Grassroots activism by Patrice Lumumba and Joseph Kasabuvu and a deteriorating local economy were among the reasons why the idea for a roundtable conference was first formulated in 1959 by the Congolese Labour party. The aim was to organise the independence of Belgian colonies in Africa. So on January 3rd,1960, the Belgian government announced that it was going to convene a roundtable conference with the goal of helping the Congolese to transition from colonial rule to independence. That was when Joseph Kabassele was approached to select a few musicians who would travel as an African jazz band to entertain the Congolese delegation in Brussels. One of the songs they performed was Independance cha cha composed by Joseph Kabasele, also known as Le Grand Kalle. It is one of the most memorable songs as well as one of the first Pan-African hits.
Independance Cha-cha to zuwi ye !
Kimpwanza cha-cha tubakidi
Table Ronde cha-cha ba gagner oh!
Lipanda cha-cha tozuwi ye!
Independence cha-cha que nous avons
Liberte cha-cha, obtenue !
Table Ronde cha-cha ils ont remporte !
Liberte cha-cha, arrachee !
Independence cha-cha declared!
Oh Freedom cha-cha we’ve conquered!
At the Round Table they won!
Oh Liberty cha-cha we’ve conquered!
Capturing, as it did, the mood of a continent throwing off the shackles of colonial domination, the song, as described by Alain Mabanckou, the Congolese-born French writer and academic, “ quickly became the hymn of the emancipation of the black continent”.
However, many of the newly independent states chose to adopt some of the symbols of statehood pioneered by their erstwhile colonial masters, including national flags and anthems. And when it came to the latter, rather than adopt the songs that symbolised liberation to their citizens, they commissioned new tunes that were more in keeping with international norms.
Just as the concept of the nation-state was premiered in Europe, so too was that of national anthems, and many today follow the conventions established there. The Netherlands has the oldest song used as a national anthem, the Wilhelmus, which was composed between 1568 and 1572 but not officially recognised as such till 1932. The United Kingdom’s “God Save The Queen” is widely considered to be the oldest national anthem and many countries, both in Europe and among her former colonies, have modelled theirs on it. Malcolm Boyd, who has analysed a great number of national anthems, described the two most common categories as hymns with a solemn pace and melody (such as “God Save The Queen”) and marches (such as the French “La Marseillaise”).
Even as Kalle’s appeal for unity was ignored in the Congo, which was quickly plunged into civil war, independence was dawning in East Africa and Kenya, Uganda and Tanzania were themselves using music to nurture and cement national traditions as well as create a sense of unity among people from diverse cultural backgrounds.
THE NATIONAL ANTHEMS OF EAST AFRICA
As David A. Butz notes, “Scholars from a variety of disciplines argue that the function of national symbols is to activate collective group membership and, as a result, to encourage belongingness and identification with one’s nation.”
Kenyan musicologist Professor Mellitus Nyongesa Wanyama of Moi and Kabarak universities, who is also the founder of the Utafiiti Foundation Research Centre, explains that in Africa, a national anthem is a patriotic song that evokes and eulogises the history, traditions and struggles of its people. Therefore, it may vary from country to country. National anthems are also used to rally people to work together for unity and development, and may symbolise praise, devotion, or patriotism. . “An anthem should be made memorable by the use of simple words that everyone can identify with and it is usually in the national language of the country,” he says.
After independence, African governments, Kenya included, tasked the elite minds available at the time to come up with national symbols for their respective countries, which included national anthems’ tunes and lyrics.
According to Wikipedia, Kenya’s national anthem was one of the first to be specifically commissioned. It was written by the Kenyan Anthem Commission in 1963, which was composed of the following five individuals:
- Professor Washington Ambrose Omondi, who is currently an associate professor in the Department of Music and Dance, School of Visual and Performing Arts at Kenyatta University.
- The late George Zenoga Zake who passed away in 2008. Zake was a Kenya-based Ugandan music professor who founded the music department at Kenyatta University; he was in charge of assisting the Railway Training School choir in recording the Kiswahili version of the national anthem.
- The late Graham Hyslop, who was an organist at the All Saints Cathedral and Kenya’s colonial Music Inspector in 1963 with a particular interest in Pokomo songs. He was also conductor of the All Saints and Alliance School choirs. He died in 1978. It was he who recorded a lullaby from Mzee Meza Maroa Galana that became the melody to the anthem.
- Peter Kibukosya, who was once chairman of the Kenya Music Festival and who died in 1978.
- Finally, the late Rev. Thomas Kalume, who not only translated the New Testament from Hebrew into Kiswahili, but was the first clergyman to be elected to Kenya’s parliament – as MP for Malindi North in 1969.
The team officially started the process of composing the anthem in May 1963, just before the Independence Day celebrations in December of that year. Years before, as a music expert visiting East African schools, Hyslop had recorded the traditional Pokomo lullaby, B-e-e Mndondo B-e-e, which Galana would later say he had “learnt and mastered as a young boy”. The song’s simplicity and originality apparently so impressed Hyslop that he took the recording back to Nairobi where it was lodged with the National Museum as part of the country’s cultural heritage. Galana described the song as “simply an adult telling a child not to fear as the sound it is hearing is of a goat bleating. The adult asks who had wronged the child and then assures the young one that he would go to fight them – the people in the farms – while the moon is shining brightly….”
In an interview published in the Daily Nation in December 2015, a month after the death of Mzee Galana, Prof. Omondi said the Kenyan Anthem Commission had visited various peoples at the Coast to sample and record folk tunes for consideration and possible adaptation. “Like most folk songs, there was no known composer of most of these Pokomo folk songs,” he said.
After several weeks, the commission presented three different tunes, including Galana’s lullaby. They then went ahead and composed lyrics in both Kiswahili and English. Additionally, they also agreed that the opening stanza be composed as a prayer, O God of all creation, bless this our land and nation | Ee Mungu nguvu yetu, Ilete baraka kwetu, following the anthem-as-hymn template established by the British. This was credited to the late Rev. Kalume.
In August 1963, the tune was accepted after the Police Band played the three verses in both Kiswahili and English to the prime minister and his council of ministers.
When the real work began, the All Saints Cathedral choir was the first to be approached to record the English version while the Railway Training School choir was asked to record the Kiswahili version. All this was done in less than four weeks. On September 4th, 1963, the respective choirs were then asked to perform the anthem at Mzee Jomo Kenyatta’s residence in Gatundu.
In addition to the choirs, there was another entry, one by the late Gerishon Manani, who in 1966 founded and became the chairman of the Kenya National Folk Music and Dance Festival. Initially, Mr. Manani had secured a scholarship from the British Council to study music at Trinity College in
London, from 1958 to 1963. Mr. Manani’s song was titled Kenya Taifa Letu. After it was official that his song would not be Kenya’s national anthem, Mr. Manani changed the title to Kenya National Song of Praise. The song was recorded in both Kiswahili and English. Sadly, the original copy cannot be traced.
After the auditions, Mzee Kenyatta requested that the commission’s and Mr. Manani’s anthems be merged into one. After consultations, however, it was decided that the anthems be performed before a gathering of local people who were present for the occasion. They unanimously chose the Commission’s anthem.
Subsequently, that month, the Commission’s English version was sung by a mixed choir from Alliance High School, Alliance Girls High School and the All Saints Cathedral, while the Railways Training School choir sang the Kiswahili version.
Subsequently, Jomo Kenyatta wrote a letter in November 1963 thanking Prof. Omondi and his team for their work; this was the only recognition the team received from the state. Interestingly, Mr. Galana would only learn that the tune he had provided to Hyslop had been selected for the anthem when it was played at the Independence Day celebrations on 12th December 1963. Like many Kenyans on that night, he and a group of friends and relatives were following the events on the radio. “We silently listened to the King’s Anthem and after it ended, we prepared to hear our own new national anthem which we had been told would be sung for the first time that night,” he told the Daily Nation in 2011. “Then the new national anthem came on air. The tune was that of my song even though the words had been changed.”
Although he did gain a measure of recognition, Mr. Galana would die a bitter man. “Never trust the government of Kenya, it only gives lip service to its heroes, most of whom are living in squalid conditions,” the then 95-year old told a writer for the Tana River County’s official website in 2013, two years before his death. “I did not hold a gun and go to the bush like Dedan Kimathi or Major Blue and others. However, I contributed the melody and the whole world acknowledges that.”
Though never a part of the Kenyan Anthem Commission, when news of Mr. Galana’s death reached State House, President Uhuru Kenyatta, the son of the man who had picked his tune for the national anthem, sent condolences and even gifts to the family. Most members of the Commission are today also deceased and little remembered.
A similar situation prevailed in Uganda. Before Professor George Wilberforce Kakoma, the man behind Uganda’s national anthem, passed away in 2012, he had filed a case in court accusing the government of infringing on his rights to own property and for not paying him royalties for the use of his song. He claimed about $1.9 million (equivalent to about Ush4.5 billion). Initially, the government had paid him Ush2,000 in 1963, which is less than a dollar today.
In early 1962, a committee was tasked with choosing Uganda’s national symbols. Its members were George Wilberforce Kakoma, Polycarp Kakooza, Bambi Katana, Senteza Kajubi and Wilberforce Nadiope, who later became President Milton Obote’s Vice President. In 1961 the commission sent out an advertisement that was published in the Uganda Argus, a government-owned newspaper, for interested people to submit compositions and designs for not only the national anthem but other national symbols too.
The short-listed individuals were invited to come and showcase their work to the committee. Unfortunately their submissions were disappointing. It was then that the head of the committee, Professor George William Kajubi, asked Professor George Kakoma, a renowned inspector of schools and a music teacher, to compose an anthem. Prof Kakoma composed the melody but Peter Wyngard, Kakoma’s friend who was then a lecturer at the Makerere Institute of Education, composed the lyrics. Interestingly, other members of the committee, including Rev. Kakooza and Mr. Katana, appear to have also made submissions of their own. Mr. Kakoma came up with the anthem overnight and it was declared the winner in July 1962, a few months before Independence.
Oh Uganda may God uphold thee,
we lay our future in thy hand,
United, free for liberty together we’ll
In 2010, Mr. Kakoma was awarded USh50 million ($14,000) by the Ugandan High Court, which recognised that he, along with the Ugandan government, had joint ownership of the copyright to the anthem. The court, however, also decreed that as a condition to his getting the money (a third of the out-of-court settlement he had rejected in 2009), Mr. Kakoma had to give up his claim to the copyright. Mr. Kakoma, who died in April 2012, appealed the judgement and as of May 2016, the case had yet to be decided.
THE ANOMALOUS CASE OF TANZANIA
As Professor Mellitus Wanyama explains, “The first line in the first stanza of Tanzania’s anthem was adopted from South Africa’s Nkosi Sikelel’ i Afrika, which was composed in 1897 by a schoolteacher and poet, Enoch Mankayi Sontonga”. Set to the tune of the Welsh hymn, Aberystwyth, written by Joseph Parry more than two decades before, the hymn became popular in South African churches and was taken up by the choir of Ohlange High School, whose co-founder was the first president of the South African Native National Congress. It was sung to close the first Congress meeting in 1912, and by 1925, had become the official closing anthem of the organisation, which had by then changed its name to the African National Congress. In 1927, a Xhosa poet, Samuel Edward Krune Mqhayi, wrote an additional seven verses, and the tune quickly spread across the continent as a liberation anthem, much as Kalle’s Independence cha cha would 30 years later.
While the Kenyan and Ugandan anthems both invoke divine favour for their respective nations, especially in the first stanza, the case changes with the Tanzanian national anthem, which opens with God Bless Africa. Why is this so? And why was Nkosi Sikelel’ i Afrika successfully adopted as a basis for several countries’ anthems unlike Independence cha cha?
Various reasons have been advanced as to why Tanzania chose the South African song. The country had played a critical role in South Africa’s struggle against apartheid. Its first president, Julius Nyerere, had, even prior to Tanganyika’s independence in 1961, been a leading campaigner against the apartheid regime, calling for a boycott of South African goods and helping to launch Britain’s anti-apartheid movement. When in power, he offered unflinching support to the ANC’s guerrilla fighters, who found refuge and a base for planning and training for their struggle in Tanzania. When the apartheid regime refused to issue them travel documents, it was on Tanzanian passports that ANC leaders, including Nelson Mandela, were able to travel the world.
Further, Tanzania had offered itself as a base for others fighting for liberation, hosting the forces of many movements such as the African National Congress (ANC) and the Pan African Congress (PAC) from South Africa, the Mozambique Liberation Front (FRELIMO), the People’s Movement for the Liberation of Angola (MPLA), the Zimbabwean African National Union (ZANU), the Zimbabwean African People’s Union (ZAPU), and the South West Africa People’s Organisation (SWAPO) from Namibia.
As Thandika Mkandawire, the Malawian-born Swedish economist, noted, “Up until independence, many of these nationalists movements of southern Africa used si Sikelel’ i Afrika as their nationalist anthem.” It therefore came as no surprise when Tanganyika adopted the Kiswahili version of the Nkosi Sikelel’ i Afrika as its national anthem in 1961 and the same was retained after it united with Zanzibar to form the United Republic of Tanzania.
African music is an incredibly rich and fertile ground. The different regions produce their own distinctive musical styles. So, away from national anthems, we have other songs across East Africa that inspired the agitation for freedom and watered the seeds of nationalism in the pre-Independence and post-independence eras.
For example, in the 1960s, Mwana wa mberi, a traditional song that literally congratulates a mother on begetting a first child, has, according to the late Prof. Naomi Shitemi, been adopted in other situations that require hero-honouring. Prof. Maurice Amutabi’s essay “Cultural History of the Abaluyia: The Role of Traditional Music”, notes that the song became “very popular with the nationalist fervor … [I]t was adopted unofficially as a nationalist anthem at political rallies in Western Kenya”. Following independence, William Ignosi Mwoshi, the man largely credited with popularising the song outside the Luyha community, performed it for Jomo Kenyatta at his Gatundu home, signifying victory over the colonial rule.
‘Mwana wa mberi … [Alas! The Firstborn Child!]
‘mwana wa mberi beyaye
‘mwana wa mberi
Mwana wa mberi ne shiekhoyero (repeat stanza)
Mwana wa mberi ni…. (mention celebrant)
Ni…. (mention celebrant)
Mwana wa mberi ne shiekhoyero
Beyaye okhali na ‘undi no!
Mwana wa mberi
‘ha’ undi, no?
Mwana wa mberi ne shiekhoyero (repeat stanza)
Lera tsimbande tsia wabikha
Mwana wa mberi
Mwana wa mberi ne shiekhoyero (mention cereals & grains)
Eee omwana wa mberi
Ee omwana wa mberi ne shiekhoyero
Ee omwana wa mberi
Ee omwana wa mberi ne shiekhoyero (repeat stanza)
The English translation:
[Alas the firstborn child!
The firstborn child
Indeed the firstborn child is real joy (repeat stanza)
The firstborn is … (mention celebrant)
Yes it is…. (mention celebrant)
Indeed the firstborn child is real joy
Alas there is no other!
A firstborn child
You have another one
Indeed the firstborn child is real joy (repeat stanza)
Bring precious grains you have stored
For the firstborn child
We shower the child
Indeed the firstborn child is real joy (mention cereals & grains)
Oh yea the firstborn child
Indeed the firstborn child is real joy
Oh yea the firstborn child
Indeed the firstborn child is real joy (repeat stanza)]
In a sense, Mwana wa mberi inaugurated an era where music encouraged nationalistic sentiment, many times reinventing history and exaggerating the virtues and deeds of founding presidents. As repressive and dictatorial single-party regimes constrained the space for democratic expression, musicians were reduced to praise-singers in the service of the state and its rulers. As Marie Korpe and Ole Reitov noted in their article on music censorship in Africa titled “Not to be Broadcasted”, “almost all broadcasting media [were] state-controlled and … performed as ‘his master’s voice’ during various regimes, be it in Tanzania under Nyerere, or Zaire under Mobuto”. In the 60s and early 70s, Kenya’s national celebrations were synonymous with live choirs performing patriotic songs. Jomo Kenyatta was a big fan and would go the extra mile to transport his favourite choirs to his Gatundu home to entertain him. Enock Ondego’s Wimbo was Historia, composed after Kenyatta’s death, recounts the arrest, trial and imprisonment of the so-called Kapenguria Six and offers a sanitised and exaggerated rendition of Kenyatta’s role in securing independence.
Enjoy the acoustic and electric guitar sounds in this song Shirikisho la Afrika by another Kenyan singer, John Mwale, which was released in 1983. The song celebrates the coming together of East African countries to form the initial East African Community (which he believed would strengthen the Organisation of African Unity, now the African Union), which was formed in 1967, collapsed in 1977, and revived on 7th July 2000.
Kenyan twist dance maestro John Amutabi Nzenze composed one song as a tribute to the Kenyan founding father Mzee Jomo Kenyatta. In the song, he also speaks against corruption and encourages Kenyans to work hard for future generations. The song is titled Kenyatta.
In Tanzania, the Atomic Jazz Band, formed in the mid-1950s, composed a song, Tanzania
Yetu,which tells of the feats of Tanzanian leader Mwalimu Nyerere. The song was famous all through the 1960s under the leadership of band leader John Kijiko.
It is rare, especially in recent times, for an artist to sing about a leader from a country other than his or her own. But Kenya’s Daniel Owino (D.O.) Misiani and his Shirati Jazz Band composed a track extolling the virtues of the fallen Pan-Africanist leader Julius Nyerere titled Piny Ema Oneno (It’s the world that has seen it). This was among Kenya’s most successful bands. Starting off as Luo Sweet Voice, it became Shirati Luo Voice Jazz around 1972, before changing its name to Orchestra D.O. 7 Shirati Jazz in 1975.
In Tanzania, the late Marijani Rajabu, who performed a musical style that was popularly known as Muziki Wa Dansi in Tanzania, composed a song titled Nyerere to acknowledge the efforts of Mwalimu in the fight for Tanzania’s freedom. He also urges Tanzanians to pray for their president.
In 1979, a year after Kenyatta’s death, Kaakai Kilonzo and his Kilimambogo Brothers Band offered a utopic vision of Kenya in the song Kenya Nchi Yangu. He followed that up with Fuata Nyayo, which extolled the virtues of Kenyatta’s successor, Daniel arap Moi. Originally Kaakai performed in Kamba, his native language, but rose to national fame after releasing his music in Kiswahili.
Another famous patriotic song was America to Africa by the veteran Kenya singer David Amunga. In this song, he expresses his joy at coming back home to Kenya after staying for several years in the USA. It was released in 1964.
Following the ouster in 1979 of Idi Amin, famously known as the “Butcher of Uganda”, the song Saba Saba celebrated his removal from power and espoused the people’s freedom from the grip of Amin’s authoritarian rule.
However, there were still sounds of resistance and protest. In 1984 John Owino released Baba Otonglo, a song decrying the poor state of the domestic economy, which so alarmed the Moi government in Kenya that the records on the market were confiscated. In 1997, the trio known as Kalamashaka rebelled against the hardships of life in Nairobi’s low-income neighbourhoods with their hit Tafsri Hii, and, as Oyunga Pala writes, “cemented the place of Sheng and Swahili rap as the voice of the urban youth all over Kenya.”
Similarly, in 2002, as the Nyayo era drew to a close, Kenyans were again dancing to the sounds of Yote Yawezekana Bila Moi (All is Possible Without Moi), a satirical corruption of the gospel song which declared Yote Yawezekana Kwa Imani (All is Possible with Faith).
A year earlier, Eric Wainaina’s Nchi ya Kitu Kidogo (Land of Bribery) expressed the common frustration with the corrupt state (and earned him notoriety after organisers at a music festival attended by the then Vice-President, George Saitoti, tried to stop him from performing the song).
By the time of the 2002 elections, Kenyans were enraptured by Gidi Gidi Maji Maji’s defiant Unbwogable (unshakeable, unbeatable, unstoppable).
And a new generation of musicians are now picking up from where their predecessors left off. Artists like Juliani in Kenya are continuing to challenge and highlight the inequities of Kenyan society and the iniquity of its politicians.
One such artist is Tanzanian superstar Diamond Platinumz, who has recently released a song titled Acha Nikae Kimya, meaning, “It is better for me to be silent if expressing myself will land me into trouble.” In recent times several people have been arrested in Tanzania for expressing themselves strongly against the government of President John Magufuli.
We cannot exhaust the list, but we leave you with a famous quote by Nelson Mandela who was very much in love with South African music, having been a great fan of the late Brenda Fassie. He said: “The curious beauty of African music is that it uplifts even as it tells a sad tale. You may be poor, you may have only a ramshackle house, you may have lost your job, but that song gives you hope.”
ALL THE PRESIDENT’S MEN: Uhuru Kenyatta’s proposed Cabinet raises serious constitutional and legal questions
On January 5, 2017 President Uhuru Kenyatta started the process of constituting his second-term Cabinet by naming some of his nominees. The President’s announcement is unusual in two significant respects. First, it was a partial list; he only announced nine nominees even though the Constitution demands a minimum of 14 and allows him to name up to 22 Cabinet Secretaries (his last Cabinet had 18).
Second, the President said he was “retaining” some Cabinet Secretaries and as such he would not be sending the names of all his Cabinet nominees to the National Assembly for vetting. His statement implied an existing Cabinet whose term continued uninterrupted through the 2017 general elections even though a December 2015 High Court decision held that the tenure of all appointed members of Cabinet ended on August 8, 2017. In attempting to retain some members of the previous Cabinet and exempting them from National Assembly approval, President Kenyatta is acting in contravention of the High Court judgment and the law. (It is also interesting to note that all the Cabinet Secretaries that the President “retained” are men, which also raises the issue of gender parity, which the Constitution explicitly encourages.)
Nominating Cabinet Secretaries and constituting a Cabinet is a constitutional obligation of the President contained in Articles 129, 130, 131 and 132. Article 152(1) defines the Cabinet as the President, the Deputy President, the Attorney General and not fewer than fourteen and not more than twenty-two Cabinet Secretaries. Note also that Article 152(1) provides that there shall be a “minimum” number of Cabinet Secretaries, indicating that the President has no discretion to have zero or no Cabinet Secretaries. The constituting of a Cabinet is, therefore, a mandatory function of the President, which must be performed as required by the Constitution.
In attempting to retain some members of the previous Cabinet and exempting them from National Assembly approval, President Kenyatta is acting in contravention of the High Court judgment and the law.
Article 129 of the Constitution provides that all “executive authority is derived from the people of Kenya and shall be exercised only in accordance with this Constitution.” This provision reminds the executive that executive power is delegated and has limited authority: it is delegated by the people and may not be legally exercised outside of the limits set by Constitution.
Article 130 defines the national executive as including the President, the Deputy President and “the rest of the Cabinet”, thereby emphasising that the Cabinet is integral to the national executive. Article 131 provides that the president exercises executive authority “with the assistance of the Deputy President and Cabinet Secretaries”, emphasising the necessity of the Cabinet as an instrument for the exercise of executive authority. Additionally, Articles 131(2a) and 131(2e) obligate the President to respect and uphold the Constitution and ensure the “rule of law”.
Furthermore, Article 132(2) explicitly vests powers to appoint the Cabinet in the President, providing that s/he “shall nominate, and with the approval of the National Assembly, appoint” Cabinet Secretaries in accordance with Article 152.
So, while the President has the power to nominate he cannot, without the approval of the National Assembly, appoint anyone to the Cabinet. In establishing the Cabinet, the President must follow the process in the Constitution and in law, which includes relevant judicial decisions.
Judicial decisions regarding the process of constituting a Cabinet would, therefore, apply to the President as he undertakes this function. On December 20, 2016, the Constitutional and Human Rights Division of the High Court in Petition 566 of 2015 held that the Cabinet was unconstitutional, as its composition violated Article 27(8) of the Constitution that says that “the State shall take legislative and other measures to implement the principle that not more than two-thirds of the members of elective or appointive bodies shall be of the same gender”.
The High Court was asked to address two issues: the constitutionality of the process of constituting Cabinet and of the composition of Cabinet. In addition to finding the Cabinet unconstitutional, the High Court found that “the actions of the President and the National Assembly…in nominating, approving and appointing the Cabinet” were unconstitutional. As such, the process of establishing the Cabinet and the resulting Cabinet were both declared unconstitutional.
Nothing precludes the President from naming all, some or none of the members of the previous Cabinet; however, all proposed members of the Cabinet, other than the Deputy President, must be nominated again and their names must be submitted to the National Assembly for approval prior to their appointment.
However, the High Court, citing public interest, suspended the judgement for “a period of eight months or until such a time a new Cabinet will be constituted either by the present government or by the new government to be elected into office in August 2017.” The effect of this judgement was that it provided temporary legal permission for the Cabinet’s continued existence, with such permission set to automatically expire if the President named a new Cabinet or if a general election was held.
Therefore, the term for all appointive members of the Cabinet ended on August 8, 2017 by judicial order. As such, the President must, by law, name all appointive members of his proposed Cabinet afresh (a minimum of 15 and a maximum of 26, including the Attorney General). Nothing precludes the President from naming all, some or none of the members of the previous Cabinet; however, all proposed members of the Cabinet, other than the Deputy President, must be nominated again and their names must be submitted to the National Assembly for approval prior to their appointment.
The decision of the High Court in Petition 566 of 2015 found that both the President and National Assembly had violated their obligations in the process of constituting a Cabinet (nominating, approving and appointing the last Cabinet). The High Court, in holding that the National Assembly had failed to perform its role in approving Cabinet nominees, found that the National Assembly must “…apply a strict scrutiny in approving of any action of the executive and where the action involves appointment to public posts a most searching examination in all aspects must be invoked by the National Assembly.” Therefore, the National Assembly cannot be a rubber stamp of Presidential nominees but must exercise the highest legal standard in the vetting and approval, or rejection, of executive nominees.
The President hasn’t violated the law by providing only a partial list of nominees. However, by failing to submit the names of all proposed Cabinet nominees to the National Assembly for approval, and asserting the existence of a valid Cabinet after August 8, 2017, the President is acting in deliberate contravention of the Constitution and the law.
The High Court was explicit that in some cases it is the role of the National Assembly to correct the President: “The National Assembly must exercise that perfect overseer role and tap the President on the shoulder where he is about to slip.” The National Assembly, therefore, has a constitutional obligation to remind the President that all proposed nominees must undergo the entire process of nomination, vetting and approval by the National Assembly prior to their appointment. In addition, the High Court clarified that the National Assembly must reject a proposed Cabinet whose composition would violate the law.
The President hasn’t violated the law by providing only a partial list of nominees. However, by failing to submit the names of all proposed Cabinet nominees to the National Assembly for approval, and asserting the existence of a valid Cabinet after August 8, 2017, the President is acting in deliberate contravention of the Constitution and the law. These actions are especially worrisome considering the opposition’s refusal to recognise the President as legitimately elected. By his actions, the President is providing additional reasons for challenging his legitimacy.
With his announcement, the President has sent important political and legal messages about his second term. It is surprising he is trying to evade the National Assembly given the Jubilee Party enjoys a majority in both houses of Parliament. It would appear that, despite a parliamentary majority, the President is not confident that his nominees will be confirmed by the National Assembly. This anxiety may stem from Jubilee party politics, including the jostling for the 2022 succession, and betrays fears that these intra-party conflicts would play out in the National Assembly approval process. It is also possible that the President may be concerned about the opposition’s ability to utilise parliamentary processes to delay, block or undermine the eventual approval of his Cabinet nominees.
It would appear that, despite a parliamentary majority, the President is not confident that his nominees will be confirmed by the National Assembly.
For an administration whose legitimacy ultimately rests on a judicial decision, the President’s wilful disregard of a court order is also evidence that the battle with the Judiciary continues. It is an assertion of executive exceptionalism saying that the decisions and actions of the President and executive are effectively beyond judicial review. It is troubling that the President isn’t averse to confrontation with the judicial branch, and courting constitutional crises, given the just concluded experiences of the electoral period and the ongoing political uncertainty.
The message is clear: This is not business as usual. If successful, the attempt by the President to bypass Parliament and nominate and appoint a Cabinet in contravention of the Constitution would result in the imposition of an unconstitutional and illegitimate national executive.
An unconstitutional national executive would create unprecedented uncertainty as to the legality of its national and international actions. It would also exacerbate existing political conflicts while signalling to other parties that it is acceptable to resort to extra-constitutional means to resolve political and other conflicts.
By wilfully weakening so many institutions – the Judiciary, the Cabinet, the National Assembly and the Constitution – in a single swoop, the executive is potentially triggering a cycle of political conflict and social instability.
Unchecked, the failure by the President and the National Assembly to accept the constitutional limitations of their authority will lay the foundation for a systematic breakdown in the rule of law. By wilfully weakening so many institutions – the Judiciary, the Cabinet, the National Assembly and the Constitution – in a single swoop, the executive is potentially triggering a cycle of political conflict and social instability. The President and the National Assembly would be best advised to reverse the current course and ensure strict compliance with the Constitution in the process of establishing a new Cabinet.
 The August 8, 2017 presidential election was nullified by the Supreme Court on September 1, 2017. Uhuru Kenyatta won the subsequent election on October 26, 2017. This election was also challenged but this time the Supreme Court, on November 14, 2017, upheld his election paving the way for his assumption of office on November 28, 2017.
(D)EVOLVED HEALTHCARE: Makueni’s trailblazing experiment in providing universal health coverage
Universal health coverage is by many measures considered to be the Holy Grail of delivering quality healthcare. In fact, achieving universal health coverage by 2030 – ensuring that all people have access to the health services they need without the risk of financial hardship – was included as part of the Sustainable Development Goals (SDGs) adopted by the United Nations in 2015. Writing a year later, Marie-Paule Kieny, Assistant Director-General at the World Health Organization (WHO), described it as “the linchpin of the health-related SDGs; the one target that, if achieved, will help deliver all the others by providing both population- and person-centred high-quality services that are free at the point of delivery and designed to meet the realities of different people’s lives.” WHO estimates that about 150 million people around the world suffer financial catastrophe annually from out-of-pocket expenditure on health services, while 100 million people are pushed below the poverty line.
According to the 2013 Kenya Household Health Expenditure and Utilisation Survey, medical expenses account for more than 40 per cent of non-food bills in over half the counties in the country.
In Kenya, though access to quality healthcare is a constitutional right, the scarcity of quality public and private health facilities, as well as the high cost of care even when it is available, means that universal health coverage remains little more than words on paper for much of the population. President Uhuru Kenyatta has made achieving universal health coverage by 2022 a major part of his second term agenda and indicated in his inauguration speech that this would be achieved by expanding coverage under the National Health Insurance Fund (NHIF). The president said that half a century after it was established in 1966, the Fund has only attracted 6.8 million beneficiaries. The World Bank estimates that only a fifth of Kenyans have any sort of medical cover, which means that as many as 35 million Kenyans are vulnerable to the financial devastation occasioned by a medical emergency.
When illness eventually strikes, it takes a huge financial toll. According to the 2013 Kenya Household Health Expenditure and Utilisation Survey, medical expenses account for more than 40 per cent of non-food bills in over half the counties in the country. In fact, direct payments by citizens accounted for a third of the country’s total health expenditure in the same year, according to Dr. Izaaq Odongo, the head of the Department of Curative and Rehabilitative Health Services at the Ministry of Health, with the balance being made up by government (36 per cent), donors (20 perc ent) and employers (10 per cent). As a result, many Kenyans are forced to resort to selling off property, relying on networks of relatives and friends, or even making desperate appeals on social media to raise the necessary funds. Hence the large, and seemingly never-ending appeals all Kenyans make when clearing medical bills. Despite this, according World Bank Country Director, Diarietou Gaye, the number of those thrust into poverty by medical expenses is close to one million.
Kenya’s network of public healthcare facilities has traditionally been hierarchically organised into 6 levels, with the lowest unit being community health workers embedded within communities. At level 2, dispensaries and clinics provide the link between community-based healthcare and the formal health system. Together with level 3 facilities – health centres, maternity clinics and nursing homes – these make up the primary healthcare units. Levels 4-6 are sub-county, county and national referral hospitals. It is at the lower levels that the majority of people interact with the healthcare system and it especially at the primary healthcare facilities that national government interventions with regard to cost have been most consequential.
Since independence, Kenya has blown hot and cold on the abolition of user fees and decentralisation, both of which, given the economic circumstances of most Kenyans as well as the devolution introduced by the 2010 constitution, are prerequisites for universal health coverage. In 1965, according to the paper “Reforming health systems: The role of NGOs in decentralization – lessons from Kenya and Ethiopia by Richard G. Wamai of the Harvard School of Public Health, “a free access policy abolished the KSh5 co-payment operative in the colonial healthcare system… [and] proposed expanding coverage through centralizing the delivery responsibilities from the counties and municipalities to the Ministry of Health”. Eighteen years later, the provision of health services was again decentralised as part of the District Focus for Rural Development programme and in December 1989, user fees were reintroduced in an effort to inject money into crumbling health facilities. The “cost-sharing” programme was part of a comprehensive health financing strategy that also included social insurance, efficiency measures and private sector development. The fees would, the argument went, generate additional revenue, incentivise use of low-cost primary healthcare services rather than the more expensive referral facilities and improve targeting of resources by reducing unnecessary demand.
Still, implementation problems led to the suspension of the policy less than a year later though it was gradually reintroduced in 1991. A 1996 study found that despite revenue increases and facilities being allowed to budget for three-quarters of the money they remitted to the districts, this did not necessarily result in improved quality of care because the funds were used to offset a fall in government funding for basic care. As evidence mounted that despite a waiver policy to protect the poor and children under five, user fees were proving to be a significant barrier to access, the government – in what came to be known as the 10/20 policy – again reversed course and in 2004 eliminated all fees in dispensaries and health centres, save for a minimum registration fee of KSh10 and KSh20, respectively. By 2007, it had instituted a maternity waiver allowing for free deliveries in public health facilities and introduced the Health Sector Service Fund (HSSF) to compensate these facilities for lost revenue.
Since October 2014, Makueni has been offering its one million residents free healthcare across all its public facilities, including county and sub-county hospitals.
However, as a study published in 2015 showed, this was largely ignored by health facilities for whom user fees represented almost all the cash income they used to cover basic operating costs. As a result, most patients ended up being charged for more than the specified amount while very few received waivers. In 2013, the government abolished all user fees in public dispensaries and health centres and allocated KSh 700 million to the HSSF.
The picture was further complicated by the fact that health is one of the services devolved by the 2010 constitution. This means that while the national government is still responsible for policy and managing two Level 5 referral facilities, namely, the Kenyatta National Hospital and the Moi Teaching and Referral Hospital, the bulk of public healthcare in Kenya is delivered in facilities run by county governments. A history of skewed investment that marginalised some counties, as well as the lack of policy coordination between the various counties and between the counties and the national government, have left a rather confused picture of access to healthcare across the country.
There have, however, been some wins. For the first time since independence, residents of historically marginalised counties, such as Lamu and Mandera, now have access to Caesarean section procedures within their county. There have been problems too: from the controversy arising from the national government forcing counties to lease equipment they neither wanted nor had the resources to use, to ambulance purchases that seemed more about burnishing a governors’ image than delivering care to constituents, to the First Lady’s much trumpeted Beyond Zero initiative that today is in shambles, with many of the facilities either abandoned or turning patients away.
The Makueni model
Nonetheless, an ambitious experiment in the provision of universal health coverage is underway in Makueni, a county that borders Kajiado, Machakos, Kitui and Taita-Taveta counties. Since October 2014, Makueni has been offering its one million residents free healthcare across all its public facilities, including county and sub-county hospitals. It is a model well worth examining if President Kenyatta is serious about expanding access to medical care across the country.
“When we took over in 2013, we realised that 40 per cent of the people of Makueni would sell land and exhaust family income to pay medical bills for relatives,” says Makueni’s Governor, Prof. Kivutha Kibwana. Given that medical services in dispensaries and health centres were already free and paid for by the national government, the county government figured that if it doubled the 100 million that its Level 4 sub-county hospitals were collecting in user fees, it could offer free, across the board healthcare to its residents.
Thus MakueniCare, as the county government has labelled it, was conceived. It piggybacks on the national government’s free primary healthcare policy and the national coverage provided by NHIF to plug the gap in between with the aim of providing seamless cover across all public health services.
Thus, for an annual subscription of KSh500 per household, which covers parents and all their children under the age of 18 years (or up to 24 years in case of students), Makueni residents can access free primary healthcare at dispensaries and health centres courtesy of the national government, free treatment, including inpatient care and ambulatory services, at the 13 level 4 hospitals within the county paid for by the county government, and, if they’re subscribed to NHIF, free care at referral facilities outside the county. The Level 4 hospitals provide free care and bill the county government, which also supplies them as well as the primary healthcare facilities with drugs, equipment and medical staff.
However, universal health coverage is more than eliminating out-of-pocket expenditure; it is also about ensuring access to healthcare. According to Dr. Cyrus Matheka, the head of the county’s Health Promotion Services, MakueniCare took two years to plan and was preceded and piloted by a programme offering free care to those over the age of 65 without a requirement for registration. Within that time, the county government invested in expanding facilities, from dispensaries and health centres to sub-county hospitals, and has continued to do so. In under five years, it has more than doubled the number of health facilities built by the colonial and national governments over the last 50 years. Apart from an additional 113 dispensaries and health centers, the county now boasts 13 Level 4 hospitals and has employed 160 doctors, compared to just 38 doctors and 3 hospitals in 2013. At KSh2.3 billion, health is the county’s single largest budget item.
All this means that the county can offer a wide array of free services to residents, from hospital admission, surgical procedures, X-ray imaging, laboratory testing, to dental and counselling services. Even in death, patients benefit from 10 days of free mortuary services. However, the cover does not apply to specialised care and equipment that are not available at the hospitals, including dialysis for patients suffering from kidney failure, intensive care units, implants, as well as auxiliary devices, such as wheelchairs.
Insurance schemes are essentially funds where people pay into a pool when they are healthy – in this case through both taxes and direct contributions – which they can draw on when sick. The Makueni recruitment model reversed this, thus courting adverse selection, or the tendency of people to get insurance only when they are seriously sick, which can consume huge resources.
Dr. Andrew Mutava Mulwa, the County Minister of Health, estimates that MakueniCare covers at least 93 per cent of the county’s healthcare needs. He says it is built on a platform of ensuring adequate provision of primary care by increasing facilities, improving services and ensuring that medicines are available. “Someone who is sorted at the dispensary will not find their way to the hospital,” he says, adding that only 35 per cent of patients in Makueni need to seek care in the secondary institutions covered by MakueniCare or in tertiary referral facilities outside the county.
However, the programme has had its share of challenges. The first, rather surprisingly, was low uptake. In March last year, when The Elephant visited Makueni, less than 10,000 households had signed up for the programme out of a potential 200,000. The scheme had a mere 30,000 beneficiaries. Part of the reason for this was the decisions taken to make the coverage voluntary, to register subscribers at county hospitals when they sought care and to make the cover active immediately upon registration and payment. Initially there did not seem to be much of a public campaign to get residents to register: there were no posters announcing the programme in all the hospitals The Elephant visited and, despite officials claiming to advertise on vernacular radio, most residents we spoke to had not heard about MakueniCare.
Julia Musau of Kaselia village, who we met at the Tawa Sub-County Hospital, is a typical case. She had been unaware of the scheme until a month prior to our visit. She found out about it after she took a patient to the Makueni General Hospital in Wote, and had difficulty settling the bill. It was another woman whose child had been admitted there who told her about MakueniCare. That was when she enrolled her family immediately.
However, even those who know about it opt to wait till they or their dependents get ill to register since there is no penalty as the cover is activated immediately and registration is done at the hospitals, anyway. This made registration vulnerable to industrial action by medical personnel. For example, during the nationwide strikes, first by doctors and then nurses, fewer people went to the hospitals as there was little expectation of receiving care. In any case, According to Dr. Matheka, less than 5 per cent of the county’s population seeks medical care at any one time, and many of these are over the age of 65, a group that already enjoys free care. This means registration will inevitably be slow unless there is a serious epidemic.
The Makueni model also faces other challenges. Insurance schemes are essentially funds where people pay into a pool when they are healthy – in this case through both taxes and direct contributions – which they can draw on when sick. The Makueni recruitment model reversed this, thus courting adverse selection, or the tendency of people to get insurance only when they are seriously sick, which can consume huge resources. This brings into question the sustainability of the programme. However, in more recent times, according to Wambua Kawive, a former Makueni County Minister, the county government has ramped up its recruitment efforts and has now launched a mass registration exercise targeting 100,000 registrations by the end of the year.
Another challenge the system needed to cope with was an initial influx of patients into hospitals once the policy was implemented. Tawa Sub-County Hospital Administrator, Justus Kilonzo, told The Elephant that the workload at the hospital had increased, which necessitated the recruitment of more staff. Further, there has been an influx of people from neighbouring counties who sought to take advantage of the system. Geoffrey Kirui, the Health Administrative Officer at Makindu Hospital next to the busy Nairobi-Mombasa highway, spoke about having to filter out patients from other counties, especially Taita Taveta, Kajiado and Kitui. Still, trying to determine someone’s place of residence using identification cards, birth certificates and a ward administrator’s or chief’s letter is an inexact science and one gets the sense that this too was not well thought through.
MakueniCare also faces a hazard where, having paid the subscription, patients will head to the hospital for even minor complaints that can be addressed at lower levels, adding stresses to the system. They may also engage in risky behaviour knowing that there is the safety net of free care. Such behaviour may be inadvertently complemented by a shift in focus from preventative to curative care by hospitals seeking to generate more revenue and county officials seeking to make political hay from the scheme.
The latter is particularly important. It is crucial to note that MakueniCare is undergirded by an administrative structure that was created to deliver a different type of healthcare where users contributed directly. Suddenly eliminating such fees can have unintended deleterious effects on both the facilities and their ability to deliver quality services. One study on the effect of the removal of user fees found that although the revenue generated was generally low, it served to ensure that facilities met the costs of services and salaries for support staff not directly funded through the government’s budget.
There is also a legitimate fear that the political priority placed on MakueniCare may be diverting resources from primary and preventative care at the health centre and dispensary levels.
In Makueni, a doctor-turned-administrator who did not want to be named told The Elephant that MakueniCare had created a mismatch of skills, with doctors having to do administrative tasks rather than attend to patients. When MakueniCare was first proposed, the doctor told us, there was much resistance from hospitals, which were concerned about the lack of a clear system as well as lack of necessary training and preparation. “Why the rush to launch in October 2016?” asked the doctor, concluding that the timing had largely been influenced by the interests of county politicians vying in the August general election.
MakueniCare essentially transfers control over funds and decision-making away from hospitals to bureaucrats at county headquarters in Wote town. Hospitals not only have to worry about delays in receiving reimbursements for resources spent in providing care – which can happen if, for example, the national government delays disbursements to the county governments – but also about losing their largely autonomous decision-making power on the equipment they need to procure and the staff they need to recruit. Similarly, where and when new facilities are built may reflect more the political priorities of those running the county government rather than the genuine health needs of the populace. Lastly, as with all government-driven procurement decisions, the spectre of corruption is never far away.
There is also a legitimate fear that the political priority placed on MakueniCare may be diverting resources from primary and preventative care at the health centre and dispensary levels. Ilatu dispensary, which was built by the Kenya Pipeline Company and opened in March 2014, may be a case in point. In September 2015, the facility was handed over to the county government that provided staff and equipment. Adjacent to a settlement scheme, it is the busiest facility in Kibwezi West and offers outpatient, maternal and child health, family planning as well as HIV testing and counselling services. The staff of two nurses and one laboratory technologist attend to between 70 and 100 patients every day. The county government is upgrading it to a health centre and building a 40-bed inpatient facility.
Jacinta Mbula is the nurse in-charge. She says staffing and resources are big challenges. When The Elephant visited the facility, her fellow nurse was on maternity leave and she was running the facility on her own. She said that there is only enough accommodation for one nurse to stay at the facility and take care of overnight maternity cases, and that nurse still has to report to work the next day. Although they receive adequate supplies of essential medicines from the county government, they do sometimes run out of non-essential drugs.
Further, she only gets KSh60,000 – “peanuts” – every quarter from the county government to pay casual labourers and purchase essential supplies. She currently employs one casual worker and one watchman but says she actually needs – but cannot afford – two casuals and a groundsman to manage the 10-acre facility. And because it was not built by the national government, the dispensary is not entitled to access the HSSF, despite its workload, though other less busy facilities do. Ilatu does, however receive, as all facilities do, reimbursement from the national government for maternal deliveries –KSh2,500 each.
Dr. Matheka says the average distance to a health facility has been nearly halved, from 9km to 5km in the last 4 years. However, having more facilities will not necessarily improve health outcomes for the people of Makueni if the quality of care they provide begins to decline as a result of underinvestment.
So as the county keeps building more dispensaries and health centres, questions must be asked about whether underfunded facilities can truly serve as the bedrock for universal health coverage even though access has been improved. Dr. Matheka says the average distance to a health facility has been nearly halved, from 9km to 5km in the last 4 years. However, having more facilities will not necessarily improve health outcomes for the people of Makueni if the quality of care they provide begins to decline as a result of underinvestment. Further, especially as the county expands the number of Level 4 hospitals, one must wonder whether this is being done at the expense of funding primary healthcare.
Makueni officials say some of the potential pitfalls are ameliorated by enhancing public participation. Governor Kibwana says local committees of citizens participate in co-supervision of projects and must, along with technical people and administrators, give approval. This, Kawive asserts, removes politics from the equation and makes bureaucrats and hospital administrators directly accountable to citizens. While it is definitely a good idea to involve local communities, true accountability must be accompanied by real access to information as well as consequences for those who are implicated in wrongdoing.
Though MakueniCare faces its share of challenges, everyone The Elephant spoke with in Makueni who was aware of the programme was full of praise for its ambition, including those who were critical of its implementation. The fact is, as Kenya ponders the way to achieve universal health coverage, the country would do well to pay attention to the lessons from Makueni. The expansion of NHIF cover by itself will not suffice; the national government must work with county governments to outline a plan that creates a seamless spectrum of cover at every level of care and provides the necessary resources at the appropriate time.
Further, there should be horizontal cooperation among counties in providing healthcare and any plan must strive for equity but without punishing the counties that have taken serious strides. Criteria for eligibility for county programmes should be clearly spelt out and counties should be encouraged to collaborate in designing their schemes within the framework of the national plan.
Thirdly, the system should primarily invest in and direct resources towards building the capacities of the public health sector, not in creating opportunities to generate private profits. It should embrace a rights-based approach that seeks to deal with health as a human right rather than an industry. That shifts the focus away from the needs of “investors” to those of citizens. As Ann Wanyoike notes, “an expanded role for the private sector became a health sector reform theme of the 1990s” but this resulted in “a dichotomous health structure that was characterised by the rich opting for high-cost private healthcare providers, with a majority of the populace who had no such means relying on the publicly run health institutions”. This means that those who can contribute the most to a national universal health coverage scheme have little incentive to do so, especially if such contributions are voluntary. More on that later.
In addition, it does no good to simply superimpose universal health coverage on a system designed for hospitals to generate revenue. The latter must be fundamentally retooled to suit the former and this will take both time and resources.
Fourth, the plan must prioritise prevention and care at the lower levels. In 2013, according to the Kenya Service Availability and Readiness Assessment Mapping report, less than 6 out of 10 health facilities in the country have the capacity to provide the Kenya Essential Package for Health (KEPH) – a standardised comprehensive package of health services – and less than half have the basic amenities to provide healthcare services. And while two-thirds have half the basic equipment required, 59 per cent do not have essential medicines. Only 2 per cent of facilities are providing all KEPH services required to eliminate communicable diseases. Providing universal healthcare on such a foundation would be building on sand.
Universal healthcare requires a substantial increase in the resources both levels of government commit to health. The point is not that both levels of government should spend more on health at the expense of other social services; rather they should increase spending on the full range of human rights and social determinants of health. For example, Kenya’s Health Policy identifies reducing the burden of violence and injuries as one of the top objectives and notes that this will require addressing causes. Given that road crashes account for between 45 and 60 per cent of all admissions to surgical wards, comprehensively addressing the problems on our roads would free up considerable resources in the health sector.
According to Djesika Amendah, an associate research scientist at the African Population and Health Research Centre, Kenya spends most of its health budget on salaries, allowances, drug supplies and other recurrent costs; only 7 per cent of the budget goes towards capital expenditure to improve the quality of healthcare by building new facilities or purchasing equipment to care for more people in the future.
How the money that is allocated to the health sector and how it is spent should also change. According to Djesika Amendah, an associate research scientist at the African Population and Health Research Centre, Kenya spends most of its health budget on salaries, allowances, drug supplies and other recurrent costs; only 7 per cent of the budget goes towards capital expenditure to improve the quality of healthcare by building new facilities or purchasing equipment to care for more people in the future.
In addition, the country spends nearly four times as much on curative care as it does on disease prevention and “we devote a higher share of our health shillings (20 per cent) on governance, health system and financing administration; in other words, paying people in the ministries of health who actually do not see any patients rather than spending money on preventing diseases or promoting health.” Further, although most Kenyans live in rural areas, government health expenditure has in the past tended to favour urban areas. Given the country’s limited resources, more prudence will need to be exercised if universal access to care is to be guaranteed to all.
Along the same lines, there should be an emphasis on getting Kenyans to pay into the system when they are healthy and not to wait till they get sick to get the cover. This also means making it easier for people to register and pay. For example, one can currently download a registration from the NHIF website but one then has to deliver it physically to their offices. There appears to be no way to pay via mobile money or credit/debit card. With nearly all Kenyans able to access the internet though their mobile phones, allowing online registrations and payments would be an easy way to bring in more registrations.
Further, whether the scheme should be voluntary or compulsory is a matter for serious debate. While Makueni’s system is completely voluntary, the NHIF is compulsory only for those in formal employment. Yet the WHO’s 2010 World Health Report titled “The Path to Universal Coverage” says that “there is strong evidence that raising funds through compulsory prepayment provides the most efficient and equitable path towards universal coverage. In the countries that have come closest to achieving universal health coverage, prepayment is the norm, organised though general taxation and/or compulsory contributions to health insurance.”
Makueni teaches us that universal health coverage is doable and that we do not need to have the resources of an industrialised country to achieve it.
There is also the question of whether, like in Makueni, everyone pays the same amount regardless of income, and whether wealthier people are asked to pay a little bit more in order to lighten the load on the poor. As the WHO notes, “financial risk protection is determined by how funds are raised and whether and how they are pooled to spread risks across population groups” and “rais[ing] funds equitably … usually implies a degree of progressivity (where the rich contribute a higher proportion of their income than the poor)”. The NHIF, rather strangely, only has a graduated scale for contributions from those in formal employment; others who join pay a flat monthly fee regardless of income. This is curious for a country where, according to the United Nations’ Economic Commission for Africa, only a quarter of workers are in the formal sector.
Fifth, accountability must permeate the entire system. Implementation of the scheme should not become, as we have seen with the free primary education reintroduced in 2003 and the Standard Gauge Railway, hostage to political priorities. Kenyans must accept that if it is to be done well, it will not be done overnight. Public participation at every stage should be encouraged and resources, especially human resources, should be utilised in the most appropriate and effective manner. Effective public participation as well as transparency will be indispensable if the country is to avoid universal health coverage becoming another avenue for looting by the state.
While universal health coverage focuses on reducing the financial burdens of patients, more will be required if access to the healthcare system is to be expanded. As the World Health Report notes, “eliminating direct payments will not necessarily guarantee financial access to health services, while eliminating direct payments only in government facilities may do little to improve access or reduce financial catastrophe in some countries. Transport and accommodation costs also prevent poor people using services, as do non-financial barriers, such as restrictions on women travelling alone, the stigma attached to some medical conditions and language barriers.”
Finally, Makueni teaches us that universal health coverage is doable and that we do not need to have the resources of an industrialised country to achieve it. All that is needed is a belief that Kenya should be run for the benefit of all Kenyans and that Kenyans are just as capable as any other people of imagining and creating better worlds and better futures. This may be the greatest lesson we can learn from Makueni County.
POT CALLING THE KETTLE BLACK? France’s shady deals in Africa
“I think the corruption of Africa is taken totally out of context, Africa is no more corrupt than any other place around us. For every African leader who is corrupt, we have a 1000 European, American, Chinese business people who are corrupt, where are those guys? Why only talk about African corruption? What about the Chinese corruption, American corruption and European corruption? We need to be really fair in looking at this issue of corruption. What about companies not paying taxes in Africa? What about profit shifting, mispricing? There is a whole lot of corruption around us. What about anonymous companies? Companies whose official ownership is not known, where people hide their stolen money. All that are issues of corruption, so that is all that needs to be discussed and let’s get away from the scenario that only African leaders have a monopoly on corruption which is not true”.
These words came from the mouth of Mo Ibrahim, the Sudanese-British businessman who in 1998 founded the telecommunications company Celtel International and is now the chairman and founder of the Mo Ibrahim Foundation, established in 2006 to support good governance and exceptional leadership on the African continent. Since 2013, Mo Ibrahim has been measuring and monitoring governance performance in African countries through the Ibrahim Index of African Governance (IIAG). He is an iconic figure: he represents African efficiency and good entrepreneurship.
The point made by Mo Ibrahim is clear: corruption is a global issue that is making the world sick. Targeting the sickness should be a priority of the whole planet. There is no moral superiority here: each country should blame itself for something. There are countries that behave like strong boxes protecting the financial secrecy of the rich world; others are still trying to colonise the poor while some allow a tiny elite to control the rest of the population.
There is a tendency to view Africa as corrupt. No doubt lack of ethical leadership and economic and political neocolonialism are key factors in the high levels of corruption on the continent. However, treating the corruption issue as an African peculiarity is unfair. Especially if the one complaining is a European country.
Related stories: Special Reports from Reuters journalists around the world
European companies are part and parcel of corruption in African countries. The most recent example concerns Eni SpA, the partially-national Italian oil company and the partially-national Dutch Royal Dutch Shell PLC. On December 20 this year, the Court of Milan indicted Royal Dutch Shell PLC, the chief executive of the Italian oil and gas company Eni SpA and other industry executives on corruption charges connected to a 2011 deal to acquire drilling rights off the coast of Nigeria. “Prosecutors say in court documents that Eni CEO Claudio Descalzi and the other executives at both Shell and Eni knew that most of the $1.3 billion Eni and Shell paid to the Nigerian government to acquire the drilling rights would be distributed as bribes. Prosecutors will argue that Goodluck Jonathan, the Nigerian president at the time of the deal, received part of the kickbacks, according to court documents”, FoxBusiness reported.
There is a tendency to view Africa as corrupt. No doubt lack of ethical leadership and economic and political neocolonialism are key factors in the high levels of corruption on the continent. However, treating the corruption issue as an African peculiarity is unfair. Especially if the one complaining is a European country.
Nigeria is ranked among the most corrupt countries in the world. Corruption has remained rampant in Nigeria, and became worse under the rule of Goodluck Jonathan. In the 2011 case connected to Eni and Shell, there are also several prominent Nigerian figures mentioned in the alleged bribing scheme.
In the European mindset, corruption is a vicious circle: nobody seems to be interested in breaking the bribe rule because it is considered “normal” and it secures success, especially in countries where impunity is the norm. Yet Western countries that have invested in Africa always claim moral superiority: they have better governance, accountable and efficient systems, and they bring jobs. But this supposed superiority is just a veneer that allows these countries to be corrupt and opaque abroad.
France is globally recognised as among the most corruption-free countries. However, there are questions being raised in Kenya concerning whether the France-based company OT-Morpho paid bribes to officials of the Independent Electoral and Boundaries Commission (IEBC) in order to be granted the contract for the electronic voting system used in the 2017 election.
The French government has also in the past been accused of being infiltrated by mafia-like groups that use bribery as a tool to influence politics. Recently, the strongest criticism of France’s dealings abroad came from the broadcaster Arte, which aired a documentary called “Mafia et Republique”.
The French government has also in the past been accused of being infiltrated by mafia-like groups that use bribery as a tool to influence politics. Recently, the strongest criticism of France’s dealings abroad came from the broadcaster Arte, which aired a documentary called “Mafia et Republique”. The historical investigation started in 1929, when in Marseille, Southern France, two friends, Carbone and Spirito, started a criminal group: the very first group of Corsican mafia. In the beginning, this was a gang dedicated to drug trafficking, but the next generation of mobsters in the ‘60s found some politicians who were closer to their interests. The most prominent one was Charles Pasqua, the former interior minister (‘86-’88 and ‘93-‘95) and congressman for almost 35 years. When he died in 2015, he was called the Godfather of Francafrique – the term coined by the former Ivorian president Félix Houphouët-Boigny to define the colonial-style influence that France has in some former French colonies in West Africa. Tchad, Cameroun, Centrafrican Republic, Gabon, Angola – these are some of the African kleptocracies, some still in power, that began their rule in these years. The other important Godfather of Francafrique was Robert Feliciaggi, the middleman between politicians and mafia gangs. He ran casinos with Michel Tomi in Western Africa and died in uncertain circumstances in Ajaccio, Corsica, in 2006.
From 1980 to 1994, France was shaken by the Elf affair, probably the biggest political and corporate sleaze scandal to hit a Western democracy since the Second World War that exposed bribes paid by the national oil company all over the world. In Africa, the intermediaries for the illicit payments were Feliciaggi and Tomi. “Elf’s former chairman, Loik Le Floch-Prigent, 60, was sentenced to five years in jail and fined €375,000 (£260,724); his principal bag-man, the former director Alfred Sirven, was given the same prison term and ordered to pay €1m. The company’s ‘Mr Africa’, André Tarallo, was jailed for four years and fined €2m”, reported the Guardian in 2003. After an eight-year investigation and four-month trial, 30 out of 37 defendants were jailed for embezzling €305 million. This case is a concrete example of an organised, hierarchical mafia-like syndicate that is able to penetrate the so-called grey zone where criminals, politicians and businesses merge together.
According to Reuters’ findings, “Areva’s mines pay no export duties on uranium, no taxes on materials and equipment used in mining operations, and pay a royalty of just 5.5 percent on the uranium they produce. A spokesman for Areva declined to confirm the authenticity of the documents and did not comment on their contents”.
Sometimes corruption is simply a matter of money and power, without criminals or gangs involved. These cases are harder to prosecute because often finding the money is impossible. One such case was reported by Reuters in 2014. The main character was Areva, the mining company that is the global leader in uranium extraction. Areva-Niger’s agreements had never made public and in 2014 they expired. According to Reuters’ findings, “Areva’s mines pay no export duties on uranium, no taxes on materials and equipment used in mining operations, and pay a royalty of just 5.5 percent on the uranium they produce. A spokesman for Areva declined to confirm the authenticity of the documents and did not comment on their contents”. Profits without expenses.
Reuters reported that Areva said that a higher royalty rate would have made the business unprofitable. “Mining Minister Omar Hamidou Tchiana, leading the negotiations for Niger, told Reuters the government wants to increase uranium revenues to at least 20 percent of the budget, from just 5 percent at present…‘For 40 years, Niger has been one of the world’s largest uranium producers, but it’s still one of the poorest countries on the planet,’ he said. ‘At the same time, Areva has grown to be one of the world’s largest companies. You see the contrast?’”.
On his last trip to Burkina Faso, the French president Emmanuel Macron said he wanted to reset French-African relations and get rid of Francafrique-style dealings. “I haven’t come here to tell you what is France’s African policy because there no longer is one, there is only a continent that we need to look straight in the face”, he said in his November 2017 speech in Ouagadougou.
How did Areva obtain these privileges? The answer has never been found.
In 2017 Oxfam France’s report called “La transaprence à l’état brut” exposed the lack of transparency in Areva’s taxes paid in Niger. The same report also mentioned some questionable tax payments by Total in Angola.
On his last trip to Burkina Faso, the French president Emmanuel Macron said he wanted to reset French-African relations and get rid of Francafrique-style dealings. “I haven’t come here to tell you what is France’s African policy because there no longer is one, there is only a continent that we need to look straight in the face”, he said in his November 2017 speech in Ouagadougou. He added: “The crimes of European colonisation are unquestionable . . . It’s a past that needs to pass.”
Despite this new approach, there are still enormous biases that divide France from its former colonies. The first one is the colonial approach of the French multinational corporations, as listed above. The second is more symbolic and maybe more important. France is still hiding secrets from its former colonies. There are strong suspicions about a French role in the conspiracy to kill Thomas Sankara, Burkina Faso’s Che Guevara, in 1987. The French government has also been accused of being involved in the Rwandan genocide in 1994. (However, the military documents that can prove that France supplied some militias with arms are still classified.) People protesting in Togo blame the French authorities of supporting President Faure Gnassigbé, the kleptocrat who has refused to follow the constitution, according to his opponents. The same situation applies to other West African ruling families who are heavily criticised at home, but who have good allies in Paris.
Corruption is criminal and immoral. While European countries benefit from this vice, African countries are left to deal with its devastating consequences.
Features2 months ago
THE BLACK SPOT: Why The Kenyan Road System Is Designed To Kill
Features2 months ago
BLACK FRIDAY: Behind The Battle for Kawangware
Features3 weeks ago
HITTING WHERE IT HURTS: How effective has NASA’s boycott been?
Features6 days ago
(D)EVOLVED HEALTHCARE: Makueni’s trailblazing experiment in providing universal health coverage
Features2 months ago
LOST AND NOT FOUND: What happens when people go missing in Kenya
Features2 months ago
WHEN A COUP IS NOT A COUP: Why The Removal Of Mugabe Will Not Change Zimbabwe
Features1 month ago
DEBT AND TAXES: Kenya is living large on borrowed money
Videos2 months ago
Anarchy in Kenya – Political Risk