The project began in 1983 as an expansion of a rural health scheme, started by the African Medical and Research Foundation (AMREF) in 1980 at the request of the Government of Kenya. It continues to this day.
Coverage
The project covers three divisions (Kibwezi, Makindu and Mtito Andei) of Makueni district with no expansion in its two decades of existence. The area is semi-arid to arid with low and erratic rainfall, hence highly prone to frequent drought, severe food shortages and scarcity of water. The average annual rainfall is 500mm. The total population in the three divisions is estimated to be about 130,000. About 90 percent of the people depend on rainfed subsistence agriculture, while 10 percent are involved in irrigated horticultural production mainly for local consumption and some for export. The project covers the whole population, but with a focus on children under five years of age and women.
Implementation
AMREF is the agency designated to facilitate the implementation under the overall coordination of the Divisional Development Committees. Depending on the nature of the activity, implementation of interventions is the responsibility of the relevant sector, with financial and technical backing from various non-governmental organizations (NGOs). The project is not implemented in a package but rather by "convergence". Various activities in food security and water supply are being implemented but they are not within the control of the project, although they work closely with it.
Operational funds
Funding for the project comes from three sources: the community (mostly in kind), NGOs and the Government. The percentage distribution of the various contributions could not be ascertained, but it is clear that the NGOs contribute the major part, followed by the community and lastly the government.
Objectives of the project
The overall goal of the ANP is to increase household food security and improve nutrition security in three divisions of Makueni district (Kibwesi, Makindu and Mtito-Andei).
Specific objectives are as follows:
There is no specific mention of reduction in the prevalence of undernutrition in the objectives.
Project focus and entry point
Interventions aimed at alleviating food insecurity, malnutrition and water supply are the three priority needs and uncompromising demands of the people. The most feasible entry point to the community is through the traditional organization of women’s groups, locally termed “Mwethya” and the village councils. The most common forum for community decision-making is the traditional “Baraza” (community general meeting).
Project impact
Adequate information to assess outcomes and impact is lacking because indicators to measure the interlinkages between outputs, outcomes and impact have not been well established. From information gathered from four community-based surveys, it was shown that there has been no significant decline in nutritional status, but the situation seems to have fluctuated somewhat depending on the drought situation. Hospital and other health facility records and information gathered from health personnel indicate a significant drop in the number of kwashiorkor and marasmus cases. This observation, however, needs to be verified through further community surveys.
Community participation
There is active involvement in identification of needs, planning and interventions as well as overall management of a targeted food-for work programme (setting of selection criteria, identifying beneficiaries and projects, distribution of food, reporting). Some communities have been able to manage some of the services such as water supply and health posts. The community involvement in monitoring and evaluation is less apparent, partly because the project itself lacks a systematic monitoring mechanism. Howver, communities know exactly what they need and they know what is going on in their locality. Against this assessment, community participation could be classified at a level of “functional involvement”, but needs to be consolidated.
Lessons learned
Strengths, weaknesses, opportunities and constraints/threats (SWOC)
Strengths
Weaknesses
Opportunities
Constraints/threats
Sustainability
The level of community involvement is high and the capacity development efforts made are commendable. Communities have been able to witness what they can achieve if they are fully involved and this seems to have encouraged them to do more. Although weak, the government institutions will continue to exist, so also the coordination under the development committees. On the other hand, the project still needs some improvement.
There is a need for a clear and measurable nutrition objective and its related indicators. The direct nutrition interventions have to be accelerated. The monitoring system must be revisited. As the area is very vulnerable to drought, and the majority of the people do not have a strong asset base (although they now have better knowledge of how to mitigate the effects of drought), some external input will still be required from the government or elsewhere. Judged against these and other elements, I would say that as it stands now, the project as "a project" has a “fair chance of sustainability”. However, some of its achievements such as the drought-tolerant seeds varieties, the agricultural skills acquired, the group seed banking system, the improved goat breed, the management of water supplies, are highly likely to be absorbed into the community system.
Kenya, with a population of about 30 million, has experienced a consistent decline in its economy over the last few years. The current per capita GNP is estimated to be about US$ 280. The economic recovery programme has been designed but it has not improved the situation substantially. The situation is further aggravated by the refusal of the international financial institutions (World Bank, International Monetary Fund, European Union and others) to give loans or grants for the last seven years. The Government has also a heavy debt to repay, and dealing with recurrent drought in some areas places a heavy burden on the country’s resources.
The Government is committed to improving the food security and nutritional well-being of the people as stated in various international resolutions, national policy documents and programmes. However, it has not gone far enough to translate these into concrete action on the ground, largely owing to the above-mentioned and other global factors.
As a result of the economic decline, expenditure on social services has dwindled leading to an inability to maintain the quality of the existing services and expansion of others, including nutrition. According to a report on public expenditure (Social Dimensions, 1998), the allocation of government expenditure on health, between 1980 and 1995 was 8-9 percent with a further decline to 6 percent in subsequent years, and most of the allocated budget goes for curative care. This situation is further aggravated by the HIV/AIDS epidemic, which not only places heavy demands on curative services, but also impacts negatively on the general economy of the country.
The Government of Kenya has developed policies and programmes and has also established institutions to address the very complex nature of nutrition problems. However, fluctuating rainfall patterns, recurrent widespread droughts and the economic situation have continued to adversely affect the country’s food security.
With respect to national human resource capacity in nutrition, according to a study conducted by UNICEF (1999), Kenya has the highest number of professionals in nutrition in the Eastern, Central and Southern Africa (ECSA) region. However, not all have been effectively utilized. There are many colleges of agriculture, a college of nutrition and a postgraduate training programme in applied nutrition, the only one of its kind in the ECSA region. The latter has also trained people from other African countries.
In a bid to promote food security and nutrition, a group of concerned nutrition professionals have formed an association called the "Kenya Coalition for Nutrition-KE-CAN". Its mission is to mobilize resources and promote food security and nutrition in the country. It also acts as a pressure group advocating for the role of nutrition in development, urging the government to invest in nutrition. Furthermore, it plans to offer an important forum for dialogue.
Makueni district is located in the Eastern province of Kenya. It is divided into 16 divisions and has a population of about 778,000 people. The district has a semi-arid vegetation, with low and erratic rainfall. Hence the people rely on an inadequate, fragile and uncertain resource base under constant threat of drought, resulting in food insecurity and undernutrition. Makueni is one of the most food-insecure areas of the country, and the situation is worst in the three divisions where the Applied Nutrition Project (ANP) is being implemented. Using both the Welfare Monitoring Survey System (WMS 1998), and the Participatory Poverty Ranking Method (PPRM), over 70 percent of households were classified as poor or very poor.
The ANP covers three divisions (Kebwezi, Makindu and Mituduni) with a total population of about 130,000. Many other development projects, mostly in food security and water supply, are also in progress. All the projects in the district have the opportunity to share their experiences through the quarterly meeting of the district development committee.
The main livelihood of the people is subsistence agriculture, of which 90 percent is rainfed and about 10 percent with irrigation. Livestock rearing, apiculture (bee-keeping) are also common. Other income generating activities include hired labour, mainly in small towns, and the irrigation schemes, selling of charcoal and fire-wood, brick making, petty trading, selling of vegetables (by those who have irrigation) and, when available, food aid. Women do most of the agricultural activities. Men are largely involved in other income generating activities in and out of the vicinity.
There is a serious concern about the environment. The forest is being depleted, owing to the massive burning of charcoal, which leads to desertification and worsens the drought situation, and thereby aggravates food insecurity. Several efforts are under way to counter deforestation, but with limited success owing to the demands of household food security.
Health and nutrition
The leading health problems affecting children are upper respiratory tract infections, malaria, diarrhoea and parasitic infestations in synergy with malnutrition. The prevalence of stunting has been fluctuating between 35-45 percent during the period 1985 to 2001 depending on the drought situation.
The effect of local culture on the project
The people belong to the Kamba tribe, which has the following characteristics relevant to the programme:
The planning and development of the ANP
In 1979, following severe drought, the Government requested AMREF to help improve the health services of the people of Makueni district. A health centre to serve the three southern divisions (Kibwezi, Makintu and Mtito) began operating in 1980.
In 1983, a community-based project was added by opening up eleven outreach posts using mobile teams. The activities focused on immunization, antenatal and postnatal care, growth monitoring and promotion, health and nutrition education and the training of community health workers and traditional birth attendants (TBA). The outreach programme was implemented for three years and then stopped due to high cost and logistic problems. However, some of the communities through their own initiative built permanent health posts using local materials and requested the government to support them with medical supplies and health personnel. Salaries of local support staff were to be paid by the community from the money collected from nominal medical care fees and sales from drugs. The management would be under a health committee. All these have materialized to date.
In 1984, the district was hit by severe drought. So AMREF opened up rehabilitation centres to provide supplementary feeding for severely undernourished children (<- 3 Z-scores). When the acute emergency subsided, the idea of developing an integrated long-term intervention (“relief to development continuum”) was conceived and after a series of consultations with the development committee and community representatives, the ANP began in the same year with a series of sensitizationmeetings.
A baseline survey was conducted with full involvement of members of the community. Community health workers (CHWs) played an active role in the survey. Relevant interventions were then identified together with the community, based on the survey results.
At this stage, AMREF also shifted its role to be more of a catalyst, mobilizing and supporting other sectors, soliciting external funds, thereby focussing on its original agency mission "enhancing community participation and support system capacity to improve and sustain communities' health, well-being and overall development" (AMREF, 1996).
The goal of the ANP is to increase household food security and improve nutrition security in three divisions of Makueni district (Kibwesi, Makindu and Mtito –Andei)
Specific objectives are as follows:
There is no specific mention of reduction in the prevalence of undernutrition in the objectives.
Due to lack of clarity of the interlinkages between activities, outputs, outcomes and impact, and the absence of comprehensive data, it was not possible to examine the full range of effects and impacts. With respect to nutritional status, in the face of constant drought and food shortages, it may be difficult to show gains. From available data, it seems there has been no significant decline, and the situation has been maintained despite the drought and inadequate direct nutrition interventions.
Two sources of information were considered to assess the nutritional impact:
The CHANIS data are fragmented and unreliable. The prevalence of underweight observed from the CHANIS does not have any similarity to information gathered for the same index from the community surveys. The CHANIS data, in any event, is no longer gathered owing to the collapse of the CHW service. So, data from four systematically conducted community-based surveys were used in this report. Three of the surveys were project area-specific, one covered the whole district but included all the three project area divisions as well. The surveys were very well designed and analysed professionally.
Table 1 : Prevalence of stunting and underweight (<-2 Z-scores): survey results
Indices |
1985 * |
1994 ** |
1999 *** |
2001 **** |
Stunting % |
33.3 |
45 |
40 |
37 |
Underweight % |
- |
32.5 |
29.2 |
31 |
Source: * AMREF: Kibwezi Integrated Study, 1985. | ||||
In 1994, a national nutrition survey undertaken by the Central Statistics Office (CSO, 1994) revealed that Makueni district had the highest prevalence of stunting in the country: 50 percent, as compared to the provincial average of 38.5 percent and the national average of 34 percent. This result concurs with the above result of 45 percent of another survey done in the three divisions in the same year, but at different seasons. The district was hit by severe drought in 1994.
Table 2 : Cases of kwashiorkor and marasmus seen at Makindu Hospital
1995 |
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
204 |
126 |
98 |
50 |
32 |
16 |
12 |
Source: Makindu Hospital Records (severe cases of any illness are referred to this hospital) | ||||||
It was also noted from the hospital and other health facility records as well as information gathered from the health personnel that the number of kwashiorkor and marasmus cases has decreased dramatically. However, this claim needs to be verified through a community survey. The prevalence of anaemia both among women and children is high and it is attributed partly to malaria, which is highly endemic in the area.
Generally, there has not been a significant improvement in the prevalence of undernutrition but the situation has been contained despite the worsening drought conditions.
Various stakeholders are involved in the planning and implementation of the project:
Other NGOs, mainly dealing with food security and water supply, are not under the direct control of the ANP but work very closely with AMREF and the respective sectors:
Other institutions: Kenya Agricultural Research Institute (KARI) and the Kenya Forestry Research Institute (KEFRI) also function in the area.
There is no decentralization yet. The administrative offices at all levels are accountable to the Office of the President through the appropriate hierarchy: from village, through division, district, province, to the Office of the President. Similarly, each sector is accountable to its ministry through the appropriate hierarchy. Each sector’s budget is also allocated by the respective ministry through the treasury. Health units, except those run by the community, are not allowed to use the income they generate directly.
At the village level there is a village council and traditional groups such as the Mwethya women groups mentioned earlier. There are also committees for specific activities such as the health committee, water committee, roads committee. Some of the committees have been created with projects while others existed before and are likely to continue to exist after the end of project support period.
Although there is no decentralization and each sector appears to function independently, there is a coordination mechanism within the government structure at each level. Under each administrative office there are various committees chaired by the respective level administrator. The most important one is the development committee. The members include representatives of sectoral ministries, relevant development partners and community representatives. The development committee has an executive technical subcommittee, which prepares the agenda and monitors the implementation of the committee’s recommendations. It is worth noting that any development project, irrespective of who initiates it, is subject to scrutiny and approval by the respective level development committee. The ANP has not been an exception to this rule.
All development committees are not active but generally the lower the level the more active they are. The divisional development committees in the ANP area are active. There are regular quarterly meetings where all development related issues are discussed including the ANP. All sectors are required to report to the committee on their activities and bring forward issues they wish to be discussed. Lacking is a well structured and systematic reporting system, which could distinguish between planned and accomplished activities.
The administrators are constrained by resources but they are very supportive of community actions and very appreciative of NGO contributions. On the issue of coordination, while the administrators feel that it is important, some extension workers felt otherwise: while desirable, it often impedes rather than facilitates actions.
Many community workers, TBAs, water supply maintenance artisans, community veterinary workers (paravets), community health workers (CHWs) have been trained in good numbers. The TBAs and the paravets are being effectively utilized, because individuals and, in the case of paravets, groups seeking their services pay the requested fee. The water supply artisans too are active, because communities are able to provide them with the tools and pay them some cash from the sale of water. The CHWs also started to do likewise but attendance decreased. Moreover, the health units did not have the means to support and supervise them and they gradually ceased to operate. Other approaches are under discussion in consultation with the community members, women’s groups and NGOs concerned, such as MACOSUD 29 .
Some of the possibilities include:
Although they may be few, there are technically qualified professionals in all the sectoral offices at the division level. Unfortunately, they are poorly facilitated to execute their duties: they have no transport and no daily subsistence allowance. The sectoral agencies at the division level do not have a significant budget, except staff salaries. As a result, there are no planned visits by extension workers. It has now become an "extension service on request", generally occurring in relation to the irrigation schemes, which serve few people.
Perhaps one of the main shortcomings of the project is its monitoring and evaluation system. This was acknowledged by the staff. Since 1998, the project has introduced activity monitoring (planned-accomplished), but it is not properly administered. The project has had only two systematic external evaluations in 1985 (Germano) and in 1992 (Bennet, et al. for AMREF, 1993).
The first evaluation of 1985 did not deal with the nutrition component adequately. The second one did attend to the nutrition component but was constrained by lack of data. The same evaluation appreciated the maturity of the community involvement and the efforts made in community capacity building by AMREF. The team had indicated some concerns: the lack of clarity of objectives, indicators; the weakness of the monitoring system and the decline in the services of the CHWs.
Since 1992, there has not been a comprehensive and systematic evaluation. However, the experiences learned from 1986-1998 have been well compiled and documented by AMREF (AMREF, 1998). Some good studies have also been done by postgraduate students on specific issues such as the CHW, credit, income-generating.
The plans of action and the various reports show that the project has indeed been dynamic. It has used recommendations to improve performance but has not been successful in correcting all shortcomings; some still persist. The objectives in the most recent proposal are much better than those in the original but still need refinement, especially in relation to indicators.
One of the strengths of the project has been its contribution to capacity development. A lot of effort, time and resources have been invested in skills training of professionals and community members. The various meetings, field visits, and the activity related to training, such as leadership and financial management, have contributed to good capacity development.
The efforts made in organizing and strengthening community groups, the establishment of seed banks, the promotion of high-yielding, drought-tolerant crops, enabling communities to manage some of their social services such as the peripheral health clinics and water supply have made good progress. Furthermore, the ability of community groups to manage targeted food-for-work programme, including identification of projects-based community felt needs, setting beneficiary selection criteria, identifying beneficiaries based on the criteria, distribution of the food by the beneficiaries themselves, and reporting on the distribution and progress, demonstrate their level of confidence and experience.
The key programme components were identified based on the survey, but they have been reviewed from time to time as indicated primarily by community members. The activities were implemented step by step, taking note of available resources and capacity (community and sectoral agencies). Training has always been given before the start of any intervention.
Increasing food production
Promotion of drought-tolerant crops: This activity is technically guided and supported principally by the Kenya Agricultural Research Institute (KARI), through the agriculture extension facilities of its dry land agriculture unit located in the ANP area.
Traditional crops in the ANP area were mainly millet, sorghum, cassava, sweet potato and cowpea. However, over the years there was a complete shift to maize and beans, which are sensitive to drought and pests. The reason for shifting to maize was mainly because it was to serve as both food and cash crop, as well as because of characteristics related to processing and preparation. There were also cultural beliefs labelling millet and sorghum as inferior foods meant for the poor (AMREF, 1996). As this shift was going on, KARI has been developing drought-tolerant sorghum and millet varieties.
The promotion of these drought-tolerant crops was facilitated by the ANP. After some training and demonstration on planting, farmers were provided with seeds from KARI to plant in their plots along with maize. When the drought came, the maize died and the sorghum, millet and cassava survived. Gradually people started mixed farming. This initiative has now taken off well with most farmers and is likely to be part of the production system once again. Discussion with community members especially women’s groups indicated agreement.
An important element included in the promotion strategy was to prepare a recipe from millet, sorghum and the legumes such as cow pea for child feeding and also to demonstrate to women that these crops can also be made into porridge and other dishes, just like maize.
Establishment of group seed banks: One of the problems in the communities was to get the right kind of seed, at an affordable cost and at the right time for planting. Even if families put aside some seed for the next season, often it is consumed in the event of a food shortage, especially in the case of poor families. With the initiative from the women’s groups, the seed bank idea came up, where every farmer (male or female) had to put a certain amount in a group seed bank to be released only at the time of planting. This has now become popular and well appreciated, especially by poor households. In fact, some groups sell extra seed to those who need more within or outside the group. Besides minimizing the access problem at the right time, the initiative has also played an important role in safeguarding the adulteration of the indigenous variety.
Some communities have overcome the problem of planting materials for cassava and sweet potato by developing centres to keep the seedlings until the planting season. Efforts have continued to extend the approach to other villages. Cassava is now becoming very popular in some areas. In one sublocation, over 80 percent of farmers have introduced it and hopefully it will expand to other areas once people appreciate its drought-tolerant qualities.
Support services include:
Increasing the income of families through credit
A credit facility was introduced in the year 2000 with a modest amount of funds received from NGOs, and coordinated by AMREF. It was aimed at helping women increase their household income by engaging them in income-generating ventures. Through a series of discussions with community members, regulations were laid down for eligibility for credit.
Any credit given should be repaid. However, there is a consideration of the repayment period. Generally, payment is dictated by how much the borrowers earn or on the drought situation. For example, in times of drought and unproductive years, they may pay half of what they are supposed to pay monthly or yearly, but in the long run all must be paid.
The rate of repayment has been encouraging. Over 85 percent of the credit given over the last 14-16 months was repaid, ready to be used by other groups. Encouraged by successful ventures, there is an increasing demand for credit. The credit facility essentially covers improvement of livestock, improved seeds, oxen, plough and petty trading. The poor households did not participate much initially except in poultry ventures, because of the 25 percent down payment, lack of experience and fear. However, after observing its success, their participation increased.
Small livestock improvement (goat and chicken): Goat breeding was preferred by the community because: a) goat breeding is common in the area; b) goats thrive well in the environment; c) they are easy to keep and are a good source of milk for children. So an improved breed was introduced: the "gala goat", which is bigger, produces more milk, and sells at a higher price. The other venture was poultry, again because it is a common practice. The project helped the introduction of a better brand of cockerel. The two ventures have done well in some communities, and people have observed examples of impressive success. However, the poultry ventures, although they have survived, have faced disease problems.
Credit for oxen and plough: The number of beneficiaries was small due to the high cost of oxen (10,000 shillings) and limitation of funds, it was however very successful. Households who made use of such credit increased their production by up to eightfold. Some of the examples from on the site visits based on an open-ended questionnaire include:
All confirmed that they survived the following year’s drought without any difficulty. They also indicated a change in the household’s food consumption in terms of diversification and frequency. In fact the scheme was so successful that more people, including the very poor, demanded credit and a reduction in the required down payment, in order to benefit more easily from the credit facility. What was not sufficiently documented is the effect of the increase in production on consumption patterns, diversification of family and child diets, and its impact on the nutritional status of children of participating families, compared to others.
The linkages between activities, outputs, outcomes and impact have not been well structured in the plan, and outcome and impact indicators have not been established, making it difficult to measure the nutritional benefit of such ventures.
Supportive services include:
Water supply and sanitation
Water is the most precious commodity for people and animals living in the arid and semi-arid lands and any agricultural project or programme not addressing the issue would be a failure. Thus, one of the most important components of the ANP project is the development of water supply. It involves mostly digging of shallow wells and, in some cases, extending pipes, roof catchments and other water harvesting methods.
The development of the water supply is a joint venture. The feasibility study, design and technical supervision of the construction is the responsibility of the branch office of the Ministry of Water through its field staff. The community participates in identifying potential issues for the feasibility study. In addition it provides labour and locally available materials. AMREF is involved in training community members in the management of water supply systems, including maintenance of the equipment such as pumps.
After the construction and installation of a water supply system, its management is the total responsibility of the community. The community forms a water committee (mostly women), charges for the services and uses the income to maintain and extend the supply system, as well as for other development work based on community needs. The committee buys the necessary maintenance tools for the trained local artisans and pays for their services. A visit was made to such locations. One community, for example, is making about 40,000 shillings (US$ 600) per month. A community was seen at work extending a pipe to another nearby village in order to help their neighbours and also to generate some additional income for other development projects for their community.
Women’s groups were asked about the advantages of participating and ultimately getting a clean water supply. Their answers were: time to care for our children, time to work on other income generating activities, unrestricted water supply, more income for families and the community. They use to walk for four hours and pay 15 shillings per 20 litres. Now for 15 shillings they can buy as much as 120 litres, at a distance of about 300 metres. Asked what this achievement means to them in terms of other development work, one woman said "I wish we had started long before, by now we could have solved most of our problems. We are now confident we can do anything if we get some assistance".
Nutrition education
Effective nutrition education requires good organization, support and supervision. Good knowledge of the subject and effective communication skills are essential, especially in view of the educational level of the rural communities. Both approaches were applied for 2-3 years at the beginning through community-based growth monitoring and promotion using CHWs. That approach did not survive due to lack of support for the CHWs. Even if that service had survived, the accuracy of the weight measurements, the plotting techniques and the quality of counselling were questionable, and the support and supervision to improve quality was not available from the health sector (AMREF, 1998).
Moreover, those attending the health unit are not given proper, individualized, nutrition education and counselling owing to shortage of staff and heavy workloads. General health and nutrition education is now offered in a group session, which is much less effective.
Food-for-work (FFW)
Food aid is another source of livelihood and is a component of the project. Since 2000, the government’s policy has changed from blanket coverage to targeted food-for-work (FFW). Communities were given the responsibility to do it by themselves with "hands off" instruction for administrators and politicians, who often tend to use food aid for their political gains.
In the ANP area, the selection of vulnerable households and subsequently the distribution is mandated to each community. “Barazas” are organized, community members set vulnerability and risk criteria, and select households accordingly. Selected households are registered, and the local administration is given the list of households for follow-up and reporting to the donor agency (WFP, through the divisional administration). The administration assures security during distribution, but has no say in distribution once decided by the Baraza. Projects to be implemented under the FFW are selected by the community. Accordingly, communities identified a variety of projects: water supply, building a maternity ward, irrigation schemes and school maintenance. The claims were verified through unplanned visits to a few sites, discussions with committee members, beneficiaries, local administrators.
On the question of equity: Equity is an important factor in community programmes to ensure that the poor and powerless have been fairly served. Looking at the ANP, generally, the project has made no distinction for all social classes of the community. In reality, however, this may not be the case due to cultural reasons, fear and time factor. As a result some of the services may not have been easily accessible to the poor. The collapse of the CHW affects the poor most because they need closer contact and support. The 25 percent down payment for credit may not be affordable by the poor. The poor have limited experience of business management, and even with training, unless there is strong extension support and follow-up, they may not benefit from the credit. Due to their weak asset base they tend not to take risks unless assurance is available. The poor need to devote their time to generating income for survival rather than attending meetings. This has been indicated during the assessment.
Decentralization has not been fully realized, and dependence on the central level remains high. However, popular participation and mobilization of resources is encouraged and supported by all government officials at all levels. This attitude is in line with what is clearly stated in the National Poverty Eradication Plan, which states “every Kenyan citizen has a basic entitlement to play a full role in participating fully in society’s affairs and help make decisions on those matters, which directly affect her or his material and social standing. Individual citizens have the right to play the full social roles to achieve a basic state of well-being, irrespective of their race, colour, sex, ethnic group, language, religion, age political affiliation, disability or any other circumstances of birth.”
With respect to the priority accorded to nutrition, policy and strategy are in place but grossly deficient in implementation. The country formulated a National Food and Nutrition Policy and Strategy, and a National Plan of Action for Nutrition (NPAN) in 1994, following the recommendation of the International Conference on Nutrition. However, the NPAN has not been effectively implemented for various reasons: lack of harmony among the various concerned sectors, lack of clarity on the plan with very broad and unspecific objectives and activities and shortage of resources (2001). However, with or without the NPAN, programmes and projects are being implemented by various agencies such as the ANP in Kibwezi.
There is growing awareness on the pivotal role of nutrition in development at the central level. In fact, Kenya has done much in nutrition advocacy using the “PROFILES", an interactive advocacy software but nutrition remains under-funded. The role of nutrition as an important development indicator is not well understood by the lower administrative levels. In the national budget allocation, the share of nutrition is subsumed within the allocation of various sectors such as health, agriculture, education, on the grounds that nutrition is not a “sector” in its own right, but an outcome of the efforts of the various sectoral interventions. The argument may be logical, however, most sectors have not ear-marked budgets for nutrition and if some, such as the Ministry of Health (MOH), have done so, nothing exists at the district level. According to the findings of the 1998 expenditure study, “the Ministry of Health’s budget share for nutrition services has fluctuated widely in the period under consideration (1980 to 1995), with no evident pattern. As a proportion of government budget and as a proportion of real gross domestic product, it remained a very negligible value.” This situation still persists:
Table 3 : Nutrition services – budget and expenditure
Year |
Nutrition services as % of MOH budget |
Per capita nutrition services expenditure (K shillings) |
1980 |
0.14 |
0 |
1981 |
0.15 |
0 |
1982 |
0.01 |
0 |
1983 |
0.32 |
0 |
1984 |
0.52 |
0 |
1985 |
0.44 |
0 |
1986 |
0.43 |
0 |
1987 |
0.40 |
0 |
1988 |
0.47 |
0 |
1989 |
0.70 |
0 |
1990 |
0.55 |
0 |
1991 |
0.51 |
0 |
1992 |
0.51 |
0 |
1993 |
0.47 |
0 |
1994 |
0.37 |
0 |
1995 |
0.08 |
0 |
Recently the government has developed and enacted the “National agricultural and livestock extension policy” in an effort to enhance agricultural and livestock production and thereby contribute to the improvement of household food security. The policy recognizes that the extension services should go beyond food production and be involved in the issue of food access and nutrition, which had been one of the weaknesses and criticisms of the extension services. Furthermore, it stresses greater participation of the private sector and the community in decision-making. “Local communities should be involved in all activities to be implemented in their areas by conducting participatory procedures”. Generally, extension must be demand driven and beneficiary led with clear mechanisms of accountability.
In general, there are many policies in support of food security and nutrition, there is a political will and commitment, the infrastructure though declining is in place, community involvement is highly encouraged and supported, but amid all these, resources are extremely limited. So sustainability through government resources is unlikely, at least for some years to come.
Community participation in the project area has evolved to greater engagement over the years. According to information gathered from various individuals, elders, leaders, extension workers, women’s groups, and administrators, community participation was very passive in the earlier years, because people were unused to demanding and receiving what they wanted, but rather they took what was given to them. However now things have changed. Any initiative could come from any level or any agency, but it will never materialize unless the people accept it and it falls within their needs and priorities. Many examples were cited by the administrators, extension workers and community members.
These communities know exactly what they need, what their priorities are. What they did not have was the capacity and the forum to express them, which has now been greatly improved, but not yet to the desired level. Many reasons were given for such developments, noteworthy among which were:
It must be acknowledged that no matter how active communities may appear to be, they need some technical support and some institution to work with them. Their problems are immense, their educational level is low, their resources few, in a fast advancing world. It is only fair to say that this holds true for the ANP area communities.
AMREF (African Medical and Research Foundation). 1985. Kibwezi Integrated Study. Kenya.
AMREF. 1993. Evaluation of the Kibwezi Rural Health Scheme: Experiences of 14 Years Community Involvement in Health and Development, by Bennet, John et al. AMREF, Kenya.
AMREF. 1994. Nutrition Survey in Kibwezi. Kenya.
AMREF. 1996. Addressing Child Nutrition Using Locally Produced Foods.
AMREF. 1998. Nutrition project proposal (1998-2000). Submitted to the European Union.
AMREF. 1999. Makueni Applied Nutrition Project: Experiences and Lessons learned, 1986-1998. Kenya
CSO/MPND (Central Statistics Office/Ministry of Planning and National Development). 1995. National Nutrition Survey 1994. Kenya.
German Agro Action/AMREF. 1999. Nutrition Survey Report. Kibwezi, Makindu and Mtito Divisions, Kenya.
Germano M. Mwabu & Abeba. 1985. Mid-term Evaluation of AMREF's MCH/FP/Nutrition Project (USAID Grant # 615-0216).
Government of Kenya. 1999. National Poverty Eradication Plan (NPEP)
Mackenzie, Caroline N. 2001. Nutrition Survey in Makueni district, 2001 (includes all three divisions of the ANP, Kenya).
Ministry of Agriculture. 2001. National Agricultural and Livestock Extension Programme: Ministry of Agriculture and Rural Development, July 2001-2003. Kenya.
Owuor, John. 2001. Kenya Country Paper. Presented at the Regional Workshop for Anglophone African Countries on the ICN Implementation Follow-up. Harare, Zimbabwe. March 2001.
Social Dimensions of Development Secretariat. 1998. Public Expenditures on Basic Social Services in Kenya. Consultancy report prepared for SDD Secretariat.
UNICEF. 1999. Training Needs Assessment in the ECSA Region for Human Resource Development in Nutrition. ESARO, Kenya.
27 In the Kamba culture, every woman young or old, of any religion or social class, must be a member of a group of women (10-15 members), locally known as “Mwethya”. Such a formation is deeply rooted and it is exclusively for women to help each other in the social and economic problems faced by their families. Groups meet once every month or two months and contribute money each time, to be given to needy members or saved for hard times. This structure can be used by any agency so long as it has to do with improving the socio-economic conditions of the groups or their community.
28 “Baraza” means community meeting. This is a forum called by administrators and community leaders to discuss and make open decisions on socio-economic conditions affecting a community, locality, district etc.
29 Makoni District Action for Community Development.
30 A farmer is given certain amount of seed to be repaid double; thus at the next round other farmers can be offered seed.
