews were recorded and transcribed verbatim for analysis. Ethical approvals were secured through the Amref Ethics Review Committee and the University of Southern California Institutional Review Board.

Mapping the Evolution of the Pandemic in the Context of Policy Response

On February 28, 2020, as a response to the looming threat of coronavirus, President Kenyatta issued the first executive order addressing Covid-19, in which he called attention to the necessity of bolstering health systems. He called for completing a national isolation and treatment facility at Mbagathi Hospital in Nairobi and establishing a National Emergency Response Committee (NERC) on coronavirus. The NERC entailed a Covid-19 Task Force, composed of the Ministry of Health, other government agencies, United Nations agency representatives, development partners, NGOs, and civil society, which plays an advisory role to the committee.⁶ Noticeably missing from the task force was representation from religious leaders, youth, women and women's organizations in civil society, marginalized communities such as refugees, and the private sector. The primary role of NERC, which was 81% male, was to advise the President and coordinate preparedness, prevention, and response to the threat of Covid-19.⁷

On March 24, 2020, the Ministry of Health issued guidelines for the promotion of preventive measures, such as physical distancing and handwashing, and ensuring the continuity of antiretroviral treatment for the 1 million people living with HIV, among other essential services. The next day, the government announced that it would put aside Ksh 1 billion to recruit medical personnel. The Cabinet Secretary for Health followed these guidelines with the issuance on April 3 of the Public Health Act on Covid-19, which consisted of general guidelines for medical officers about Covid-19 patients and people potentially exposed to the coronavirus. Later in April, a guideline was issued to support the continuity of reproductive, maternal, newborn, and family planning services.

The Kenyan government launched significant health system measures on June 10 in response to data showing that 78% of infected persons admitted to hospitals were either asymptomatic or mildly symptomatic. These protocols included advice on home-based isolation and care, especially as asymptomatic Covid-19 positive cases were discharged from health centres. Protocol implementation was designed to start immediately. However, according to the protocols, if positive cases could not afford to be isolated at home due to spatial concerns, facilities within the community that met specific recommendations were available to provide care.

The Nairobi Hospital formed a strategic partnership with the United Nations on July 21 to manage diplomatic personnel and all dependents with suspected or confirmed cases of Covid-19. The agreement included the construction of an Ksh 1.1 billion health facility with an Intensive Care Unit consisting of 25 beds and an additional 50 in the High Dependency Unit. The facility was intended to serve over 20,000 United Nations staff based in Kenya and East Africa, along with locals in the vicinity. In addition, during a September 10 meeting overseen by President Kenyatta, the Cabinet approved a comprehensive insurance plan to cover all health workers on the frontline of the pandemic. They also announced an Inter-Agency Programme to prevent and respond to gender-based violence, which had increased because of Covid-19.

At the county level, Homa Bay County had enacted a County Health Act less than a month before the Covid-19 pandemic, which included guidance on addressing emergencies such as pandemics and was therefore valuable in guiding the local response.⁸

Other policy measures included travel restrictions, quarantining and closing public places and schools, and scaling down the work of the judiciary. These restrictions began on March 15, 2020, and gradually expanded with intensity and geography. Some of these included suspensions of flights, quarantining of passengers, and imposition of a 7 pm–5 am curfew, among others.

It appears that compliance with government response measures varied widely. Some people chose not to comply, mainly if the regulation did not make biomedical sense (e.g. wearing a mask while driving alone in a car); some people did not want to comply, and some people could not comply due to more urgent competing needs (e.g. they could not afford a face mask). Of those who complied, many believed in the public health measures, while some were simply trying to avoid arrest.⁹

Mitigation Measures

Kenya implemented a range of fiscal measures to counter the negative economic impact of the pandemic on individuals and businesses. This began on March 12, 2020, when the Ministry of Tourism and Wildlife announced that it had set aside the US$5 million to support the tourism sector for a post-Covid-19 recovery plan.

On March 15, Safaricom and the Central Bank announced that charges on mobile money transactions would be dropped to limit the use of cash. Then on March 24, the Central Bank lowered its policy rate to 7.25% (which was then lowered to 7% on April 29), lowered banks’ cash reserve ratio to 4.25%, increased the maximum tenor of repurchase agreements from 28 to 91 days, and announced flexibility to banks on loan classification and provisioning for loans that were performing on March 2 but were restructured due to the pandemic.

Immediately after this, on March 25, President Kenyatta outlined tax interventions the government would make to protect the country against the economic effects of Covid-19. This included the government’s decision to earmark funds for expediting payments of existing obligations to maintain business cash flow during the crisis. The President also declared that resident corporate income tax would be reduced from 30 to 25% and that the turnover tax rate would be reduced for Micro, Small, and medium enterprises from 3 to 1%. In addition, the plan included 100% tax relief for anyone in the low-income earner's category. In addition, the Ministry of Labour and Social Protection planned to allocate Ksh 10 billion (about €76m) to the elderly, orphans, and other vulnerable groups through cash transfers to cushion them against the effects of Covid-19.

On April 15, 2020, the Central Bank suspended for six months the listing of adverse credit information for borrowers whose loans became non-performing after April 1, setting a new minimum threshold of $10 for negative credit information submitted to credit reference bureaus.

The Head of Public Service announced a voluntary government pay cut programme which started in April and aimed to cover lower cadre civil servants. With savings towards funding the Covid-19 response, voluntary pay cuts of 80% for the President and his deputy, 30% for cabinet secretaries, and 20% for chief administrative were announced.

The President announced the National Hygiene Program on April 25, designed to create youth employment while addressing health promotion. Phase 1 of the programme launched on April 29 and targeted 26,000 youth in 23 informal settlements most affected by the pandemic. Also, in April, the government earmarked Ksh 40 billion (about 350m USD) for the following additional health expenditures: surveillance, laboratory services, isolation units, equipment, supplies, and communication; social protection and cash transfers; food relief; and funds for expediting payments of existing obligations to maintain cash flow for businesses during the crisis.

On May 23, President Kenyatta showcased a new 8-Point Economic Stimulus Programme, which totalled Ksh 53.7 Billion. The programme focused on (1) infrastructure, including the hiring of local labour to fix roads and bridges, (2) education, including the hiring of 10,000 teachers and ICT interns to support digital learning, (3) fast-track payment of outstanding VAT refunds and other pending payments to small and medium enterprises, (4) health care, including 5,000 healthcare workers and the expansion of bed capacity in public hospitals, (5) agriculture, including e-vouchers for 200,000 small-scale farmers, (6) soft loans to support the tourism industry, (7) the environment, including the rehabilitation of wells, water pans, and underground tanks, and (8) manufacturing, such as the investment to purchase locally manufactured vehicles under the “Buy Kenya Build Kenya” policy.

Kenya’s National Treasury announced on May 1 that they would create a fund of close to Ksh 100 billion to protect micro, small, and medium enterprises against the effects of Covid-19. Additionally, on August 8, the Education Cabinet Secretary stated that the Ministry would provide Ksh 7 billion concessionary loans to struggling private schools. Finally, on September 10, the government approved establishing a Credit Guarantee Scheme to support the businesses mentioned above.

Social Protection and Cash Transfer Programmes

The Ministry of Labour and Social Protection is responsible for social protection and cash transfer programmes. They used pre-existing cash transfer programmes to reach “the most vulnerable” (elderly, orphans, people with disabilities) with cash transfers.¹⁰ At the time of writing, the reach and impact of these programmes had not yet been documented, but the absence of poverty status as an inclusion criterion is striking.

The government social protection programmes are complemented by programmes implemented by non-State actors. These are described below in turn.

The government has implemented four main cash transfer programmes (see Table 9.1).

Table 9.1 Summary of cash transfer programmes in Kenya

That all the government programmes pre-dated, the pandemic suggests that stakeholders key to the Covid-19 response were not included in the design of these programmes, nor were they tailored to the realities of the Covid-19 pandemic.

Under the Covid-19 Emergency Response Fund, Kenya’s private sector stepped in to try to help fill the gap between the government's limited response and those in need, establishing a Board led by the CEOs of the biggest companies, which worked with a consortium of NGOs to disburse money via M-Pesa.¹¹ Under the Inua Jamii programme, KShs 13 billion was disbursed by the government to cover January to June 2020 Government to Persons (G2P) payments and cushioned recipients from Covid-19 shocks.¹² The Ministry of Labour and Social Protection was instrumental in successfully transforming this programme’s payment delivery mechanism from a manual system to a fully digital solution that offered choice, convenience, and greater dignity to the recipients.¹³ No literature was found documenting (potential) beneficiaries’ experiences of the programme. Key informants suggested that government-run cash transfer programmes did not reach all intended beneficiaries and that, for those in the programme, long delays were experienced. They intimated that there were some problems with corruption, but they could not be specific regarding the extent to which the different cash transfer programmes were affected.¹⁴

The governmental cash transfer programs were complemented by various additional programmes implemented by multilateral agencies and NGOs. For example, the European Union (EU) partnered with several other organizations and foundations aiming to provide cash transfers to 20,000 households in Nairobi informal settlements for three months starting in June 2020. The EU also provided Ksh 606 million earmarked to be distributed to 80,000 households in informal settlements through M-Pesa.¹⁵ Aiming to reach 120,000 people, Oxfam Kenya, with other NGO partners, distributed cash transfers through M-Pesa to Nairobi urban settlers and women and girls at risk of gender-based violence in Mombasa and Nairobi.

Despite all these programmes being documented, many studies reported participants stating that they had not received any support of this nature. There were also complaints that the transfer amounts were insufficient, delays in payments were a challenge, some people were overlooked, and others told they were ineligible. People noted that registration processes were not transparent, and people did not have information about how to access these cash transfers. Caregivers were omitted even if they were unable to work due to their care duties: the transfer was designed to be sufficient only for the vulnerable individual targeted.¹⁶ Evaluation of these cash transfer programmes is needed.

A final note on the cash transfer dilemma hinges on unease about privacy concerns. A key informant explained that individuals were concerned about what the government might do with personal data about them and therefore were unwilling to share the type of information that might better underpin cash transfer and other social safety net programmes.¹⁷

In September 2020, Kenya introduced the Covid-19 Country Socio-economic Re-engineering and Recovery Strategies (CCSERS). As part of these strategies, Kenya planned to protect health services and systems, scale-up social protections and essential services, protect jobs and support small and medium-sized enterprises (including the most vulnerable productive actors), enhance social cohesion and community resilience, and provide ‘green’ recovery strategies that embraced technology. As a subset of these measures, initiatives were introduced to enhance access to affordable credit for microenterprises, financial literacy programs were promoted, frameworks were introduced for microleasing, and access to a credit guarantee scheme was enhanced. Kenya also introduced plans to provide material and non-material resources to help build business capacity. Among these resources were support to improve market access, physical infrastructure, and designated worksites for creating and selling goods and services.¹⁸

On December 22, Kenya’s parliament voted to end all Covid-19 tax relief schemes, noting that this would help plug gaps in government revenue even as others warned of a negative impact on individuals. The only tax relief measure that was maintained was that Kenyans earning less than KShs 24,000 ($220) would still be granted 100% tax relief.¹⁹

Inclusivity of Mitigation Measures and Policy Responses

Many civil society organizations raised the issue of participatory Covid-19 management, noting the lack of inclusivity in initial responses. Many key informants interviewed felt that the level of inclusion of vulnerable communities in policy development was insufficient; therefore, the policy did not cover them. Even where they were considered, such as for cash transfer programmes which targeted the elderly, people with disabilities, orphans, and vulnerable children, these groups were not involved in developing or implementing the programmes. Also, there was a lack of clarity about beneficiary selection. Moreover, many vulnerable people were unaware of the programmes.²⁰

The unforeseen negative impacts of the curfew on pregnant women who needed to access health facilities for deliveries at night were attributed to the minimal participation of women in the design of the policy.²¹ One key informant noted a significant class differential in the impact of the Covid-19 response, noting that the ‘political elite’, which includes those involved in policy-making, was least affected while the low-income earners, the people who rely entirely on the informal economy and survive on daily income, were most affected.²² This suggests that the elite designed a policy response with minimal participation of less advantaged groups and little consideration of how these policies might work for and affect them.

Over time, there were some efforts to become more inclusive, such as Ministry of Health officials advocating for the inclusion of sex workers in the national response and setting up communication platforms for government partners to exchange inclusive strategies.²³ In addition, in an initiative in Siaya, efforts were made to include adolescent girls in Covid-19 prevention efforts.²⁴

Within the education sector, in the guidelines and training for safe return to school, there were considerations of children with disabilities. Some of the areas in the guidelines included how to help children with autism wear masks appropriately; ensuring that children in wheelchairs can reach handwashing facilities and adapting materials for students or teachers with visual or hearing impairments. There were some sensitization efforts with duty bearers to highlight the needs of people with visual or hearing impairments, particularly in the context of required face masks.²⁵ Some efforts were also made to distribute learning materials to students in hard-to-reach areas during the time that schools were closed. Although efforts were made to teach online and to broadcast educational programmes on the radio, the coverage remained low, and it was the most vulnerable students who could not access these programmes.²⁶

There were also concerns about the plans for using the private sector to roll out vaccines, which would likely disadvantage those of lower socioeconomic status who might struggle to access these services.²⁷

Impacts of the Covid-19 Response Measures

The Covid-19 response measures had many impacts on a range of vulnerable groups and health workers. One of the challenges that existed from the outset, from a civil society perspective, was the definition of ‘vulnerable’ in the context of Covid-19. The government focused on older people and people with underlying medical conditions. They defined vulnerability biomedically. This overlooked the social and economic vulnerability that is so prevalent in Kenya. The government reportedly gave very little attention to addressing poverty in the context of the pandemic, including trying to understand the potential impacts of mitigation measures on people living in poverty, which undermined the success of these efforts. The lack of attention to people living in informal urban settlements and people living on the street was a particularly striking shortcoming of the national response.^28,29 A member of the national Covid-19 Response Taskforce explained that the government wanted to reach the most vulnerable, but due to the inadequacy in the identification and classification of the very poor and the near-poor population, this might not have happened as intended.⁸⁵ Relatively early in the pandemic response, members of the national task force visited different counties to document the situation and capacity to respond across the country.³⁰ Later on, the Presidential Policy & Strategy Unit, Executive Office of the President, working with partners, carried out a study to document the impact Covid-19 had had on adolescent girls in particular around school dropout, teenage pregnancy, and early marriage; and how these short-term effects translated into longer-term economic disadvantages, poorer health outcomes, and increased violence for women.

The primary ‘vulnerable groups’ covered in the literature include people living in urban informal settlements, informal sector workers, boda boda (motorcycle taxi) riders, individuals in poverty, youth, and women. In addition, the literature documents lessons learned about what was and was not working for vulnerable groups across different areas of the response, as explored below.

The health sector itself was hit immensely by Covid-19 measures. There was insufficient support and protection for health risks for health workers and caregivers throughout Kenya. They complained about a lack of personal protective equipment (PPE), including N95 masks and surgical gloves.^31,32,33 Clinics reported shortages of hand sanitizer even though they had been recommended to use sanitizer between client visits when water was not accessible. Furthermore, smaller clinics could not follow 1.5 metre separation guidelines due to their small rooms. Community health workers were not provided protection and had to buy and bring their sanitizing products and/or water containers before visiting households. In addition, their transportation costs to carry out their work were not covered. Also, healthcare providers and community health workers reported lack of training on Covid-19. Some healthcare providers even fled from patients with Covid-19-like symptoms. Poor quality PPE was linked to Covid-19 infections in healthcare workers.³⁴

The Covid-19 response reduced the affordability of healthcare services (due to lost income) and the quantity and speed of services available due to pandemic restrictions. It also affected access to essential drugs such as antiretrovirals, reduced antenatal attendance, and caused shortages in contraceptives among many other commodities. It is of concern that Caesarean-section rates increased during the pandemic to beyond the WHO recommendation of 10–15%.³⁵ In addition, maternal health resources, including health workers, were being reallocated for Covid-19 patients, slowing down maternal health services.³⁶ In neonatal care, health providers were under increased burden because regulations mandated that Covid-19-positive mothers should be separated from their babies and that both should be cared for separately. In addition to the health system strain, mandating the separation of Covid-19-positive mothers from their infants was more harmful than helpful, particularly as it can cause physiological stress for both mothers and children.

Overall, Covid-19 was characterized by mass unemployment, loss of income, and increased dependents. Labour participation fell due to the pandemic from 75% in 2019 to 56.8% in April 2020.³⁷ At least one million people lost their jobs or were placed on unpaid leave in both formal and informal sectors as of June. This is in part because curfews and restrictions that made jobs redundant. According to a survey published in August, 69% of Kenyans reported reduced earnings and 43% reported a complete loss of income. Many upper/middle-class Kenyans let go of their domestic workers due to fears of contracting Covid-19, exacerbating unemployment among the lower class.³⁸

Economic insecurity caused by reduced earnings and job cuts made it difficult for vulnerable individuals to pay rent, with 30.5% of Kenyans reporting that they could not pay rent in April and only 41.7% of tenants reporting that they paid their rent on time.³⁹ However, only 8.7% of landlords waived rent in April, while others resorted to ending contracts, locking tenants out, and cutting essential services.

According to one survey, 92% of Nairobi County’s low-income residents had suffered reduced income by May 2020.⁴⁰ A study by the Population Council revealed that 80% of individuals living in Nairobi’s most significant urban informal settlements had experienced a decline in income, increase in expenditures, and increase in food prices. Most respondents had not received government support. In general, there was a lack of social support systems that could provide adequate resources for sustenance. Individuals who worked from home often experienced internet problems, including low connectivity and affordability of internet services. This restricted the ability to work from home, forcing some back to workplaces where they could not socially distance themselves.

According to one key informant, it appeared that the guidelines influencing the fiscal response were ‘copy/pasted’ from well-established economies that had substantial stimulus packages that Kenya did not have. In doing this the response did not accurately consider the challenge of supporting vulnerable groups.⁴¹ Another key informant pointed to the gaps in mitigation measures for vulnerable groups, noting that the extent of their consideration was not very reflective in the issuance of guidelines. Had the government focused its attention on specific populations, the language would have been less generalized across policies.⁴²

Research suggests that attempts to create policies and plans mitigating the impact of the lockdown did not take into consideration the specific needs of women, and as a result, the lockdown measures also disproportionately impacted the livelihoods of women.⁴³ More women worked in jobs that were vulnerable to disruption, including the service and manufacturing industries. Women also tend to operate businesses associated with traditional gender roles and therefore require face-to-face interactions. Single mothers who contracted Covid-19 or could not work due to pandemic measures risked bringing the household into economic insecurity more so than in two-parent households. In addition, fewer women work in formal employment and thus did not benefit from tax reliefs to the same extent as men.⁴⁴

Women comprise more than 60% of informal businesses. The partial lockdown disproportionately impacted informal sector workers, who survive on daily wages and work in casual labour or petty trade and often lack access to the financial resources, social protection, or employment benefits necessary to survive financial shocks.^45,46 In addition to the impact of travel restrictions, the imposition of a curfew limited their income and put them in danger of poverty.⁴⁷ Due to the lack of a regional response to Covid-19, trade declined by more than 50% in the early months of the pandemic and impacted cross-border traders, most of whom were women.^48,49 Finally, significantly more women than men reported increases in household expenses.⁵⁰

Many fiscal policies designed to provide financial reliefs focused on those with a steady income, leaving out all of those in the informal sector (which comprises 85% of the urban population). These exclusionary policies included tax relief for low-income individuals, relief funds, suspension of listing with the Credit Reference Bureau, and a Covid-19 support stipend to target poor communities.^51,52 Social protection relief measures came into effect after people had lost their income, and logistical challenges impeded implementation in many cases, leading to minimal relief.^53,54 One study proposed that direct cash transfers and utility fee waivers could have been more beneficial for informal sector workers. Tax relief programmes did not reach those who did not pay taxes, such as those in the informal sector who live most ‘hand to mouth’. Further, the tax relief benefit was repealed even as the curfew remained, still limiting the hours people could work, making it hard for them to earn enough money to start paying taxes again and supporting their families.

Eligibility for cash transfers was determined by pre-existing government registers, which are widely recognized to be incomplete. Key informants noted that there was a ‘poverty of data’ to help identify the most vulnerable and that the few data that existed were under-utilized for appropriate targeting. A key informant explained that the cash transfer programme, which pre-dated the pandemic, “has been based on a single registry, but this single registry has a blind spot-on poverty”, which seems like a significant shortcoming for such a programme.⁵⁵ Referring to the cash transfers, another key informant described them as “basically seeping out of the pipes that are supposed to deliver them to the recipients”⁵⁶ suggesting that, through corruption or inefficiencies, they did not reach their intended beneficiaries.

A key informant noted that had the government considered the number of people in Kenya who are small-scale traders or women or youths living in informal settlements or even in rural communities and had brought populations such as these to the decision-making table; the economy may not have been as affected as it was. The absence of trade unions, including for street hawkers, ‘matatu’ drivers, and other informal business sectors, from policy development processes created blind spots that exacerbated the economic impact of the response.⁵⁷

For young children, alongside the vulnerability of caregivers to morbidity and mortality, the restricted access to social protection services or psychosocial support may have prevented caregivers from providing effective nurturing care to their children.⁵⁸ When caregivers succumbed to Covid-19 or indirect health impacts of Covid-19, children were orphaned.⁵⁹ Moreover, when caregivers experienced financial hardship or became ill during the pandemic, children were forced to beg for food and engage in hazardous work, and they also became vulnerable to violence and exploitation.⁶⁰ To supplement the family income, children participated in a variety of labour activities, including khat plucking, fetching firewood, tea picking, coffee harvesting, working as part-time house help, running farming errands, household chores for employers, selling water at kiosks, and babysitting, all of which prevents them from engaging in learning.

Young people were disproportionately affected as they were primarily employed in the informal sector.⁶¹ Youth reported income loss, increased expenses, increased food costs, and loss of jobs. As a result, they were forced to engage in income-generating activities to support their families.⁶² An economic stimulus plan included a particular focus on youth to reach large segments of informal workers and invest in long-term economic success; it will be important to evaluate its implementation and impact.⁶³

Sex workers, whose income was essentially wiped out by curfew measures, were noted to lack alternative sources of income, and yet some were openly criticized for breaking physical distancing rules in crowded informal settlements. Some sex workers produced and sold personal protective equipment (masks, sanitizer) to generate alternative forms of income.⁶⁴

Released prisoners face a range of challenges, including vulnerability to criminality, difficulties reintegrating into the community due to insufficient re-entry preparation and a lack of counselling, lack of access to income-generating activities, and, for those living with HIV, particularly the elderly, a potential lack of support. Offenders on probation would have challenges meeting with probation officers due to Covid-19 measures.⁶⁵ The pandemic measures exacerbated challenges faced by refugees trying to be economically productive and resulted in greater economic instability among this population.⁶⁶

The most common coping strategy was to change dietary patterns and rely on savings. Other strategies included reduced gifts/remittances, lending less money, postponed loan repayments, depositing less new savings, increased support from family and friends, and selling assets. As economic strain increased, there was a reported increase in dependence on relatives and friends for food, remittance, masks, sanitizers, and medicine. Coping through savings was more associated with the ability to withstand income shocks and remain food secure than coping through social protection schemes.^67,68 Two groups of people reported financial gains from the pandemic: boda boda riders who indicated that sneaking individuals past road barriers was financially rewarding due to their increased rates, and those who were eligible for full or partial tax relief.

GDP growth of about 6% was forecast prior to the pandemic, but this was not realized, subsequently affecting the financial sector. The effects of this contraction were widespread and had significant implications on the government’s ability to raise taxes and carry out necessary functions. One key informant pointed out that the debt level rose as Kenya had to take on additional debt from the World Bank, among others, for the emergency response.

Small businesses were negatively impacted, with permanent closures and an enormous loss of savings. Businesses experienced decreased production, a shortage of goods, and disruption within the supply chain. The worst-hit sectors were tourism, transport, horticulture, communications, and education. Changes in burial traditions due to Covid-19 had a spiralling impact on multiple different groups of people, including catering service groups, photographers, small traders selling things outside funerals, music providers, motorcycle operators transporting mourners to funerals, loitering groups who preyed on food at funerals, and illicit brew sellers. The closure of bars, restaurants, and schools pushed employers to terminate contracts, sometimes in a manner contrary to their employment contracts.

Curfews and other restrictions reduced the number of hours of work available per week in almost all sectors of the economy, especially in education and the hotel sector, causing reduced revenue and job losses. In addition, while Kenya reduced VAT from 16 to 14%, this did not help the business community because their sales volume had decreased dramatically. One study suggested that to aid businesses, it would have been helpful for the government to remove payroll costs. Some businesses benefited from the pandemic response; 12 companies were awarded Ksh 3 billion contracts with KEMSA to provide items not covered by the government budget.⁶⁹

The pandemic measures specifically impacted the fishing industry, causing a decline in fishing trips. Market closures made it hard for fisherfolk to sell their fish and farmers to sell their cattle. Farmers were more likely to suffer income shocks compared to salary and wage earners because they reported difficulties accessing their farms, accessing farming inputs, and transporting their produce to markets due to the lockdown. Some wage earners, although by no means all, could work from home and earn an income. Kenyan farms also reduced exports to 50%, placing them in danger of downsizing and closure, which would increase poverty, insecurity, and hunger.⁷⁰ Lack of manufacturing from neighbouring countries caused a halt in the production of the dairy meal and unaffordable hay, leading to reductions in milk yield for farmers and an increase in milk prices. Rather than relying on savings as a coping strategy as salary-earning workers do, farmers and low-wage earners are more likely to cope by changing dietary patterns.

Though there was the intention to reach the most vulnerable, including the poor, through the different measures, it appears that this was unsuccessful due to two main factors: first, the government appears not to have anticipated the impact the mitigation policies would have, particularly on the vulnerable and therefore failed to consider this when structuring the pandemic mitigation as well as the social protection measures. Secondly, the system in place to implement the social protection measures such as cash transfers and tax relief was blind to poverty and the informal sector⁷¹ hence it further disadvantaged the poorest and the near-poor who were sliding back into poverty. The need to update the register through various means was clearly articulated by most key informants who were not from the government sector.

There were reported rises in sexual offences, domestic violence, intimate partner violence, gender-based violence, and violations of the rights of children during the pandemic.⁷² Financial pressure due to Covid-19 stimulated violence against individuals, some of whom were thrown out of their homes during the pandemic without financial support. A survey revealed that 10% of Kenyans reported being worried about GBV and 21% reported being worried about domestic violence during the pandemic.⁷³

Covid-19-related isolation and economic anxiety amplified the mental health crisis in Kenya: isolation, cessation of movement, and loss of jobs due to the pandemic caused fear, anger, loneliness, stress, and anxiety in most Kenyans, particularly those of low income. As a result, about 75% of Kenyans reported worry, stress, and anxiety; suicides were also reported.⁷⁴ The inability to attend social gatherings contributed to these feelings of fear, uncertainty, and stress. The mental and psychological stress could partially be attributed to lack of health insurance and fear of loss of livelihood, both of which disproportionately affect those of lower socioeconomic status.⁷⁵

Accessibility to food was reduced due to food shortages, income loss, increases in food prices, bans on outdoor markets, and diversion of funding from nutrition services to the Covid-19 response.^76,77 The pandemic was reported to have worsened an already bad food crisis; many individuals limited food consumption and a majority of Kenyans worried about food insecurity. Three-quarters of individuals reported eating less or skipping meals and that their most significant unmet need was food.^78,79,80 86% of Kenyans overall were worried about having food.⁸¹ Families incurred debts from vendors, neighbours, and landlords and reported sacrificing their nutrition to provide adequate food for children.⁸²

Covid-19 Responses: Inclusion and Accountability

Many stakeholders were active in the Covid-19 response but seemingly working independently rather than seeking involvement in the national response. The main role of these non-state actors seems to have been to provide financial support for vulnerable communities and direct funds for Covid-19-related relief programmes and innovation. Global and international organizations, as well as the private sector, collaborated to provide support to Kenya through money, food assistance, and other essential resources. The national private sector institutions involved in these efforts appear to represent large-scale, well-established companies. Representatives of the informal economy, on which most Kenyans rely, were not included in advisory committees nor the management and distribution of Covid-19-related relief funds.

Civil society was more proactive in pushing for inclusion in the governmental response and demanding government accountability for the response. National-level civil society actors tried to help shape the legal and policy environment from the very beginning of the response, informing the government about things it would be essential to consider. However, one key informant described this as “an exercise in futility” as the government did not heed this advice. In some instances, they only provided 1–2 days for civil society input, making comprehensive consultation impossible; in most cases, none of the recommendations were taken on board. The minimal room for public input into the regulations, which limited public and parliamentary scrutiny of the response, was challenged in Court.

There was disappointment among civil society actors with the measures that the government introduced, with one key informant highlighting the stigmatizing language used in some regulations and the negative impacts that many of the regulations have had. Furthermore, the top-down approach led to inappropriate measures with unintended negative consequences that might have been better foreseen had civil society, including representatives of vulnerable and marginalized populations, been active participants in designing the response.⁸³

There were challenges to ensuring accountability for the national Covid-19 response. Ostensibly, the Kenyan Judicial system was an accountability mechanism to ensure that all laws enforced during the pandemic did not infringe upon citizens’ civil, political, economic, or social rights. In some cases, this worked well. For example, when Kenya Airways tried to amend workers’ contracts due to economic hardships during the pandemic without consulting unions, the Court ruled against this. They specifically protected the workers’ rights and prevented the company from making decisions that could have consequences for employees, regardless of the pandemic.⁸⁴ However, in other cases, perceived impunity persisted. For example, one key informant shared reports that parliamentarians were involved in the ‘disappearance’ of PPE, yet no action was taken to investigate this. Responsibility for the health worker strike fell between the national and county governments, with nobody assuming ultimate responsibility for its cause or resolution.⁸⁵ Civil society organizations took the lead in pressuring the government to implement Covid-19 measures and address accounts of police brutality and corruption. In Homa Bay County and Siaya County, lobby groups and civil society contacted the police and released statements urging police to not act with force.⁸⁶

Overall, the responses and reactions to Covid-19 in Kenya may endure and exacerbate inequalities, worsening health conditions of the most vulnerable due to resource allocation and other measures.

Conclusion and Recommendations

The pandemic exposed societal inequalities and lack of emergency preparedness, which must now be addressed. Fighting poverty and addressing inequalities should be prioritized. The importance of a targeted approach that considers people’s differing vulnerabilities and resilience has been emphasized. This might best have been achieved by ensuring that all appropriate stakeholders were represented in the design and governance of the Covid-19 response. While this might not have been possible in the initial stages of the response, at the later stages, membership of advisory committees and other governance structures might usefully have been revisited. It would have been essential to improve coordination between national and county governments and governments at all levels and civil society. Transparency in decision-making would have been essential to allow people to understand how trade-offs among competing needs were being made and to provide avenues for accountability as necessary.

While fully recognising the government's need to move quickly in the face of a crisis, adopting a participatory approach that included broader inclusion of stakeholders from different parts of the private sector as well as civil society might have helped identify potential shortcomings and allowed for more appropriate options to be put forward. Young people constitute a large proportion of the total population; they are embedded in communities and often committed to effecting positive change. This is a demography whose involvement in the response should have been considered.

Although key informants’ views on government receptivity to criticism varied, civil society representatives working on health noted that the government was open to criticism and magnanimous even in accepting that criticism. Instead of ignoring feedback, the government listened and showed some degree of openness to the media too. Furthermore, as the pandemic progressed, the government appeared to react more responsibly and responsively to people’s needs.

The people’s trust in their government is critical during a crisis such as Covid-19 when the government must ask people to make sacrifices and follow public health directives. Mired in a long history of corruption allegations, the government was not well-positioned in this regard going into the Covid-19 pandemic. It should not wait for the next disaster to try to build this trust. A conscious effort to rebuild trust in government structures, institutions, and leaders is urgently needed. As noted by one interview participant, community trust in government is critical, and two immediate opportunities for helping to rebuild this trust include ensuring an efficient and equitable vaccine rollout programme and building a robust health system to support the achievement of Universal Health Coverage.

It would be helpful to create emergency structures that can be mobilized as the need arises to tackle pandemic. This would include multi-stakeholder planning groups that would allow for government responses to be informed by a broad range of civil society and private sector actors and representatives of different sectors, including public health, economy, education, labour and justice, to help ensure a coherent, comprehensive response. In addition, understanding and better documenting the synergies between different stakeholders’ work in the response would help allay competition concerns and identify how each organization or constituency can best play to its strengths in a collaborative and coordinated response.

All restrictions can have economic consequences. That is not to say that epidemic response is a trade-off between health and the economy. Rather that if restrictions are warranted from a public health perspective, the economic impacts on different groups of people must be foreseen and mitigated. Given that there will be more infectious disease outbreaks, it will be helpful for the government to plan how they might financially support a large proportion of the population in order that they might be able to follow the necessary directives. For any response to succeed, it must be pro-poor. This is another area where attention to committee membership is critical: those with a seat at the table can lobby for their constituents’ interests; those excluded from the committees have no voice in these policy discussions.