Meet Winnie Nyamboki, Health Economist and Mawazo Scholar

Winnie Nyamboki.JPG

The Economic Burden of Poor Health in Kenya

By Winnie Nyamboki

The economics literature identifies health as having both direct and indirect effects on the population as well as a country’s output.  Economists have argued that a healthier workforce is more productive and this is an illustration of the direct effect. The indirect effect is mostly analysed from a long-term perspective. For example, healthy individuals are less likely to be absent from school thereby diminishing the quality of their education and impacting labour market outcomes over time. The economic burden that is associated with poor health outcomes poses a twofold threat to any economy. Over and above the macroeconomic costs of ill health which are linked to variables like Gross Domestic Product (GDP), mounting evidence shows that microeconomic costs are also significant. Besides the diminished capacity to work, the dilemma of dealing with additional medical and related expenditures can be catastrophic, making households and individuals vulnerable to poverty.

The Government of Kenya, through its ‘Big Four’ agenda , is keen on providing universal health coverage by 2022 to guarantee quality and affordable health care for all. While such an initiative goes a long way in redistributing health resources, Kenya is struggling to cope with the burden of traditional communicable diseases, which continue to account for a sizeable share of health spending. Notably, over the 2012 - 2013 period, the total health expenditures on HIV/AIDS, malaria, TB, diarrhoeal diseases, nutritional deficiencies, vaccine preventable diseases, and diseases of the respiratory system amounted to 106 billion Kenya shillings, which translates to approximately 3% of our GDP.  With such huge investments, favourable health outcomes are expected. However, these diseases are among the key drivers of both morbidity and mortality, which describe rates of poor health and death, respectively, among the Kenyan population.  According to recent data from the Kenya National Bureau of  Statistics, morbidity cases for both communicable and non - communicable diseases have increased from 31.2 million in 2007 to 47 million cases in 2015. Malaria and diseases of the respiratory system continue to be the leading causes of morbidity and together account for 55.3% of all reported morbidity cases in 2015. While the prevalence of these conditions is still rising, it is not clear how this affects labour supply in the Kenyan context.

Previous studies on the relationship between health status and labour market behaviour have generally focused on developed countries. The findings suggest that the relationship between health and labour market outcomes remains ambiguous owing to measurement errors, reverse causality, and omitted variable bias. First and foremost, there is no universal consensus on what really constitutes health. Secondly, there may be other unmeasured factors such as time preferences, risk, and motivation, that simultaneously affect both health and labour supply. These factors all introduce significant complexities when analysing this relationship.  Additionally, while self- assessed summary measures of health have been studied widely (i.e. individuals are asked to rate their health on a scale of 1 to 5 where “1 = poor health” to “5 = excellent health”), little attention has been paid to the contribution of specific health conditions on the capacity to work, with a few exceptions in developed countries which concentrate on certain types of chronic illnesses.

It is against this background that my PhD research aims to examine and quantify the contribution of specific types of acute illness on the propensity to participate in the labour market in Kenya. This study focuses on four disease groups:  malaria, diseases of the respiratory system, stomach ache complications, as well as injuries resulting from burns, fractures, wounds, and poisoning. These four acute conditions were responsible for 68.9% of Kenya's morbidity burden in 2015. In particular, I will: (1) explore the association between health and participation outcomes across socioeconomic and demographic variables, (2) examine and compare the labour supply outcomes of groups with different acute diseases, and (3) test whether is there a bidirectional relationship between participation in the workforce and specific acute illnesses outcomes among the working age population (“endogeneity”). I anticipate that this research will provide sound economic analysis on the burden of illness and injuries in Kenya, and provide important evidence for investment targeting specific diseases at both the National and County levels.



Winnie Adhiambo Nyamboki is an Economist at the National Treasury and is a Ph.D. student at the University of Nairobi’s School of Economics. Her research title is “The Economic Consequences of Poor Health in Kenya”. She is passionate about contributing to the economic aspects of different health outcomes in Kenya.

Mawazo Scholars Participate in Open Africa Power Initiative Training

 Mawazo Scholars Susan Gichuna and Judith Koskey at the OAP training hosted at Strathmore University, Nairobi 

Mawazo Scholars Susan Gichuna and Judith Koskey at the OAP training hosted at Strathmore University, Nairobi 

Three Mawazo Ph.D. Scholars participated in the inaugural training module of the Open Africa Power (OAP) programme last month. OAP is a collaboration between the Enel Foundation and academic institutions in Africa and Italy, and aims to build the next generation of African leaders who are equipped to drive a clean energy future in their countries. The training module was hosted in Nairobi by Strathmore University and the University of Nairobi. It featured in-depth sessions covering core technology, policy and business aspects of the electricity sector, as well as their interactions with broader societal issues such as sustainable development goals, climate change, and urbanization. The training course is part of a four-month intensive leadership development programme for 34 postgraduates who were competitively selected from across the continent.  Mawazo Scholars Susan Gichuna, Judith Koskey, and Marilyn Ronoh, who have backgrounds in mathematics, environmental studies, and urban studies, were invited to participate in the training module alongside OAP students. In addition to the formal training sessions, the event also gave Mawazo Scholars a chance to interact with peers from different African countries and academic backgrounds. Finally, Mawazo's CEO Dr. Rose M. Mutiso also delivered remarks during the event. 

Meet Susan Gichuna, Sustainable Urban Development Expert and Mawazo Scholar

Susan Gichuna - Pic.JPG

Understanding How Climate Change Impacts Residents of Nairobi’s Informal Settlements

by Susan Gichuna

Globally, climate change is now recognized as the greatest threat to humanity. Climate impacts such as droughts and extreme weather events have increased in recent times and are projected to grow over the coming decades. Although these impacts are being experienced globally, the effects are disproportionate. Lower income countries in sub-Saharan Africa and other developing regions, who are the smallest contributors to global warming, are the most vulnerable because they lack the capacity to respond to and recover from climate impacts.

As the burden of climate change in developing countries continues to grow, the effects are most pronounced among the poorest segments of population, such as the urban poor residing in informal settlements. African countries such as Kenya are fast urbanizing resulting in increased growth of the informal settlements. In Nairobi, for example, an estimated 60 to 70 percent of residents live in slums.  The urban poor who reside in these informal settlements are particularly vulnerable to the effects of climate change for a number of reasons. These settlements tend to be located in risk-prone areas such as hillsides, river banks and near damping sites. Poverty compounds these environmental risks, limiting the ability of the inhabitants to cope when disasters such as flooding strike, as was the case during the recent heavy rain season. The county government of Nairobi has since allocated an emergency fund of Ksh. 194 million to deal with impacts of the floods in the city. However, the initiative came a little too late to avert the catastrophe, pointing to poor planning and failed disaster management. Thus, there is an increasingly urgent need to understand the unique effects of climate change phenomena such as extreme weather events on the urban poor, as well as identify effective strategies to mitigate these risks and build their resilience to the impacts.

The challenge of climate change is a complex multi-faceted issue that requires a combination of scientific, societal and political knowledge to address it. For instance, climate impacts such as floods affect multiple sectors including housing, agriculture, health, transport, and energy. Such problems cannot be solved by one sector or academic discipline, nor through a single perspective. The Institute for Climate Change and Adaptation (ICCA) at the University of Nairobi where I am a PhD student emphasizes the use of a transdisciplinary approach in addressing climate change and adaptation. This approach requires close cooperation and collective learning by various stakeholders.

My Ph.D. research will focus on climate change impacts and adaptation in Nairobi’s informal settlements, specifically Majengo Slums.  Majengo is located in Pumwani Ward, a few kilometres from Nairobi’s central business district and bordering the highly polluted Nairobi River. The settlement has been in existence since 1921 and comprises four smaller settlements including Sofia, Mashimoni, Katanga and Digo. According to the Kenya National Housing and Population Census 2009, Majengo has over 16,000 residents.  The geographic location and poor condition of the settlements increases the vulnerability of Majengo residents to climate impacts. The goals of my research are three-fold. First, I will identify the specific impacts of climate change on Majengo residents, and secondly, establish how the residents of Majengo cope and respond to the climate impacts. Finally, I will use my findings to develop recommendations for policy actions that government and city authorities can take to enhance resilience of the urban poor against the climate impacts. My research will involve close engagement with the Majengo community and key stakeholders such as relevant government ministries and bodies, local and county government, non-governmental organizations, and community-based organizations. Data collection will entail both quantitative and qualitative methods including household surveys, key informant interviews, and focus group discussions.

Nairobi’s informal settlements have certainly been studied widely. However, focus has mainly been on issues such as healthcare, poverty and education access, with little emphasis on the growing impacts of climate change in these settings. More systematic studies specific to climate change are required, and my research aims to contribute to addressing this gap in the literature. Ultimately, I aim to provide concrete insights to inform climate adaptation policy and planning, and thus strengthen pro-poor development outcomes in Nairobi county.  


Susan Gichuna is a researcher on Climate Change and Adaptation, and Sustainable Urban Development. She is a Ph.D. student at the Institute for Climate Change and Adaptation at the University of Nairobi.

Meet Jacqueline Owigo, Migration Policy Expert and Mawazo Scholar

Jacqueline Owigo - Pic.JPG

Linking Return Migration and Development in Somalia

By Jacqueline Owigo

International migration is increasingly seen as a high-priority policy issue by governments, practitioners, scholars and the public at large. In recent years, there has been a significant increase in human displacement, which has resulted from conflict and environmental factors. Further, UNHCR cautions that the number of displaced people has continued to soar and it is estimated that globally, one in every 113 persons is now either a refugee, internally displaced or seeking asylum.

Return migration is a component of international migration. The main forms of return migration include voluntary return and involuntary return associated with, for example, deportation of migrants to their country of origin. Governments and international organizations have adopted policies that are aimed at improving return processes and outcomes, such as  linking return with national development. Kenya, for example, has a diaspora policy to harness the diverse skills, expertise, and potential of Kenyans living abroad. This recognizes that people who’ve spent years abroad often return with financial capital, new skills or international business connections, which can be leveraged to foster growth.

On the global policy agenda, return migration has proved problematic, as experienced in the ongoing negotiations for the Global Compact for Safe, Orderly and Regular Migration. The zero-draft  released in February, makes no commitments in relation to addressing the increasing challenge of ‘forced return’ of migrants i.e. deportation and expulsion. Equally important, the number of returning refugees and migrants is on the rise whether through voluntary repatriation, deportation, or other circumstances in which lines between forced and voluntary returns are indistinct as refugees are confronted with a choice between detention or repatriation. While acknowledging the sovereign prerogative of states to conduct removals, states are also obliged to respect the principle of non-refoulement as well as human rights during returning or removing migrants from their territories.   

My research focuses on Somalia, which is experiencing significant return migration encompassing migrants from the diaspora, deportees (failed asylum seekers) and voluntary repatriation of refugees. Somalia is also home to over 1.5 million internally displaced persons. These returns are not all voluntary, and the returnees do not have the same needs. Given the increasing number of coerced returns to Somalia, more research is needed to understand their experiences and reintegration strategies. The study will highlight the experiences Somali returnees face from their very own perspective, with a view to identify areas for policy intervention that may be effective in improving reintegration outcomes. 


Jacqueline Owigo is currently in the second year of her PhD in International Relations at the United States International University – Africa in the School of Humanities and Social Sciences. Her research interests include links between return migration and development, specifically the social inclusion of forced migrants in a community and diaspora returnees.