Kenya’s Response to COVID-19
By Charity Mukiri Limboro
Introduction
Globally, countries are employing various strategies to contain COVID-19 pandemic that has led to an unprecedented crisis in the health, economic and social sectors and Kenya is not behind. A multi-agency approach, at two levels (policy and technical) involving pertinent ministries, departments and agencies has been employed to deal with the threat of COVID-19.
Notably, before the first coronavirus disease 2019 (COVID-19) case was identified in Kenya, the national Government had put some measures into place, such as strengthening the healthcare system and introducing health and hygiene guidelines to counter the pandemic. On February 2, 2020, the Ministry of Health advised Kenyans to observe hand washing hygiene, avoid contact with persons coughing or sneezing and to visit the nearest health facility for assessment and treatment, especially if they had recently travelled to China. Furthermore, the President appointed a new Cabinet Secretary for Health as well as instituted the National Emergency Response Committee (NERC) on coronavirus on February 28 through an Executive order No. 2 of 2020. The committee was mandated to monitor the evolving situation and take all necessary measures for averting, containing and mitigating the transmission of COVID-19 in the country.
Following the World Health Organization (WHO) declaration of the novel coronavirus (COVID-19) outbreak a global pandemic on March 11, 2020, the National Emergency Response Committee on Coronavirus presented to the President the first report on the level of the National and County Government’s preparedness and measures to counter coronavirus on March 12, 2020. These included:
- Mandatory screening of all persons coming into the country through airports, sea ports and land crossings.
- Isolation and treatment capacity at Mbagathi Hospital ready for use.
- Institution of isolation centres in level 4 and 5 hospitals across the country in collaboration with County Governments.
- Establishment of backup capacity for treatment at Kenyatta University Teaching Research and Referral Hospital, Kenyatta National Hospital and Moi Teaching and Referral Hospitals, in addition to some private health facilities.
- Training and sensitization of healthcare workers, service providers in the transport sector including minibuses crew, taxis, security personnel, airport and border staff among others.
- Deferment of international conferences, meetings and events planned to take place in Kenya for a period of 30 days.
- Postponement of non-essential international travel by government officials.
- Provision of personal protective equipment to all County health facilities, security and response teams.
- Improved diagnostic capability at the National Influenza Centre and KEMRI.
The first case of COVID-19 was confirmed in Kenya on March 13, 2020, since the pandemic was reported in China in December 2019. The case was 26-year-old Kenyan woman who had travelled back to Nairobi (on March 5, 2020) from the United States of America through London, United Kingdom. She was confirmed positive by the National Influenza Centre Laboratory at the National Public Health Laboratories of the Ministry of Health. Immediately, the government through the Ministry of Health traced and isolated a number of people who had come into contact with her for 14 days. Since then, the Ministry of Health holds daily press conferences to update the country on the status of COVID-19 – sample testing, infections, recoveries and fatalities.
Kenya’s approach
The Government of Kenya largely adopted ‘containment’ as the strategy in the fight against COVID-19. After the confirmation of the first case in the country, the government’s immediate reaction was to contain the spread of COVID-19 by instituting policy measures and behavioural protocols aimed at averting the spread of the virus especially into the rural areas where most of the senior citizens reside.
Restriction on movement
On March 15, 2020, President Uhuru Kenyatta ordered the closure of all schools and institutions of higher learning with effect from March 20, 2020. In addition, he directed employees from public and private sectors to work from home wherever possible; with an exception of essential services staff. Moreover, President Uhuru Kenyatta declared Saturday, March 21, 2020, a national day for prayer to petition God for forgiveness, protection and blessings in the face of COVD-19 pandemic threat.
Other COVID-19 containment measures taken by the government include restriction of travel from countries with any cases of coronavirus, and travellers into the country were limited to Kenyan citizens and foreigners with valid residence permits and who had to proceed on self-quarantine for a period of 14 days. Persons who violated the self-quarantine requirement were to be forcefully quarantined for a period of 14 days at their cost, and thereafter, arrested and charged under the Public Health Act. People were encouraged to practice cashless over cash transactions.
Wearing face masks in public, including while visiting supermarkets and when using public and private transport was made mandatory, effective from March 15, 2020. Further, in order to give effect to the social distancing requirement in the public transport sector, public service transport (PSV) operators were directed to operate at 60 percent occupancy with 14-seater vehicles allowed to carry a maximum of 8 passengers while those with a capacity of 25 could only carry 15 passengers. In addition, they were to observe high cleanliness standards by cleaning their vehicles after every trip and provide sanitizers for passengers. Flouting of these directives would lead to impounding of such vehicles and suspension of their Sacco licenses. Thereafter, the offenders would be charged in a court of law in line with the Public Health Act for deliberately spreading the virus.
Social distancing rules were also extended to private vehicles. Private car owners were limited to carrying 50% of their vehicle’s passenger capacity. This meant that a five-seater vehicle would only be allowed to carry one passenger in addition to the driver, while a seven-seater vehicle would carry only two passengers in addition to the driver. To date, there has been little evidence of compliance or successful implementation of this directive by private vehicle owners.
On March 17, 2020, a toll-free number (719) was set up to facilitate public reporting of suspected coronavirus cases. This strategy has paid off in the fight against transmission of coronavirus as many people have taken it positively and reported many cases of those flouting precautionary measures with respect to self-quarantine, gatherings, and restriction on movement from COVID-19 hotspots to other counties.
On March 20, 2020, congressional gatherings such as weddings, night clubs, religious meeting were suspended while limitation of visits to hospitals and correctional facilities was enforced. Gathering at funerals was limited to 15 immediate family members. However, restaurants and eateries were to remain in operation to offer take-away services only. These measures were intended to enforce the social distancing requirement so as to minimize the risk of transmission. These precautions have been followed fully despite initial resistance by the public.
Furthermore, on March 25, the President imposed a nationwide dusk-to-dawn (7 pm – 5 am) curfew for 21 days, except for essential service workers. However, the curfew has been extended twice since then with the third extension covering May 16 to June 6, 2020. During this period, everyone must stay at home or indoors and anyone flouting this rule is forced into compulsory quarantine in either a government or private facility for 14 days at his or her own cost. The curfew regulation has largely been obeyed across the country with employers releasing their staff at 3-4 pm in order for all to be home before 7 pm.
Hospitals, shopping malls, supermarkets and other public places were directed to provide water for washing hands or sanitizers; ensure social distance of 1.5 metres and uphold a high degree of cleanliness in the premises. These entities have done a commendable job in the implementation of these guidelines. The supermarkets are providing water and soap for their clients to wash their hands or hand sanitizers. To maintain a social distance of 1.5 metres, supermarkets are using brightly coloured posters on the floor to guide customers in maintaining the distance as they queue to make payments at the cash counters. Additionally, in some supermarkets, staff make regular announcements to remind people to maintain distance; and restrict the number of people entering into the shop to avoid overcrowding. Trollies are disinfected after every use and payment cards are sanitized after use. Carrefour supermarket outlets have a gone a notch higher by providing shoppers with gloves before entry to the shop and a disposal bin for disposal during exit.
However, there is the shortage of hand-washing facilities in the informal sectors and this could be a time bomb in the fight against coronavirus given that in cities like Nairobi majority of the population resides in the informal settlement with inadequate water and sanitation facilities.
On April 5, 2020, the President restricted movement into or out of Nairobi metropolitan due to the rising number of new coronavirus infections. The restriction was extended to Mombasa, Kilifi and Kwale counties with effect from April 7, 2020. Further, the same restrictions on movement were stretched to Mandera county from April 22, 2020, after eight people tested positive. Similarly, a travel suspension in and out of Kakuma and Dadaab refugee camps was imposed for 21 days with effect from April 29, 2020. Moreover, as the number of COVID-19 soared in Nairobi and Mombasa counties, the Government of Kenya announced the cessation of movement into and out of the Eastleigh neighbourhood in Nairobi and Old Town in Mombasa on May 6, 2020. The Government also rolled out mass testing in virus red spots such as Kawangware, Eastleigh, Kibra in Nairobi and Old Town in Mombasa among others. Kenya closed borders with Somalia and Tanzania to contain the spread of COVID-19.
Economic response
Certainly, all these health policy measures negatively impacted people’s sources of livelihood. As a result, the government of Kenya came up with a raft of measures to cushion individuals and employers against economic hardships.
On March 17, the Central Bank ordered commercial banks to waive bank transfer levies on individuals moving money between their banks and on mobile money transfer from bank to mobile wallets. Mobile money transaction was increased from 70,000 Kenyan Schillings to 150,000 (≈ $700 to $1,500) per day to allow individuals and SMEs make larger mobile money transfers. In addition, Safaricom (the main mobile money platform in the country) waived transactions under 1,000 Kenyan Schillings (≈ $10) for the next 90 days. The rationale for these incentives was to limit contact through cashless transactions.
On March 18, the Central Bank reached an agreement with commercial banks to restructure nonperforming loans caused by COVID-19 layoffs. Moreover, business entrepreneurs were allowed to postpone their loan repayment from microcredit agencies for a period of 6 months. Overall, the government has pledged Sh53.7 billion stimulus package to stimulate the economy by creating jobs in manufacturing, tourism, agriculture, SME and informal sector.
On March 25, 2020, the President outlined several measures to lessen economic hardship facing individuals and employers. These included 100 % Tax Relief for persons earning gross monthly income of up to Ksh. 24,000 (US$228) and below, reduction of Income Tax Rate (Pay-As-You-Earn) and resident Income Tax (Corporation Tax) from 30% to 25% while Value Added Tax (VAT) was reduced from 16% to 14%, effective April 1, 2020. In addition, the turnover tax rate was reduced from 3% to 1% for all Micro, Small and Medium Enterprises (MSMEs); while an additional Ksh. 10 Billion (US$95 million to was approved to support the elderly, orphans and other vulnerable members of our society. The Kenya Revenue Authority was ordered to expedite the payment of all verified VAT refund claims amounting to Ksh.10 Billion within 3 weeks so as to improve cash flows for businesses.
The government also approved KSh 1 billion (US$9.5 million) from the Universal Health Coverage kitty to facilitate the employment of additional health workers to help combat the spread of COVID-19. Moreover, the Central Bank Rate (CBR) was lowered to 7.25% from 8.25% to stimulate credit expansion, and the Cash Reserve Ratio (CRR) was decreased to 4.25% from 5.25% to provide additional liquidity to commercial banks while the listing of loan defaulters for of any person, micro, small and medium enterprise and corporate entities whose loan account is in arrears was temporarily suspended with effect from April 1, 2020. In addition, the President and the Deputy President, plus the senior administrative officers in the National Executive voluntarily offered reduction in their salaries to free some fund for use in the fight against COVID-19
On April 1, 2020, President Uhuru Kenyatta established the COVID-19 Emergency Response Fund whose mandate is to raise funds to support the government’s efforts in the provision of medical facilities and equipment; and support vulnerable communities with food and other basic necessities. To this end, on April 14, cash transfer of 2,000 Kenyan shillings, or $19 was disbursed to approximately 2000 families or registered persons in Kibra. So far, provision of foodstuff to some needy residents in urban slums of Mombasa and Nairobi has been managed by well-wishers and government initiatives to a minimal scale.
On April 27, 2020, the Ministry of Health approved re-opening of restaurants and eateries after complying with COVID-19 public health protocols. Some of the measures include social distancing via spacing of seats and tables, ensuring their staff has been tested for coronavirus and taking customers’ temperatures. Any customer whose temperature is found to be above 37.5 degrees Celsius will be denied entry, and the case reported to the Ministry of Health immediately. The restaurants can only operate between 5 am and 4 pm.
On May 6, 2020, Salaries and Remuneration Commission (SRC) approved Ksh.3B (≈ $30 Million) emergency allowance for healthcare workers due to the risks they subject themselves to and the increased workload in their line of duty in the wake of the pandemic.
On May 8, 2020, the government took the responsibility of footing the quarantine bills for persons suspected for COVID-19, a move aimed at encouraging more people to turn up for testing to curb the spread of the disease.
Status of COVID-19 infections as on May 31, 2020
Despite all the containment measures that have been put into place, Kenya has not managed to flatten the curve. Instead, Kenya has witnessed an exponential increase in the number of infections in the month of May 2020. This increase can be attributed to the larger samples tested in the month of May 2020 (through mass testing in high-risk neighbourhoods) as well as non-adherence of precautionary measures imposed to limit transmission of coronavirus. The total number of positive cases stands at 1,962, as of May 31 after 74 people tested positive from a sample of 1,574. So far, the country has tested a sample of 78,536 people. Meanwhile, recoveries have reached 474 with 64 fatalities according to data released by the Ministry of Health. Further, 34 out of 47 counties nationally have registered coronavirus infections. Nevertheless, the highest number of infections has remained in Nairobi and Mombasa counties.
On May 24, 2020, notwithstanding the spiralling number of COVID-19 cases, the President of the Republic of Kenya hinted to a possibility of relaxing of rules that include, dusk-to-dawn curfews, restriction on movements, among others in a bid to re-open the economy after two months closure.
Impact of COVID-19
A recent report from World Bank predicts a slump in the economic growth from 1.5 percent in 2020 in the baseline scenario, to 1.0 percent, if COVID-19 economic-related disruptions last longer. Already the country has recorded a massive loss of jobs especially from the hospitality and tourism sectors and reduced income from the businesses as a result of curfew and restriction on movements. Approximately, 1.2 million jobs have been lost. Besides, the economic measures implemented by the government to cushion people against the impact of COVID-19 mainly benefited individual in salaried employment while the majority who earn their living through daily wage, hawking, petty traders were left out.
The pandemic has also affected the education sector like never before. Schools and higher institutions were abruptly closed from March 2020. The extended closure of schools will have far-reaching consequences on learners that range from increased drop-out rates, teen pregnancy, early marriage, female genital mutilation (FGM), child labour and exposure to violence, among others.
Since the first case of COVID-19 was reported in the country, treatment and care of the existing ailments have largely been ignored. With the Ministry of Health focusing mainly on COVID -19 coupled with people’s fear of contacting coronavirus during their visits to hospitals, treatment of people suffering from other diseases more so those with chronic diseases like cancer, HIV and maternal health are not being given the attention they require.
Challenges encountered
Whereas the government through the Ministry of Health has been credited for giving daily updates on the number of infections by gender, age and county, there has been a notable information gap such as the number of infected persons who are symptomatic or asymptomatic, with mild or acute infection, those in isolation wards, or in intensive care units (ICUs). Such details would help the public have a clear picture of the COVID-19 health crisis.
Before May 8, 2020, persons suspected of COVID-19 were quarantined in government or private facilities at their own cost. The government facilities charged the lowest fees of at least $20 (£16) a day even though it was out of reach for many people (as reported in the local media houses). This was protested by the patients and made many people avoid being tested.
The start of the nation-wide curfew was marked with incidences of police brutality that ranged from assault to erroneous shooting of innocent civilians. The worst affected counties were Nairobi and Mombasa where police were accused of using excessive force to enforce the government-instituted curfew.
Undoubtedly, mass testing of persons susceptible is one of the surest strategies of containing the transmission of COVID-19. However, Kenya, like any other developing country, is over-reliant on donations from development partners and international organisations, like WHO and others, to assist in acquiring test kits. Consequently, the lack of sufficient COVID -19 testing kits has hampered Kenya’s fight to contain the spread of the virus. Nevertheless, targeted testing with the available kits has also had its share of challenges including low turnout, delayed results as well as the provision of inaccurate contact details or wrong telephone numbers or residential addresses making it difficult, if not impossible, to reach those individuals especially if the results come out positive. Moreover, there have been reported cases of some people escaping from quarantine facilities. This implies that those infected might not be traced and isolated in good time, thereby, compromising the fight against the disease.
It is also disturbing that some people are flouting COVID-19 containment measures such as curfew regulations, social distancing, wearing of masks and washing hands. Some of the PSV operators have gone back to operating on full capacity instead carrying of a limited number of passengers.
Finally, in view of WHO’s projection that COVID-19 pandemic is not going away soon, extension of curfew and restriction on movements are not tenable due to their negative impact on the economy with over 1.2 million jobs estimated to have been lost. Consequently, it is advisable that Kenya emulate other nations across the globe that are gradually opening their economies while implementing precautionary measures to control further spread of the virus. The public should also be educated on the need to take personal responsibility in the fight against the spread of the virus.
Author
Charity M Limboro, Lecturer Department of Educational Department Policy and Curriculum Development, Kenyatta University, Kenya
Disclaimer: The views and opinions expressed in this article are those of the author/s and do not necessarily reflect the official policy or position of Azim Premji University or Foundation.
