KAKAMEGA SOCIAL SECTOR BUDGET BRIEF

KAKAMEGA SOCIAL SECTOR BUDGET BRIEF (2013-14 to 2015-16) Highlights In 2015-2016, county spent Ksh 9.9 billion, out of which 36 per cent was spent on social sector. Between 2013-2014 and 2015-2016, along with the increasing budget, the overall budget execution has steadily increased and it was 81 per cent in 2015-16. In 2015-16, around 27% of the total expenditure was spent on health sector with improved budget absorption rates. However, with execution of development budget at 71 per cent, there is still a scope of improvement and needs to be reviewed by the county government. The county government launched the Mother and Child support programme which has led to improvement in skilled deliveries. This is one of the best practices and can be adopted by other counties. From 2014-15 to 2015-16, budget and expenditure for education sector has decreased and overall absorption of education budget also dipped. Given the lower performance in education indicators like NER, GER than the national averages. It is appreciated that the county has specified budget lines for HIV/AIDS, child survival, nutrition, social services and children services which enables tracking of budget/expenses towards such critical interventions. This practice should be followed by other counties. 1

KAKAMEGA Introduction Kakamega is one of the four counties in the western region of Kenya, covering an area of 3050.3 km 2. The county is divided into 12 subcounties and 60 wards. The estimated population of the county is around two million, consisting of 48 per cent male and 52 per cent female. The county s broad strategic priorities as per the county s fiscal strategy paper (2016) include promotion of health care through investing in quality and accessible health services; promotion of value addition for agricultural produce to enhance food security; development of key infrastructure to spur economic growth; improving and upgrading education standards; creating an enabling environment for business and entrepreneurial development; promotion of equitable economic and social development for stability; and Overall budget/expenditure In 2013-14, the first year of devolution, the county budget estimate was Ksh 9.6 billion (Figure 1). The county scaled up the budget to Ksh 10.6 billion in 2014-2015, representing a marginal increase by 10 per cent. In 2015-16, budget was further increased to Ksh 12.3 billion, recording a 16 per cent growth. In 2015-16, 36 per cent was allocated to the social sector out of the overall budget of the county. In terms of actual expenditure, county spent Ksh 9.9 billion in 2015-16 which was 32 per cent higher than actual expenditure in 2014-15. In 2015-16, 36 per cent of the total expenditure was spent on social sector. Despite increased budget provisions, the performance of county in terms of budget execution during the reporting period had not been satisfactory. In 2013-14, the overall budget absorption was 54 per cent, mainly due to low absorption of development budget at only 27 per cent. One of the reasons for this was the delay in preparation and submission of departmental procurement plans which delayed the requisition of funds and ultimately led to low absorption of funds. Apart from this, delay in implementation of IFMIS and GPAY, and low revenue collection also affected budget implementation. The county took several steps to address these issues (e.g. improvement in local revenue collection; improvement in staff capacity through training 100 80 60 40 20 Administrative and demographic profile Area (km 2 ) 3050.3 Number of sub-counties 12 Number of wards 60 Total population (2015) 1,929,401 Male 926,112 Female 1,003,289 Under 5 year 337,718 Primary school age (6-13) 448,729 Secondary school age (14-17) 182,671 Source: CIDP (2013-17) enhancing governance, transparency and accountability in the delivery of public goods and services. 0 14 12 10 8 6 4 2 0 Figure 1: County budget & Expenditure (Ksh billion) 9.6 10.6 Budget 12.3 5.2 7.5 Expenditure 9.9 2013-2014 2014-2015 2015-2016 91 Figure 2: County budget absorption rates (%) 27 54 80 71 81 61 88 72 2013-2014 2014-2015 2015-2016 Recurrent Development Total 1

and recruitment; and embracing the use of IFMIS to process financial transactions) and as a result absorption of development budget significantly improved to 61 per cent in 2014-15. In 2015-16, the development budget absorption rate further increased to 72 per cent and overall budget execution rate improved to 81 per cent (See CBIRR 2013-14, 2014-15 and 2015-16). Health Services Kakamega has 252 health facilities 1 consisting of 11 primary care hospitals, 4 secondary care hospitals, 177 dispensaries and 60 primary care health facilities, albeit these facilities are not evenly and equitably distributed within the county. It takes 51 per cent of the population about 5 km to the nearest health centre, while for 17 per cent of the population the distance is less than one km. As per the CIDP report, the doctor patient ratio stands at 1:34,916 and the nurse patient ratio is 1:2,658 (For further details see The Promise of Devolution, 2015). The county s health indicators reflect a mixed trend. Between 2013 and 2015, the coverage of 4+ ANC visits significantly improved from 39 per cent to 58 per cent, and skilled delivery increased from 56 per cent to 77 per cent. However, during the same period, immunization coverage dropped from 82 to 79 per cent. In terms of nutrition indicators the county seems to be performing well in comparison to the national average. It has only 2 per cent wasted children and 10 per cent underweight children, compared to the national average of 4 per cent and 11 per cent respectively. The county has 28 per cent of stunted children which is marginally above the national average of 26 per cent. With the HIV adult prevalence at 5.9 per cent which is approximately same as the national average of 6 per cent, the county runs a high risk of HIV. Other factors such as early sexual debut (34 per cent of individuals have sexual intercourse before the age of 15 years), and low utilisation of health facilities (24 per cent) for delivery of the HIV-positive pregnant women adds to the concern (See Kenya HIV County Profiles, 2014). In 2013-14, salary/wage bills amounted to Ksh 2.6 billion, representing 50 per cent of the total county expenditure. The salaries/wage bills during 2015-16 i.e. 3.7 billion represented an increase of 27.2 per cent compared to 2014-15 when the county spent Ksh 2.9 billion. This was mainly due to recruitment of new staff and promotions of existing staff, but the share in overall expenditure declined to 39 per cent in 2015-16 from 50 per cent in 2013-14. Select health indicators MCH service coverage (%) 1 2013 2015 4+ ANC visits 39.1 58 Skilled delivery 55.6 77.1 Exclusive breastfeeding 38.5 40.3 Fully immunized child 81.8 78.7 Nutrition status (%) 2 Kakamega Kenya Stunted children 28.4 26 Wasted children 1.8 4 Underweight children 10.1 11 HIV (%) 3 HIV adult prevalence 5.9 6 ART adult coverage 66 79 ART children coverage 33 42 1 DHIS 2013 & 2015 2 KDHS 2014 3 Kenya HIV County Profiles 2014 Na Mtoto) in 2014. This programme provides incentives to poor mothers for undertaking prenatal and post-natal health care through conditional cash transfer support of Ksh 12,000 in the first 1,000 days of life, with the aim of increasing skilled delivery. Since inception the programme has registered over 34,000 cases of mothers going through safe deliveries. This is one of the best practices and this model can be replicated across the other counties. It is worth noting that the Kakamega county government has specific budget allocated to HIV/AIDS, child survival and nutrition which has been discussed in the next section. One of the reasons for improvement in skilled delivery and 4+ ANC visits could be implementation of the the Mother and Child support programme (Imarisha Afya Ya Mama 1 Health facility data: http://kmhfl.health.go.ke/#/home 2

In 2014-15, the county government allocated Ksh 2.3 billion for health sector, representing 22 per cent of its total budget (Figure 3). Next year, the budget was increased by almost 45 per cent to Ksh 3.3 billion, increasing the health share to 27 per cent. In terms of composition, development budget had a share of only 27 per cent in the total health budget in 2014-15 that increased to 35 per cent in 2015-16, marginally meeting the requirements of the PFM Act (2012) of a minimum recurrent and development budget ratio of 70:30 (Figure 4). To improve health service delivery in the county, the government may re-consider the share of development budget in the composition in coming financial years. Figure 5: Health Expenditure and Absorption Rates The actual health spending by the county were Ksh 1.7 billion in 2014-15, and Ksh 2.7 billion in 2015-16, representing budget absorption rates of 76 per cent and 83 per cent respectively (Figure 5). The execution of recurrent budget in 2014-15 was around 88 per cent that improved slightly to 89 per cent during 2015-16 (Figure 5). The utilization of the development budget had been much lower than the recurrent budget. In 2014-15, absorption of development budget was 46 per cent that significantly improved to 71 per cent in 2015-16. Acute shortage of human resources, insufficient and delayed disbursement of funds, and long and tedious procurement procedures had been responsible for low budget absorption (See Programme Based Budget 2015-16, p 75). However, in line with its development plans, the county had implemented a number of projects such as upgrading and equipping the health facilities; construction of maternity wards and increasing capacity of existing wards; recruitment of health workers; construction of pit latrines for primary schools; purchase of X-Ray and CT scan machines; and procurement and distribution of drugs to public health facilities (For further details see The Promise of Devolution, 2015; Annual Development Plan, 2016-17). 3

Source: Development budget allocation from IFMIS data sheet April 2016 In 2015-16, at 55 per cent, construction of non-residential buildings accounted for more than half of the total development budget of the health sector (Figure 6). The other major budget heads were free maternity service fund, Imarisha Afya Ya Mama Na Mtoto Education Under devolution, the county has targeted three key areas for the education sector vis-àvis infrastructure expansion and access to education. At present, the county runs 1,530 early childhood development and education (ECDE) centres and 52 youth polytechnics. In addition, there are 901 primary and 397 secondary schools that are funded and managed by the national government. The number of teachers currently providing basic education is 17,447, consisting of 2,971 ECDE, 10,704 primary, and 3,772 secondary school teachers. The county seems to be performing better in provision of access to education at the primary and secondary level in comparison to the preprimary level. As of 2015, gross enrolment ratio (GER) was only 63 per cent at preprimary level compared to the national average of 76.5 per cent. While the GER at primary level and secondary level was higher than the national average. Similarly, with net enrolment ratio (NER) of 98.5 per cent at primary level and 48.9 per cent at secondary level, the county has recorded better progress in provision of higher education vis-à-vis the national average. However, the pre-primary level NER in the county was lower than the national average. program, and community strategy with shares of 21 per cent, 9 per cent and 8 percent respectively. The county also allocated budget for HIV & AIDS, malaria control program, child survival, and Nutrition in 2015-16. Select education indicators (2015) Pre-primary education Kakamega Kenya Gross enrolment ratio (%) 63 76.5 Net enrolment ratio (%) 62.2 74.6 Gender parity index (value) 1.01 0.96 Pupil teacher ratio* (no.) 32.4 31.9 Primary education Gross enrolment ratio (%) 120.8 103.6 Net enrolment ratio (%) 98.5 88.4 Gender parity index (value) 1.02 0.96 Pupil teacher ratio* (no.) 44.1 35.2 Secondary education (%) Gross enrolment ratio (%) 67.9 63.3 Net enrolment ratio (%) 48.9 47.8 Gender parity index (value) 1.00 0.89 Pupil teacher ratio* (no.) 20.5 20.7 * The figures pertain to public schools Source: State Department of Education, Nairobi At present, gender parity index (GPI) values of the county at ECDE, primary, and secondary education level stand at 1.01, 1.02, and 1 respectively, signifying higher girl enrolment at all levels of basic education. Also, the GPI is much higher than the national averages, which indicates a better-than-national performance in providing equitable access to education. 4

The county s budget allocation for education was 6 per cent and 5 per cent in 2014-15, and 2015-16 respectively (Figure 7). In absolute terms, the budget decreased by around 8 per cent from Ksh 668 million in 2014-15 to Ksh 612 million in 2015-16, mainly due to a steep fall in the recurrent budget. Consequently, the recurrent and development budget ratio shifted from 18:82 in 2014-15 to 4:96 in 2015-16 increasing the fiscal space for development activities (Figure 8). Figure 9: Education expenditure and absorption rates From 2014-15 to 2015-16, overall absorption of education budget fell from 84 per cent to 76 per cent (Figure 9). This was largely due to a decline in the execution of recurrent budget from 75 per cent to 69 percent, which was a result of low number of personnel and undeveloped structures (For further details see Programme Based Budget 2015-16, p 106). Though development budget increased over the years, actual spending declined. The absorption rate decreased from 86 per cent in 2014-15 to 77 per cent in 2015-16. Some of the factors that adversely affected execution of budget were insufficient funding, delays in exchequer release, poor implementation and supervision of projects, and delays in procurement process (For further details see Programme Based Budget 2015-16, p 107). The county government needs to focus on removing these administrative bottlenecks to enable higher efficiency in budget implementation. As part of its development initiatives, the county had undertaken various infrastructure development projects that included construction ECDE centres, primary schools, secondary schools and polytechnics. To ease teaching staff shortage, the county also extended financial support for recruitment of teachers in secondary schools and hired ECDE assistants. In 2014-15, the county government also launched the University Education Loans scheme that provides assistance to needy students and also students in polytechnics with fees support programme (For further details see The Promise of Devolution 2015, p 112). 5

Source: Recurrent budget allocation from COB data sheet (RECC) 2015-16 and development budget allocation from IFMIS data sheet April 2016 Among the programmes, education support programmes had received the highest budget allocation of 50 per cent in 2015-16. Also, budget allocations for county polytechnics, ECDE, and infrastructure development were 21 per cent, 17 per cent, and 12 per cent respectively (Figure 10). Of the total education development budget, 38 per cent was allocated towards scholarships/bursaries for secondary and tertiary education and subsidized fees for polytechnics. Social Services The labour, social services, youth & sports department is responsible for undertaking programmes related to social services in Kakamega. In 2015-16, the county allocated 3 per cent of the total budget outlay to this department. In actual terms this corresponds to Ksh 274 million of which 90 per cent i.e. Ksh 247 million was spent in 2015-16. Amongst all the programmes majority of the budget viz. 68 per cent was allocated to labour services and sports. While only 11 per cent was allocated to social services and 3 per cent to children services. The main components of children services that included construction of children rescue centres; social security benefits as foster care grants; social security benefits in cash to charitable children organizations; and capital grants and transfers for the children intervention programme were allocated 38 per cent; 29 per cent; 17 per cent and 16 per cent of the development budget allocated to children services programme in 2015-16. Some of the key achievements of this department include increased enrolment rate in ECD centres and county polytechnics; reduced understaffing in ECD centres and secondary schools after hiring 900 ECD teachers and 390 teachers on BOM; and enhanced access to secondary education by providing bursaries worth Ksh 20 million (See Annual Development Plan 2016-17, Programme Based Budget 2015-16, p 107). Similarly, of the development budget allocated to social services programme in 2015-16, 75 per cent was distributed as capital grants and transfers for shelter improvement programme; 12 per cent for infrastructure and civil works; 8 Source: Development budget allocation from IFMIS data sheet April 2016 6

per cent as social security benefits in kind for the disabled; 3 per cent for awareness campaigns related to social empowerment; and 2 per cent as capital grants for purchase of materials for vocational rehabilitation centres (VRC). Water Services The environment, natural resources, water, and forestry department of Kakamega County, is responsible to improve access to water among other mandates (See Programme Based Budget 2015-16, p 38). The main sources of water in the county are the major rivers like Nzoia, Sasala, Viratsi, Isikhu, Yala and Lusumu among others. However, the distance to the water sources varied greatly. On average it took 44.2 per cent and 28.1 per cent of the population 5-14 and 1-4 minutes respectively to fetch water. For around 16.7 per cent of the population, the time taken was between 15-29 minutes (See Kakamega CIDP 2013-17, p 32-33). Even though the proportion of budget spent on children and social services is low, it is appreciated that such specific budget lines have been defined by the county government. Select water indicators County population within service areas of WSPs (%) 2013 2016 14 16 Water coverage (%) 72 73 Non-Revenue Water (NRW) (%) 67 53 Source: Report on performance review of Kenya s Water services sector 2013 and 2016 Between 2013 and 2016, the water coverage in county government increased marginally from 72 per cent to 73 per cent. Also, county population within service areas of WSPs rose from 14 per cent in 2013 to 16 per cent in 2016. Though, the non-revenue water fell from 67 per cent to 53 per cent in the same period, it is much higher than the Kenya water sector benchmark of 25 per cent. In 2014-15, the county government allocated Ksh 247 million for water services, representing 2 per cent of its total budget. Next year, the budget was marginally reduced to Ksh 245 million, keeping the share in the total budget of 2015-16 constant at 2 per cent (Figure 13). Water services is an infrastructure intensive sector and hence the composition of budget has remained skewed towards development, as evident from a shift in the recurrent development ratio from 30:70 in 2014-15 to 20:80 in 2015-16 (Figure 14). 7

Figure 15: Water services expenditure and absorption rates Source: Recurrent budget allocation from COB data sheet (RECC) 2015-16 and development budget allocation from IFMIS data sheet April 2016 In 2014-15 and 2015-16, overall absorption of water budget increased from 54 per cent to 68 per cent (Figure 15). During the same period, execution of recurrent budget declined while the execution of development budget improved. The low absorption rates could be due to inadequate allocation of funds to projects; delays in preparation of project documents; inadequate specialized staffs; and delays in disbursement of funds (See Annual Development Plan 2016-17, p 25). Among the programmes within the department, water services received highest budget allocation. In 2015-2016, budget allocations for water services, environment, forestry and natural resources were 40 per cent, 37 per cent, 21 per cent and 2 per cent respectively (Figure 16). Majority of the expenditure of water services was incurred on provision of water and storage facilities for water supplies and sewerage (See The Promise of Devolution, 2016). 8

Technical Note The social sector analysis is based on the financial data of the four departments, viz. (a) health services; (b) education, science & technology; (c) labour, social services, youth & sports; (d) environment, natural resource, water and forestry. For 2014-15, budget data has been sourced from Expenditure Report 2014-15 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. While, the recurrent budget bifurcation has been taken from RECC data sheet 2015-16 and development budget allocation from IFMIS data sheet April 2016. The study could track and comment on allocation for HIV, sanitation, nutrition, children and social services related activities on the basis of available data. However, the study could not track the expenditure of the same due to lack of disaggregated data. 9