The Opportunity Cost of a Lost Girl: Why Adolescent Health Is an Economic Issue

To address the structural challenges of adolescent health in Kenya, experts are increasingly viewing the Triple Threat, the intersection of teenage pregnancy, HIV, and gender-based violence, as a singular public health emergency that requires a unified institutional response. The gradual erosion of national pregnancy rates, which dropped from 18% to 15%, is seen by policy analysts as a sign of progress, yet one that masks deep-seated regional inequalities. In areas like Samburu, where the rate remains at 50%, the crisis is viewed not merely as a health issue, but as a systemic breakdown of the protective social infrastructure intended to support the girl child. This crisis is compounded by the Triple Threat synergy, a lack of agency to negotiate safe sex often results in a simultaneous surge in new HIV infections and unplanned pregnancies, frequently rooted in gender-based violence.

Education remains the most significant predictor of reproductive outcomes in the country. Data from the Kenya National Bureau of Statistics (KNBS, 2022) indicates that only 5% of girls who complete secondary school become pregnant, a stark contrast to the 40% observed among those with no formal education. Institutional experts emphasize that education is thebest contraceptive, serving as the most effective long-term shield for a girl’s future. The current Education Re-entry Policy is designed to treat pregnancy as a temporary pause in a girl’s development rather than a permanent exit from society. By mandating that schools readmit young mothers without conditions, the government is prioritizing the long-term economic viability of these young women. We must support her return and protect her potential to mitigate the massive opportunity cost to the national GDP.

With the rollout of the Social Health Authority (SHA), there is a strategic move to eliminate the financial barriers that often drive transactional sex. This phenomenon occurs when girls, particularly from the poorest households, exchange sexual favours for basic necessities like sanitary pads or school fees. Health administrators argue that removing the cost of maternal care is a pivotal step in normalizing adolescent health services. When girls can access youth-friendly clinics without the fear of financial strain or the stigma of judgment, the likelihood of safe deliveries and the adoption of postpartum family planning increases. This approach frames reproductive care as an essential public service, similar to the management of other chronic health conditions.

Sociological research highlights that the social death of a pregnant teenager is frequently a by-product of community-level shaming. While childbearing rates are significantly higher in the lowest income bracket, they drop drastically for the wealthiest, suggesting that pregnancy is often a symptom of economic desperation. The community’s role must shift from isolation to integration, especially as new threats like digital grooming emerge. Experts suggest that a girl’s destiny should be shaped by her dreams, not her zip code, and that ending thesocial death of teenage pregnancy is Kenya’s path to a stronger nation. Breaking the cycle of poverty requires community leaders to stop negotiating defilement cases through traditional settlements and instead move toward formal legal accountability.

For Kenya to reach its development goals, the focus must remain on the enforcement of the Sexual Offences Act at the grassroots level. Legal advocates insist that justice cannot be settled with livestock or secret payments. Every instance of legal accountability sends a clear signal that the safety and education of the girl child are non-negotiable national priorities. By aligning government policy, community action, and economic support, the goal is to ensure that every girl has the power to decide her own future on her own terms.

@doddyokelo

Simply Hope

The sky pulls a charcoal blanket over its shoulders,
heavy and weeping.
From a great height, the rain descends,
turning the world into a place of hiding,
a place where we fold ourselves small
behind locked doors,
wishing to vanish with the light.

But the atmosphere is restless.
A sudden fracture of silver splits the grey,
and the silence is startled
by the loud, golden arrival of the sun.

It isn’t just light,
it is a prism breaking across the horizon,
the earth looking up and finally smiling back.
The air feels new,
charged with that sudden, sharp pain of romance,
the kind that arrives when you realized
you survived the storm.

We learn then,
watching the shadows dissolve into nothing,
that darkness is a poor tenant.
It has no permanent address here.
The light is the only thing
that knows its way home.

@doddyokelo

What Next for Kenya’s HIV Response?

Otieno, a resident of Kamwango in East Kamagambo, Rongo Sub-county, sits on the edge of his bed, the weight of the world pressing heavily upon his shoulders. He looks at his wife, Achieng, who is meticulously organizing their remaining ARV tablets, and their seven-year-old daughter playing by the window. For years, those pills have been their lifeline, a daily ritual of survival. But the news on the radio is cold. Following the transition in Washington on January 20th, 2025, and the looming impact of March 2026, the whispers in the clinic queues have turned into a dull roar of panic. He hears that the containers might stop coming, and the thought of the virus waking up in his daughter’s blood because of a political shift thousands of miles away is a terror no father should carry.

For 23 years, Kenya has been receiving roughly 69% of its HIV funding from the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR). This massive investment, totaling over 8 billion dollars (approximately 1.1 trillion Kenyan shillings) was the backbone of the national response, paying for the very ARVs Otieno’s family is counting on, the laboratory reagents for viral load testing, and the salaries of over 40,000 health workers, nearly 18% of the country’s total health workforce, who now face an uncertain future.

The crisis has ceased to be a storm on the horizon, it has become the drying of the well, a sudden, natural silence where the ever-flowing vein of supply once lived long. Since the executive freeze in early 2025, approximately 34 million dollars (4.5 billion Kenyan shillings) worth of life-saving commodities have been caught in a logistical gridlock. This disruption was triggered by a stop-work order that deactivated the payment and distribution systems managed by U.S.-funded agencies. By March 2026, the buffer stocks that once protected patients like Otieno from supply shocks will have run dry. In many facilities, doctors have been forced to ration medicine, moving from three-month prescriptions to one-week emergency packs, a desperate measure to ensure that at least everyone gets something, even if it isn’t enough.

To bridge this gap and heal the mess of daily adherence, there is a growing call to develop and deploy long-acting treatments for reactive individuals. While currently available injections like Cabenuva require a visit every two months, the dream is to innovate even further, creating a once or twice yearly injection specifically for treatment. Such a breakthrough would be the ultimate sustainability tool by replacing 365 daily reminders with just one or two clinical visits, the government could drastically reduce the logistical nightmare of monthly pill distribution. It would solve the adherence crisis for families like Otieno’s, ensuring that even if a shipment is delayed or a clinic is crowded, their protection remains locked in their blood for months. This transition to long-acting treatment is the missing piece that could turn the tide, making the 2030 goal of zero transmission a reality by removing human error and pill fatigue from the equation.

The physical landscape of care is also shrinking. Community Drop-In Centers, which provided a refuge for vulnerable groups to receive medication away from the prying eyes of the general public, have begun to shut their doors as their rent and staff costs were tied directly to the now-paused U.S. grants. This has pushed thousands of patients back into overcrowded outpatient clinics where stigma remains a biting reality. The shift is driven by a fundamental pivot in U.S. foreign policy toward domestic rescissions, clawing back billions in global health aid and leaving a Sh30 billion hole in Kenya’s 2026 health budget.

The Kenyan government has responded with urgency and strategic redesign. Health officials, led by the Ministry of Health, are frantically working to integrate HIV services into the new Social Health Authority (SHA). The goal is to move HIV care from a donor-funded silo into the national insurance framework, essentially treating it like any other chronic condition. To prevent a total stockout, the government is also fast-tracking licenses for local pharmaceutical companies to manufacture ARVs within Kenya, aiming to break the cycle of dependency on foreign shipments that can be halted by a single signature in a foreign capital.

Sustainability is the ultimate goal, but it is a bridge built under fire. The National Treasury is being asked to ring-fence emergency funds to unlock meds held in private warehouses, while civil society groups under the National Empowerment Network of People living with HIV in Kenya (NEPHAK) have taken to the streets to demand that laboratory tests, like viral loads and CD4 counts, remain free under the new insurance scheme. While the move toward a Kenyan-led, self-reliant system is the only long-term solution, for Otieno’s family, the immediate reality is a month-by-month struggle to stay undetectable while the country waits for the first gears of its own factories to turn with purpose.

@doddyokelo

Still Home

Your touch was magical, a sudden and quiet healing
that reached through the skin to the very bone of me.
It was a gentle conjuring, a way of saying yes to the light
until my eyes danced with a glee I had long forgotten,
shining like smooth stones at the bottom of a clear, bright river.

Your look was intense, a steady fire that did not burn
but saw through the masks I wore for the world.
And oh, your talk, it was a pure water, a holy sound
that pulled me in like a song you’ve known since birth.
There was no struggle in the falling, I simply leaned
into the grace of you and found myself finally home.

But now the rooms are wide and the air is thin and still,
and I am singing the melody of a name I miss too much.
I am holding a place for you, built out of my own heart,
waiting for your footsteps to wake up the morning once more.
Come back to the warmth you started, come back soon,
for the joy in me is waiting for your hand to lead it out.

@doddyokelo

Daughter of The Mountain

I met her on an afternoon
when the sun burned low,
spilling gold across the earth
as though the day itself leaned close
to let slip its quiet confessions.

She was slim-thick,
a flame held steady in the wind,
with a presence that filled the space
more surely than height or breadth could command.
Her skin bore the quiet radiance
of fertile Kenyan earth after rain,
luminous, alive with the memory of rivers.

Her beauty was the beauty that stays,
like a song remembered long
after the singer has gone.
Her eyes were wide, dark pools,
holding the innocence of unspoken dreams,
and the fierce pride of the hills,
green and ancient,
keepers of stories older than memory.
When she looked, it was not merely at you,
it was into you,
as though the soul were something
she had always known,
and only sought to confirm.

Her laughter was small, quick,
yet it carried,
like the delicate chiming of cowbells
drifting from a far valley.
Her movements, precise, almost shy,
the way a swallow folds its wings before flight,
yet within them was a grace
no stage could rehearse.

She was not made of ornaments or excess
but of silences,
of natural songs,
of that soft balance between fragility
and unyielding strength.

To call her beautiful
would be to simplify what was infinitely complex.
She was the outline of twilight
against the ridge,
the fragrance of tea leaves
crushed between fingers,
the silence of evening rain on tin roofs.
She was the Mountain itself,
its promise, its mystery,
its unbroken spirit made flesh.

And in her presence,
I felt the world pause,
as though even time leaned in
to watch her pass.

@doddyokelo

Love, Receipted

You call me lazy,
as if rest were rebellion,
as if the absence of a paycheck meant
I’d married idleness and sworn fidelity to failure.
You think I wake each morning to romance poverty,
to sip on the bitter tea of rejection
and call it breakfast.

You think I don’t hunt for work,
darling, I’ve applied so hard the internet knows my name.
I’ve learned new skills until my mind wheezes from exhaustion,
repackaged my dreams in “professional tone,”
and written cover letters that could melt granite.
Still, the silence from employers breathes louder
than any sermon on hard work.

But go on, roll your eyes like coins in a rich man’s pocket.
You love the performance of pity, don’t you?
The way you sigh,
You wear my struggle like a badge
that says “look what I tolerate.”
You hold my empty wallet against my neck
like a priest offering salvation through mockery.

Your friends, the walking bank accounts,
toast to success with imported laughter.
They look at me the way one studies
a museum exhibit labeled Before Success.
And you,
you shrink beside them,
embarrassed to be seen loving someone
who doesn’t come with receipts.

I know I can’t afford dinner dates,
but baby, I can give you poetry,
written with hunger’s ink,
where every word costs a piece of my pride.
You want steak, I offer metaphors,
you want champagne, I bring conversation.
But apparently, love without a tip is just noise.

You say I make excuses,
as if failure were a choice I make before breakfast.
Man, I’ve tried,
tried until my hope broke its spine
from bending too long under your expectations.
But effort doesn’t trend, does it?
It’s not sexy on Instagram.

You used to look at me like promise,
now you look at me like pity dressed for dinner.
Your eyes audit my worth
like a cashier scanning expired dreams.
You don’t even say it out loud,
but your silence spells liability.
Love, it seems, needs a payslip now.

So go ahead, call me disgusting,
a broke ass night certified by circumstance.
Laugh with your friends,
they’ve earned their arrogance.
I’ll be here, broke but breathing,
scribbling poems on the back of rejection letters,
because even in poverty, darling,
I write better than they ever will live.

@doddyokelo

Light of My Days

There are many names for a woman,
but none that speak your fullness,
you are dawn in its first whisper of gold,
a soft psalm wrapped in morning light,
a cathedral of calm where my heart kneels,
finding faith again in the sound of your voice.

You walk as if the earth remembers your kindness;
flowers lift their faces in your passing.
Your laughter, a river that knows its way home,
sculpts joy across the landscape of our days.
Even silence becomes sacred when shared with you,
for you breathe poetry into the air itself.

Once, you were a girl with suns in her eyes,
and the world crowned you mother,
not with jewels, but with gentle burdens,
and you bore them like grace itself.
Your hands stitched comfort into chaos,
turning hunger into hope, noise into hymn.

In your eyes, I have seen God’s tender art,
the patience of oceans, the courage of storms.
You are the soft peace that follows heartbreak,
the reason broken wings learn to fly again.
Your love has been both shelter and sword,
cutting fear from the edges of my name.

Every word I’ve ever spoken carries your echo,
each dream is scented faintly with your prayers.
You are the unseen flow in my becoming,
the quiet architect of my strength.
When I stumbled, you became the ground beneath me,
steady, forgiving, endlessly near.

What language could ever hold your worth?
What poet could bind your light in ink?
You are not to be described, but felt,
like rain, or grace, or home after exile.
And so, I do not thank you with words,
but with the life you helped me build.

Here’s to you, Mum,
keeper of warmth, bearer of mornings,
woman of endless tomorrows.
May joy drape you like silk at sunrise,
and time bow gently before your smile.
You are every beautiful thing I know.

Happy Birthday,
for the world grew softer the day you were born,
and I have been blessed to call its miracle Mother.

@doddyokelo

Tailored To Your Ego

You teach me how to love,
like a tutor with a chalk of affection,
sketching rules on my heart’s blackboard,
telling me where to pause, where to ache,
how to sing your name.
And I, the willing fool, take notes,
hoping to pass your exam of devotion.

You say, be the best person you can be,
but only when that person pleases you.
How noble, how godly, how perfectly human
to mold me into a version of you,
and call it growth.
Love, you say, is sacrifice,
but it’s always my neck on the altar.

A romance tailor-made, you claimed,
stitched with precision and care,
fitted to the edges of your comfort zone,
hemmed with your insecurities,
fastened with silent rules I never signed.
Sorry, my love, correction,
fitted not for love, but your ego’s parade.

Still, I tried.
God knows, I tried.
And in the trying, I learned,
how love can shape a man into a shadow,
how tenderness can bruise if held too tight,
how devotion, when one-sided,
becomes self-destruction in silk.

You ask what I’ve learned in return?
That your affection has terms and conditions,
your heart is a subscription service
that renews only when I bow enough,
laugh enough, obey enough.
You call me names when I forget,
darling, I’ve never seen such poetry in cruelty.

You say you can’t do this anymore,
compare me to your gallery of ghosts,
men built in marble, flawless in memory.
And still, I stand there,
a living, breathing imperfection,
learning that your love speaks fluent disappointment.

So walk, my sweet torment.
Take your lessons, your mirrors, your masks.
You’ve taught me what love is not,
and that’s worth a diploma in heartbreak.
Go, darling devil,
your absence will be my peace,
and my freedom, finally tailored to me.

@doddyokelo

Stay With Me

I have never known a pain this sharp,
a hurt that stays in every breath,
as if sorrow has built a home inside my chest.
I sit here drowning in my own silence,
tears spilling like tides I cannot command,
wondering how I strayed,
wondering if I’ve lost the best part of me,
you.

I keep replaying my mistakes,
each one cutting deeper than the last,
and I fear that in their shadow,
your love for me might dim.
The thought alone unmakes me.
It is a heaviness I cannot outrun,
a shame that knots itself into my bones.

If only regret could mend,
if only apologies could erase,
I would gather up every fragment of your hurt
and carry it away until you felt light again.
But healing, I know, is not so quick.
It asks for patience. It asks for trust.

“I’m sorry” feels too small,
too fragile for the weight of what I mean.
Yet it is the truth on my tongue,
and I speak it with trembling hope.
Because we have weathered storms before,
you and I,
and somehow we’ve always come through
stronger, side by side.

Still, I know you deserve better
than the hurt I’ve caused.
I hate myself for placing this burden on you.
But if your heart can find space
for one more chance,
I promise I will spend every day
proving love right again,
proving us right again.

@okelododdychitchats

The Hour of Resignation

Is not the deep, dark rest a better plea,
When every single waking breath is war?
What am I fighting for, and what’s in store
But the same old tide that washes over me?
I searched the sunrise for a silver coin,
A simple piece of joy I could rejoin,
But found the coffer empty, shut, and cold,
The story of my striving left untold.

They promise gain, a comfort to be won,
If I just keep my shoulder to the stone.
But I have carried burdens all alone
From the first shadow cast beneath the sun.
I’ve seen no profit, felt no easing touch,
Just giving everything and getting much
Less than the peace the simple stones enjoy,
A hollow effort that I can’t employ.

Look on the record, read the final count,
There is no happiness beneath this sky.
The truth is written in the tear-wet eye,
The only offering from a spent account.
Every hard-won moment just a trade
For a new hurt, a deeper struggle made,
The only harvest that my hands can claim
Is the slow, bitter knowledge of the flame.

I tell you plainly, I can take no more.
The line is drawn, the final cord is cut.
My stubborn spirit, now locked in a rut,
Cannot hold past the breaking of the core.
This weight is not a thing you lift and clear,
It is the atmosphere of sorrow here.
The mind gives way, the tired will descends,
And all the forced endurance finally ends.

The anchors slip, the vessel has no guide,
The heart’s great drum beat only low and faint.
I won’t pretend, nor make myself a saint,
I only know I can no longer hide.
I am too fractured to be fixed again,
Too soaked in the relentless, icy rain,
The scaffolding of hope has bowed and split,
And I am done with all the grit and wit.

So let this truth be clear when I am gone,
My failing was not weakness of the soul.
I did not stumble short of any goal,
But fell beneath the weight of every dawn.
It was not sickness, foe, or sudden blast,
Life Itself came for me, and overcame at last.
The battle’s over. Hear the final word,
I lay my weary head down, like a bird.

@@okelododdychitchats