I recently returned from a trip to Kenya, during which I met the new president and ministers of health, education and information.
I also met the leadership of the National Aids Control Council, the UN country team, representatives of civil society and people living with HIV/Aids, and made a trip to Kabera, the huge, sprawling, abject slum in Nairobi, to meet more than 100 sex workers, all of whom are involved in a programme of HIV prevention.
Everyone I met and everything I encountered was fascinating, but it’s the political leadership I’d like to focus on.
All too often, when I report back after a visit to Africa, I’m consumed by gloom and apocalyptic utterance. But not this time. This time I came away with a greater degree of hope and optimism than I’ve felt for months.
It’s hard to describe the sense of change from the previous administration: suffice to say, where HIV/Aids is concerned, the change is night and day. Where before senior officials’ attention to Aids was perfunctory, on this occasion every conversation, without exception, demonstrated a new leadership that is intense, committed to confronting the pandemic, determined to put policies and programmes in place, and consumed by the recognition that every single family in Kenya is affected in some way by the ravages of HIV/Aids.
The president has appointed an HIV/Aids Cabinet committee of nine members, which he chairs. He’s providing open and public leadership on the issues of Aids and demands the same of his Cabinet colleagues.
What was particularly impressive and unusual in the meeting with the president was his refusal to accept, at face value, any reassurances that his administration has the pandemic well in hand. He frequently challenged what others said, asserting, almost by instinct, that the crisis is far from under control and insisting that the fight against the pandemic must be intensified.
It was one of the most refreshing meetings I’ve attended with a head of state. We covered prevention, particularly in schools, anti-retroviral drugs, financial resources, orphaned children, stigma, the role of religious communities, the role of parliamentarians in their constituencies, the effects on women and girls, the lifting of school fees and the question of prevalence rates.
The discussion was followed by a meeting with the minister of education. This is the arena where the full force of the new government has been felt. The key promise of the election campaign was the abolition of fees for primary school. No sooner was the present government elected than the promise was fulfilled.
And an extraordinary thing happened: when school reconvened in January, 1,2-million new students poured into the educational system within one week — an increase of more than 20%. The numbers are still rising and are expected to reach 1,5-million by June.
The implications are stunning: 1,2-million children who had not been in class turned up for school. Kenya has an estimated 1,2-million children orphaned by Aids. Are they identical cohorts? Of course not. Is there a significant overlap? Everyone agrees that the overlap is large.
How is it possible that a campaign to eliminate school fees has not been launched across Africa? Where is the leadership to come from?
Why should such vast numbers of children, who have lost one or both parents to Aids, be denied schooling and the prospect of a future because they’re impoverished?
What is so distinctive about Kenya is the new government’s determination to see the lifting of fees as applicable to everything, including books, uniforms or any extraneous levy. In the view of the minister of education, the policy is driven by the guarantees contained in the Convention on the Rights of the Child and the internationally agreed principles of education for all.
In one instance, in an urban slum community many kilometres from Nairobi, the population of the primary school, after the fee announcement, jumped from 1 000 to 5 000 students. But when the headmistress insisted that every child must come to school in a uniform, the numbers dropped to 2 600 — a major revelation in itself. The Ministry of Education asserted that absolutely nothing, including uniforms, was to stand in the way of school attendance, and the numbers are moving back up.
It was understood that abolishing school fees would be costly, but the free education campaign slogan said it all: “If you think education is expensive, try ignorance.” The ministry is scrambling to put together the money to finance the policy. A task force announced in March that it would cost $97,1-million through June and another $137,1-million through the 2003/04 school year.
A major portion of the money will come from the Kenyan Treasury, part of it from the World Bank, part of it from bilateral donors.
Let me now move to the minister of health. Again the conversation illustrated a government determined to break the grip of the Aids pandemic on Kenyan society. This minister speaks with passionate clarity, knowledge and resolve about the need to proceed simultaneously on care, prevention and treatment. More, in a fashion with few parallels, this is a minister who understands the appalling toll being taken on the women of her country and the need to address their vulnerability.
The government of Kenya has just received money from the Global Fund. The $56-million allocated to the next two years will help to provide anti-retroviral treatment for another 3 000 Kenyans. There are roughly 7 000 in treatment now, mostly in the private sector. A target has been set of 40 000 Kenyans in treatment by 2005.
How will the government achieve it? In four ways. First, it is examining legislation to introduce a national health insurance plan. The Ministry of Health intends that treatment for opportunistic infections, and for full-blown Aids, be covered, at least in part, by the plan.
Second, the government hopes to persuade the private sector to further expand its coverage.
Third, the government has set aside in this fiscal year, with increased recurrent funding in mind, the sum of $4-million for laboratory infrastructure to address HIV/Aids, and it is hoped that some of the money will be directed to treatment.
Fourth, the government is preparing its next proposal for the Global Fund, which will include financing for the treatment of another 10 000 people. In that regard, it should be added that the government will wish to purchase generic drugs, from the World Health Organisation list of approved anti-retrovirals, probably from India, to keep the prices down.
Finally, a word about the minister of information. He’s taking a very unusual step. Using the authority granted to him under the broadcasting legislation, he will direct that a certain limited percentage of airtime on all radio and television stations be devoted to programming on Aids prevention. It’s a move that will undoubtedly attract criticism, but just as in the case of his colleagues, the minister is unshakeable.
There is no reason, given the commitment of the new government to tackle HIV/Aids, why Kenya cannot become the next Uganda. But they’ll need lots of help: they must get it.