Why infrastructure still matters: Unravelling water reform processes in an uneven waterscape in rural Kenya

Since the 1980s, a major change took place in public policies for water resources management. Whereas before governments primarily invested in the development, operation and maintenance of water infrastructure and were mainly concerned with the distribution of water, in the new approach they mainly focus on managing water resources systems by stipulating general frameworks for water allocation. This paper studies the rationales used to justify the water reform process in Kenya and discusses how and to what extent these rationales apply to different groups of water users within Likii catchment in the central part of the country. Adopting a critical institutionalist’s perspective, this paper shows how the water resource configurations in the catchment are constituted by the interplay between a normative policy model introduced in a plural institutional context and the disparate infrastructural options available to water users as result of historically produced uneven social relations. We argue that, to progressively redress the colonial legacy, direct investments in infrastructure for marginalized water users and targeting the actual (re)distribution of water to the users might be more effective than focusing exclusively on institutional reforms.Water Resource

Lack of clear national policy guidance on COVID-19 vaccines influences behaviors in pregnant and lactating women in Kenya

SARS-CoV-2 infection in pregnancy is associated with a greater risk of maternal and newborn morbidity and maternal death. In Kenya, pregnant and lactating women (PLW) were ineligible to receive COVID-19 vaccines until August 2021. How shifts in policy influence vaccine behaviors, such as health worker recommendations and vaccine uptake, is not well documented. We conducted qualitative interviews with PLW, health workers, and policymakers in Kenya to understand how different stakeholders’ perceptions of national policy regarding COVID-19 vaccination in pregnancy shaped vaccine behaviors and decision-making. Policymakers and health workers described pervasive uncertainty and lack of communication about the national policy, cited vaccine safety as their primary concern for administering COVID-19 vaccines to PLW, and expressed that PLW were inadequately prioritized in the COVID-19 vaccine program. PLW perceived the restrictive policy as indicative of a safety risk, resulting in vaccine hesitancy and potentially exacerbated inequities in vaccine access. These findings support the need for the development and dissemination of effective vaccine communication guidelines and the prioritization of PLW in COVID-19 vaccination policies and campaigns. To ensure PLW do not face the same inequities in future epidemics, data on infectious disease burdens and vaccine uptake should be collected systematically among pregnant women, and PLW should be included in future vaccine trials