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Kenya's government says it is committed to building the economy by increasing revenue collection, reducing government spending, and ensuring the country is able to repay its debt and live within its means.
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The government announcement comes days after the African Development Bank, in its outlook report for 2024, said many nations continue to grapple with higher commodity prices, citing weak domestic currencies and slow economic activities in countries that import more than they export.
"The strategy we have put in place over the last one year has seen the cost of living come down, whether you talk about the cost of food, whether you talk about inflation, and what we have done with the management of the debt situation in the country," he said.
The government removed fuel subsidies which were meant to cushion Kenyans from the high prices of food as part of its economic reform agenda. That reform, the African Development Bank said, could cause unrest.
According to AfDB research, 19 African countries recorded double-digit inflation rates last year. Earlier this month, The Central Bank of Kenya's Monetary Policy Committee warned citizens to brace for high food prices due to soaring inflation and expensive imports because of the depreciation of the local currency.
"Kenyans, their patience is eroding unless some of these issues are addressed with urgency. There will be some animosity whether you like it or not," Nyandemo said. "You can even see it in political meetings. People are now so courageous they are shouting at the president. What does that show you? It shows you that people are getting disgusted. We better start addressing key issues first and the first thing is reducing the cost of living."
"The 500 billion Kenya shilling we spend every year to import food into Kenya will only go down the day we produce that food in Kenya. That's a step we are taking and we made a commitment as a government that we want to reduce imports by 50 percent in the next five years," he said.
"All macroeconomic valuables have shown red lights. We should not be fooled that the shilling is going to stabilize soon. A shilling cannot stabilize because of some mischievousness through the Euro bond," Nyandemo said. "I think it is a short-lived phenomenon. And as long as the shilling is not going to be stable, as long as the interest rates are going to be very high, businessmen are not going to be able to source loans for investments. In any case, you can see from the Kenya Revenue Authority the revenue being collected is not in line with the targets."
Allyson Ward and her husband loaded up credit cards, borrowed from relatives, and delayed repaying student loans after the premature birth of their twins left them with $80,000 in debt. Ward, a nurse practitioner, took on extra nursing shifts, working days and nights.
The investigation reveals a problem that, despite new attention from the White House and Congress, is far more pervasive than previously reported. That is because much of the debt that patients accrue is hidden as credit card balances, loans from family, or payment plans to hospitals and other medical providers.
To calculate the true extent and burden of this debt, the KHN-NPR investigation draws on a nationwide poll conducted by KFF (Kaiser Family Foundation) for this project. The poll was designed to capture not just bills patients couldn't afford, but other borrowing used to pay for health care as well. New analyses of credit bureau, hospital billing, and credit card data by the Urban Institute and other research partners also inform the project. And KHN and NPR reporters conducted hundreds of interviews with patients, physicians, health industry leaders, consumer advocates, and researchers.
"Debt is no longer just a bug in our system. It is one of the main products," said Dr. Rishi Manchanda, who has worked with low-income patients in California for more than a decade and served on the board of the nonprofit RIP Medical Debt. "We have a health care system almost perfectly designed to create debt."
Medical debt is piling additional hardships on people with cancer and other chronic illnesses. Debt levels in U.S. counties with the highest rates of disease can be three or four times what they are in the healthiest counties, according to an Urban Institute analysis.
And it is preventing Americans from saving for retirement, investing in their children's educations, or laying the traditional building blocks for a secure future, such as borrowing for college or buying a home. Debt from health care is nearly twice as common for adults under 30 as for those 65 and older, the KFF poll found.
Allyson and Marcus Ward of Chicago moved across the country to be closer to family after the premature birth of their twins, Milo and Theo, left them with about $80,000 in medical debt. Taylor Glascock for KHN and NPR hide caption
Hospitals recorded their most profitable year on record in 2019, notching an aggregate profit margin of 7.6%, according to the federal Medicare Payment Advisory Committee. Many hospitals thrived even through the pandemic.
But for many Americans, the law failed to live up to its promise of more affordable care. Instead, they've faced thousands of dollars in bills as health insurers shifted costs onto patients through higher deductibles.
Now, a highly lucrative industry is capitalizing on patients' inability to pay. Hospitals and other medical providers are pushing millions into credit cards and other loans. These stick patients with high interest rates while generating profits for the lenders that top 29%, according to research firm IBISWorld.
"People are getting harassed at all hours of the day. Many come to us with no idea where the debt came from," said Eric Zell, a supervising attorney at the Legal Aid Society of Cleveland. "It seems to be an epidemic."
As of last year, 58% of debts recorded in collections were for a medical bill, according to the Consumer Financial Protection Bureau. That's nearly four times as many debts attributable to telecom bills, the next most common form of debt on credit records.
How much medical debt Americans have in total is hard to know because so much isn't recorded. But an earlier KFF analysis of federal data estimated that collective medical debt totaled at least $195 billion in 2019, larger than the economy of Greece.
The credit card balances, which also aren't recorded as medical debt, can be substantial, according to an analysis of credit card records by the JPMorgan Chase Institute. The financial research group found that the typical cardholder's monthly balance jumped 34% after a major medical expense.
Monthly balances then declined as people paid down their bills. But for a year, they remained about 10% above where they had been before the medical expense. Balances for a comparable group of cardholders without a major medical expense stayed relatively flat.
It's unclear how much of the higher balances ended up as debt, as the institute's data doesn't distinguish between cardholders who pay off their balance every month from those who don't. But about half of cardholders nationwide carry a balance on their cards, which usually adds interest and fees.
The couple had diligently saved. And they had retiree health insurance through Con Edison. But Sherrie's surgery led to numerous complications, months in the hospital, and medical bills that passed the $1 million cap on the couple's health plan.
When Foy couldn't pay more than $775,000 she owed the University of Virginia Health System, the medical center sued, a once common practice that the university said it has reined in. The couple declared bankruptcy.
In the 19th century, male patients at New York's Bellevue Hospital had to ferry passengers on the East River and new mothers had to scrub floors to pay their debts, according to a history of American hospitals by Charles Rosenberg.
The arrangements were mostly informal, however. More often, physicians simply wrote off bills patients couldn't afford, historian Jonathan Engel said. "There was no notion of being in medical arrears."
Debt is most widespread in the South, an analysis of credit records by the Urban Institute shows. Insurance protections there are weaker, many of the states haven't expanded Medicaid, and chronic illness is more widespread.
In some places, such as the nation's capital, disparities are even larger, Urban Institute data shows: Medical debt in Washington, D.C.'s predominantly minority neighborhoods is nearly four times as common as in white neighborhoods.
In minority communities already struggling with fewer educational and economic opportunities, the debt can be crippling, said Joseph Leitmann-Santa Cruz, chief executive of Capital Area Asset Builders, a nonprofit that provides financial counseling to low-income Washington residents. "It's like having another arm tied behind their backs," he said.
Medical debt can also keep young people from building savings, finishing their education, or getting a job. One analysis of credit data found that debt from health care peaks for typical Americans in their late 20s and early 30s, then declines as they get older.
Dantona, 31, was diagnosed with blood cancer while in college. The cancer went into remission, but when Dantona changed health plans, she was hit with thousands of dollars of medical bills because one of her primary providers was out of network.
She enrolled in a medical credit card, only to get stuck paying even more in interest. Other bills went to collections, dragging down her credit score. Dantona still dreams of working with injured and orphaned wild animals, but she's been forced to move back in with her mother outside Minneapolis. 152ee80cbc
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