MOMBASA SOCIAL SECTOR BUDGET BRIEF

MOMBASA SOCIAL SECTOR BUDGET BRIEF (213-14 to 215-16) Highlights The Mombasa County spent Ksh 8.5 billion in 215-216, out of which 4 per cent was spent on social sector. The performance of the county in terms of budget execution has improved over the years, however huge wage bill, having 47 per cent share in total expenditure, is a concern for the county government. In the health sector, the development budget share was just 15 per cent, way below the PFM (Act 212) rule of minimum ratio of 7:3. This needs immediate attention of the county government. The county has severe HIV issues and it is suggested to include specific programmatic budget lines under health sector to enable proper tracking and prioritisation of such investments. With the decreasing budget and low water coverage & high NRW, the water sector of the county is not doing well and needs to be reviewed. Across all the social sectors including health, education and water, the study noted low absorption rate of development budget and suggests review of the same. Though the county had been planning construction of child protection and child rescue centres since devolution, there was no actual expenditure for the same and is an area of concern. 1

MOMBASA Introduction Mombasa, located in the South Eastern part of the coastal region, is the smallest county in size in Kenya, covering an area of 229.9 km 2. The county is divided into 6 sub-counties and 3 wards. The estimated population of the county for the year 215 is around 1.1 million, consisting of 52 per cent male and 48 per cent female. The county s development agenda (as per County Fiscal Strategy Paper 216) will be implemented through the five major priority areas; transport infrastructure improvement, provision of water, sanitation and sewerage services, provision and support of better land services, investing in quality and accessible health care services and quality education. The county expects that implementation of programs under these five strategic sectors will raise efficiency and productivity in the county s economy and in turn accelerate and sustain inclusive growth, create opportunities Overall budget/expenditure In 213-14, the first year of devolution, the county budget estimate was Ksh 11.5 billion (Figure 1). The county decreased the budget to Ksh 9.9 billion in the next year, representing a decrease of 14 per cent and budget remained almost constant at Ksh 1 billion in 215-16. As per the County Budget Review Outlook Paper, the budget were adjusted for the subsequent years as per the actual expenditure in the previous year and absorption capacity as per the availability of resource. In 215-216, out of total budget, 41 per cent was allocated to social sector. In terms of actual expenditure, the county spent Ksh 8.5 billion in 215-216, which was 63 per cent more than the expenditure in 213-214. Around 4 per cent of total expenses were spent on social sector in 215-216. The performance of the county in terms of absorption of the budget has significantly improved over the years. In 213-14, the lower budget absorption rate of 45 per cent was mainly attributed to lower absorption of both recurrent and development budget viz. 67 per cent and 3 per cent respectively, ambitious budget and stringent procurement procedures (see County Budget Review Outlook Paper, 214, 215). The key factors behind underperformance in development budget Administrative and demographic profile Area (km 2 ) 229.9 Water mass (km 2 ) 65 Number of sub-counties 6 Number of wards 3 Total population (215) 1,145,259 for growth and ensure high standard of livings for Mombasa County residents. 1 8 6 4 2 Male 593,411 Female 551,848 Under 5 year 152,194 Population within 5-14 217,345 Population within 15-19 13,386 Source: CIDP (213-17); Analytical Report on population projection Volume XIV 12 1 8 6 4 2 Figure 1: County budget & expenditure (Ksh billion) 11.5 9.9 1 Figure 2: County budget absorption rates (%) 67 Budget 45 3 78 5.2 7.7 8.5 Expenditure 213-214 214-215 215-216 84 87 66 86 83 213-214 214-215 215-216 Recurrent Development Total 1

were delayed disbursement of funds by the National Treasury, delay in procurement and under reporting of externally funded donor projects. This led to the slow implementation of the development projects (see Annual CBIRR 214/15). The county made progress in addressing some of the identified challenges (e.g. recruitment and training of technical staff; establishment of mechanism and procedures to enhance absorption of development funds) and as a result absorption of development budget significantly improved to 66 and 88 per Health Mombasa County has total 241 health facilities 1, including 22 basic primary health care facility, 24 dispensaries and clinicoutpatient only facility, 13 primary care hospitals and 2 secondary care hospitals. The county s health indicators reflect an encouraging trend. Between 213 and 215, the MCH service coverage indicators like 4+ ANC visits, skilled delivery, exclusive breastfeeding, and immunization coverage improved. The county has some nutrition challenge but overall performance is better than national average. It has 21 per cent stunted and 1 per cent underweight children, which is lower in comparison to the national average. However HIV adult prevalence and ART adult coverage in county stands at 7.4 per cent and 98 per cent, which are significantly higher than the national average of 6 and 79 per cent respectively. As per the key outcomes of Mombasa HIV profile it 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 utilisation of health facilities (29 per cent) for delivery of the HIVpositive pregnant women (see Kenya HIV County Profiles, 214). In 213-14, the county government allocated Ksh 915 million for health sector, representing 8 per cent of its total budget (Figure 3). In 215-16, budget increased to Ksh 2.4 billion, increasing the share of health sector in its total budget to 24 per cent. In terms of composition, development budget had a meagre share of 21 per cent in the total health budget in 213-14, which further declined to 15 per cent in 215-16. The county didn t adhere to the PFM Act (212) rule of cent in 214-215 and 215-216 respectively. In terms of economic classification, in 213-14, personnel emoluments amounted to Ksh 3.2 billion, representing 59 per cent of the total county expenditure. The figure went up to Ksh 4. billion in 214-15 mainly due to recruitment of new staff, promotion, confirmation of contractual staffs and annual increments in salaries, but the share in overall expenditure declined to 52 per cent. The share of personnel emoluments in 215-216 was 47 per cent of total expenditure. Select health indicators MCH service coverage (%) 1 213 215 4+ ANC visits 54.5 7.1 Skilled delivery 72.6 85. Exclusive breastfeeding 49.7 68.4 Fully immunized child 81.4 86.9 Nutrition status (%) 2 Mombasa Kenya Stunted children 21.1 26. Wasted children 4.1 4. Underweight children 9.6 11. HIV (%) 3 HIV adult prevalence 7.4 6. ART adult coverage 98 79 ART children coverage 41 42 1 DHIS 213 & 215 2 KDHS 214 3 Kenya HIV County Profiles 214 3, 2,5 2, 1,5 1, 5 215-216 214-215 213-214 Figure 3:Trends in health budget 2,42 2,11 915 213-214 214-215 215-216 Figure 4: Composition of health budget (%) 84 79 85 16 21 15 1 Health facility data: http://kmhfl.health.go.ke/#/home Recurrent Development 2

ensuring ratio of recurrent to development of at least 7:3 per cent (Figure 4). 2,5 2, 1,5 1, 5 - Trends in expenditure 225 Figure 5: Health expenditure and absorption rates 1,536 2,285 213-214 214-215 215-216 1 8 6 4 2 31 25 Absorption rates (%) 83 73 21 11 94 1 2 3 59 Recurrent Development Total Figure 6: Health budget by programmes (215-16) (in percentage) 23% 1% Adminitrative Unit Clinical/Health Services Unit 76% Preventive and Promotive Services Unit Source: CoB data, county government of Mombasa, Fourth quarter Report FY 215-216 The actual health spending by the county was meagre Ksh 225 million in 213-14, which increased manifold times (around 7 times) to Ksh 1.5 billion in 214-15, and further to Ksh 2.3 billion 215-16 representing overall budget absorption rates of 25 per cent, 73 per cent, and 94 per cent respectively (Figure 5). The execution of recurrent budget in 213-214 was low at 31 per cent which significantly increased to 83 and 11 per cent in 214-215 and 215-216 respectively (Figure 5). Salaries and wages represented bulk of the recurrent expenditure, with total 95 per cent in 214-15. The amount will further go up if the existing health facilities are adequately staffed (especially the nutritionist in the health facilities). The utilization of the development budget had been much lower than the recurrent budget. In 213-14, absorption of development budget was nil, which rose to 21 per cent in 214-15, and then significantly increased to 59 per cent in 215-16. However given meagre 15% development budget composition in the overall health budget, an improved development absorption rate of 59 per cent in 215-216 is definitely not sufficient and needs to be reviewed by the county government. Aligned with its development plans, the county had implemented a number of projects such as construction of new health facilities with maternity wing; construction of dispensaries; procurement of new ambulances and mobile clinics; and strengthened outreach services (like mass campaigns to improve immunization coverage, building capacity of health workers to undertake growth monitoring of children, distribution of deworming drugs and Vitamin A supplements in schools etc.). The county has also recruited new staff including nurses and specialised doctors and has budgeted ksh 1 million in 216-17 to procure equipment and engage more staff. (From the field) In 215-16, in terms of programmatic allocation, clinical health services unit was allocated 23 per cent and preventive and promotive services unit received just 1 per cent of total health budget. The majority of the 3

health budget was allocated to administrative unit. In the absence of specific budget lines, this brief could not track the county s own budget and expenditure for nutrition and HIV/AIDS. However, UNICEF, EU and USAID provide Education Under devolution, the education sector of Mombasa is responsible for early child hood development education and youth training. Specifically, county is in charge of pre-primary education, child care centres, and polytechnics for youths and children with special needs. At present, the county runs 112 early childhood development and education (ECDE) centres and 4 youth polytechnics. In addition, there are 97 primary and 37 secondary schools that are funded and managed by the national government. The number of teachers currently providing basic education is 2,713, consisting of 334 ECDE, 1,722 primary, and 657 secondary school teachers. In comparison to national level, access to basic education in the county stands at par at pre-primary level, while it is way lower at primary and secondary level. With net enrolment ratio (NER) of 77.3 per cent at preprimary level, the county has recorded better progress vis-à-vis the national average of 74.6 per cent. However, the primary and secondary level NER in the county are quite low at 67.9 per cent and 26.9 per cent. The rate of enrolment at pre-primary and primary has improved due to the efforts taken by county government like free primary education and school feeding programme. However, there is a need to address the issue of transition rates from one level to another, specifically from primary to secondary (see ADP 15-16). At present, gender parity index (GPI) values of the county at ECDE, primary, and secondary education level stand at.97,.97, and.6 respectively. The values indicate that boys and girls have nearly equal access to pre-primary and primary education, while at the secondary level boys enrolment is more than the girls. The county s budget allocation for education and absolute budget were steadily increased over the last three years. In terms of budget allocated to education with respect to total county budget, there was an upward trend from 2 per cent to 4 per cent and 7 per cent in 213-14, 214-15, and 215-16 respectively (Figure 7). Over the same period, the recurrent and development budget ratio shifted from support for various areas like nutrition, adolescents HIV care, school feeding programme, maternal and child health etc. It is suggested that county add separate budget line for such programmatic investments to enable prioritization and transparency. Select education indicators (215) Pre-primary education Mombasa Kenya Gross enrolment ratio (%) 77.7 76.5 Net enrolment ratio (%) 77.3 74.6 Gender parity index (value).97.96 Pupil teacher ratio* (no.) 27.7 31.9 Primary education Gross enrolment ratio (%) 74.4 13.6 Net enrolment ratio (%) 67.9 88.4 Gender parity index (value).97.96 Pupil teacher ratio* (no.) 35.3 35.2 Secondary education (%) Gross enrolment ratio (%) 38.8 63.3 Net enrolment ratio (%) 26.9 47.8 Gender parity index (value).6.89 Pupil teacher ratio* (no.) 19.4 2.7 * The figures pertain to public schools Source: State Department of Education, Nairobi 8 6 4 2 Figure 7:Trends in education budget 662 196 386 213-214 214-215 215-216 Figure 8: Composition of education budget (%) 215-216 214-215 213-214 23 Recurrent 37 51 23:77 in 213-14 to 37:63 in 215-16 decreasing the fiscal space for developmental activities (Figure 8). 77 63 49 Development 4

5 4 3 2 1 Figure 9: Education expenditure and absorption rates Trends in expenditure 2 2 338 457 213-214 214-215 215-216 1 8 6 4 2 5 Absorption rates (%) 1 88 93 83 8 69 62 213-214 214-215 215-216 Recurrent Development Total Figure 1: Education budget by programmes (215-16) (in percentage) 1% Administration Unit 51% 48% Quality In Learning and Learning Unit Child Care Source: CoB data, county government of Mombasa, Fourth quarter Report FY 215-216 Post devolution overall absorption of education budget increased significantly from 1 per cent in 213-214 to 88 per cent in 214-15 (Figure 9). However the overall absorption rate dropped in 215-216 to 69 per cent and needs to be reviewed by the county. The absorption rates of development budget was around 93 per cent in 214-215 which dropped to 62 per cent in 215-216. In the presence of initiatives like school milk program, free primary school and bursaries and scholarship to secondary and university students, the county has improved accessibility and enrolment. However inadequate school infrastructure and human resources are negatively impacting the education standards in county in comparison to neighbouring counties and county should improve the absorption of development budget to reduce the gaps. (see Annual Development Plan, 215-16, p 18). The development budget was mainly spent on implementing projects like construction of ECDE centres with advanced facilities including water and sanitation facilities; distribution of bursaries to children with special needs; supply of teaching and needs secondary schools (in progress); and development of marine technical university. In 215-216, among the programmes, quality in learning and learning unit had received highest budget allocation of 51 per cent while only 1 per cent of education budget was allocated to child care (Figure 1). The county has continuously endeavoured to improve the basic educational infrastructure such as classrooms and other school facilities. The county has 86.3 per cent literacy level and the introduction of free primary education and subsidized fee for secondary education has improved the status of education in county. Despite significant progress in education the county is faced with challenges. Inadequate infrastructure and human resources will exert pressure on the county and the challenge is to provide adequate school infrastructure such as desks, chairs, classrooms, laboratories and staffing (see ADP 215-216). Social Service The youth, gender & sports department of the county is responsible for sustainable and equitable social economic empowerment of the county residents (see PBB 216-217 p 5

59). The county utilised the allocated development budget to implement various programmes that include, renovation of the community social halls, procurement to form entrepreneur groups of women and distribution of fund for sustainable projects. However no initiatives have been taken to construct child protection or child rescue centres. Water Service Water in the county is managed by the Mombasa Water and Sewage Company. The main source of water supply for the county is from Mzima Springs in Taita Taveta County, Marere, Sabaki/Baricho in Kilifi County and Tiwi Boreholes in Kwale County. This supply only meets a small per cent of the county s water demand. Additionally, most residents rely on borehole water, which is sometimes highly contaminated and thus not very safe for domestic use (See ADP 215-216 p 15). Between 213 and 216, the performance of county declined in terms of the county population within service areas of WSPs which decreased from 1 per cent to 97 per cent and water coverage decreased to 54 per cent. As per latest report, the NRW stands at 54 per cent which is much higher than the Kenya water sector benchmark of 25 per cent. The county s budget allocation for water increased to 8 per cent in 214-215 from 2 per cent in 213-214, however it further declined to 7 per cent in 215-216 (Figure 11). In absolute terms, the budget rose to Ksh 762 million in 214-215 from Ksh 233 million in 213-214. However in 215-216, the allocation reduced to Ksh 739 million. Over the same period, the recurrent and development budget ratio shifted from 66:34 in 213-214 to 59:41 in 214-215 to 7:3 in 215-216, decreasing the fiscal space for development activities in 215-216 (Figure 12). In 213-214, the county spent Ksh 52 million in water sector. The overall absorption rate of water budget showed a mixed trend and it dropped to 67 per cent in 215-216 from 88 per cent in 214-215 (Figure 13). During the same period, execution of recurrent budget Figure 11:Trends in water budget 1, 762 739 5 215-216 214-215 213-214 Select water indicators County population within service areas of WSPs (%) 233 213-214 214-215 215-216 Figure 12: Composition of water budget (%) Recurrent budget 59 66 decreased from 95 per cent in 214-215 to 88 per cent in 215-216. The development budget utilisation was as low as 19 per cent in 215-216 and need to be improved to meet the gap in the service delivery in water sector. 7 213 216 1 97 Water coverage (%) 81 54 NRW (%) 47 54 * n.d. = no data; n.c.d. = non-credible data Source: Report on performance review of Kenya s Water services sector 213 and 216 41 3 34 Development budget 8 6 4 2 Figure 13: Water expenditure and absorption rates Trends in expenditure Absorption rates (%) 673 1 88 52 492 213-214 214-215 215-216 5 34 23 95 79 88 67 19 213-214 214-215 215-216 Recurrent Development Total 6

Some of the development projects implemented by the county were construction of water and stud pipelines; establishment of water kiosks; Non-revenue water reduction project (with support from World Bank). The county has extensively invested on sanitation projects including construction of toilets in primary public schools (allocated Ksh 2 million in 215-216 for construction of WASH facilities in schools); drilling boreholes and rain water harvesting for water supply etc. Despite of the significant progress, the county faces the challenge of inadequate funding; unmatched supply of the water in comparison to the demand of water; high non-revenue water; aged and outdated water pipelines and other infrastructure. 7

Technical Note: The social sector analysis is based on the financial data of the four departments, viz. (a) health; (b) education; (c) youth, gender & sports; and (d) water, environment, natural resources. The annual budget and expenditure data has been sourced from County Budget Implementation Review Report of 213-214, 214-215 and 215-216. The programme wise budget bifurcation has been taken from CoB data, county government of Mombasa, Fourth quarter Report FY 215-216. Programme Based Budget (PBB) for the county was not available. Due to absence of specific budget lines, the study could not track and comment on allocation/ expenditure for HIV, sanitation and nutrition related activities. 8