Kenya faces tremendous development

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1 Makig the Lik P O P U L A T I O N R E F E R E N C E B U R E A U INTEGRATING POPULATION, HEALTH, AND ENVIRONMENT IN KENYA by Melissa Thaxto Box 1 Keya faces tremedous developmet challeges i early all sectors: Poverty is edemic, deforestatio is cotiuig, ad ifat mortality remais high. Still, most developmet efforts whether by govermet or ogovermetal orgaizatios focus resources ad expertise o oe particular area, such as reforestatio or improvig materal ad child health, rather tha itegratig iterrelated cocers ito a holistic approach. While a umber of policies ad programs likig populatio, health, ad eviromet cocers have bee tried i Keya, a assessmet of the overall state of itegratio had ot bee udertake util recetly (see Box 1). The lessos from this assessmet, udertake by the Natioal Coordiatig Agecy for Populatio ad Developmet ad the Uiversity of Nairobi, suggest that itegrated programs require greater efforts i plaig, coordiatio, ad commuicatio, but they ca yield substatial rewards for commuities ad the eviromet, icludig reduced Keya Populatio, Health, ad Eviromet (PHE) Assessmet This policy brief is based o the Keya PHE Assessmet coordiated by the Natioal Coordiatig Agecy for Populatio ad Developmet (NCAPD) ad coducted by the Uiversity of Nairobi ad the Keya PHE task force betwee October 2006 ad April The Populatio Referece Bureau coordiated a comparative study of populatio, health, ad eviromet itegratio ad cross-sectoral collaboratio i East Africa. Teams from Ethiopia, Keya, ad Tazaia assessed the state of PHE itegratio i their respective coutries, icludig idetifyig relevat stakeholders; assessig the policy eviromet for cross-sectoral collaboratio; highlightig the most saliet populatio, health, ad eviromet issues; ad describig the curret state of itegratio amog projects, programs, ad policies. The methods used to coduct the assessmet i Keya icluded a review of relevat govermet policies ad project documets, key iformat iterviews, site household surveys, ad focus group discussios. The Keya PHE Assessmet was made possible with fudig from the U.S. Agecy for Iteratioal Developmet (USAID). SUDAN UGANDA TANZANIA ETHIOPIA KENYA Nairobi SOMALIA Mombasa INDIAN OCEAN depedece o forest resources, greater food security, cleaer drikig water, ad icreased access to health services. 1 Populatio, Health, ad the Eviromet: What Are the Liks? The umber of people, where they live, ad how they live all affect the eviromet. People alter the eviromet by clearig lad for developmet, usig atural resources, ad producig wastes. Chages i evirometal coditios, i tur, affect huma health ad well-beig. Rapid urbaizatio, deforestatio, ad polluted water ad air, for example, all pose challeges for policymakers i Keya ad elsewhere i Africa. The itegrated populatio-health-eviromet (PHE) approach to developmet recogizes the itercoectedess betwee people ad their eviromet ad supports cross-sectoral collaboratio ad coordiatio. As its ame suggests, the approach places particular emphasis o the populatio, health, ad eviromet sectors. However, the uderlyig philosophy is fudametally oe of itegratio. It ca accommodate other sectors ad be successfully applied to achieve a rage of developmet goals, from poverty reductio to food security to geder equity. B R i g i g I f o r m a t i o t o D e c i s i o m a k e r s f o r G l o b a l E f f e c t i v e e s s

2 2 PRB Makig the Lik 2007 Box 2 Keya s Ecoomic Developmet History Immediately after Keya s idepedece from Great Britai i 1963, the coutry pursued a developmet strategy that was iformed by Africa socialism, but placed uambiguous emphasis o rapid ecoomic growth rather tha huma developmet. The ew govermet assumed that poverty, uemploymet, ad icome disparities would improve as a result of a robust ecoomy. These issues were cosidered tagetial to ecoomic growth. Access to educatio ad health services, property rights, political participatio, ad equality ad odiscrimiatio were evisioed from a purely ecoomic perspective. I 1978, Keya etered a ew phase of ecoomic ad huma developmet with the implemetatio of Structural Adjustmet Programs ad ecoomic policies that itroduced some drastic measures ivolvig trade liberalizatio, privatizatio of public eterprises, retrechmet of public employees through public sector reforms, ad reductios i govermet expediture. These measures led to the impositio of user fees o such social ameities as educatio ad health, ad dimiished the access to these services by the poor ad vulerable. At the same time, Keya was seeig ecoomic growth. The coutry s ecoomy grew by a aual average of 6 percet betwee 1964 ad 1980 ad by 4 percet betwee 1980 ad But Keya faced decliig per capita icome i the 1990s. Betwee 1990 ad 2002, the coutry saw aual GDP growth of 1.9 percet while the populatio grew 2.9 percet aually. Eve with a substatial ecoomic recovery sice 2003 ad a declie i absolute poverty from 52 percet to 46 percet betwee 1997 ad 2006, Keya remais oe of the poorest coutries i Africa. Source: Uited Natios Developmet Programme (UNDP), Keya Huma Developmet Report, Keya s Developmet Policies Keya s developmet history has bee usteady sice the coutry gaied its idepedece from Great Britai i 1963 (see Box 2). There has bee some progress i recet years, however. Educatio reforms, such as free ad compulsory educatio i primary schools, have traslated ito more childre i school with a good balace betwee girls ad boys. 2 HIV prevalece fell from 6.8 percet to 6.1 percet betwee 2003 ad Ad sice 2003, Keya has see positive ecoomic gais, with the gross domestic product (GDP) growth rate reachig 5.8 percet i Milleium Developmet Goals I September 2000, Keya pledged to achieve the UN Milleium Developmet Goals (MDGs) by the target date of A atioal MDGs task force cosistig of the Miistry of Plaig ad Natioal Developmet, the UN system, ogovermetal orgaizatios (NGOs), ad the private sector was created to spearhead the efforts to achieve the goals laid out by the declaratio. 4 So far, Keya has made oteworthy progress toward meetig two of the eight MDGs: achievig uiversal primary educatio (Goal 2), with 90 percet of girls ad 95 percet of boys ow erolled i primary school; ad combatig HIV/AIDS, malaria, ad other diseases (Goal 6). 5 Keya Visio 2030 Sice 2005, Keya has worked to develop a logterm atioal developmet strategy called Keya Visio The Keya Visio 2030 evisios a globally competitive ad prosperous atio with a high quality of life by The visio is achored o three key pillars: The ecoomic pillar: Keya maitais a sustaied ecoomic growth rate of 10 percet per aum over the ext 25 years. 6 The social pillar: Keya achieves a just ad cohesive society ejoyig equitable social developmet i a clea ad secure eviromet. The political pillar: Keya establishes a issuebased, people-orieted, results-orieted, ad accoutable democratic political system. Populatio Treds ad Policies Keya s populatio which icludes more tha 70 tribes ad peoples has icreased rapidly durig the past half cetury, from 8 millio i 1960 to 37 millio i With a curret growth rate of 2.8 percet per year, the coutry s populatio is projected to reach 51 millio by The populatio is youg: 42 percet are uder age 15 ad oly 2 percet are age 65 or older. 7 Keya was the first sub-sahara Africa coutry to adopt a Natioal Family Plaig Program i The relatively log history of populatio programs i Keya icludes a umber of successes. The total fertility rate ow stads at 4.8 lifetime births per woma (below the average of 5.5 childre per wome for easter Africa 9 ) ad early oe-third of reproductive-age wome use moder cotraceptives. However, use of family plaig methods especially ijectables, combied oral cotraceptives, ad IUDs has plateaued i recet years. The total fertility rate remais well above the so-called replacemet level of 2.1 childre per woma the umber of childre that would lead to a stable populatio size.

3 PRB Itegratig Populatio, Health, ad Eviromet i Keya The stagatio i family plaig use has bee attributed to a stall i socioecoomic progress, itermittet availability of cotraceptive methods, the shift of health agecies focus ad resources to the fight agaist HIV/AIDS, ad a lack of cotiuous family plaig educatio ad outreach. Twetyfour percet of married wome report a umet eed for family plaig that is, they would prefer to avoid a pregacy but are ot usig a cotraceptive method. I oe effort to revitalize the family plaig movemet i Keya, the Natioal Coordiatig Agecy for Populatio ad Developmet (NCAPD) is leadig a process of repositioig family plaig, which attempts to gai greater govermet support for family plaig programs through iformatio dissemiatio ad advocacy. Some ecouragig progress was made i 2005, whe the Miistry of Health created a budget lie for reproductive health services, callig family plaig a priority. This additioal support has improved the availability of commodities at family plaig delivery poits where commodities are free. Keya s recetly revised Natioal Populatio Policy icorporates the targets cotaied i the Programme of Actio of the Iteratioal Coferece o Populatio ad Developmet (ICPD) held i Cairo i The policy is implemeted through a collaborative process ivolvig stakeholders from both public ad private sectors, icludig ogovermetal ad commuity-based orgaizatios. The policy emphasizes raisig awareess amog decisiomakers ad developmet plaers about the effect that populatio chage ca have o social ad ecoomic developmet, ad the beefits of lowerig fertility. Ad the policy seeks to match the populatio growth to the available atioal resources over time i order to improve the well-beig ad the quality of life of the idividual, the family, ad the atio as a whole. The policy recogizes that populatio icrease is puttig greater pressure o atural resources ad wars that the degradatio of the atio s soils, water sources, ad forests will costrai the coutry s ability to produce food ad guaratee acceptable health ad ecoomic stadards. 10 The policy implies a resposibility withi the populatio ad health sectors to deal with evirometal issues ad lays the foudatio for populatio-healtheviromet cross-sectoral collaboratio. Health: A Mixed Picture Keya has see a mix of positive ad egative treds i its health sector. While access to safe water ad saitatio is improvig (62 percet ad 48 percet of the rural populatio had access to a improved water source ad improved saitatio, respectively, i 2002), 11 ifat ad child mortality idicators, amog others, are deterioratig. As the table shows, the key health idicators did ot improve betwee 1993 ad 2003: Ifat ad child mortality are risig, fertility ad family plaig use are stagat, ad completed vacciatio coverage has deteriorated sharply. Stutig (chroic malutritio) has decreased somewhat, but still affects almost oe-third of the childre uder age 5. Materal mortality has decreased oly omially. The uderlyig causes of icreased ifat ad child mortality may iclude: reduced access to health services for the poor followig the itroductio of user fees; declie i food availability; decreased immuizatio coverage ad efficacy (due to the declie i completed vacciatios); persistece of HIV/AIDS as a major health problem (life expectacy decreased from 58 years i 1990 to 53 years i 2007 because of AIDS); ad persistet poverty, with 58 percet of Keyas ow livig o less tha US$2 a day. 12 There are opportuities for itegratig evirometal issues withi the health sector, especially withi saitatio ad hygiee programs. Typhoid, Keya s Populatio ad Health Treds, Idicator * Percet of married wome usig cotraceptio (moder methods) 27.3% 31.5% 31.9% Ifat deaths (< age 1) per 1,000 live births Child deaths (< age 5) per 1,000 live births Materal mortality, deaths per 100,000 live births Percet childre (ages moths) fully vacciated 79% 65.4% 60.1% Percet childre <age 5 stuted 33.0% 30.6% Total fertility rate** (lifetime births per woma) * Excludes orther ad ortheaster provices ot icluded i previous surveys for comparability. ** The average umber of lifetime births a woma would have give curret birth rates. Source: Cetral Bureau of Statistics (CBS) [Keya], Miistry of Health (MOH) [Keya], ad ORC Macro, Keya Demographic ad Health Surveys, 1993, 1998, 2003.

4 4 PRB Makig the Lik 2007 diarrhea, cholera, ad itestial worm ifestatio have icreased i Keya durig the past several years, particularly i low-icome areas with poor saitatio services. Water pollutio from urba ad idustrial waste poses a evirometal problem i most parts of the coutry. The govermet through the Natioal Health Policy Framework is addressig these problems by shiftig the emphasis from curative health services to prevetative health care. However, Keya does ot yet have a well-coceived strategy for addressig evirometal health issues. Evirometal Challeges Keya is home to 35,000 kow species of flora ad faua. Remarkable coservatio achievemets have bee made durig the past half cetury; most otably the establishmet of more tha 50 atioal protected areas, icludig five Biosphere Reserves ad three World Heritage Sites. Thirtee percet of Keya s total surface area is curretly i protected areas. The govermet has log bee committed to coservig Keya s valuable atural resources ad wildlife ad has eacted a umber of policies for evirometal maagemet ad coservatio, such as the Wildlife Policy, Forest Policy, Fisheries Policy, ad Natioal Lad Policy. Despite these efforts, a wide rage of evirometal problems persist. Key evirometal challeges i Keya iclude a declie i wildlife populatios, deforestatio, soil erosio, ad water scarcity due i large part to icreased areas of lad i agricultural productio ad livestock grazig ad icreased demad for wood for fuel ad timber. Three-quarters of Keya s populatio live i rural areas ad 64 percet of the ecoomically active populatio deped o agriculture as their primary source of icome. With oly 20 percet of the lad surface suitable for cultivatio, a rapidly growig populatio puts tremedous pressure o lad ad water resources. Furthermore, cotiued deforestatio, loss of atural habitat, ad illegal poachig have led to a declie i most wildlife species i the coutry, icludig large mammal species such as elephats, rhioceros, ad wildebeests; 113 aimal species are ow threateed or edagered i Keya. The deterioratio of Keya s eviromet has precipitated a umber of evirometal hazards that have affected public health ad safety. The lowlad areas of wester Keya have suffered regular flood disasters, for example. Kakamega, i wester Keya, ad Muraga, i cetral Keya, have experieced serious ladslides. Other evirometal ad health hazards iclude the icreased icidece of waterbore diseases i wester Keya, ad the devastatig ivasio of water hyacith (Eicchoria crassipes) i Lake Victoria ad mesquite (Prosopis juliflora) i drylad eviromets. The Need for a Eviromet Policy The Evirometal Maagemet ad Coordiatio Act (EMCA, 1999) serves as Keya s pricipal legal istrumet o the eviromet, but there is o comprehesive umbrella policy o the eviromet. Curretly, the alterative to a far-reachig eviromet policy is Sessioal Paper No. 6 of 1999 o Eviromet ad Developmet. The overall goal is the itegratio of evirometal cocers ito the atioal plaig ad maagemet processes ad provisio of guidelies for evirometally sustaiable developmet. It specifically cites poverty, populatio growth, rural-urba migratio, ad urba evirometal degradatio ad pollutio as key challeges to achievig this goal. Over the years, the govermet tried to implemet evirometal policies withi a multisectoral developmet framework. However, strategies to achieve these objectives have ot bee fully developed or implemeted. They have bee blocked maily by the lack of istitutioal capacity ad resources to mobilize ad lik activities effectively withi ad betwee sectors. Moreover, the idividual evirometal policies that ow exist do ot adequately articulate the liks betwee populatio ad evirometal cocers. A umbrella policy o the eviromet is ecessary to: Clearly demostrate populatio-eviromet likages; Harmoize ad streamlie the existig evirometal policies; Provide the Natioal Evirometal Maagemet Agecy (NEMA) with the ecessary maagemet procedures ad istitutioal madates which are officially edorsed by the Miistry of Eviromet ad Natural Resources (MENR) to uphold EMCA; ad Successfully itegrate eviromet ito a atioal sustaiable developmet framework.

5 PRB Itegratig Populatio, Health, ad Eviromet i Keya Cross-Sectoral Collaboratio i Keya: PHE at the Policy Level The Keya PHE assessmet showed that existig atioal policies have embraced the spirit of crosssectoral collaboratio. However, the coutry lacks clear legal frameworks ad istitutioal capacity to carry out policy madates ad recommedatios. A review of all the relevat regulatory ad structural frameworks is ecessary to develop a implemetatio strategy that will esure that workig across sectors becomes the orm withi the various govermet agecies. Some of the key cotetious areas to be cosidered are istitutioal guidelies o leadership, coordiatio, ad cotrol of PHE programs ad projects; ad sharig of istitutioal budget allocatios to fiace PHE programs ad projects. New iitiatives i Keya are attemptig to stregthe cross-sectoral collaboratio ad coordiatio, reflected especially i the Keya Visio 2030 ad its ecoomic, social, ad political pillars. I additio, the Keya Poverty Eviromet Iitiative (PEI) was established as a partership betwee the Miistry of Plaig ad Natioal Developmet ad Uited Natios Developmet Programme i The purpose of PEI is to iclude eviromet cocers i the developmet policy, plaig, ad budgetig process by improvig uderstadig of eviromet-poverty likages, stregtheig the govermet s capacity to implemet evirometal policy that beefits the poor, developig tools for the itegratio of eviromet ito developmet plas ad budget processes, ad icreasig effective participatio of stakeholders i eviromet ad developmet policymakig ad plaig processes. 13 Itegrated Projects ad Approaches i Keya: PHE at the Commuity Level The PHE assessmet foud that most policymakers ad developmet professioals i Keya ow prefer the cross-sectoral collaboratio approach to developmet. A recet (2005) review of itegrated programs i the Philippies ad Madagascar offers some evidece to support this view. The review cocluded that, very ofte, itegrated PHE programs yield better results tha sigle-sector programs ad are more programmatically efficiet. 14 Oe of the most valuable beefits of itegrated programmig accordig to the results of operatioal research ad the views of NGO practitioers is the potetial for reachig expaded target audieces. 15 PHE programs have bee especially effective i icreasig the participatio of wome i coservatio activities ad the participatio of me ad youth i family plaig ad health activities. Itegrated programs have also documeted reduced operatig expeses by avoidig duplicatio ad redudacy ad stregtheig cross-sectoral coordiatio at the local level; galvaized ad maitaied greater commuity goodwill ad trust; ad icreased wome s status ad self-perceptio i project areas, especially whe programs iclude microcredit or other livelihood activities. Eve with all the beefits associated with itegrated programmig, may challeges exist i makig these itegrated projects work. Traditioal fudig mechaisms withi door agecies make it difficult to fud such projects. Itegrated PHE projects have come uder icreased scrutiy from developmet plaers ad the door commuity, with aalysts questioig whether they are more cost-effective ad at least as successful as sigle-sector focused projects. 16 Alterative cost-effectiveess aalyses may be eeded to measure the time ad cost savigs of itegrated approaches. Commuity members time is ot usually icorporated ito cost estimates, for example, yet itegrated programs ca save their time by discussig several sector-specific issues at a sigle meetig. Ad multiple project itervetios ca be plaed, implemeted, ad moitored usig commo maagemet plas ad evaluatio systems. The istitutioal capacity for PHE projects is still weak i Keya. Collaboratio betwee govermet departmets, lead agecies, ad NGOs require clear mechaisms such as the Memoradum of Uderstadig (MoU), but these ofte do ot exist for itegrated PHE projects. Ad commuicatio ad publicity efforts are ot yet broad eough to garer the support ad cooperatio of all key stakeholders, particularly at the commuity level. Despite these challeges, some successful itegrated projects have brought positive chage to people ad the eviromet i a relatively short time. The followig four projects are amog the success stories. Il Ngwesi Group Rach The Il Ngwesi Group Rach (Laikipia District), which represets a commuity of approximately 6,000 people, established a ecotourism project to

6 6 PRB Makig the Lik 2007 coserve wildlife ad local culture, create employmet, ad reduce overdepedecy o livestock by geeratig alterative livelihood optios. A ecolodge geerates icome to provide beefits to the commuity, such as ew schools ad improved commuity health services, icludig a improved water supply, distributio of mosquito bed ets, ad a itesive AIDS awareess campaig. Through coservatio measures such as cotrolled grazig, watershed protectio, ad reforestatio, the project has reduced evirometal degradatio ad slowed the loss of wildlife species i a relatively short period of time, with sigificat payoffs for the local commuity. For example, a pilot program by the Laikipia Wildlife Forum eabled the first black rhio to be reitroduced ito Il Ngwesi Group Rach i Curretly, Il Ngwesi has three black rhios ad is oe of the few areas i sub-sahara Africa where the local commuities have madates to protect a edagered species. Such effective evirometal stewardship has helped Il Ngwesi become a popular tourist draw ad, with the success of the ecolodge, the project has proved to be self-sustaiig after the iitial door ivestmets. Kibera Water ad Saitatio Project The Keya Water for Health Orgaizatio (KWAHO) has implemeted the Kibera Water ad Saitatio Project i Nairobi s largest iformal settlemet a urba slum with 10 villages ad a estimated 500,000 to 700,000 people. The project has helped the commuity costruct vetilated pit latries, educate commuity members o health ad hygiee, ad establish a garbage collectio poit, amog other activities. Solar Water Disifectio (SODIS) was itroduced as a simple ad cheap techology to purify drikig water for household cosumptio usig radiatio from sulight. The project demostrated that impoverished commuities are willig ad able to adopt moder, evirometally friedly techologies to improve their quality of life, ad that commuity-based orgaizatios are critical for mobilizig people to egage i such PHE projects. Kiuga Marie Natioal Reserve Project The World Wildlife Fud (WWF) has itegrated a comprehesive health compoet ito its Kiuga Marie Natioal Reserve (KMNR) Coservatio ad Developmet Project, which ecompasses seve villages i Lamu District. WWF, the Miistry of Health, ad local parters ow provide reproductive health ad child immuizatio services; basic hygiee, malaria, ad HIV/AIDS prevetio awareess; ad have opeed a staffed dispesary. Coservatio measures, which are implemeted by WWF ad the Keya Wildlife Service, have icluded exchagig illegal fishig gear for legal, sustaiable gear ad cooperatig with WWF to demarcate o-go zoes for fishig so that marie life ca regeerate. Itroducig a effective health compoet ito the larger Kiuga project has prompted a icrease i goodwill amog commuity members, improved health, icreased access to ad use of family plaig, ad fostered greater participatio i coservatio activities. Sauri Milleium Village Project The Milleium Villages Project is a Uited Natios iitiative aimed at empowerig ad workig with impoverished rural commuities i 12 coutries i Africa icludig Ethiopia, Keya, Rwada, Tazaia, ad Ugada to achieve the Milleium Developmet Goals withi 10 years. People i the selected villages work with a wide rage of experts icludig scietists from the Earth Istitute at Columbia Uiversity ad the World Agroforestry Ceter (ICRAF), as well as local developmet professioals ad commuity-based orgaizatios with expertise i agriculture, utritio, health, educatio, eergy, water, commuicatios, ad eviromet. Sauri Milleium Village, located i Siaya District o Lake Victoria, is a coglomerate of 11 villages ad oe tow of about 5,000 people. Whe the project bega i July 2004, 85 percet of the populatio was experiecig food isecurity. Notable improvemets i agricultural productio helped reduce food isecurity to 18 percet by The Sauri Milleium Village Project helps provide safe drikig water through raiwater harvestig ad improved sprigs; improve saitatio through the costructio of pit latries; reduce malaria cases i the village through the widespread distributio of treated mosquito ets ad a malaria prevetio commuicatio campaig; ad ehace the atural eviromet with the platig of idigeous tree species aroud sprigs ad establishig commuity tree urseries.

7 PRB Itegratig Populatio, Health, ad Eviromet i Keya While the projects beefit tremedously from the kowledge ad skills of iteratioal experts ad large fiacial iputs advatages few other itegrated iitiatives ejoy the Sauri project is providig valuable lessos o PHE itegratio. Noteworthy lessos iclude: Strog leadership ad effective maagemet are essetial to successful commuity-based PHE projects that must itegrate a wide variety of itervetios ad egage multiple stakeholders. Cross-sectoral itervetios ca be itroduced at differet times ad at differet scales, depedig o the eeds ad priorities of the stakeholders. Low-cost itervetios, such as raiwater harvestig, improved cook stoves, ad pit latries, ca quickly improve the health ad well-beig of commuities ad provide icetives for cotiued egagemet i such loger-term iitiatives as reforestatio ad immuizatio efforts. Challeges Remai but Itegratio Is Worthwhile Some PHE itervetios, such as those promotig household hygiee, child immuizatio, ad reforestatio, take more time to achieve results ad, therefore, require cotiuous awareess-raisig i the targeted commuities to keep stakeholders egaged. Itervetios that are relatively simple ad cheap are more readily adopted tha itervetios that require heavier ivestmets, thereby limitig their popularity ad sustaiability. Ad itervetios to improve livelihoods ca be adversely affected by market circumstaces outside the projects cotrol. Lack of cosistet data across sectors, particularly at the local level, makes evaluatio of PHE programs extremely difficult. Furthermore, crosssectoral research is still very limited ad without stadard methodologies, variables, ad idicators. This hiders scietific cotributios to the discussio o the beefits ad challeges of itegratio ad exacerbates the research-to-policy gap. The Keya PHE assessmet cocluded that itegrated approaches at both project ad policy levels are more complicated ad time-cosumig i the prelimiary plaig phases, requirig greater commuicatio ad coordiatio tha sigle-sector efforts. Yet oce strategies are i place to implemet itegrated policies ad programs, the results i terms of program outcomes ad bureaucratic efficiecies surpass those of siglesector programs. What does Keya eed to do to cotiue these efforts? The assessmet showed that existig policies have embraced the spirit of cross-sectoral collaboratio, but that Keya lacks the clear legal frameworks ad istitutioal guidelies ecessary to make itegrated projects a reality ad help the atio realize the Keya Visio Ehacig itegratio amog sectors will require: Establishig a strog istitutioal framework that liks existig policies ad creates icetives for pursuig itegrated approaches; Buildig istitutioal capacity to lik activities amog sectors effectively ad to maage multifaceted programs; Dissemiatig best practices i PHE approaches; Improvig commuicatio ad etworkig amog orgaizatios i differet sectors; Maitaiig a effective policy advocacy campaig to raise awareess ad wi policymakers support for cross-sectoral collaboratio; ad Creatig mechaisms for istitutioal collaboratio, which is a key igrediet for PHE itegratio. Stregtheig huma ad istitutioal capacity will make it possible to fully reap the beefits of itegratio i Keya s developmet efforts i the log term. The result will be a improved quality of life for the Keya people ad a healthier eviromet for their childre to iherit. Refereces 1 Fracis Mwaura, Populatio, Health, ad Eviromet Itegratio ad Cross-Sectoral Collaboratio: Keya Coutry-Level Assessmet (Jue 2007), available from [email protected]. 2 UNFPA, Keya Coutry Profile, accessed olie at www. ufpa.org, o Sept. 17, UNAIDS, data accessed olie at o Oct. 4, The eight Milleium Developmet Goals are: 1) eradicate extreme poverty ad huger; 2) achieve uiversal primary educatio; 3) promote geder equality ad empower wome; 4) reduce child mortality; 5) improve materal health; 6) combat HIV/ AIDS, malaria, ad other diseases; 7) esure evirometal sustaiability; ad 8) develop a global partership for developmet. 5 UNFPA, Keya Coutry Profile; ad UNAIDS, data accessed olie at o Oct. 4, 2007.

8 8 PRB Makig the Lik Sice 2003, Keya has tried to improve ecoomic performace through its Ecoomic Recovery Strategy (ERS). By 2005, the GDP growth rate had reached 5.8 percet. 7 Carl Haub, 2007 World Populatio Data Sheet (Washigto, DC: Populatio Referece Bureau, 2007). 8 UNFPA, Keya Coutry Profile. 9 Followig UN defiitios, East Africa icludes Burudi, Comoros, Djibouti, Eritrea, Ethiopia, Keya, Madagascar, Malawi, Mauritius, Mayotte, Mozambique, Reuio, Rwada, Seychelles, Somalia, Tazaia, Ugada, Zambia, ad Zimbabwe. 10 Natioal Coucil for Populatio ad Developmet, Miistry of Plaig ad Natioal Developmet (MPND) [Keya], Sessioal Paper No. 1 of 2000 o Natioal Populatio Policy for Sustaiable Developmet (2000). PRB s Populatio, Health, ad Eviromet Program works to improve people s lives aroud the world by helpig decisiomakers uderstad ad address the cosequeces of populatio ad eviromet iteractios for huma ad evirometal well-beig. For more iformatio o the PHE program, please write to [email protected]. The Populatio Referece Bureau iforms people aroud the world about populatio, health, ad the eviromet, ad empowers them to use that iformatio to advace the well-beig of curret ad future geeratios. For more iformatio, icludig membership ad publicatios, please cotact PRB or visit our website: Policy Briefs i PRB s Makig the Lik Series: Itegratig Populatio, Health, ad Eviromet i Ethiopia (2007) Itegratig Populatio, Health, ad Eviromet i Keya (2007) Itegratig Populatio, Health, ad Eviromet i Tazaia (2007) Likig Populatio, Health, ad Eviromet i Fiaaratsoa Provice, Madagascar (2006) Breakig New Groud i the Philippies: Opportuities to Improve Huma ad Evirometal Well-Beig (2004) Ripple Effects: Populatio ad Coastal Regios (2003) Wome, Me, ad Evirometal Chage: The Geder Dimesios of Evirometal Policies ad Programs (2002) Childre s Evirometal Health: Risks ad Remedies (2002) Fidig the Balace: Populatio ad Water Scarcity i the Middle East ad North Africa (2002) All publicatios are available o PRB s website: 11 World Bak, 2006 World Bak Idicators (Washigto, DC: The World Bak, 2006): Cetral Bureau of Statistics (CBS) [Keya], Miistry of Health (MOH) [Keya], ad ORC Macro, Keya Demographic ad Health Survey 2003 (Calverto, MD: CBS, MOH, ad ORC Macro, 2004). 13 Uited Natios Eviromet Programme, Poverty ad Eviromet Iitiative: Keya Profile, accessed olie at org o Sept. 20, Joh Pielemeier, Review of Populatio-Health-Eviromet Programs Supported by the Packard Foudatio ad USAID, accessed olie at o Sept. 4, Pielemeier, Review of Populatio-Health-Eviromet Programs Supported by the Packard Foudatio ad USAID. 16 Pielemeier, Review of Populatio-Health-Eviromet Programs Supported by the Packard Foudatio ad USAID. Ackowledgmets Melissa Thaxto prepared this policy brief. Special thaks to the Natioal Coordiatig Agecy for Populatio ad Developmet (NCAPD) for coordiatig the Keya PHE Assessmet process ad providig techical iput to the report; to Dr. Fracis Mwaura of the Uiversity of Nairobi for servig as lead author of the report; ad to the Keya PHE task force members Karugu Ngatia, Dr. Boiface K Oyugi, ad Hosea Mulatya of NCAPD; Naftali Ndugire, Natioal Eviromet Maagemet Agecy (NEMA); Katherie Muoki, Miistry of Plaig ad Natioal Developmet; Zipporah Gathiti, UNFPA; Margaret Kirimi, Uiversity of Nairobi; Kepha Ombacho, Miistry of Health; ad Dr. Lawrece Oteba, Family Health Optios Keya for cotributig the ecessary techical expertise to the assessmet ad workig collaboratively for six moths o the project. Thaks also to Roger-Mark De Souza, Sierra Club; Cara Hozak, World Wildlife Fud; ad Charlotte Feldma-Jacobs, Lori Ashford, Charles Teller, ad Richard Skolik of the Populatio Referece Bureau for reviewig various drafts of the brief ad providig isightful commets ad suggestios. Fudig for this policy brief was provided by the U.S. Agecy for Iteratioal Developmet, uder the BRIDGE Project (Cooperative Agreemet GPO-A ). POPULATION REFERENCE BUREAU 1875 Coecticut Ave., NW, Suite 520, Washigto, DC USA Tel.: Fax: [email protected] Website: POPULATION REFERENCE BUREAU PRINTED WITH SOY INK TM