TURKANA SOCIAL SECTOR BUDGET BRIEF

TURKANA SOCIAL SECTOR BUDGET BRIEF (2013-14 to 2015-16) Highlights In 2015-2016, county spent Ksh 10.2 billion, out of which 28 per cent was spent on social sector. Overall, execution of development budget remains a challenge with an absorption rate of 66 per cent in 2015-16. The study suggests that poor execution of development budget is a caveat and needs to be reviewed by the government. As per DHIS 2015 data, Turkana county has the worst coverage of skilled delivery among the 10 counties studied. So, there is a need to employ more heath workforce and develop new infrastructure to improve access to health services. Turkana has extremely high rates of wasted and underweight children. It is suggested that the county undertake higher investments towards child specific nutrition programmes. It is appreciated that the county has specific budget lines for social protection programmes, HIV/AIDS, Child Health Services, Nutrition and WASH which enables tracking of such critical interventions. This practice should be followed by other counties. The pupil teacher ratio at pre-primary and primary levels is extremely poor. It is suggested that the county government increases recruitment of teachers or improves retention of teachers by providing more incentives/benefits. Despite increased investment to water services, the county faces acute water shortage. Hence, the county needs to embark on the rehabilitation of the existing water schemes to increase their efficiency and undertake construction of new water supplies infrastructure. 1

TURKANA Introduction Turkana County is situated in the North Western part of Kenya, covering an area of 68,680.3 km 2. The county is divided into 7 subcounties and 30 wards. The estimated population of the county is around 1.3 million, consisting of 52 per cent male and 48 per cent female. The county has a high young population i.e. under the age of 19 years, representing 60 per cent of the total population. The key priority areas as per the county s fiscal strategy paper (CFSP 2016) are investing in agricultural transformation to ensure food security; investing in infrastructure in areas such as water, roads and energy; investing in quality and accessible health care services and quality education; enhancing a conducive business environment for wealth and employment creation; and effective and efficient delivery. For the social sectors, operationalization of facilitates has been given Administrative and demographic profile Area (km 2 ) 68,680.3 Number of sub-counties 7 Number of wards 30 Total population (2015) 1,256,152 Male 653,583 Female 602,569 Under 5 year 163,854 Primary school age (6-13) 345,184 Secondary school age (14-17) 131,257 Source: ADP (2016-17) priority to ensure enhanced access and quality of services provided. These interventions aim to improve staffing, equipping and related needs to ensure standards are met and possibly surpassed. Overall budget/expenditure In 2013-14, the first year of devolution, the county budget estimate was Ksh 8.1 billion (Figure 1). The county scaled up the budget to Ksh 13.1 billion in the next year, representing a phenomenal increase by 61 per cent. In 2015-16, budget increased to Ksh 13.5 billion, recording only a 2 per cent growth. In 2015-16, 34 per cent was allocated to the social sector out of the overall budget of the county. In terms of actual expenditure, county spent Ksh 10.2 billion in 2015-16 which was 30 per cent higher than actual expenditure in 2013-14. In 2015-16, 28 per cent of the total expenditure was spent on social sector. Despite increased budget provisions, actual expenditure during the reporting period had not been satisfactory. In 2013-14, the overall budget absorption rate was only 42 per cent. Some of the challenges that affected budget implementation were inadequate staff capacity in the procurement unit, lack of monitoring and evaluation framework, and low local revenue collection which affected funding of planned activities. The county took several steps to address these issues (e.g. improvement in staff capacity, full adoption of IFMIS in processing financial transactions, compliance with budgetary timelines) and as a result absorption of budget significantly improved to 71 per cent 100 80 60 40 20 0 15 10 5 0 Figure 1: County budget & Expenditure (Ksh billion) 8.1 13.1 Budget 13.5 3.4 9.3 Expenditure 10.2 2013-2014 2014-2015 2015-2016 36 Figure 2: County budget absorption rates (%) 48 42 98 71 61 98 75 66 2013-2014 2014-2015 2015-2016 Recurrent Development Total 1

in 2014-15. In 2015-16 the budget absorption rate further increased to 75 per cent, mainly on account of better adherence to budget timelines. However, execution of development budget still remains a challenge at 66 per cent in 2015-16, which is a matter of concern and should be reviewed by the county government (See CBIRR 2013-14, 2014-15 and 2015-16). In terms of economic classification, salary/wage bills amounted to Ksh 542.5 million, representing only 16 per cent of the total county expenditure in 2013-14. The figure went up to Ksh 1.4 billion in 2014-15 which accounts for 15 per cent of the overall expenditure. In 2015-16 the salary/wage bills significantly increased by 66 per cent to Ksh 2.3 billion. Also, the share in overall expenditure increased to 22 per cent, mainly due to growing workforce and annual increments in salaries. Health Services Turkana has 147 health facilities 1 consisting of 5 primary care hospitals, 4 secondary care hospitals, 17 basic primary health care facilities, and 121 dispensaries albeit these facilities are not evenly and equitably distributed within the county. The county government has succeeded in bringing health services closer to the people, with walking distances for patients having reduced from 55 kms to 35 kms (See The Promise of Devolution, 2015; field visit). The county s health indicators reflect a mixed trend. Between 2013 and 2015, skilled delivery increased marginally from 32 per cent to 43 per cent, and exclusive breastfeeding increased from 45 per cent to 66 per cent. As of 2015, Turkana county has the worst coverage of skilled delivery amongst the 10 counties studied. So, there is a need to employ more heath workforce and develop new infrastructure to improve access to health services. The county is also faced with a nutrition challenge. It has 23 per cent wasted and 34 per cent underweight children, much higher than the national average of 4 per cent and 11 per cent respectively. Even in terms of HIV indicators, the county is performing poorly with adult prevalence at 7.6 per cent, which is above the national average of 6 per cent. The county runs high risk of HIV due to several factors such as early sexual debut (55 per cent of individuals have sexual intercourse before the age of 15 years), and a very low utilization of health facilities (26 per cent) for delivery of the HIVpositive pregnant women (See Kenya HIV County Profiles, 2014). In 2014-15, the county government allocated Ksh 2.06 billion for health sector, representing 16 per cent of its total budget (Figure 3). Next year, the budget was reduced by almost 33 per cent to Ksh 1.38 billion, decreasing the health share to 10 per cent. In terms of composition, MCH service coverage (%) 1 Select health indicators 2013 2015 4+ ANC visits 57.5 48.9 Skilled delivery 31.9 43.2 Exclusive breastfeeding 44.5 66 Fully immunized child 65.3 64.1 Nutrition status (%) 2 Turkana Kenya Stunted children 23.9 26.0 Wasted children 22.9 4.0 Underweight children 34 11.0 HIV (%) 3 HIV adult prevalence 7.6 6.0 ART adult coverage 20 79 ART children coverage 19 42 1 DHIS 2013 & 2015 2 KDHS 2014 3 Kenya HIV County Profiles 2014 1 Health facility data: http://kmhfl.health.go.ke/#/home 2

development budget had a majority share of 60 per cent in the total health budget in 2014-15, which steadily rose to 89 per cent in 2015-16 (Figure 4). However, in absolute terms there has been a marginal decline in the development budget from Ksh 1.24 billion in 2014-15 to Ksh 1.23 billion in 2015-16. Figure 5: Health expenditure and absorption rates Source: Budget allocation is from COB data 2015-16 (revised on March 2016) The actual health spending by the county was Ksh 1.03 billion in 2014-15, and Ksh 861 million in 2015-16, representing budget absorption rate of 50 per cent and 62 per cent respectively (Figure 5). The county government needs to monitor the execution of development budget, as it declined from 64 per cent in 2014-15 to 59 per cent in 2015-16 (Figure 5). Turkana county has one of the lowest rates of execution of health budget amongst the 10 counties studied, which calls for immediate action from the government. However, in line with its development plans, the county implemented countywide health coverage initiatives like free maternity services and immunizations; eradicating prevalence of neglected tropical diseases; equipping public hospitals with specialized medical equipment; reducing morbidity and mortalities from Malaria, HIV/AIDs, tuberculosis and non-communicable diseases; recruitment of more health workers and strengthening health research for improved quality of health (For further details see County Fiscal Strategy Paper 2016, p 16). Amongst the programmes, health infrastructure development programme accounted for the largest share with 69 per cent in the total health development outlay of 2015-16 (Figure 6). While, allocation for health programme support services and sub-county health support and subsidies was 30 per cent and 1 per cent respectively. Under the health program support services, the county allocated specific budget for HIV, AIDS and STI control, Nutrition, Child health services and Water, Sanitation and Hygiene (WASH). In addition to this, the Turkana UN Joint Programme also has budget allocated for HIV/AIDS and WASH interventions. 3

It should be noted that Turkana still has extremely high rates of wasted (23 per cent) and underweight (34 per cent) children. So, there is a need for higher investment towards child specific nutrition programmes by the county government. Education and Social Services The department of education and culture of Turkana county is responsible for programmes related to education and social services. Post devolution, in terms of education, the county is responsible for early childhood development (ECD) and technical education via village polytechnics. At present, the county runs 412 ECDE centres and 7 village polytechnics. In addition, there are 380 primary and 42 secondary schools that are funded and managed by the government. The number of teachers currently providing basic education is 3,190, consisting of 1,166 ECDE, 1,651 primary, and 373 secondary school teachers. As of 2015, gross enrolment ratio (GER) is 94.1 per cent at pre-primary level compared to the national average of 76.5 per cent. While the GER is only 81.5 per cent at the primary level, and a mere 17.7 per cent at secondary level compared to the national average of 103.6 per cent and 63.3 per cent respectively. Similarly, with net enrolment ratio (NER) of 87.8 per cent at pre-primary level, the county has recorded much better progress vis-à-vis the national average of 74.6 per cent but has underperformed in the case of primary schools. Also, the secondary level NER in the county is drastically low at 11 per cent. It is evident from these education indicators that access to pre-primary education in the county stands better than the status at national level. But, the county is facing challenges in provision and promotion of secondary education as that has not yet been devolved. Also, it should be noted that the pupil teacher ratio at pre-primary and primary levels is Some of the active development partners providing health services in Turkana are UNICEF (ICCM training and training of health workers and staff), USAID (equipping health centres especially in maternal and child health), and DFID (building centres of excellence in support of MCH services, equipping medical facilities and training staff) (Source: Field visit). Select education indicators (2015) Pre-primary education Turkana Kenya Gross enrolment ratio (%) 94.1 76.5 Net enrolment ratio (%) 87.8 74.6 Gender parity index (value) 0.79 0.96 Pupil teacher ratio* (no.) 79.45 31.9 Primary education Gross enrolment ratio (%) 81.5 103.6 Net enrolment ratio (%) 71.6 88.4 Gender parity index (value) 0.70 0.96 Pupil teacher ratio* (no.) 84.1 35.2 Secondary education (%) Gross enrolment ratio (%) 17.7 63.3 Net enrolment ratio (%) 11 47.8 Gender parity index (value) 0.42 0.89 Pupil teacher ratio* (no.) 25.7 20.7 * The figures pertain to public schools Source: State Department of Education, Nairobi extremely poor at 79 and 81 respectively. Hence, the county government needs to increase recruitment of teachers or improve retention of teachers by providing more incentives/benefits. At present, gender parity index (GPI) values of the county at ECDE, primary, and secondary education level stand at 0.79, 0.70, and 0.42 respectively. With a disproportionate share of boys having access to education facilities, there is a need of the county government to align its focus on providing equitable access at all levels of education. 4

The county s budget allocation for education and social services was 12 per cent in 2014-15 and 15 per cent in 2015-16 (Figure 7). In absolute terms, the budget was steadily scaled up from Ksh 1.5 billion in 2014-15 to Ksh 2 billion in 2015-16. As for the composition of the budget, it had been highly skewed towards development activities as the recurrent and development budget ratio was 10:90 in 2014-15 and 2:98 in 2015-2016 (Figure 8). Figure 9: Education & social services expenditure and absorption rates Though development budget increased over the years, actual spending fell from Ksh 972 million in 2014-15 to Ksh 968 million in 2015-16. Execution of development budget declined by approximately one-third from 67 per cent in 2014-15 to 49 per cent in 2015-16 (Figure 9). This adversely affected overall implementation of budget that significantly fell from 63 per cent to 49 per cent in the same period. Some of the challenges that led to constraints in the implementation of some crucial development programmes were inadequate human resources, lack of office space, slow procurement processes, and omission of some activities in the department (For further details see Programme Based Budget 2016-17, p 74). Hence, the county government need to strengthen their administrative processes. Notwithstanding low utilization of development budget, the county had implemented several projects e.g. construction of ECDE centres; recruitment and deployment of ECDE teachers and youth polytechnic instructors; renovations and equipping of youth polytechnics; establishment of PWDs using sub-county leadership structures and facilitating the disbursements of educational bursary to college, universities, secondary and vocational trainings (See Programme Based Budget 2016-17, p 74). 5

Source: Budget allocation is from COB data 2015-16 (revised on March 2016) Among the programmes, access to education for all programme was allocated 67 per cent of the total education development budget in 2015-16 (Figure 10). This was further subdivided into three programmes, with a budget allocation of 37 per cent to ECDE development programme, 19 per cent to education support programme and 11 per cent to tertiary education programme. While, 21 per cent of the total education development budget in 2015-16 was allocated to social protection/affirmative action programme (Figure 11). This included budget allocations of 16 per cent, 3 per cent, and 2 per cent respectively to youth and women development programme, persons with disabilities support programme, and children support programme respectively. The key achievements in this sector include improved access to early childhood education countywide through construction and completion of ECDs and village polytechnics, and establishment of a feeding program for ECDs countywide. The county also had a Skill Development Fund that benefitted students every year across all secondary and tertiary education (See The Promise of Devolution 2015; County Fiscal Strategy Paper 2016). Water Services The water, irrigation, agriculture department of the county is mainly responsible for livelihoods, water services, and agribusiness (See Programme Based Budget 2016-17, p 33). The main rivers flowing in the county are Tarach, Kerio, Kalapata, Malimalite and Turkwel. Overall, 33,237 households had access to potable water, while the average distance to the nearest water point was around 5 to 10 km (See Annual Development Plan 2016-17, p 18). Between 2013 and 2016, the water coverage in county government increased from 48 per cent to 49 per cent. Also, the non-revenue water fell from 50 per cent to 40 per cent in the same Select water indicators County population within service areas of WSPs (%) 2013 2016 13 7 Water coverage (%) 48 49 Non-Revenue Water (NRW) (%) 50 40 Source: Report on performance review of Kenya s Water services sector 2013 and 2016 period, but this is well above the Kenya water sector benchmark of 25 per cent. However, county population within service areas of WSPs dipped by more than half from 13 per cent in 2013 to 7 per cent in 2016. 6

In 2014-15, the county government allocated Ksh 1.1 billion for water services, representing 9 per cent of its total budget. Next year, the budget was significantly increased to Ksh 1.3 billion, which translated into 10 per cent of the total budget for 2015-16 (Figure 12). As for the composition of the budget, it had been highly skewed towards development activities as the recurrent and development budget ratio was 14:86 in 2014-15, that shifted to 3:97 in 2015-2016 (Figure 13). This is due to the fact that water services is a highly infrastructure extensive sector. Figure 14: Water services expenditure and absorption rates From 2014-15 to 2015-16, overall absorption of water budget significantly rose from 48 per cent to 75 per cent (Figure 14). Also, actual spending increased by nearly 80 per cent from Ksh 547 million in 2014-15 to Ksh 978 in 2015-16. During the same period, execution of development budget increased from 49 per cent to 75 per cent. Source: Budget allocation from COB data 2015-16 (revised as on March 2016) 7

In line with development plans, several projects were implemented during this period such as, drilling and equipping of 80 boreholes; construction of 14 piped water supplies; rehabilitation of non-functional; construction of 16 water pans; capacity building of around 30 water users associations; and upgradation of 4 motorized piped water supplies/hand pumps to solar systems (See Programme Based Budget 2016-17, p 33) In 2015-16, on the basis of distribution of the development budget into different programmes, the share of water development programme and agriculture development programme was 77 per cent and 19 per cent respectively (Figure 15). The Turkana rehabilitation programme didn t take off in 2015-16 due to lack of funding (See Programme Based Budget 2016-17, p 35). The government should ensure that there is enough revenue generated for water services so that budgeted programmes are implemented and not stalled due to lack of funding. Despite increased investment, the county has inadequate water for domestic use and is highly dependent on surface water (For further details see Annual Development Plan 2016-17, p 13). Hence, the county needs to embark on the rehabilitation of the existing water schemes to increase their efficiency and undertake construction of new water supplies infrastructure. 8

Technical Note The social sector analysis is based on the financial data of the three departments, viz. (a) Health; (b) Education & Culture; (c) Water, Irrigation & Agriculture. For 2014-15, programme wise budget data has been sourced from Supplementary Appropriation Budget 2015 and expenditure from Turkana County Monthly Expenditure Report which was collected during the field mission. For 2015-16, due to lack of disaggregated budget and expenditure data, only total values from County Budget Implementation Review Report (CBIRR) of 2015-2016 have been sourced. The programme wise budget bifurcation has been taken from Budget Supplementary Appropriation (revised as on March 2016). The allocation/expenditure being incurred on social services is mentioned along with education as it was a part of the education department in 2015-16. The study could track and comment on allocation for HIV, sanitation and nutrition related activities on the basis of available data. However, expenditure on the same wasn t trackable due to lack of disaggregated data. 9