Is this value for money?

Interrogating the outcomes and motives behind prioritisation and resource allocation in Kenya

On the East African (Edition March8 – 14, 2014) Page 33 a new report by the Kenya Institute for Public Policy Researchand Analysis (KIPPRA) indicates that the average kid born in Migori, Siaya, Kisumu and Homa Bay counties in Kenya today will not live beyond 40 years.

According to KIPPRA, the counties have the lowest life expectancy, Homa Bay 39.8; Kisumu 40.4; Siaya 40.4 and Migori 46.4, compared to Bomet with the highest expectancy in the country – 66.1 years. Kenya’s average life expectancy is at 56.6. The report attributes the low levels of live expectancy in these bottom five counties to HIV/AIDS that has been highly prevalent in the Nyanza region for over a decade now.

What defeats me is how to reconcile this new statistic with the colossal amounts of domestic and external resources that have been invested in programming, interventions, research, community/organisational development and capacity building to combat the HIV/AIDS scourge in the Nyanza region in Kenya since the late 1990s.

Notably there wasn’t a significant change in the prevalence of HIV in Nyanza and in these counties despite over a decade of policy and resource commitment (both amongst development partners and the government of Kenya). The Kenya Demographic HealthSurvey (2003), the Kenya AIDS Indicator Survey (2007) and the Kenya AIDS IndicatorSurvey (2012) showed an overall lack of progress in Nyanza. Almost no change in the average prevalence rate in the region: HIV prevalence was at 15.1% in 2003, 14.9% in 2007 and 15.1% in 2012.  Of course this appreciates that the averages could mask progress amongst some counties or localities in the region.

Between 2003 and 2011, Kenya received well over US$ 1.9 billion cumulatively for HIV and AIDS programmes. If we chose to spend this money on primary education; this would pay school fees for 1,655,729 children from grade one up to grade eight at Ksh 1,200 per child (the current capitation fund sent to schools). Alternatively, if we chose to use it to employ extra teachers; this would hire and maintain 7,198 new teachers for 8 years at Ksh 23,000 per month (average salary of a P1 teacher). And if we chose to spend the equivalent of these resources on the coveted laptops project, this would procure 10 batches of the laptop project US$200 million (the value quoted by Olive). Better still the same amount of money could complete the infamous Standard Gauge Railway line from Mombasa to Nakuru (644.9 km) at US$2.9 million/Km.

Now if you know the Kenya health and aid landscape well, you will also know that the largest proportion of HIV money (the US$ 1.9 billion) has gone to these four counties, formerly Nyanza province where HIV prevalence was reportedly highest, HIV related deaths most pronounced and the socioeconomic impact greatest.

If you also know the NGO landscape in Kenya as well, you will know that in these counties (Migori, Kisumu, Homa Bay, and Sisya) cradle the largest proportion of registered civil society organisations (CSOs) reportedly working to deal with HIV/AIDS in one way or another. I know someone who argues that HIV/AIDS has been a standalone industry supporting the economy in Kisumu. I did a quick search on the Kenya NGOs Coordination Board dataset for Civil Society organisations in the country looking for any CSO located in the four counties and with the words ‘HIV’ and ‘AIDS’ or both in their name and or objectives. See the results are below. These 5 counties out of the 47 in Kenya are home to 20.2% (1428) cumulatively of all CSOs in the country (7082) operating in all other sectors.  

What then have the many CSOs established in the Nyanza region and the huge amount of aid money (largest proportion of total funding to HIV) invested in HIV/AIDS programmes in these counties yielded?

I am not even remotely trying to argue against investments in HIV/AIDS programmes and interventions. I am sure there other counterfactuals and intervening factors that could partly explain these outcomes. I am sure there is progress in particular output indicators. 

My point is that in a lot of development work in Kenya, and in many other African countries, inept prioritisation and inefficient Monitoring and Evaluation mechanisms are preventing a focus on results and achievement of value for money. Invariably, loads of resources are expended on expensive, sometimes very ambitious projects without an assessment of the value of the returns of such investments.  

How could we have funded HIV/AIDS so heavily in Nyanza province with so little returns over such a long time? How could Kenya have spent all that resources on HIV over a decade yet receive very minimalist returns? How could the declining rates of life expectancy in these counties in Nyanza be still attributed to HIV and AIDS (a decade later) when money has been spent on drugs for prolonging life, preventing new infections?

And you could ask this question to many other programmes:

The Free Primary education – beyond increments in enrolment and primary school completion rates, what else would you use to justify Kenya’s massive expenditure on basic education? In fact the quality of basic education has declined considerably. 

The Thika super highway that cost the country US$ 360 million (US$ 7.2 million per Km) - what spectacular contribution has that road connecting Nairobi to Thika (a town of little impact on the economy compared to others) made to the economy thus far, that could justify the investment? Or what could be spectacular prospects of the road beyond ‘national pride’ as President Kibaki termed it?

In the FY 2013/14, the Government of Kenya allocated 3.6 billion shillings to the Galana irrigation project. You ask yourself what the merits and motivations of such a decision were. Clearly, this is an investment best executed through public private partnerships (PPPs). Go to Siaya county, there is a private investment called Dominion farms that successfully reclaimed portions of the idle Yala swamp. Today employing loads of people, generating tax revenues for government and producing food for the country.

Clearly, we are either not paying attention to the outcomes of our investments OR our expenditures are motivated by alien interests.

Beyond the ill motivations, misallocation and misapplication, and inefficient execution of projects - a lot of development work is overly focused on outputs with little attention to the ultimate, the often non-tangible outcomes. Development partners, implementing NGOs and government are obsessed with reporting the number of bicycles bought, number of community health workers hired, number of condoms dispensed, number of people tested for HIV or the kilometre of road/railway built while the ultimate is not interrogated. How these end up improving the lives of Kenyans, increasing money in people’s pockets, making their neighbourhoods/businesses safer or putting food on dinner tables is LEAST interrogated or talked about.    

Are we measuring progress? Are we measuring the real outcomes? Or are we in the business of burning resources made available by hard pressed taxpaying citizens ill informed to demand accountability and by Development Partners least concerned about whatever we do with the money?

The public debt burden in Kenya is exponentially expanding – Ksh 320 billion (2012), Ksh 331 billion (2013) and treasury proposing Ksh 414 billion in 2014. The explanation by government is that: we borrowed to fund HIV, we borrowed to finance Thika super highway, we borrowed to pay for free primary education blah blah. The Division of revenueBill 2014 proposes Ksh 414 billion (38.5% of total government revenues and double allocation to counties – Ksh 228 billion) be allocated for debt servicing, denying the country of much needed resources for development. If we are going to end up decades after borrowing with mediocre results – then this is the time to rethink such decisions.

• We must begin to interrogate our priorities, our plans, and the motives behind resource allocation to these priorities. 
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• We must now actively monitor and evaluate the execution of projects, especially the megaprojects financed by large sums of money, loans that Kenyans are least aware they will keep paying and bequeath their children. 
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• We must effectively measure progress, but most importantly invest in simulating the cost and benefits of foreseen outcomes; and when projects are done, evaluate the merits of such outcomes accordingly.