Analysis of Kenyans' Access to the COVID 19 Vaccine in Urban-Informal Settlements
Suhayl Omar & Wanjiku Kariuki
Analysis of Kenyans' Access to the COVID 19 Vaccine in Urban-Informal Settlements
Suhayl Omar & Wanjiku Kariuki
With thanks to the assistance of:
The Mathare Social Justice Center
The Kayole Social Justice Center
The Kiamaiko Social Justice Center
Feminists for Peace, Rights and Justice Center
the Kibera, Kayole, Mathare and Dandora communities
and single out the continued effort and support by
Hildah Nyakwakah, Naeema Muga, Fatma Guleid, Bryan Mutai, Jenifer Omae, Lucy Wambui, Mama Rahma, Dennis Orengo and Mike
We would like to affirm and acknowledge the power and resilience of the working-class communities in Kenya’s urban-informal settlements, who for them every day is a revolution in different ways. We honor their labor, strength and demand for freedom every day.
We stand in solidarity and togetherness to ensure the continued agitation for our collective access to health and nationwide freedom.
The People’s Vaccine Kenya campaign seeks to ensure equitable and accessible rollout of a safe and free vaccine nationwide. Through various mechanisms of research and advocacy in close collaboration with communities that are at the perennial risk of denial of not just healthcare and medical facilities but also basic needs for human security, we achieve to amplify their voices and demands in the quest for free and accessible healthcare with focus on the COVID-19 vaccine.
This report focuses on the continual denial by state and county management of basic services with a focus on healthcare and medical needs to the residents of Nairobi who have always faced the brunt of government ineptness and continual perennial state sanctioned violence at a personal level.
In addition to research by various other institutions, People’s Vaccine Kenya employed a multifaceted approach in the survey on key items such as; the demographics, accessibility of health care facilities and services, and the economic capacities of individuals from various urban-informal settlements in Nairobi area namely Mathare, Kibra, Kayole and Dandora with individual age groups between 18 and those above 50 years old.
Female respondents constituted 54% of the population compared to 46% of the male respondents. The key goal in including individuals in the 14-16 years age group was to gauge the knowledge of younger populations on the vaccine.
In all the settlements we conducted the surveys in, there was a visible topography of exclusion from access to social services by government. As a coping mechanism, the residents of these areas are further exploited through the rhizomatic trajectories of privatized ecologies of exclusion as access to the most basic of needs have been captured by private entities and individuals and can only be accessed at a fee.
The abandonment of these areas by government has allowed the creation of specific fragments of spatial management that lead to the creation of de facto governments within the communities that feed on the lack of access, to further add onto the pre-existing exploitation of the residents, and increasing the denial of access based on economic disability.
In terms of healthcare, a plethora of issues build up to ensure complete exclusion from medical care within these specific areas. In this report we attempt to delve into and acknowledge these topographies of exclusion that lead to this inaccessibility.
i. Access to Healthcare Facilities
During the survey, various participants noted that there are hospitals close to them. However, they cannot access them because they cannot afford the services.
The biggest hinderance of medical access in urban informal settlements is the lack of adequate, equipped and close distance hospitals and healthcare facilities. Article 43 of the Constitution of Kenya (2010) establishes the right to “the highest attainable standard of health, which includes the right to health care services”. The lack of medical infrastructure in these areas is in direct violation of the constitution and further encompasses the contempt of poor communities in Nairobi.
Vaccination is being carried out predominantly in healthcare facilities in accordance with the facilities listed by the Ministry of Health (Ministry of Health, 2021).We therefore note that the lack of understanding of the comprehensive aspects of accessibility suggests that many participants of the surveys may be in proximity to hospitals and healthcare facilities however they do not have access to them.
ii. Access to Insurance Covers
82.14% of the individuals who participated in the survey were unable to afford insurance and 1.79% of the participants had no clear understanding of the workings of insurance.
The positive impact of healthcare insurance covers is indisputable, and more so for low income households whose effect would be to lower out-of-pocket expenditures and improve access to healthcare. According to research carried out by KEMRI Wellcome Trust Research Programme, only 19% of Kenyans are covered by any form of health insurance which translates to only 3% of Kenyans living in poverty having access to any health insurance coverage compared to 38% among the rich (KEMRI Wellcome Trust, 2019).
Without healthcare cover, the high cost of health care has devastating consequences for low-income households, including delaying or foregoing care and/or financing health emergencies with loans, savings or asset sales.
Kenya’s efforts towards the provision of Universal Health Coverage was the introduction of the National Hospital Insurance Fund cover in 2004 as a means of facilitating access to cheaper health care. According to the Ministry of Health, only 11% of Kenyans are NHIF covered leaving majority of the population without the government- subsidized healthcare plan (Ouma, Masai, & Nyadera, 2020). 71% of the sampled population are not covered by NHIF which results in individuals incurring high health care costs.
Challenges in financing health care and low awareness of health issues are among the main reasons why low-income populations in Kenya do not use health care services even when facilities are within their reach. Kenyan financial diaries show that 38% of poor households postpone treatment (Impact Insurance, n.d.).
Further, the national insurer has been unable to commit to cover the testing and treatment of
COVID 19 patients claiming that it would not be financially viable and that they are not under any financial obligation to do so as per the globally recognized best practices or its current model of operation (Kagwe, 2020). Therefore, resulting in Kenyans catering for these costs out of pocket.
The inability of NHIF to cover any pandemic related costs inexplicably ensures that the burden of accessing, obtaining and affording the vaccine is borne by the Individuals.
2. Price Freedom
Kenya National Bureau of Statistics, 67% of Kenyans lack the economical means to support their upkeep and cater to the basic needs. 33% of the population is spread out in the formal and informal sector (KNBS, 2020).
The following chart represents sample data of individuals and their income earning capability with 30% being unemployed, 34% being employed and 36% being individuals who do not have a constant flow of finances.
Whereas it can be argued that a vast 34% of individuals are able to earn a living, research indicates that the monetary poverty line is Kshs. 3,252 in Rural areas and Kshs. 5,995 in Urban areas (All Africa, 2020) which means that 95.74% of the population would be burdened with obtaining and distributing their resources between their basic needs and acquiring the vaccine.
The following chart demonstrates the salary distribution of the individuals who took part in the survey;
The following data further demonstrates the reluctance of individuals to use their minimal resources in acquiring the vaccine as opposed to meeting their needs, the various participants acknowledged the lack of stable finances. In one instance, a participant claimed, “I do not have money to feed my children, where will I get money to buy the vaccine.” The visible existing survival and competitiveness of basic needs is a key factor that will exclude various individuals from accessing the vaccine due to price exclusion. In this regard, majority were open to getting the vaccine if it was free and voluntary.
Additionally, 68% of the participants want the vaccine rollout to be voluntary whereas 30% want the vaccine process to be mandatory as they believe this will ensure the whole population is vaccinated and there will be focus on slum settlements too.
2% of those who took part in the survey did not provide any response on their preference of the vaccine being mandatory or voluntary.
According to our survey 69% of the participants that they will be vaccinated, 23% said no and 7% did not answer.
The Kenyan government through the COVAX facility has received the Oxford-AstraZeneca vaccines for the national roll-out. Based on data provided by the vaccine manufacturer, the efficacy rate is 63% in various ongoing clinical trials. The vaccine is given in 2 doses and the minimum interval for the doses is 28 days. As of the publication of this report, the protection duration of the vaccinations isn’t fully known. It is important to note however, that the vaccine lowers the risk of symptomatic COVID-19 and in turn hospitalization, not the infection. Therefore, there is a possibility of infection and transmission of the virus even for vaccinated individuals.
However, we understand that vaccine hesitance in Kenya as of now is a misnomer. Many Kenyans including health care workers are not vaccine hesitant but rather there are no clear flows of information on the vaccine roll-out and vaccination programs with concerns of the safety of the vaccine as there is lack of sensitization and training regarding the vaccine (Kyobutungi, 2021). Therefore, the risk of exclusion from vaccine is prevalent as many Kenyans lack information on the vaccination sites and the critical nature of the vaccination.
COVID 19 is a key threat to the health and well-being of individuals around the world with it having an exponential spread rate and a high rate of mutation. According to the latest report by the People’s Vaccine Alliance, epidemiologists have delivered a stark warning of the risk of slow vaccine roll-out. In the report, two-thirds of epidemiologists warn mutations could render current COVID vaccines ineffective in a year or less (Dransfield & Thériault, 2021).
“Europe is trying to vaccinate 80% of its population. The United States is trying to vaccinate everybody. They will finish vaccinating, impose travel restrictions and then Africa becomes “the continent of COVID” – Dr John Nkengasong (Adeoye & Allison, 2021).
As of the publication of the report, out of 52 million Kenyans only 1,116,021 have been partially vaccinated and 13,194 fully vaccinated (Ministry of Health, 2021). The majority of Kenyans are willing to voluntarily get the vaccine, however the harsh conditions surrounding access and information make it difficult to access the vaccine and align to factual information. Whereas most information such as the list of MOH approved vaccination centres is disseminated on the Internet, a recent survey indicated that access to the internet is limited with only 40% of Kenyans having access to the internet (Kemp, 2021).
Recognizing the interwoven nature of top to bottom tier hierarchy of access to the vaccines, we do acknowledge the global barriers of vaccine access such as the rejection of the TRIPS waiver by some members of the World Trade Organization, vaccine hoarding by rich countries and the increased dependence on the COVAX facility by countries within the developing world that has been disrupted by the ban in exports by India’s Serum Institute, the world’s largest producer of vaccines.
However, we cannot fully absolve the barriers manufactured by national government and the Ministry of Health. The Kenyan government has engaged in clandestine indemnity agreements with vaccine manufacturers on procurement of vaccines and service delivery, there has been mistrust between citizenry and government in terms of vaccine efficacy and public confidence in the vaccines. The Kenyan government has actively refused to share information on national vaccine procurement even though the vaccines have received public support either in terms of funding or efficacy trials, therefore the public demand to know what agreements are being made.
Additionally, the Ministry of health has done minimal work to combat vaccine hesitancy and misinformation which has seen the slow uptake of vaccines in almost 9 counties, forcing the vaccines to be recalled to the capital (Mugo & Wako, 2021). Currently, Kenya like many African countries lays in a precarious position as many citizens and residents in these areas remain at risk of COVID-19 infections with deteriorating public health facilities and specifically in Kenya, minimal COVID-19 combatting measures with notable disregard for public safety which is noted in various areas such as Kisumu where leaders encourage state sanctioned gatherings (Mohammed, 2021).
While initial steps – nationally – can be taken to immediately improve the situation in Kenya, it is vital that the Ministry of Health and larger national government work together to ensure that all Kenyans have access to the vaccine, knowledge about the vaccine and factual information regarding efficacy of the vaccines that are being administered.
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