Situation Analysis of Children and Women in Kenya, 2017 Situation Analysis Situation Analysis of Children and Women in Kenya, 2017 Suggested citation: UNICEF (2018) Situation Analysis of Children and Women in Kenya 2017, UNICEF, Nairobi, Kenya. Cover photo © UNICEF Kenya/2016/Noorani. ii of Children and Women in Kenya Situation Analysis of Children and Women in Kenya, 2017 iii Situation Analysis Table of Contents Foreword xiii Acknowledgements xiv Executive Summary xv Introduction xv Key findings xv Enabling environment xvi Surviving and thriving xvii Learning xix Protection from violence, abuse, exploitation and family separation xx Safe and clean environment xxii Children and emergencies xxiv Equitable chances in life xxv Introduction 1 Chapter 1: Background 2 Geographical and climatic overview 3 Demographic overview 4 Economic overview 6 Social overview 7 Gender overview 8 Political overview 9 Chapter 2: The framework for children’s rights in Kenya 10 The Sustainable Development Goals and Kenya Vision 2030 11 Children’s rights framework 12 Devolution 12 Financing and coordination of government policy on children and youth 14 Information and data on children’s rights 15 Role of private sector in development 16 Chapter 3: Surviving and thriving 18 Healthcare system 19 Healthcare workforce 20 Financing and planning 21 Health information 24 Community level healthcare 25 Maternal and child health 27 Maternal health 27 Newborn health 30 Infant and child health 31 Immunization 33 Childhood disease and healthcare-seeking behaviour 36 Malaria 37 HIV and AIDS 38 Children and adolescents 39 iv of Children and Women in Kenya Awareness 40 Policy and guidelines 40 Adolescent and youth health 42 Sexual and reproductive health 42 Harmful substances 44 Mental health 44 Food security 45 Nutrition 47 Policy and coordination 47 Undernutrition 50 Stunting 50 Acute malnutrition 52 Underweight 55 Overweight and obesity 55 Maternal, infant and young child nutrition 56 Maternal dietary diversity 56 Breastfeeding and complementary feeding 57 Management of severe acute malnutrition 58 Micronutrients 59 Monitoring, evaluation and the nutrition information system 60 Nutrition advocacy 61 Health emergencies 61 Cholera 61 Other health emergencies and response 62 Chapter 4: Learning 64 Enabling environment 65 Governance 66 Pre-school governance 68 Education financing 68 Education information 69 Access to education 71 Early learning 71 Pre-school education 72 Primary education 74 ASAL counties 76 Children with disabilities 77 Other barriers to education 78 Secondary education 80 Technical and vocational education and training 82 Quality of education 82 Teaching 82 Infrastructure and learning materials 83 Assessment results 84 Barriers to quality education 85 Improving the quality of education 85 Education and emergencies 86 Refugee education 87 v Situation Analysis Chapter 5: Protection from violence, abuse, exploitation and family separation 88 Enabling environment 89 Legislation 89 Policy 89 Capacity and financing 90 Coordination 91 Violence and abuse 92 Violence and children 92 Gender-based violence 92 Harmful practices 94 Female genital mutilation 94 Child marriage 96 Children without parental care 98 Adoption 100 Commercial sexual exploitation of children 101 Other specific groups of children at risk 102 Children in contact with the law 102 The children’s court system 102 Remand 103 Other children in contact with the law 104 Children in street situations 106 Child online protection 106 Protection of refugee children 108 Chapter 6: Safe and clean environment 110 Water, sanitation and hygiene 111 WASH policy framework 111 Policy environment 111 Planning process 111 Budgeting 112 Water supply 114 Sanitation 118 Hygiene 121 Housing and energy 122 Environmental pollution and climate change 125 National priorities for addressing climate change 126 vi of Children and Women in Kenya Chapter 7: Children and emergencies 127 The humanitarian context 128 The impact of the 2016-2017 drought 128 Flooding 129 Social cohesion 130 Inter-clan conflict 130 Violent extremism 130 Electoral violence 131 Child refugees and internally displaced persons 131 Resilience of children to disasters, shocks and crises 133 Chapter 8: Equitable chances in life 135 Birth registration and documentation 136 Children with disabilities 137 Children from families living in poverty 138 The social protection system 139 Policy 139 Governance 140 Financing 141 Expansion and coverage of children 142 Adolescent empowerment 146 vii Situation Analysis List of Abbreviations ACSM Advocacy, Communication and Social Mobilization AIDS Acquired Immune Deficiency Syndrome ARI Acute respiratory infection ART Antiretroviral therapy ASAL Arid and semi-arid lands BCG Bacillus Calmette–Guérin vaccine BMI Body mass index BMS Breast milk substitutes CBO(s) Community Based Organisation(s) CCI(S) Charitable children’s institution(s) CDF Capacity Development Framework CFR Case Fatality Rate CFA/FFA Cash for Assets / Food for Assets CHEW Community Health Extension Worker CHV Community Health Volunteer CIDP Country integrated development plan CLTS Community Led Total Sanitation CNAP(s) Community Nutrition Action Plan(s) CPiE Child Protection in Emergencies CPIMS Child Protection Information Management System CRA Commission on Revenue Allocation CRC Convention on the Rights of the Child CRPD Convention on the Rights of Persons with Disabilities CSG County Steering Group CSPS Civil Service Pension Scheme CT-OVC Cash Transfer for Orphans and Vulnerable Children DALY Disability-adjusted life year DANIDA Danish International Development Agency DCS Department of Children’s Services DFID (United Kingdom) Department for International Development DVD Digital video disc EAC East African Community EARC(s) Educational Assessment Resource Centre(s) EDE Ending Drought Emergencies initiative EMIS Education Management Information System viii of Children and Women in Kenya ENAC Emergency Nutrition Advisory Committee FAO Food and Agricultural Organisation FGM Female Genital Mutilation FNSP Food and Nutrition Security Policy GAVI Global Alliance for Vaccines and Immunization GDP Gross Domestic Product GER Gross Enrolment Rate HDI Human Development Index HIV Human Immunodeficiency Virus HSNP Hunger Safety Net Programme ICCM Integrated Community Case Management IMAM Integrated Management of Acute Malnutrition IMCI Integrated Management of Childhood Illness IPV Inactivated polio vaccine ITN Insecticide-treated mosquito net KABP Knowledge, Attitudes, Behaviour and Practices KCPE Kenya Certificate of Primary Education KCSE Kenya Certificate of Secondary Education KDHS Kenya Demographic and Health Survey KEPSA Kenya Private Sector Alliance KFSSG Kenya Food Security Steering Group KHO Kenya Health Observatory KHSSP Kenya Health Sector Strategic and Investment Plan KNBS Kenya National Bureau of Statistics KSh Kenyan Shillings MDG(s) Millennium Development Goal(s) MEACLSP Ministry of East African Community, Labour and Social Protection MICS Multiple Indicator Cluster Survey MODA Multidimensional Overlapping Deprivation Analysis MTCT Mother to child transmission of HIV MTP Medium Term Plan MTPII Second Medium Term Plan NACONEK National Council for Nomadic Education in Kenya NDMA National Drought Management Authority NER Net enrolment rate NGO(s) Non-Governmental Organisations(s) NHIF National Health Insurance Fund ix Situation Analysis NNAP National Nutrition Action Plan NSNP National Safety Net Programme NSPP National Social Protection Policy OCHA Office for the Coordination of Humanitarian Affairs ODA Official Development Assistance OPCT Older Persons Cash Transfer ORS Oral Rehydration Salt PMTCT Prevention of mother to child transmission of HIV PPP Public-private partnership PWSD-CT Cash Transfer for Persons with Severe Disabilities RDT Rapid diagnosis test RMNCH Reproductive, maternal, newborn, and child health SAU Social Assistance Unit SDG(s) Sustainable Development Goal(s) SMART Standardized Monitoring and Assessment of Relief and Transitions SPS Social Protection Secretariat SUN Scaling Up Nutrition STI Sexually Transmitted Infection TSC Teacher Services Commission TVET Technical and vocational education and training UN United Nations UNAIDS Joint United Nations Programme on HIV/AIDS UNDP United Nations Development Programme UNFPA United Nations Population Fund UNHCR United Nations High Commission for Refugees UNICEF United Nations Children’s Fund USAID United States Agency for International Development US United States US$ United States dollar VSO Voluntary Service Overseas WASH Water, sanitation and hygiene WaSReB Water Services Regulatory Board WFP (United Nations) World Food Programme WHO World Health Organisation WSP Water service provider WWDA Water works development agency x of Children and Women in Kenya List of Figures Figure 1: Counties of Kenya by climate 3 Figure 2: Population of Kenya by year, 2009 to 2018 4 Figure 3: Number of births and deaths 2011-2015, Department of Civil Registration 5 Figure 4: Number of births in health facilities and at home, 2011-2015, Department of Civil Registration 28 Figure 5: Trends in under five mortality by age group, 2003-2014, KDHS figures 30 Figure 6: Regional disparities in access to healthcare, 2014 32 Figure 7: Full immunization coverage, 2016, administrative data 33 Figure 8: BCG coverage, 2016, administrative data 35 Figure 9: Measles vaccination coverage by country, 2016, administrative data 36 Figure 10: Fertility rate per 1,000 15-19-year-old girls, 1989-2014, KDHS figures