Browsing by Subject "Kenya"

Now showing 1 - 20 of 44
  • No Thumbnail Available
    Item
    Open Access
    A review of the National Payment Systems ecosystems in South Africa, Kenya and Nigeria
    (2025) Davids, Saarah; Alhassan, Abdul Latif
    Remittances are a critical financial connection between migrant workers and their families back home. They contribute to Sustainable Development Goals (SDGs) like reducing inequality and ending poverty, while aligning with the objectives of South Africa's National Development Plan, which seeks to foster economic growth, financial inclusion, and regional integration. This dissertation examines the cost elasticity of remittance flows between South Africa and 11 sub-Saharan African countries from 2011 to 2023, focusing on how changes in remittance costs influence the volume of remittances sent. Panel regression analysis reveals a significant negative relationship between remittance costs in South Africa and remittance outflows to 11 SSA countries, particularly for smaller transfer amounts. Specifically, a moderate statistically significant negative correlation between the remittance cost of sending USD $200 and the personal remittance received. This indicates that an increase in remittance costs results in a decrease in the remittance volumes, supporting cost elasticity and the Law of Demand. The variability of remitting $500 is less than remitting $200, indicating that it is cheaper for migrants to remit at larger amounts due to lower transaction costs. However, remittance behaviour suggests inelastic demand: while costs increases, the remittance inflows decrease however not drastically. Regression analysis results show that an increase in the transaction costs results in a steady decline in volumes, while descriptive statistics suggest variations across the different South Africa-SSA corridors. Additionally, results indicate a statistically negative relationship between remittance inflows and GDP of the home country, indicating both influence remittance behaviour. This means that with a higher income in the home country, there is less reliance on remittances. Higher GDP per Capita in both sending and receiving countries is associated with higher remittance costs, suggesting income-related pricing trends. The study highlights how lower remittance costs can contribute to financial inclusion, economic growth, and poverty reduction and empower household savings, and is consistent with National Payment System's Vision 2025 of the South African Reserve Bank and policies such as the Conduct of Financial Institutions (COFI) Act. The findings underscore the need for targeted policy interventions aimed at fostering competition, innovation and cost effectiveness to reduce remittance costs and improve financial access, to promote equitable economic participation and supporting broader development objectives in the region.
  • Thumbnail Image
    Item
    Open Access
    An analysis of the user-free policy for health care in Kenya : is the effort worth it?
    (1999) Mwangi, PK; Thomas, Stephen
    This study analyses the user fee policy for health care in Kenya that was introduced to try and recoup some of the costs incurred in providing care as well as rationalise the use of resources. The study aims to generate policy-related findings that are crucial to MOH policy makers in their attempt to provide quality and affordable care. In particular, factors associated with proper function or malfunction of the user fee policy are discussed. The study focussed on four hospitals located in Central province of Kenya. This province was purposefully chosen for its convenience and its high potential for cost recovery. Equity in health care consumption, efficiency, sustainability and perceived quality of care are reviewed. Both primary and secondary data were used. Quantitative and qualitative data were solicited by way of administering questionnaires. Respondents were divided into two categories: providers (staff) and consumers (patients) of health care. The latter were subdivided into inpatients and outpatients. Each of these categories had a specific questionnaire. Further, an attempt is made to estimate net revenue generated in the year 1997/98 by the facilities under study. Costs associated with fee collection were estimated on monthly basis and then projected for the whole year. There are important findings from the study; though patients are charged higher fees at hospitals than at primary levels in order to bolster the referral system, many patients are bypassing the nearby primary care facilities. This study recommends that bypassing patients should be charged higher fees than referred ones.
  • No Thumbnail Available
    Item
    Open Access
    Assessing the efficacy of Kenya's international and national obligations in enhancing the effective political participation of persons with disabilities (PWDs) in Kenya
    (2025) Muasya Kasema, Roy Michael; Phaahla, Elias; Seegers, Annette
    The overall objective of this research is to examine the effectiveness of Kenya's legal frameworks (including the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), Constitution of Kenya (CoK) and Persons with Disabilities Act (PDA)) that condition the political participation of persons with disabilities (PWDs)1, and to explore the extent to which, consequently, PWDs do and can exercise their participatory rights2. Based on a desktop-study, using primarily secondary literature and qualitative evidence, this study observed that, despite Kenya's broad legal framework in support of the full inclusion of PWDs in political activities, the same has not been effectively realized. It also assesses why, despite the adoption of these seemingly progressive laws, PWDs have struggle to fully actualize their political rights. It is evidenced that, in some areas, there are gaps and shortfalls in the statutes thereby derogating PWDs' rights and submitting them to, as opposed to protecting them from, exclusion and marginalization in Kenya. Furthermore, there is a shortage in reasonable accommodations and measures to foster an environment conducive to PWDs effectively engaging in politics in Kenya. This, coupled with the underrepresentation of PWDs in decision-making, militates against, instead of promoting the exercise of their political rights in Kenya. Therefore, a lot more needs to be done to ensure that PWDs can fully and effectively participate in political affairs in Kenya.
  • Thumbnail Image
    Item
    Open Access
    Climate change adaptation and sustainable agricultural intensification in developing countries
    (2020) Mulwa, Chalmers Kyalo; Visser, Martine
    The recent threat of climate change has exacerbated the inherent risks in smallholder farming such as soil degradation, resulting in an unprecedented decline in agricultural yields in developing countries. This has threatened the livelihoods of large segments of populations that are heavily dependent on agriculture for survival in these regions. This dissertation focuses on identifying barriers and enablers of effective management of these risks, with an aim of coming up with potential policy interventions that can reduce vulnerability to the mentioned risks. To achieve this, the dissertation utilizes various methods and approaches as well as diverse datasets in two countries in sub Saharan Africa i.e. Namibia and Kenya. Diversification into non-farm activities is seen by many as a risk management strategy in rural areas where highly variable low farm incomes are transformed into stable high non-farm incomes, thus improving the welfare of the rural populations. While this theory of change is uncontested, the importance that the agricultural sector plays as a source of livelihood for rural populations, as well as food provisioning for urban populations, cannot be downplayed. This is more so given the limited non-farm opportunities in developing countries and the exponential population growth in these countries. The two factors combined impede on the envisioned transformation of rural production sectors and also create a sub-population of food insecure urban poor due to rural-urban migration. To mitigate these problems, rural agricultural development is still paramount and strategies that enhance resilience to risks in the sector are still vital. Chapter 2 of this dissertation focuses on this issue and addresses how farm diversification can be leveraged for improved food security in the rural areas, which has potential spill-over effects to other segments of the population. Focusing on northern Namibia, the study evaluates how different levels of diversification in both crop and livestock farming affect household food security outcomes i.e. per capita food expenditure and dietary diversity score. The study employs relatively new econometric methods in these type of studies to evaluate the joint determinants to both crop and livestock diversification, as well as their singular and joint effect on mentioned food security outcomes. The results show that high levels of diversification in either enterprise leads to high food security outcomes. Combined with climate change adaptation strategies that create resilience of agricultural production to climatic shocks, the use of sustainable agricultural intensification practices can further enhance productivity in the sector. Inputs like inorganic fertilizer, organic manure and improved seeds can further build on resilient systems to improve yields. Chapter 3 of this dissertation addresses this issue by looking at whether changes in the larger agri-food systems can be used to incentivize take up of such practices at the farm level. The study evaluates how the emergence of large traders in smallholder grain markets can drive the uptake of inorganic and organic fertilizer and improved seeds. The study thus expands the intervention space available to policy makers who have in the past resorted to potentially distortionary direct policies in the input markets e.g. through subsidy provision, as well as in the output markets e.g. through regulation of prices. To achieve this, the study uses a large panel dataset from Kenya spanning over a decade to evaluate how engagements between farmers and these market actors can be leveraged to drive adoption of these sustainable intensification inputs. Results show that engagements between large grain traders and farmers enhance use of inorganic fertilizer. There is no evidence that these engagements lead to enhanced use of improved seeds or manure. However, past use of improved seeds and manure are shown to affect their subsequent use, implying path dependency in the use of these sustainable inputs hence low dis-adoption rates. Traditional technology adoption studies show that access to information is a critical success factor for the uptake of new technology. Proxy variables for information access, for example proximity to extension services or frequency of extension contact, have consistently been shown to be positively correlated with technology adoption. In the context of climate change, access to weather information can be a critical factor to adoption of adaptation technology. Chapter 4 of this dissertation deals with this issue and assesses whether provision of weather information to farmers can enhance adoption of improved farming technologies that are resilient to climatic shocks. The study focuses on northern Namibia where access to such information, as the study shows, is very limited. A framed experiment approach is utilised to evaluate how climate change-induced uncertainty affects farmers' decision making in a farming season, based on their elicited behavioural attitudes towards risk and uncertainty. Further, the study tests whether providing weather information that reduces this uncertainty leads to adoption of technologies that are welfare improving. Lastly, the demand for weather information is assessed by eliciting the willingness to pay for information under various levels of weather uncertainty. Results indicate that high levels of uncertainty dampen uptake of welfare improving technologies, regardless of individual attitudes towards uncertainty. Availing of weather information leads to welfare improving technology choice, given the prevailing levels of weather uncertainty. There is also a high demand for weather information which is shown to increase with increase in the level of weather uncertainty. The chapters in the dissertation therefore identify key policy variables that can be used to manage vulnerability to risks emanating from climate change and unsustainable production in smallholder farming. Access to comprehensive climate information encompassing weather information and climate change-specific management information on both crop and livestock farming is shown to be a key factor in the uptake of adaptation strategies like use of resilient inputs and farm diversification. Interventions along the value chain like teaming up with large market actors in a private-public engagement is shown to be a potential pathway towards enhancing uptake of sustainable intensification inputs. Other policy variables like credit provision, high education and access to off-farm incomes are also key in explaining uptake of risk management strategies by smallholder farmers in Namibia and Kenya.
  • Thumbnail Image
    Item
    Open Access
    A comparative study of an NGO-sponsored CHW programme versus a ministry of health sponsored CHW programme in rural Kenya: a process evaluation
    (BioMed Central Ltd, 2014) Aridi, Jackline; Chapman, Sarah; Wagah, Margaret; Negin, Joel
    The varied performance of Community Health Worker (CHW) programmes in different contexts has highlighted the need for implementation of research that focuses on programme delivery issues. This paper presents the results of process evaluations conducted on two different models of CHW programme delivery in adjacent rural communities in in Gem District of Western Kenya. One model was implemented by the Millennium Villages Project (MVP), and the other model was implemented in partnership with the Ministry of Health (MoH) as part of Kenya's National CHW programme.
  • Thumbnail Image
    Item
    Open Access
    Contextual influences on health worker motivation in district hospitals in Kenya
    (BioMed Central Ltd, 2009) Mbindyo, Patrick; Gilson, Lucy; Blaauw, Duane; English, Mike
    BACKGROUND:Organizational factors are considered to be an important influence on health workers' uptake of interventions that improve their practices. These are additionally influenced by factors operating at individual and broader health system levels. We sought to explore contextual influences on worker motivation, a factor that may modify the effect of an intervention aimed at changing clinical practices in Kenyan hospitals. METHODS: Franco LM, et al's (Health sector reform and public sector health worker motivation: a conceptual framework. Soc Sci Med. 2002, 54: 1255-66) model of motivational influences was used to frame the study Qualitative methods including individual in-depth interviews, small-group interviews and focus group discussions were used to gather data from 185 health workers during one-week visits to each of eight district hospitals. Data were collected prior to a planned intervention aiming to implement new practice guidelines and improve quality of care. Additionally, on-site observations of routine health worker behaviour in the study sites were used to inform analyses. RESULTS: Study settings are likely to have important influences on worker motivation. Effective management at hospital level may create an enabling working environment modifying the impact of resource shortfalls. Supportive leadership may foster good working relationships between cadres, improve motivation through provision of local incentives and appropriately handle workers' expectations in terms of promotions, performance appraisal processes, and good communication. Such organisational attributes may counteract de-motivating factors at a national level, such as poor schemes of service, and enhance personally motivating factors such as the desire to maintain professional standards. CONCLUSION: Motivation is likely to influence powerfully any attempts to change or improve health worker and hospital practices. Some factors influencing motivation may themselves be influenced by the processes chosen to implement change.
  • Thumbnail Image
    Item
    Open Access
    Correcting mortality for loss to follow-up: a nomogram applied to antiretroviral treatment programmes in sub-Saharan Africa
    (Public Library of Science, 2011) Egger, Matthias; Spycher, Ben D; Sidle, John; Weigel, Ralf; Geng, Elvin H; Fox, Matthew P; MacPhail, Patrick; van Cutsem, Gilles; Messou, Eugène; Wood, Robin
    Background: The World Health Organization estimates that in sub-Saharan Africa about 4 million HIV-infected patients had started antiretroviral therapy (ART) by the end of 2008. Loss of patients to follow-up and care is an important problem for treatment programmes in this region. As mortality is high in these patients compared to patients remaining in care, ART programmes with high rates of loss to follow-up may substantially underestimate mortality of all patients starting ART. Methods and Findings: We developed a nomogram to correct mortality estimates for loss to follow-up, based on the fact that mortality of all patients starting ART in a treatment programme is a weighted average of mortality among patients lost to follow-up and patients remaining in care. The nomogram gives a correction factor based on the percentage of patients lost to follow-up at a given point in time, and the estimated ratio of mortality between patients lost and not lost to follow-up. The mortality observed among patients retained in care is then multiplied by the correction factor to obtain an estimate of programme-level mortality that takes all deaths into account. A web calculator directly calculates the corrected, programme-level mortality with 95% confidence intervals (CIs). We applied the method to 11 ART programmes in sub-Saharan Africa. Patients retained in care had a mortality at 1 year of 1.4% to 12.0%; loss to follow-up ranged from 2.8% to 28.7%; and the correction factor from 1.2 to 8.0. The absolute difference between uncorrected and corrected mortality at 1 year ranged from 1.6% to 9.8%, and was above 5% in four programmes. The largest difference in mortality was in a programme with 28.7% of patients lost to follow-up at 1 year. Conclusions: The amount of bias in mortality estimates can be large in ART programmes with substantial loss to follow-up. Programmes should routinely report mortality among patients retained in care and the proportion of patients lost. A simple nomogram can then be used to estimate mortality among all patients who started ART, for a range of plausible mortality rates among patients lost to follow-up.
  • Thumbnail Image
    Item
    Open Access
    Creating an African HIV clinical research and prevention trials network: HIV prevalence, incidence and transmission
    (Public Library of Science, 2015) Kamali, Anatoli; Price, Matt A; Lakhi, Shabir; Karita, Etienne; Inambao, Mubiana; Sanders, Eduard J; Anzala, Omu; Latka, Mary H; Bekker, Linda-Gail; Kaleebu, Pontiano
    HIV epidemiology informs prevention trial design and program planning. Nine clinical research centers (CRC) in sub-Saharan Africa conducted HIV observational epidemiology studies in populations at risk for HIV infection as part of an HIV prevention and vaccine trial network. Annual HIV incidence ranged from below 2% to above 10% and varied by CRC and risk group, with rates above 5% observed in Zambian men in an HIV-discordant relationship, Ugandan men from Lake Victoria fishing communities, men who have sex with men, and several cohorts of women. HIV incidence tended to fall after the first three months in the study and over calendar time. Among suspected transmission pairs, 28% of HIV infections were not from the reported partner. Volunteers with high incidence were successfully identified and enrolled into large scale cohort studies. Over a quarter of new cases in couples acquired infection from persons other than the suspected transmitting partner.
  • Thumbnail Image
    Item
    Open Access
    Crises and resilience at the frontline-public health facility managers under devolution in a sub-county on the Kenyan Coast
    (Public Library of Science, 2015) Nyikuri, Mary; Tsofa, Benjamin; Barasa, Edwine; Okoth, Philip; Molyneux, Sassy
    BACKGROUND: Public primary health care (PHC) facilities are for many individuals the first point of contact with the formal health care system. These facilities are managed by professional nurses or clinical officers who are recognised to play a key role in implementing health sector reforms and facilitating initiatives aimed at strengthening community involvement. Little in-depth research exists about the dimensions and challenges of these managers' jobs, or on the impact of decentralisation on their roles and responsibilities. In this paper, we describe the roles and responsibilities of PHC managers-or 'in-charges' in Kenya, and their challenges and coping strategies, under accelerated devolution. METHODS: The data presented in this paper is part of a wider set of activities aimed at understanding governance changes under devolution in Kenya, under the umbrella of a 'learning site'. A learning site is a long term process of collaboration between health managers and researchers deciding together on key health system questions and interventions. Data were collected through seven formal in depth interviews and observations at four PHC facilities as well as eight in depth interviews and informal interactions with sub-county managers from June 2013 to July 2014. Drawing on the Aragon framework of organisation capacity we discuss the multiple accountabilities, daily routines, challenges and coping strategies among PHC facility managers. RESULTS: PHC in-charges perform complex and diverse roles in a difficult environment with relatively little formal preparation. Their key concerns are lack of job clarity and preparedness, the difficulty of balancing multidirectional accountability responsibilities amidst significant resource shortages, and remuneration anxieties. We show that day-to-day management in an environment of resource constraints and uncertainty requires PHC in-charges who are resilient, reflective, and continuously able to learn and adapt. We highlight the importance of leadership development including the building of critical soft skills such as relationship building.
  • Thumbnail Image
    Item
    Open Access
    The effect of capital flows on the Kenyan economy
    (2014) Muthuuri, Njoki; Gossel, Sean J
    Foreign capital inflows (FCI) play an important role in the economic development of the recipient country as they fund investments and promote growth. However, the size and composition of such inflows are determined on the basis of country specific requirements. The study investigates the impact of capital inflows on the economy of Kenya at a time when the government implemented economic reform measures to stabilize the economy and restore sustainable growth. More specifically, the study examines the impact of foreign capital flows remittances such as overseas workers remittance, official development aid, and external debt, on selected macro-economic variables using monthly time series data and a single-equation empirical approach. The study findings reveal that some forms of FCI are not influenced by the macro economic variables in the country but by other factors such as political stability and policy variables.
  • Thumbnail Image
    Item
    Open Access
    Effects of agricultural biodiversity and seasonal rain on dietary adequacy and household food security in rural areas of Kenya
    (2015-04-25) M’Kaibi, Florence K; Steyn, Nelia P; Ochola, Sophie; Du Plessis, Lisanne
    Abstract Background Kenya has a high prevalence of underweight and stunting in children. It is believed that both agricultural biodiversity and seasonal rainfall influences household food security and dietary intake. In the present study we aimed to study the effects of agricultural biodiversity and seasonal rains on dietary adequacy and household food security of preschool Kenyan children, and to identify significant relationships between these variables. Methods Two cross-sectional studies were undertaken in resource-poor households in rural Kenya approximately 6 months apart. Interviews were done with mothers/caregivers to collect data from randomly selected households (N = 525). A repeated 24-hour recall was used to calculate dietary intake in each phase while household food security was measured using the Household Food Insecurity Access Scale (HFIAS). A nutrient adequacy ratio (NAR) was calculated for each nutrient as the percent of the nutrient meeting the recommended nutrient intake (RNI) for that nutrient. A mean adequacy ratio (MAR) was calculated as the mean of the NARs. Agricultural biodiversity was calculated for each household by counting the number of different crops and animals eaten either from domestic sources or from the wild. Results Dietary intake was low with the majority of households not meeting the RNIs for many nutrients. However intake of energy (p < 0.001), protein (p < 0.01), iron (p < 0.01), zinc (p < 0.05), calcium (p < 0.05), and folate (p < 0.01) improved significantly from the dry to the rainy season. Household food security also increased significantly (p < 0.001) from the dry (13.1 SD 6.91) to the rainy season (10.9 SD 7.42). Agricultural biodiversity was low with a total of 26 items; 23 domesticated and 3 from the natural habitat. Agricultural biodiversity was positively and significantly related to all NARs (Spearman, p < 0.05) and MAR (Spearman, p < 0.001) indicating a significant positive relationship between agricultural biodiversity of the household with dietary adequacy of the child’s diet. Conclusion Important significant relationships were found in this study: between agricultural biodiversity and dietary adequacy; between agricultural biodiversity and household food security and between dietary adequacy and household food security. Furthermore, the effect of seasonality on household food security and nutrient intake was illustrated.
  • No Thumbnail Available
    Item
    Open Access
    Environmental governance in Kenya: the role of institutions
    (2011) Katee, Jacqueliyn Philomena; Gibson, John
    This study centers on a critical research problem namely: how does Kenya approach the question of Environmental Governance(EG) and what roles do the institutions created under the Environmental Management and Co-ordination Act (EMCA) play to facilitate EG in the country? The study is conducted within the context that Kenya's attempts to reform its EG institutional framework under the EMCA have been experiencing numerous challenges. Paitly due to these setbacks, the management of natural resources in the country is apparently stuck in the centralized and sectoral approach inherited from the colonial government. This is notwithstanding the fact that in the past decade the country registered abundant legal and institutional reforms that could easily be utilized to enhance a coordinated and decentralized approach in the management of natural resources. In spite of their perceived promise of Good Environmental Governance (GEG), these reforms are yet to have tangible impact in reality. The present reality is natural resource management that is scattered across sectoral lines and minimal decentralization to the rural areas. This state of affairs presents vital implications for Kenya's environmental future. The study therefore not only analyses the extent to which the EMCA promotes good governance by its institutions, but also provides proposals for strengthening EG in the country.
  • Thumbnail Image
    Item
    Open Access
    Essays on institutions and economic development in Kenya
    (2015) Letete, Emmanuel Maluke; Mare, Sarr
    This thesis focuses mainly on three related issues of the broader new institutional economics and political economy research: (i) the evolution of formal economic and political institutions over time (ii) the causality between political institutions and economic institutions, and that between institutions and economic development; (iii) and the role of institutions on economic development through the channel of foreign direct investment, and on the control of rent seeking and corruption in Kenya. These issues are discussed in four distinct essays, each essay constituting an independent and self-contained chapter. It adopts the conceptual framework on institutions proposed by Douglass North. The central theme of the thesis across all chapters is the demonstration of how political players holding de-facto political power operating under weak political rights and civil liberties use legal operators to benefit themselves and their close associates. For instance, starting with British rule - protectorate period (1885-1920) and colonial period (1920-1963) - an extensive legal apparatus designed by those holding de-facto political power expropriated much of the land and redistributed it to themselves at the expense of the indigenous populations whose political rights and civil liberties were crossly undermined. However, even after independence, several political players in the newly independent Kenya made little effort to fundamentally change the colonial laws that governed land rights and could not as well promote strong political rights and civil liberties. The thesis argues that despite pressures from the populace, political leaders and their interest groups holding de-facto political power entrench themselves in the system under weakly institutionalized environment, and oppose the constitutional reforms by all means including force, since such reforms go against their interests. The delay in such reforms often leads to the breakdown of governance. Such breakdown inevitably leads to conflict and social crisis such as the Kenya post-election crisis of 2007. The chapters in the thesis are organized in such a way that they start by tracing the evolution of rights promoted by people holding de-facto political power, then later the remaining chapters take on the assessment and implications of how such rights promoted under weakly institutionalized environment affect economic outcomes.
  • Thumbnail Image
    Item
    Open Access
    Ethical issues in genomic research on the African continent: experiences and challenges to ethics review committees
    (2014-08-21) Ramsay, Michèle; de Vries, Jantina; Soodyall, Himla; Norris, Shane A; Sankoh, Osman
    Abstract This is a report on a workshop titled ‘Ethics for genomic research across five African countries: Guidelines, experiences and challenges’, University of the Witwatersrand, Johannesburg, South Africa, 10 and 11 December 2012. The workshop was hosted by the Wits-INDEPTH partnership, AWI-Gen, as part of the H3Africa Consortium.
  • No Thumbnail Available
    Item
    Open Access
    Exploring the drivers of using microinsurance in managing business risks by MSMEs in Kenya
    (2025) Wangalachi, Anne; Alhassan, Abdul Latif
    Micro, small and medium-scale enterprises (MSMEs) provide jobs and support economic growth. They are a lifeline to millions of individuals and families in Kenya. Protecting the resilience of these enterprises in Kenya and across Africa is a strategic imperative given their significance and their disproportionately heightened vulnerability to external socio-economic shocks from events such as the COVID-19 pandemic. This research explored the potential of insurance to enhance MSME resilience by protecting businesses and livelihoods against typical and emerging risks. Using a qualitative research design strategy with non-probability purposive sampling, data gathered through in-person interviews with MSME owners and employees provided insights into their perceptions, beliefs, and use of insurance, in particular microinsurance, for risk management. Findings indicated that most MSMEs were aware of and were using microinsurance to cover various aspects of their businesses. Some MSMEs had effectively relied on microinsurance to maintain their operations during the COVID-19 pandemic. They expressed their readiness to adopt a well-designed business interruption insurance product should this be available ahead of future pandemics. The study revealed key insurance product attributes that MSMEs value during times of risk including affordability, flexible premiums, timely claims payouts, and bundling with inventory, salary and income protection insurance. These insights are useful for insurers designing products to meet the specific needs of MSMEs in Kenya. The study also identified a research gap for future studies on the subject of supply-side drivers of MSME insurance in Kenya. Ultimately, building MSME resilience to shocks and sudden disruptions like the COVID-19 pandemic will require coordinated and concerted effort among insurers, regulators, policymakers, and multilateral development banks to design and promote context-specific MSME microinsurance products. At scale, these products will protect the livelihoods of MSME owners and employees and sustain the business operations of MSMEs for continued economic activity during future crises of similar magnitude to COVID-19.
  • Thumbnail Image
    Item
    Open Access
    Factors influencing institutionalization of health technology assessment in Kenya
    (BioMed Central, 2023-06-22) Mbau, Rahab; Vassall, Anna; Gilson, Lucy; Barasa, Edwine
    Abstract Background There is a global interest in institutionalizing health technology assessment (HTA) as an approach for explicit healthcare priority-setting. Institutionalization of HTA refers to the process of conducting and utilizing HTA as a normative practice for guiding resource allocation decisions within the health system. In this study, we aimed to examine the factors that were influencing institutionalization of HTA in Kenya. Methods We conducted a qualitative case study using document reviews and in-depth interviews with 30 participants involved in the HTA institutionalization process in Kenya. We used a thematic approach to analyze the data. Results We found that institutionalization of HTA in Kenya was being supported by factors such as establishment of organizational structures for HTA; availability of legal frameworks and policies on HTA; increasing availability of awareness creation and capacity-building initiatives for HTA; policymakers’ interests in universal health coverage and optimal allocation of resources; technocrats’ interests in evidence-based processes; presence of international collaboration for HTA; and lastly, involvement of bilateral agencies. On the other hand, institutionalization of HTA was being undermined by limited availability of skilled human resources, financial resources, and information resources for HTA; lack of HTA guidelines and decision-making frameworks; limited HTA awareness among subnational stakeholders; and industries’ interests in safeguarding their revenue. Conclusions Kenya’s Ministry of Health can facilitate institutionalization of HTA by adopting a systemic approach that involves: - (a) introducing long-term capacity-building initiatives to strengthen human and technical capacity for HTA; (b) earmarking national health budgets to ensure adequate financial resources for HTA; (c) introducing a cost database and promoting timely data collection to ensure availability of data for HTA; (d) developing context specific HTA guidelines and decision-making frameworks to facilitate HTA processes; (e) conducting deeper advocacy to strengthen HTA awareness among subnational stakeholders; and (f) managing stakeholders’ interests to minimize opposition to institutionalization of HTA.
  • No Thumbnail Available
    Item
    Open Access
    Financial development and economic growth – the role of mobile money: empirical evidence from Sub-Saharan Africa and a comparative study of Kenya and Uganda
    (2025) Tinyinondi, Grace Ainomugisha; Nikolaidou, Efi; Mpofu, Trust
    The relationship between financial development and economic growth is well established in the finance-growth literature, which is predicated on the existence of a well-functioning financial system that underscores the complementarity between financial institutions and financial markets. Financial inclusion, defined as the participation of individuals in the formal financial system, is a critical component of financial development and, by extension, the finance-growth nexus. In many developing countries, financial exclusion remains a significant challenge, with a substantial proportion of the population lacking access to formal financial services. However, the advent of mobile money, which achieved notable success in Kenya following its introduction in 2007, has provided a considerable boost to financial inclusion across the Sub-Saharan African (SSA) region, home to the largest concentration of low-income countries globally. Empirical evidence indicates that mobile money has enhanced financial inclusion by expanding access to financial services, thereby contributing to financial development through improved resource mobilization, increased savings, and broader participation in the financial sector. Notably, SSA continues to lead globally in mobile money adoption and usage. This thesis examines the role of mobile money, an important driver of financial inclusion, in shaping the finance-growth nexus in Sub-Saharan Africa (SSA). It employs a broad measure of financial development that incorporates mobile money, financial institutions, and financial markets. The study contributes to the literature by providing empirical evidence from 17 SSA countries, selected based on data availability, covering the period from 2015 to 2022, a timeframe during which mobile money was widely adopted across the region. To gain deeper insights into the impact of enhanced financial inclusion on the finance-growth relationship in developing economies, Kenya and Uganda, two of the leading adopters of mobile money, are analyzed as case studies. While financial inclusion has gained increasing recognition, existing research on the finance-growth nexus in Kenya and Uganda often relies on a single proxy of financial development, typically bank credit to the private sector, thereby overlooking the broader dynamics of a more inclusive financial system. The study constructs a broad-based financial development index encompassing mobile money services, financial institutions, and financial markets, measured across the dimensions of depth, access, and efficiency, to offer new evidence on the finance-growth nexus in Sub-Saharan Africa (SSA), with a particular focus on Kenya and Uganda. As a robustness check, the study employs Svirydzenka's (2016) multidimensional financial development index, which has been widely adopted in recent empirical literature. The Kenyan case study utilizes annual data spanning the period 1980 to 2022, while the Ugandan analysis covers the years 1982 to 2022. To investigate the relationship between financial development and economic growth, the study applies Granger causality tests and a formal growth model. The direction of causality is examined through Granger causality tests based on a Vector Autoregressive (VAR) framework. Furthermore, the analysis incorporates the system Generalized Method of Moments (GMM) panel estimator, along with the Johansen and Juselius (1990) cointegration approach and the Vector Error Correction Model (VECM), to address potential endogeneity concerns inherent in the finance-growth relationship. The Granger causality test results for Sub-Saharan Africa (SSA) and Uganda reveal aunidirectional causality running from real GDP per capita to financial development. This finding lends empirical support to Patrick's (1966) supply-leading hypothesis, which posits that economic growth can be stimulated by the deliberate development of financial institutions and markets. In contrast, the results for Kenya are consistent with the demand-following hypothesis, also proposed by Patrick (1966), which argues that financial development occurs as a response to increasing demand generated by economic growth. These divergent patterns suggest that policy prescriptions should be context-specific: in the case of Uganda, strategies aimed at enhancing financial development may serve as a catalyst for economic growth, whereas in Kenya, promoting economic expansion may be a more effective means of fostering financial sector development. The findings based on the growth model, utilizing an overall Mobile Money Index, constructed from six mobile money indicators (i.e., the value of mobile money transactions as a percentage of GDP; number of mobile money transactions per 1,000 adults; number of registered mobile money agent outlets per 100,000 adults; number of agent outlets per 1,000 km²; mobile cellular subscriptions per 100 people; and number of registered mobile money accounts per 1,000 adults), indicate that financial inclusion positively influences the finance-growth nexus in Kenya and Uganda. However, when the analysis is disaggregated by individual mobile money indicators, the results for Sub-Saharan Africa (SSA), Kenya, and Uganda also reveal negative effects of mobile money on economic growth. This apparent contradiction suggests that, despite notable improvements, financial inclusion remains relatively low in these regions. These results are consistent with prior studies which have shown that financial development may exert a negative effect on economic growth at early stages of financial inclusion. Moreover, the findings highlight several challenges and potential risks associated with mobile money, as identified in existing literature. These include issues related to integrity, privacy, and security; limitations in infrastructure and resources; insufficient alignment of stakeholder incentives; low levels of financial literacy; and the entry of unsophisticated borrowers into the financial system. Thus, this study underscores an important policy implication: while mobile money is a critical tool for advancing financial inclusion, it does not inherently lead to positive economic outcomes. Its benefits can only be fully realized when accompanied by appropriate institutional frameworks, regulatory safeguards, and targeted policy interventions that address its associated risks.
  • Thumbnail Image
    Item
    Open Access
    Genetic diversity in L1 ORF of human papillomavirus in women with cervical cancer with and without human immunodeficiency virus in Botswana and Kenya
    (2022-01-27) Tawe, Leabaneng; Choga, Wonderful T; Paganotti, Giacomo M; Bareng, Ontlametse T; Ntereke, Tlhalefo D; Ramatlho, Pleasure; Ditshwanelo, Doreen; Gaseitsiwe, Simani; Kasvosve, Ishmael; Ramogola-Masire, Doreen; Orang’o, Omenge E; Robertson, Erle; Zetola, Nicola; Moyo, Sikhulile; Grover, Surbhi; Ermel, Aaron C
    Background The variation of human papillomavirus (HPV) genotypes shapes the risks of cervical cancer and these variations are not well defined in Africa. Nucleotide changes within the L1 gene, nucleotide variability, and phylogeny were explored in relation to HIV in samples from Botswana and Kenya. Methods A total of 98 HPV-positive cervical samples were sequenced to identify different HPV variants. Phylogenetic inferences were used to determine HPV genotypes and investigate the clustering of sequences between women living with HIV (WLWHIV) and -women not living with HIV (WNLWHIV). Results Out of 98 generated sequences, 83.7% (82/98) participants had high-risk (HR) HPV genotypes while 16.3% (16/98) had low-risk (LR) HPV genotypes. Among participants with HR-HPV genotypes, 47.6% (39/82) were coinfected with HIV. The prevalence of HR-HPV genotypes was statistically higher in the Botswana population compared to Kenya (p-value < 0.001). Multiple amino acid mutations were identified in both countries. Genetic diversity differed considerably among WLWHIV and WNLWHIV. The mean pairwise distances between HPV-16 between HIV and HIV/HPV as well as for HPV-18 were statistically significant. Six (6) new deleterious mutations were identified in the HPV genotypes based on the sequencing of the L1 region, HPV-16 (L441P, S343P), HPV-18 (S424P), HPV-45 (Q366H, Y365F), and HPV-84 (F458L). The majority of the patients with these mutations were co-infected with HIV. Conclusions Genomic diversity and different genomic variants of HPV sequences were demonstrated. Candidate novel mutations within the L1 gene were identified in both countries which can be further investigated using functional assays.
  • No Thumbnail Available
    Item
    Open Access
    Herding behaviour in African stock markets: evidence from South Africa, Nigeria, Egypt & Kenya
    (2025) Swart, Hermanus; Ndlovu, Godfrey
    In the presence of herding, collective investor behaviour tends to gravitate toward the same or similar investments. When herding behaviour becomes widespread, it can create asset bubbles or market crashes through panic-driven buying and selling. Consequently, comprehending how markets might react during periods of crisis becomes crucial for effectively hedging against artificially inflated asset prices. The objective of this paper is to examine the herding behaviour of investors in African markets – namely South Africa, Nigeria, Egypt and Kenya – using weekly and monthly stock data from January 2000 to October 2023. The study applies the cross-sectional standard deviation of returns (CSSD) and the cross-sectional absolute deviation of returns (CSAD) to examine herding in both normal and turbulent times, particularly during periods of significant turbulence such as the Global Financial Crisis (GFC) in 2008/9 and the recent COVID-19 pandemic. The findings indicate the existence of herding behaviour in the four African stock markets across various periods, with herding being less prominent during highly turbulent phases like the GFC and the COVID-19 pandemic. Additionally, the study reveals a significant spillover from the South African stock market to Nigeria and Kenya during the GFC and to Egypt during the COVID-19 pandemic. Furthermore, U.S. investor sentiment, represented by the VIX index, does not appear to influence herding behaviour in African stock markets. This would suggest that the African markets are correlated and that there are instances of high indications of herding behaviour.
  • Thumbnail Image
    Item
    Open Access
    How does decentralisation affect health sector planning and financial management? a case study of early effects of devolution in Kilifi County, Kenya
    (2017) Tsofa, Benjamin; Molyneux, Sassy; Gilson, Lucy; Goodman, Catherine
    A common challenge for health sector planning and budgeting has been the misalignment between policies, technical planning and budgetary allocation; and inadequate community involvement in priority setting. Health system decentralisation has often been promoted to address health sector planning and budgeting challenges through promoting community participation, accountability, and technical efficiency in resource management. In 2010, Kenya passed a new constitution that introduced 47 semi-autonomous devolved county governments, and a substantial transfer of responsibility for healthcare from the central government to these counties.