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Somaliland’s Quiet Revolution

Denied international recognition for nearly three decades, the breakaway republic has built a hybrid political system that some scholars term the first modern African democracy

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Somalia Rise

“Never dress a deep wound superficially.”Somali proverb

At the recent London conference on Somalia, representatives from Somaliland were conspicuously absent, as they have been at all conferences on Somalia that have been taking place over the past two decades. Somaliland even boycotted the recent elections in Somalia, “even if it means stopping or destroying vehicles carrying ballot papers across the border,” as one Somalilander put it. This is because Somaliland does not consider itself as being part of Somalia; it views itself as a sovereign state, even though the international community has stubbornly failed to recognise it as such since it broke away from Somalia in 1991.

Most Somalilanders are still haunted by the memories of May 1988, when President Siad Barre’s generals bombed northwestern Somalia, a stronghold of the opposition Somali National Movement, and killed thousands of people, mainly from the Isaaq clan. Memories of this massacre are the glue that holds Somalilanders together, like Jews whose memories of the Holocaust are never allowed to fade.

A MIG FIGHTER JET IN HARGEISA THAT SAYS: NEVER FORGET

Somalilanders will never let it get that bad again. That is why a Mig-15 fighter jet that was shot down during Barre’s carpet-bombing attacks has been permanently mounted as a public monument in a prominent square in Somaliland’s capital Hargeisa, a physical reminder of the atrocities committed, and a symbol of Somalilanders’ defiance.

Yet, Somaliland offers important lessons on the governance models that can work in a strife-torn society divided along clan lines and where radical Islamist factions have taken root. Since it separated from Somalia, Somaliland has remained relatively peaceful, unlike its southern neighbours, and has its own government and institutions that have brought a semblance of normality to this troubled region.

When Somaliland gained independence from Britain in 1960, it opted to unite with the newly independent Somali Republic (which after the Second World War had become a UN trusteeship under Italian administration). In 1991, it decided to forge its own path and disassociate from the dysfunction that marked both the latter part of Barre’s regime and the warlordism that replaced it. (Somaliland claims that since no legislation was passed to officially unite this former British protectorate with Somalia, it has every right to reclaim its territory.) It adopted a unique hybrid system of governance that incorporates elements of traditional customary law (known as xeer), Sharia law and modern secular institutions, including a parliament, a judiciary, an army and a police force. The Guurti, the upper House of Somaliland’s legislature, comprises traditional clan elders, religious leaders and ordinary citizens from various professions who are selected by their respective clans.

Hargeisa adopted a unique hybrid system of governance that incorporates elements of traditional customary law (known as xeer), Sharia law and modern secular institutions, including a parliament, a judiciary, an army and a police force

The Guurti wields enormous decision-making powers and is considered one of the stabilising factors in Somaliland’s inclusive governance model. Michael Walls, the author of A Somali Nation-State: History, Culture and Somaliland’s Political Transition, has described Somaliland’s governance model as “the first indigenous modern African form of government” that fuses traditional forms of organisation with those of representative democracy.

Incumbent President Ahmed Silanyo came to power in 2010 following elections that were considered free and fair by international observers. In 2001, 97% of Somalilanders voted for a Constitution that declared Somaliland an independent nation. Unlike Somalia, Somaliland also has a well-resourced security apparatus, one that has successfully warded off Al Shabaab, the terrorist organisation that lays claim to much of southern and central Somalia, and which in recent weeks has carried out several suicide bombings in Mogadishu and attacked Kenya Defence Force bases in areas along the Kenya-Somalia border.

Somaliland’s road to nation-building has been long and messy, and has witnessed many of the clan divisions and feuds that characterise Somali politics, albeit on a lesser scale than those in Somalia, as the dominant Isaaq clan has remained fairly united. As Walls, notes, voting systems, such as the open lists used in elections, tend to exacerbate these divisions, but they are only a small part of Somaliland’s discursive politics.

Somaliland’s governance model is based on a system that is prevalent in many parts of Somalia, but which has been dismissed as undemocratic by proponents of Western-style democracy. The reality is that much of Somalia since the fall of Barre has been self-governing using a mix of clan-based systems, Sharia law and customary xeer administered by traditional elders. As public institutions collapsed or became dysfunctional, traditional governance systems, such as xeer and Sharia law, became more important. According to Ken Menkhaus, a professor of political science at Davidson College in North Carolina, these informal governance systems filled a governance vacuum after the collapse of the Somali state in 1991 and some, such as those adopted in Somaliland, have incorporated some elements of Western-style democracy, including independent secular institutions. By adapting governance to local cultures and traditions, Somaliland may just provide a sustainable governance model that could be replicated throughout Somalia.

WHAT IS THE ALTERNATIVE?

Those who argue that Somaliland is a spoiler in Somalia’s dream of a united country fail to recognise that the government in Mogadishu doesn’t offer much of an alternative – and lacks credibility in the eyes of many Somalis, particularly Somalilanders. Current President Mohamed Abdullahi “Farmajo” and his predecessors were not elected through a nation-wide referendum or general election but through a highly corrupt system that allowed selected clan elders to form “electoral colleges” that cast the vote. Besides, Farmajo’s authority, like his predecessors’, does not extend much beyond Mogadishu since most of the country is still controlled by clan-based fiefdoms or Al Shabaab. His and his predecessors’ governments have been viewed by many Somalis as Western-backed processes established to please the international community and to create the illusion of a Western-style democracy in Somalia.

A former diplomat believes the rain started beating Somalia when ‘urban, corrupt, treacherous, power hungry, selfish, unpatriotic and unscrupulous’ faction leaders replaced ‘rural, apolitical, straightforward, morally upright’ traditional elders

The bitter truth is that the majority of Somalia’s people have not experienced the benefits of a strong government or democratic institutions for more than 20 years; the concept of a state that delivers services to the people has remained a mirage for most residents living outside Mogadishu, especially in remote areas where the only system of government is customary law or Sharia. Services, such as health and education, are provided by various foreign foundations and non-governmental organisations or the private sector. (For example, Mogadishu University is funded by a Qatari foundation. Many hospitals and schools are similarly funded by foreign, mostly Arab, governments or religious organisations. State institutions, such as the Central Bank and revenue collection authorities, are non-existent or dysfunctional. It is believed that most of the revenue collected by past governments, for example, from the port of Mogadishu, was regularly diverted by senior government officials for personal use.

Ironically, with its strict codes and hold over populations through systems of “tax collection” or “protection fees” combined with service delivery, Al Shabaab offers a semblance of “governance” that the government in Mogadishu has been unable to provide.

Even when African Union (Amisom) forces liberate regions from the clutches of Al Shabaab, they essentially leave behind a governance vacuum that neither the Federal Government of Somalia nor the emerging regional administrations can fill. This has made these regions more prone to clan-based conflicts, which are apparent already in Jubbaland, where some members of the marginalised Bantu/Wagosha minority group have taken up arms in response to what they perceive to be a form of “ethnic cleansing” by both Al Shabaab and the new Ogaden-dominated Jubbaland administration of the Kenya-backed Ahmed Madobe (who was once a member of Al Shabaab) and the radical Islamic militia Hizbul Islam led by Sheikh Hassan Dahir Aweys). Kenya brought Madobe into its fold when it joined forces with the latter’s Ras Kamboni militia to invade Somalia in October 2011; it is believed that this merger was prompted by Nairobi’s desire to have a proxy Kenya-friendly administration in Jubbaland and by Madobe’s desire to reclaim the lucrative port of Kismayo.

A CABINET OF ROGUES

All of Somalia’s post-Barre governments have thus failed to re-establish state institutions that were destroyed during the civil war or to deliver services to the Somali people, though President Farmajo has promised to reverse this trend. In its entire eight-year tenure, from October 2004 to August 2012, the Transitional Federal Government (TFG) did not have the capacity to become a fully functioning government, with a fully fledged revenue collecting authority and robust ministries. Ministers had no portfolios and ministries had skeletal staff. The national army was weak and underfunded, and since 2007, the government has relied almost exclusively on African Union soldiers for security, though there have been attempts to revive the Somali National Army. The various TFG leaderships often gave former warlords ministerial positions on the assumption that political power would placate them. This resulted in what the former Somali diplomat Ismail Ali Ismail calls “a Cabinet of rogues”.

Ismail believes that the rain started beating Somalia when “urban, corrupt, treacherous, power hungry, selfish, unpatriotic and unscrupulous” faction leaders replaced “rural, apolitical, straightforward, morally upright” traditional elders. The former remained immune to the destruction and displacement that conflict unleashed on the Somali people, who lived as internally displaced persons in their own country or as refugees in neighbouring countries.

Farmajo’s attempts to build a strong and united Somalia may not bear much fruit as much of Somalia still suffers from a “trust deficit”; the country is still plagued by clan conflicts and many people do not want to risk having the kind of highly centralised government that was prevalent during Siad Barre’s regime. The Qatar-based Somali analyst Afyare Elmi proposes a “decentralised unitary system,” rather than what he calls the “clan-federalism” proposed and supported by the international community. In this system, sovereignty and constitutional powers would remain within the central government, while administrative, political and fiscal powers would devolve to different entities and regions. This would lead to a “de-concentration of authority” that is more responsive to local needs.

Although Barre is credited with many progressive reforms, such as expanding literacy and women’s rights, he failed to bring about democracy in Somalia, and is also blamed for pitting clans against each other through favouritism, political patronage and persecution of certain clans

There has been some debate on which type of governance model is most suitable for a country that is not just divided along clan/regional lines, but where political/militant Islam and lack of functioning secular institutions threaten nation-building. Federalism, or regional autonomy within a single political system, has been proposed by the international community as the most suitable system for Somalia as it caters for deep clan divisions by allocating the major clans semi-autonomous regional territories. But so far, it doesn’t look like it is working because Somalia remains fragmented at so many levels that even federal states cannot offer much-needed unity. The 4.5 political arrangement used for parliamentary and government allocation of seats, which gives power to the four largest clans (Darod, Hawiye, Dir and Rahanweyne), and (0.5) minorities does acknowledge the reality of a clan-based society, but as Somalia’s recent history has shown, clan can be, and has been, manipulated for personal gain by politicians. As dominant clans seek to gain power in a federated Somalia, there is a danger that the new federal states will mimic the corruption and clannism that has prevailed at the centre, which will lead to more competition for territories among rival clans and, therefore, to more conflict. This is one among many reasons why Somaliland is not keen to be part of Somalia.

Besides, the various federal states that are emerging in Somalia under the new Constitution may end up as clan enclaves that are disconnected from the centre, and which actually work to undermine the central government in Mogadishu. Fears that entrenched clan interests will dominate the future political landscape in Somalia have generated heated debates about whether a unitary system is more suited to a country that is so divided and where minority groups have been denied a say in national politics for decades. Thus the vision of a united Somalia under one strong central government that dispenses security and services and distributes national resources equitably across the country, remains a dream.

A PATCHWORK OF SEMI-AUTONOMOUS TERRITORIES

Several experts have also proposed a “building block approach,” whereby the country would be divided into six “local administrative structures” that would eventually “resemble a patchwork of semi-autonomous territories defined in whole or in part by clan affiliation.”. In one such proposed model, the Isaaq clan would dominate the former British Somaliland in the northwest; the Majerteen in present-day Puntland would dominate the northeast; the Jubbaland and Gedo regions bordering Kenya would have a mixture of clans (though there are now fears that the Ogaden, who are politically influential along the Kenya border, would eventually control the region); a Hawiye-dominated polity would dominate central Somalia; the Digil-Mirifle would centre around Bay and Bakol; and Mogadishu would remain a cosmopolitan administrative centre.

Some analysts argue that the proposed federalism will eventually lead to the balkanisation of Somalia as clan-based fiefdoms start competing for more resources and territories. Other critics, such as the US-based Somali scholar Abdi Samatar, have argued that federalism would lead to “institutionalised discrimination” against minority clans and groups, which would undermine national unity, citizenship and meritocracy. There is also a concern that the larger (armed) clans would manipulate the system, entrench corruption and pursue their political elites’ agendas at the expense of the Somali people. Observers say that one of the biggest dangers of an exclusionary political system is that rent-seeking and the grabbing of the spoils of war that have dominated Somali politics for so long may be replicated at the federal state level.

HALF-BAKED DEMOCRATIC CULTURE

Many people, including Somalis, believe that Somalia will take years before it has a functioning government because the country has little experience in representative democracy and because recent attempts to revive a democratic culture are coming a little too late. Somalia’s relatively peaceful and democratic first decade after Independence was abruptly ended by the assassination of President Abdirashid Sharmarke in 1969, just two years after he had taken over from the first post-Independence president, Adan Abdulle Osman (also known as Adan Adde). Barely a week later, Siad Barre gained control over Somalia through a bloodless military coup. Barre suspended the constitution, dissolved parliament, banned political parties and nationalised the economy. Parliament was replaced by the Supreme Revolutionary Council, the ultimate decision-making authority in the country.

Although Barre is credited with many progressive reforms, such as expanding literacy and women’s rights, he failed to bring about democracy in Somalia, and is also blamed for pitting clans against each other through favouritism, political patronage and persecution of certain clans. His failures and weaknesses set the stage for his ouster in 1991 by the United Somali Congress led by Mohammed Farah Aideed and Ali Mahdi, who, depending on whom you ask, are either seen as heroes who liberated Somalia from the clutches of a dictator, or brutal warlords who unleashed violence and lawlessness in the country.

Some argue that state-building efforts in Somalia have been hampered by a “pastoral ethos” characterised by competition, inter-clan rivalry, disdain for authority (except for traditional elders and religious leaders) and a deep mistrust and suspicion of outsiders. In his seminal book A Pastoral Democracy, first published in 1961, I.M. Lewis claimed that Somali society lacked “the judicial, administrative, and political procedures that lie at the heart of the Western conception of government.”

I.M Lewis and other Western anthropologists fail to recognise that other pastoralist societies have successfully adopted modernisation and democracy and that blaming pastoralism for Somalia’s woes is to assume that Somali society is static and incapable of reinventing itself

While acknowledging the importance of kinship and clan loyalty in the political organisation of traditional Somali society, Lewis was pessimistic about whether these could deliver Western-style democracy to Somalia. In Somalia’s lineage politics, he argued, “The assumption that might is right has overwhelming authority and personal rights… even if they are not obtained by force, can only be defended against usurpation by force of arms.” Critics of this “Somali exceptionalism” thesis argue that Lewis and other Western anthropologists fail to recognise that other pastoralist societies have successfully adopted modernisation and democracy and that blaming pastoralism for Somalia’s woes is to assume that Somali society is static and incapable of reinventing itself.

SECRETIVE DEALS: THE OIL FACTOR

There are fears that the secretive contracts between the Somali government and foreign oil companies could further sabotage Somalia’s institution-building efforts. There is widespread suspicion that oil looms large in Britain’s dealings with the Somali government, and that the former may be willing to overlook corruption and bad governance in the latter in order to preserve its economic interests.

Somaliland and the semi-autonomous Puntland, have also been granting licences to oil companies without any reference to the central government in Mogadishu. Already, competition over an oil block that stretches across Somaliland and Puntland has increased tensions in these regions. These tensions indicate that in the absence of agreed-upon legal frameworks, the oil factor is likely to be a source of conflict in Somalia’s oil-producing regions in the near future. If Somaliland and its arch-enemy Somalia do not handle these oil deals in a transparent manner, there is a risk that peace in the Horn of Africa’s most fragmented region may remain elusive for many more years.

However, Somaliland’s governance system, which tends to be consensual and inclusive, rather than prescriptive, may avoid the “resource curse” that has afflicted so many African countries. There are many more checks and balances in Somaliland’s hybrid system of tri-party democracy and traditional clan-based governance than in the governance model adopted by the Federal Government of Somalia.

Which is not to say that Somaliland’s governance model is perfect; fear of conflict emerging from clan rivalries has led to the repression of the media and the consensual clan-based politics has hindered issue-based politics, eroded individual rights and led to the perception that some clans, such as the dominant Isaaq clan, are favoured over others. Tensions across its eastern border with Puntland also threaten the future stability of Somaliland. Somaliland’s strong economic ties with Ethiopia are also viewed with suspicion by the Somalia government, though it is no secret that the TFG often invited Ethiopia to quell insurgencies and to oust the Islamic Courts Union (some remnants of which morphed into Al Shabaab) from Mogadishu in 2006.

There are fears that if recognised as an independent nation, Somaliland, like South Sudan, may experience clan-based conflicts that will undermine peace and democracy. However, Somaliland is unlikely to repeat the mistakes made by South Sudan’s myopic leaders

Nonetheless, Somalilanders are unlikely to put their faith in a Mogadishu-based leadership, even if it is at the expense of not gaining international recognition as an independent state. The pan-Somali vision of a “Greater Somalia” that prompted this former British protectorate to unite with the newly independent Somali Republic in 1960, and which saw Siad Barre go to war with Ethiopia to claim the Ogaden region in 1977, vanished long ago.

There are fears that if recognised as an independent nation, Somaliland, like South Sudan, may experience clan-based conflicts that will undermine peace and democracy. However, Somaliland is unlikely to repeat the mistakes made by South Sudan’s myopic leaders because, as Walls, points out, “The attributes that have served Somaliland so well until now are likely to continue to do so in the future – these are pragmatism and flexibility, coupled with an understanding of the past and an eye on the desired goals of the future.” International recognition of Somaliland could go a long way in achieving some of these goals.

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Ms Warah, the author of War Crimes, a sweeping indictment of foreign meddling in Somalia, and A Triple Heritage, among several other books, is also a freelance journalist based in Malindi, Kenya.

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INVISIBLE CITIZENS: Branding Kenya for foreign investors and tourists

Kenya’s historical preoccupation with being an attractive destination for foreigners and their money has come at the expense of catering to the needs and aspirations of its citizens. By WANDIA NJOYA

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INVISIBLE CITIZENS: Branding Kenya for foreign investors and tourists

In March 2008, Kenya was reeling from the shock of post-election violence. Over 1,000 people were dead, hundreds of thousands were displaced, women were traumatised by rape and some were even pregnant from those rapes, and some men were victims of genital mutilation in the name of circumcision.

When the weapons were down and the burning had stopped after the February 2008 accord, the priority of the leaders would have been to heal the country, seek justice and reparations, and restructure the whole society to uproot the endemic inequality and tribalism that were at the root of the political crisis. But in the midst of such trauma and need for healing and reconciliation, what did President Mwai Kibaki do? He set up Brand Kenya.

The gazette notice establishing Brand Kenya paid lip service to promoting patriotism, but its main interest was not really whether Kenya was a country Kenyans would be proud of. Its primary preoccupation was that Kenya remained a country in which foreigners could invest or relax.

The government’s target audience was not the people of Kenya but foreigners. The focus on business was roughly similar to George W. Bush’s call on American citizens to express their patriotism after 9/11 by going shopping, except for a small difference. Unlike Bush whose appeal was to his fellow Americans, the Kibaki-Raila coalition sought to appeal to foreigners to invest or spend their money in Kenya.

The establishment of Brand Kenya is just one of the more egregious examples of Kenya’s history of governments more preoccupied with pleasing foreigners than with serving its own citizens. Every time Kenyans are in distress, the main worry of the government is whether the investors will notice anything, and how soon we can cover up our human weaknesses so as not to scare them away.

Hegemony

This idea of Kenya as a country for investors and tourists is normalised through social institutions like the media and education. Indeed, a few weeks before, on January 7, 2008, at the height of the chaos, Peter Kiragu would express concern about Kenya’s image in an article in the Star, making no mention about the injustice and horror that Kenyans were experiencing.

The establishment of Brand Kenya is just one of the more egregious examples of Kenya’s history of governments more preoccupied with pleasing foreigners than with serving its own citizens. Every time Kenyans are in distress, the main worry of the government is whether the investors will notice anything, and how soon we can cover up our human weaknesses so as not to scare them away.

Kiragu complained: “The 2007 elections have painted a bad image of Kenya, far from one which was created after the 2002 elections.” He expressed hope that foreigners would not think of us as a typical African country that cannot conduct elections properly, and concluded the article with this shockingly insensitive declaration: “The brand Kenya needs to be protected more than anything or anyone else.”

An interesting element that emerges from Kiragu’s article is Kenya’s notorious belief in its exceptionalism, which is in turn based on accepting the West’s racist disdain for Africa and expressing pride that Kenya is not a typical African country. Throughout the article, Kiragu talks of a Kenya that was doing well with tourism and export, and that had been the envy of other African countries, “many of which were in even more desperate shape than Kenya”. He contrasts Kenya to DR Congo, Somalia, Sudan and Côte d’Ivoire, distinguishing Kenya from the others as a country “best known for its unspoiled game parks, which attract hundreds of thousands of international visitors who want to see lions and elephants and other animals roaming free”.

One would wish that this was just one journalist writing a personal opinion, but unfortunately it isn’t. What Kiragu is voicing is the hegemonic definition of Kenya, if we think of hegemony in terms of the ideas of the ruling class that are diffused through social institutions such as religion, media and education.

Between the investor and the tourist

In Kiragu’s article, we also see a disturbing acceptance of the racist image of Africa that requires us to achieve two contradictory targets. These targets mirror the urban-rural dichotomy, the inequality in development, and worse, the ethnic distinctions between deserving “developed” and undeserving “backward” ethnic groups.

The rationale is that because Kenya must attract investors, it must work at meeting targets of “development” set by the West in the urban areas, while on the other hand, Kenya must continue to attract tourists, which it can do by offering resource-deprived regions as the image of an Africa untouched by Western civilisation, where wildlife “roam free”.

This dual and racist tension between the investor and the tourist permeates all Kenyan life and institutions. Since independence, the government has reserved the areas around the railway for “development,” and the areas further from the railway for tourism.

One institution in which this logic is evident is Brand Kenya. In the Brand Master Plan, a document that Brand Kenya commissioned Interbrand Sampson, a South African PR firm, to write, Brand Kenya prioritises people in the following descending order: foreign investors; foreign tourists; and Kenyan citizens. The master plan reduces our constitution into a selling point that could be exploited for the Kenyan “brand”.

The master plan is a shocking document to read because it uses the investor-tourist dichotomy in its description of Kenya. Indeed, the document has profiled Kenya as “an exotic destination that is surprisingly familiar, where people and nature live in harmony alongside ambitious economic developments”.

This description is disturbing because it rehashes the colonial anthropological discourses of the 19th century. For instance, being “exotic” and “surprisingly familiar” is an oxymoron typical of the European romantic period, because being exotic necessarily means being strange, and necessarily unfamiliar.

The brand document separates the people from the nation, and relegates us to a frozen past together with our natural environment. If there is any economic development, it is not part of our lives. We are just living “alongside”, meaning that the elite are promising investors that flesh and blood Kenyans will not interfere with their investments by being unruly, or being visible for that matter. Indeed, ecologist Mordecai Ogada often says that the tourism which Kenya markets is a tourism with wildlife and no people, which is why many of the photographs advertising tourism and wildlife do not show the pastoralists grazing their herds near the wildlife.

The brand document separates the people from the nation, and relegates us to a frozen past together with our natural environment. If there is any economic development, it is not part of our lives.

Even when the master plan considers the people, it is only as labour for capital. Any democratic claims are not for the Kenyan people to live in dignity, but for ensuring that Kenyans remain out of the way while businesspeople invest in the cities, and while tourists relax in the wild.

Likewise, the recently launched National Tourism Blueprint leaves no doubt about the stereotypical profiling of Africans, and particularly of the Maasai. The document contains a photo of a man in a Maasai shuka skipping while holding the hands of two white girls, with a caption that reads: “Enriching cultural encounters with friendly people and ancient tribes.”

After all the work done by theorists on Orientalism and “decolonising the mind”, references to Africans as “ancient tribes”, using 19th century anthropological tropes, are simply mindboggling.

Daily and institutional violence

The focus of Kenya’s consciousness on foreign affirmation would explain why Kenyans experience daily life and institutional and collective processes as a form of physical, moral, emotional and intellectual violence. The institutions are not for serving them, but for pleasing foreigners.

In electoral democracy, for instance, elections are often followed not with sympathy for Kenyans’ frustration with the ineptitude with which the process is handled. Rather, Kenyans are treated to expressions of irritation about the lengthy periods Kenyans take to complete the process of elections, which interrupt business in the country. Democracy is not for Kenyans to have a say in the governance of their country, but for the government to prove to the West that Kenya is an ideal business and tourism destination – because we can manage “civilised” ideals like democracy and elections, unlike other African countries.

Similarly, roads are not planned to serve poor Kenyans or to be used by ordinary Kenyans. As Patrick Gathara has said in different forums, roads are prioritised over the people who should use them. The poor are evicted to make way for roads, and the roads are so badly designed that they kill hundreds of pedestrians, fail to accommodate bus stops or bus lanes for commuters, and have no walkways or bicycle paths for users without cars.

Another example is healthcare where Vision 2030 and the Jubilee manifesto use tourism as the model for healthcare. The tourism framework for healthcare essentially leaves the cheaper treatment of communicable diseases in the realm of the public healthcare system, and reserves the more expensive treatment for non-communicable diseases, especially cancer, to private hospitals.

That is why the filling up the coffers of the National Hospital Insurance Fund (NHIF) is not the universal healthcare that the Big Four agenda makes it out to be. NHIF money will end up in private hospitals with the best equipment and specialists, which means a windfall for medical equipment manufacturers, pharmaceuticals and medical insurance companies. Meanwhile, government doctors fail to achieve the job satisfaction they went on strike for, and they watch as the government imports doctors from Cuba and pays them more than the local doctors.

In education, the same lack of care for Kenyan children applies. The shoddily written and launched curriculum includes pathways that are potentially discriminatory because they would allow schools to choose favourite or privileged children to pursue subjects that have better prospects of social mobility. Each time the Kenya Institute of Curriculum Development (KICD) officials discussed the document in public, the most common rationale for the curriculum change they cited was that the curriculum was what the business community wanted, and was following the trends in education abroad. And, no surprise, most of the theories on which the curriculum was tailored were up to 40-years-old and were almost all foreign.

Despite decades of major overhauls in political administration, the rationale of Kenya’s institutions has remained deeply colonial.

Starting afresh

Kenya achieved a great milestone when it ratified the progressive constitution in 2010. However, the institutions, their rationale and operational style remain firmly colonial and rabidly racist, which explains why Kenyan daily life is so violent.

Despite decades of major overhauls in political administration, the rationale of Kenya’s institutions has remained deeply colonial.

Calling our institutional culture colonial does not mean that our institutions have not changed over the past sixty years. Rather, it means that the colonial rationale is repeatedly and deliberately reinforced in the present day. Decade after decade, regime after regime, government institutions have wired themselves, built themselves, and reproduced policy documents to remain focused on the West, and to wipe Kenyans out of the picture. These institutional reinforcements would explain why the government seems to be meeting little institutional and collective resistance as it rolls back the political and social gains made with the new constitution.

Seeking to explain why political reforms in Kenya have never translated into the material improvement of Kenyans’ lives, Gathara wrote five years ago that Kenya had “tried everything except reform the patterns of thought that find their genesis in the attitudes and divisions of the half century of colonial rule that preceded them.”

Our biggest political problem is no longer our constitution. It’s our institutions.

We need to deconstruct, and probably destroy and rebuild, Kenyan public institutions. The few government documents I have interacted with, especially from the education and tourism sectors, are all riddled with racist tropes of Africans, and an obsession with Western approval so that we can earn Western money.

Kenyans will have to go through a national mental re-engineering that heals us of our inferiority complex and deals with our historical wounds, and then write an affirmation of dignity as human beings. Using that affirmation, professionals should write new major policy documents to cleanse them of their racist tropes, and to make the needs and aspirations of Kenyans paramount.

Such work will require a lot of brain work and will probably bring little glory. But if we do not spend time on understanding the ideas, attitudes and behaviour of Kenyan public institutions, the current government will reverse all the political gains we have made. And by 2022, Kenya will look curiously similar to the 1970s, when we were ruled by crony elites under a one-party system. We have to put our minds to work, and rewrite Kenyan policy documents and rebuild Kenyan institutions so that their primary reason for existence is to serve Kenyans.

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DREAMS OF EMPIRE: Stepping out of America’s Fading Lustre

As Donald Trump surrenders America’s global preeminence, Africans – at home and in the diaspora – should work to build an African superpower rather than succumb to Chinese colonization. By MKAWASI MCHARO HALL

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DREAMS OF EMPIRE: Stepping out of America’s Fading Lustre

The first African Diaspora Young Leaders summit was coming to a close in Washington DC. The State Department had sent me an invitation to the closing dinner. RSVP for one, I wrote back. State Department dinners are often a microcosm of the global political structure, and schmoozing around with the diplomatic corps is like listening to the whispers of countries bottled up in one room.

Sometimes you catch the ambitious Washington-based African ambassador gunning for the presidency in his or her country, but I’m yet to catch one with a big idea for a United States of Africa. Most of the African envoys do not want to stay in America once their tour of duty is done. They are not economic refugees and their dreams are made. I want to find out from the room filled with ambitious African youth if they want to stay on and catch the American dream. They are also looking to lead the continent in conquering an uncertain 21st century and the US might just be a launching pad.

I asked as many as I could, and without hesitation they all quipped a version of, “I’m going back home of course!” I qualified my question further and asked, “If you got an offer for a job or graduate studies here, would you stay?” One tall Malian fellow hesitated and shook his head in a circular manner. That was the extent of his commitment to pursuing the American dream. He did not care for pecan pie either. These are not singular-story instances meant to create a bias. America has lost its lustre even among young Africans.

In a short while, this realisation would be ascertained by none other than the Under Secretary of State for African Affairs. He stood up to speak and asked the young Africans to speak well of America when they got back to their countries; that America is not as bad as they show it on television. I almost keeled right off my playing-diplomat-for-a-night seat. When did the script change so drastically? It’s no longer Africa asking America to stop spreading the unsavoury story about a dark continent. Now an American top-ranking diplomat is trying to right the image of a superpower that’s suffering an ugly meltdown and the whole world has a front row seat.

In spite of America’s fading lustre, there is still a growing African diaspora in the United States, and they will in a few decades be part of the “people-of-color” majority in the United States. For the American-Africans or Continental Africans who have become citizens, this is their home, one that enables them to play out their transnational citizenship as successfully as other diasporas before them have. An understanding of Continental Africans’ positioning along the timeline of American empire-making is important. It should help get Africans becoming more proactive in establishing an influential presence in American politics and policy-making, and also in pushing Africans to conquer their own continent for themselves.

A savage inspiration

Empire rises through stages: Conquest of territory; elimination or assimilation of indigenous peoples; and the building of new and more efficient trade routes. Those who lead conquests embody the animus dominandi, a necessary force of evil in the usurpation of power, wealth and security.

The end goal in a humane conquest, if the oxymoron can be believed, is the establishment of peaceful coexistence with those conquered, or the removal of oppressive leadership from the land invaded. In modern history, only one humane conquest comes to mind: Tanzania’s invasion of Uganda in 1979 to dislodge the brutal regime of Idi Amin. It lasted all of five months. America’s preemptive invasion of Iraq post-9/11 was sold to the people as a remedy that mirrored Mwalimu Julius Nyerere’s Uganda invasion: to free the people of Iraq from Saddam Hussein’s oppressive rule. But it soon became clear it was a greed-driven opportunity for war profiteering and expansion of the American corporate empire that had become a monstrosity.

Empire rises through stages: Conquest of territory; elimination or assimilation of indigenous peoples; and the building of new and more efficient trade routes. Those who lead conquests embody the animus dominandi, a necessary force of evil in the usurpation of power, wealth and security.

There are many wars that America has fueled to maintain its interests and footprint in foreign soil. It wasn’t always like that. America grew out of European immigrants who were running away from persecution, famine, and war in their own lands. They came to America seeking fortune and new beginnings, and they formed a country that rejected monarchy and its extreme powers. America was the biggest and boldest experiment in democracy and freedoms that attracted people from all over the globe. This roaring inspiration was also ruthless as European immigrants who became white Americans held millions of Africans in bondage and massacred millions within indigenous nations, with the survivors confined to reservations. Vicious greed easily becomes a reality in empire-building.

Eventually, a civil war that killed over 600,000 Americans brought an end to slavery. This is a price they had to pay for the dream of a truly free nation whose citizens were all considered as created equal and endowed with the same inalienable rights. It took bold and selfless political leadership to apply this principle of freedom to enslaved persons. President Abraham Lincoln’s emancipation proclamation in 1863 was met with disdain and dismissal from his friends and enemies alike. It ranked poorly as a political move.

Lincoln was driven by his own conscience and the American Constitution, a document that captures the ideals of a people, written with the ink of human kindness. It is also a document that has made America the “home of the free and land of the brave”. The irony of it all is that America was also built through the savage inspiration of those who stopped at nothing to succeed; immigrants who never gave up, never made excuses, and never let hunger, disease or the ravages of unpredictable Mother Nature stop them.

Dust bowls came and threatened famine, and the new Americans started afresh. The Ireland famine they escaped from was far worse as it had killed over a million. Floods came and carried the homes of new Americans carving a home from scrub in the wild West, and they rebuilt. They had far worse memories of homes shelled with bombs and bullets in war-torn Europe. Religious persecution in Europe brought the Anabaptist Amish to America where they found freedom and thrived in exclusive communities of their own defining. Persecuted Mormons trekked west through harsh territory and built their city on the hill out of a mirage of hope. Diseases came and killed families that moved to nowhere-places in the expanding America, and they picked up their shredded hearts and kept on striving. The Chinese suffered calculated segregation through the Exclusion Act but they found a way to remain an important part of building America throughout the 1800s.

Enter the Africans

How could anyone not feel inspired by a country made up of people who came from every corner of the world and found more ways than one to dream and achieve? Is it any wonder that the American Dream phenomenon took root and became the country’s biggest thought export that kept drawing in the rest of the world? The land where every dream is possible also became the allure for African immigrants from the mid-twentieth century, their numbers spiking from the early 1980s.

New legislation broke the Europeans-only influx into America and allowed more Africans to become part of America’s citizenry. A place of great contradictions: on one extreme, African descendants were enslaved for two-and-a-half centuries, and on the other extreme, free and educated Continental Africans were provided a way in through the Immigration and Nationality Act of 1965.

Empire and smart nation-building knows that human capital is key in its expansion and stability. From the Roman Empire that had earlier been the cradle of modern democracy to the United States of America, citizenship held the highest value for the inhabitants. It gave them the power to vote, to gain access to economic opportunities, to hold office, and to move freely.

New legislation broke the Europeans-only influx into America and allowed more Africans to become part of America’s citizenry. A place of great contradictions: on one extreme, African descendants were enslaved for two-and-a-half centuries, and on the other extreme, free and educated Continental Africans were provided a way in through the Immigration and Nationality Act of 1965.

Stages to citizenship become goals that an immigrant works very hard to achieve. In a land where the biggest pull factor is the American Dream, achieving that dream becomes a calculated get for African immigrants so that tales of their personal conquest will vindicate their desertion of home. When Europeans set out for the United States on boats and scraps of boot, many died out of pride, refusing to return to homes that still had their arms open wide for them in case things did not work out. The shame of not achieving that dream would be too much to bear. They would die in the gold rush melee, in the coal mines, in the cowboy ventures, in the farmers’ fight against nature, and in the run-in with Native Americans fighting to hold on to their lands.

Africans who come to the United States are no different from those first immigrants. Much as most come with a mind to acquire their education, a slice of the American Dream, and promptly go back to beloved Africa, they discover that the road to achieving what they came for is entangled in legislation and privilege. They are outsiders standing in a long line of immigrants waiting to get in to the gates of a new belonging.

Becoming American for an African is very rarely a personal goal but a necessity acquired to assist with personal conquest. Africans do not carry the pride of nation as Americans do. My neighbours, like many Americans, fly the US flag every public holiday and any other odd day. I have recently purchased a Kenyan and a US flag that I will fly on my front porch to test out the feel of nationalism. In Kenya, I would not be allowed to fly my Kenyan flag. However, in a changing America, pro-Trump neighbours will also look at my Kenyan flag askance as it will indicate an unwelcome immigrant presence.

As the latecomers in the game of American belonging, there isn’t much out there on African immigration statistics. Shaw-Taylor and Tuch (2007) surmise that about a million Africans immigrated to the United States between 1965 and 2007. These records are usually far below the real numbers as many who come and stay do not participate in the census. Second generation Continental Africans have also increased significantly. The Nigerian diaspora has become one of the fastest growing, both in numbers and in economic success. A Bloomberg research bursts the myth that Asians are the only ones at the top of the intellectual wealth pyramid.

The Kenyan diaspora, meanwhile, continues to astonish as its remittances to Kenya grow to a whopping Sh197 billion (nearly US$2 billion) this year, up from Sh174 billion (about US$ 1.8 billion) last year. The tragedy of the Kenyan diaspora, at least those in the US, remains their insistence on staying cocooned in cliques and tribal mindsets while abroad, an attitude that makes them ineffective pawns in America. A long straw extends from the mouths of family and community in Kenya and dips into diaspora pockets, and each year, the gulp gets bigger, thanks to the powerless generosity of a splintered diaspora. With all their smarts, Kenyans in the US have refused to invest in the strategy of building a united front as a power bloc, and so their remittances remain untapped influence. Eight years after the constitutional enshrining of their right to vote, the Kenyan diaspora in the US still cannot vote back home.

The Kenyan diaspora, meanwhile, continues to astonish as its remittances to Kenya grow to a whopping Sh197 billion (nearly US$2 billion) this year, up from Sh174 billion (about US$ 1.8 billion) last year. The tragedy of the Kenyan diaspora, at least those in the US, remains their insistence on staying cocooned in cliques and tribal mindsets while abroad, an attitude that makes them ineffective pawns in America.

No immigrant community has ever achieved influence without the strategic politics of mobilisation and organisation in their adopted country. Kenyans are adept at splitting their power by dismissing each other’s efforts. They duplicate, triplicate and quadruplicate initiatives instead of supporting what is on the ground. The new entrants to a cause will dismiss others as failures and with great humility argue that they are the ones who will make it happen. The community politics of the Kenyan diaspora is not only a microcosm of Kenyan society in Kenya but a far darker version of it.

Lessons from how other immigrant communities in the United States conquered in spite of their political or ethnic diversity are yet to sink in for the Kenyans. Collective intelligence is a switch that an initiative-taker turns on, but the bulb will not light up until the people with their hands around it stop the sabotage. (I have played significant roles in the Kenyan community in America long enough to observe its ways, which gives me a measure of authority on the subject.) Perhaps the growing second-generation Kenyan-Americans will shape its power.

Conquest, China and African superpowerdom

If the American republic has risen to superpowerdom through conquering occupied lands, eliminating indigenous peoples, and building infrastructure through the wilderness, all while using stolen labour and the legitimisation of a cruel injustice, why hasn’t the African continent achieved as much in its own continent where its nations are free? Dreams of a Pan-African state have flared up with the staunchest Africanists and died like a kerosene flame, leaving only a smoky trace of it that still lingers.

To build empire, Africa would not need to engage in the cruelty of displacing or enslaving anyone. The Morgenthaunian animus dominandi or necessary evil-nature approach to raising empire has to be redefined if Africa is to use it to achieve superpowerdom. By superpowerdom I do not mean a hunger for domination over others, but a reaching towards the highest levels of self-realisation as Africans. Such realisation comes with technological advancement, an end to poverty, the inalienable right to freely acquire knowledge for its own sake, and definitely the restructuring of political systems and inculcation of integrity in the continent’s democratic processes.

But is Africa interested? The current trend has African countries firmly serving nationalistic self-interest at best, and more of individual strongman interests. A continental trading bloc covering at least fifty African countries has been in the works, but its success is yet to unfold. The assumption that an African economic bloc could set the giant continent off to the 21st century superpowerdom is unlikely; at least not without independent institutions powerful enough to ensure economic accountability and social justice.

The success of America’s rise, savage inspiration that it was, also came from the independent institutions that checked its rogue politics, demanded a righting of wrongs, and allowed for people power. If African is not ready to hold its rogue leaders to account as South Korea recently did by throwing its corrupt president in jail, an economic bloc will only create a deeper chasm between those who can manipulate trade and those too far from the decision-making table.

Africa is a willing victim in the unfolding conquest by the rising Chinese global power, which is carrying out open surgery on the continent. As they open up the innards of Africa and plant Confucius centres in colleges, popularise Mandarin classes, establish television stations to transmit Chinese propaganda, and build breathtaking infrastructure, Africa seems content with the drip of modernisation-on-loan feeding its arteries. There is nothing the Chinese are doing that global powers of the past – Malian, Roman, British, American and others – did not do.

China’s Belt and Road Initiative (BRI) that seeks to etch the most ambitious trade routes across several continents is reminiscent of the Trans-Sahara trade routes that gave superpower status to the kingdom of Mali for a span of seven hundred years – until the Europeans made more efficient trade routes through the Atlantic. It wasn’t until America built the Transcontinental railway that connected it from sea to shining sea that the country actually started its rise to superpower status. Throughout history, control of new and more efficient trade routes have led to the rise of new empires. How is it that free African nations and their rich diasporas cannot build an engineering marvel from Cape to Cairo all by themselves?

The unfolding conquest of Africa is a willing victim eyes-wide-open surgery on the continent by the Chinese rising global power. As they open up the innards of Africa and plant Confucius centres in colleges, popularise Mandarin classes, establish television stations to transmit Chinese propaganda, and build breathtaking infrastructure, Africa seems content with the Chinese drip of modernisation-on-loan feeding its arteries.

White nationalism and the Age of Trump

Trump’s America is a surrender of empire in exchange for white nationalism. Stoking trade wars and supporting white extremism is a calculated recipe for white nationalism. The president has been on an anti-globalisation rampage. He has attacked regional and inter-governmental trade treaties, environmental agreements and military alliances that have kept America at the helm of the current global political structure. The president is in the throes of a ferocious tariff war against China, Canada and European countries, all trading allies of the United States. It has become common to wake up to news about American industries now making significant losses and some shutting down because the targeted countries are no longer buying American products. Farmers and fishermen whose products are exported to China now need a government bailout to survive.

Anti-immigrant policies have restricted temporary work visas that usually bring in seasonal workers from Mexico to work on farms and in the crab industry. As a result, massive fields of unpicked crop have gone to waste and the crab industry has suffered. The same policies have created the parent-child separation debacle in Texas, a racket that turns out to be, no surprise at all, a profiteering racket. While the world reels in shock at how low America has sunk, the detention business continues to thrive as it nets in new clients in immigrants seeking asylum. The GEO Group that runs private prisons also happens to be the biggest contractor for the U.S. Immigration and Customs Enforcement (ICE). The company is also accused of sponsoring politicians in Texas, the same state where unconscionable detention of children is happening.

In all this, good old American activism stays fired up and keeps agitating its way to justice. A company as powerful as the GEO Group now feels threatened by the Dream Defenders Action who have exposed them. A strategic and sustained fist pumped in the air has proven a formidable weapon against massive corruption in a country as powerful as America.

As the Mexican border immigration wars rage, some African immigrants who never thought themselves unsafe now find themselves targets of the government’s ransacking of those who supposedly cheated in their citizenship interviews. The U.S. Citizenship and Immigration Services is on record explaining the task to de-naturalise “errant” Americans who took up citizenship since 1990. That is the decade the numbers of Africans in America started rising significantly.

It is well-known that Trump has an issue with Nigerians, an identifier he uses to mean Africans. And he’s not alone in calling all Africans Nigerians. Perhaps it is the rising power of Nigerians in America that feels too threatening. The whitening of America in the Trump era is real. The immigration witch-hunts conjure up histories that led to some of the worst human atrocities in places like Nazi Germany where unwanted groups of people who had started thriving were exterminated.

While this remains an interesting time in America, perhaps the incredulous nature of it drives one to the conclusion that it is all in futility. The numbers will sort it all out. Unless white people increase their population at an astronomical rate in the next few decades, America is destined to become a country of majority “people of colour”, for lack of a better term. It is a scary thought that stoked the flames of white nationalism in Britain, leading to Brexit, and now in the United States. Human civility is superficial. Once threatened with the possibility of extinction, conquest or minority status, the human becomes the brute in a jungle where all civility disappears.

While this remains an interesting time in America, perhaps the incredulous nature of it drives one to the conclusion that it is all in futility. The numbers will sort it all out. Unless white people increase their population at an astronomical rate in the next few decades, America is destined to become a country of majority “people of colour”, for lack of a better term.

Only communities that have lived in close connection to the earth will tend to have a greater sense of civility and welcome for the stranger, conquering only to ensure their own survival, but not to fuel uncontrollable greed. America is a corporate empire built upon unexpiated savagery, and like all empires, it will come to its end.

An ode to indigenous peoples

Sitting Bull. Crazy Horse. Little Wolf. Spotted Tail. Red Cloud…the list is long. These Native American warriors who defended the usurpation of their land with fierce skill and legendary valour will inspire for ages. Their defeat will also depress the human spirit that cheers on the emancipation of the conquered. Victories of Native American nations against American expansion are filled with breathtaking courage. The Lakota, the Nez Perce, Cherokee, Navajo, Sioux, and many of the almost 600 indigenous nations held their ground against an army with numbers, resources and technology they could not match. As with most peoples who get conquered, the lack of a united front plays into their defeat.

A story is told in the annals of history that Sitting Bull once had a dream that his Lakota people of Standing Rock would vanquish the approaching American army led by the feared General Custer who had never lost a battle. On this day, Sitting Bull and his vastly outnumbered Lakota warriors prepared to fight yet again. His dream came true, and to America’s shock, the inconquerable Custer was killed and his army decimated at the famed battle of Little Bighorn.

But it wasn’t the dreams of one who prayed to the Great Spirit that won the battle; it was the ferocious zeal to survive when faced with extinction. It was the same zeal that led Shaka Zulu to victory against a British army with superior weaponry at the battle of Isandlwana; the same Ethiopian dare that trounced the invading Italians at the battle of Adoa; the same fire that led to the Mau Mau uprising against Empire in Kenya.

It is the same fire of indigenous African peoples that need instruction to rise and conquer a continent they already occupy, lands that already belong to them, resources that are theirs to exploit. The unfolding development in Africa is the footprint of another encroaching superpower. Africa should not surrender to a second colonisation so soon.

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HEALTH FOR ALL: A reflection on the current state of healthcare in Kenya

The goal of universal healthcare must take into account how Kenyans access and pay for health services, and eschew the concept of “world class” as a standard for what good quality care should be. By NJOKI NGUMI

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HEALTH FOR ALL: A reflection on the current state of healthcare in Kenya

There are three main concerns Kenyans from all walks of life have during illness or any manner of health crisis: 1) Who is going to take care of me, and where do I have to go to access that care? 2) Will all the options I need for full care be available to me, and are they the best ones there are? 3) Who is going to pay for the options I take? Is it going to have to be me, and what does that mean for my budget and my life?

These are obviously very valid and important questions, and it is a challenge to separate them because they weave so intractably into each other. Where we go and who we see when ill are dictated by who we are. Our age, gender, religion, socio-economic class, employment status, tribe, and proximity to an urban area or hub dictate the options available, and all these rest on the bedrock of the available funds to create and maintain a system of administration, equipment and skilled workers that avail healthcare services. All that considered, let us unpack each of these questions to see much more clearly where we sit in this often confusing and scary place.

Becoming a patient

The first thing we need to remember is that nobody plans for illness, and in that African cultural and spiritual way, we actively assume full wellness in anyone until they are on the verge of collapse. This is rooted in a commonly understood and yet completely unsaid superstition that if we summon illness it will come to stay; so we deny it until we cannot any longer. Kenyans are much less likely to be hypochondriacs than they are to sit uncomfortably on a symptom until it is alarmingly close to its worst possible manifestations.

The first thing we need to remember is that nobody plans for illness, and in that African cultural and spiritual way, we actively assume full wellness in anyone until they are on the verge of collapse. This is rooted in a commonly understood and yet completely unsaid superstition that if we summon illness it will come to stay; so we deny it until we cannot any longer.

A lot of this is linked to the roles we play in society: many people have hostile employers who view illness as a way to chicken out of work. Additionally, there are things we cannot opt out of, even while ill: parenting, especially by mothers of small children, is an example of a 24-hour shift regardless of our state of health. Many doctors will actually make a decision to admit and keep a mother who needs bed rest in hospital because sending her back home is a guarantee that nobody will let her stay in bed longer than five minutes. Many mothers cannot even have a short call in peace when in a house with a small and active child, let alone have a quiet meal or a full night’s sleep.

The idea of who is going to take care of a sick person, therefore, has to begin with who is available to take over or cover for the tasks they have, because this helps them on the path to acknowledging lack of wellness that is severe enough to need intervention from an outside source. Women again tend to draw the short straw and take on a third shift of minder to the sick and frail in a household. Predictably, another woman will likely be destabilised from other roles to come and hold fort for a woman if she herself is sick. Women therefore end up trading their time (as it is seen as less valuable) to take sick relatives to hospital and to assist recuperation there and at home.

Where we go to find help

When seeking help for illness, we prefer to play our cards as close to our chests as possible, and as Kenyans we cannot really blame ourselves for this. In a society where trust metrics have been in active decline for a while now, we are used to being scammed. We watch liars every day on our news channels and listen to them every Sunday at church. Choosing the devils we know, however inefficient they may be, is an easier option emotionally for a people weary of untruths.

One option is to go straight to a chemist, because most people end up at one, one way or another, to buy medicine. They relay the group of symptoms to the person behind the counter, whose only claim to care is a white coat. This person listens to the symptom list: to be fair, it is usually pain, stomach problems, or something respiratory, the majority of which are not too serious, and these things can mostly be managed over the counter. There is definitely room for one-stop interventions and medications, but one key issue is that a single quick public exchange often reduces the quality of the questions and the depth of the answers given. It is thus very easy to miss the subtle nuances between a series of self-limiting symptoms which need instant calming for quick relief, and an unfolding disease process which would need a more intensive treatment plan, as mapped out by lab and image investigations.

Another key locus in an honest healthcare analysis in Kenya is the traditional practitioner, who can be a herbalist, spiritualist, medium or even a medicine man or woman. Often the holders of cultural knowledge and trust, and able to speak to us deeply in language we can understand, using a frame of reference we are instantly familiar with, they have often been much more affordable and much easier to access, sparing us the long queues on hard chairs which end with cold, uniformed people using hard words that nobody understands.

Traditional practitioners can also seamlessly weave in spiritual ideology around healing, which can be a challenge for Western-trained caregivers. Several schools of thought would seek to corral or erase the traditional practitioner, but if anything, they are becoming increasingly popular in light of the limits current care has in seeing the person as a whole being as opposed to a concatenation of symptoms that need solving. Additionally, with the rise of Eastern practices, we are seeing more of Chinese medicine and Ayurvedic methods being explored in academic spaces. A reasonable strategist can project that the diverse African healthcare methods are the next frontier for Big Pharma. This is a conversation that is going on globally, not just in Kenya, and we would do well to take the brief headstart we have to explore some of these areas to whatever advantage we can.

The list of formal facilities available to Kenyans includes public hospitals, clinics and dispensaries, known mostly for understaffing, overcrowding, and subsequent inefficiency. Though many Kenyans go in and out of them daily without too many issues, they boast few stories of consistently stellar service. Faith-based and mission spaces have had many successes, but the vast majority of them are small operations and the footprint of their impact, even cumulatively, is thus limited. Private facilities close out the ranks; they are known for better quality amenities and offerings, but with the price tag we have learned to expect from all private suppliers of goods that should be publicly available—including transport, education and security. They are mitigated by market forces alone, and not subsidised by our taxes or regulated by public policy.

The list of formal facilities available to Kenyans includes public hospitals, clinics and dispensaries, known mostly for understaffing, overcrowding, and subsequent inefficiency. Though many Kenyans go in and out of them daily without too many issues, they boast few stories of consistently stellar service.

The case against being “world class”

We should really worry about the concept of “world class” as an abstract standard permeating our ideas of what good quality should be, especially with a sector as vast as healthcare. First of all, the idea of urbanness and urban contexts is intractably tied to the availability of specialist caregivers and facilities all over the world. Attracting and keeping certain cadres of healthcare providers necessitates certain amenities and access to a lifestyle associated with upward social mobility. However, rural contexts have human beings who are just as much in need of these exact services, but “world class” escapes an association with village life and small scale. There is nothing inclusive about it. It is not a term that was designed to make room for people who fall outside its reach.

Secondly, the trappings of “world class” care are almost, blow by blow, things that can be associated with luxury and availability of high budgets to afford the comforts over and above the basics. In the mostly capitalist context of the Kenyan economy, dignity is one of those things, because in many senses people have to pay to matter. The speed at which people will rush to the bedside of a VIP will tell you that even though the value system of care argues that all people are equal, the Orwellian situation where some are more equal than others, as detailed in the classic literary work Animal Farm, can most often be trusted to prevail. A “world class” situation where people who pay and people who don’t pay are getting the same quality of service can create conflicts, and we therefore find that we have to create discomfort for people who pay less in order to justify the comfort of those who are paying more. A practical example of that is the ever-shrinking size of economy class seats in most airliners.

Thirdly, “world class” in resource-limited contexts like these has tended to focus, rather dangerously, on flashiness of equipment and an array of available specialties, rather than on how the people feel about how they are being treated and guided on the path back to health. We have seen billboards with photos of futuristic diagnostic machines, but heard horrifying stories of patients suffering in the same hospitals where the sci-fi imagers sit. In many ways, we like the idea of a hospital that looks like one abroad but haven’t thought beyond that to a hospital where Kenyans are treated as though they matter.

But even as regards care, we must focus on the caregivers, and the situation with them in this country has been tenuous for a while. The line between public healthcare workers and private ones is very thin because most of them receive their education in the same institutions. The labour issues of the healthcare sector have been known for a while, with strikes rocking the nation at different points, causing unfathomable gaps in direct patient care and public health interventions for vulnerable populations, such as children under the age of 5, people living with HIV, pregnant mothers, the elderly etc. For many reasons, top among which are understaffing, overwork and underpayment, many caregivers are burned out and unable to engage humanely in the lives of their patients, and this humane engagement is the bedrock of what the intention of the word “care” is. Professor David Ndetei et al published a preliminary sample study in 2014 that found that over 95 percent of caregivers at Kenyatta Hospital, Kenya’s largest teaching and referral hospital, were showing clinical signs of burnout. As such, we can have all the best machines in the world, but if we do not also ensure that our caregivers are at their best, we are already running a losing race. The same can be said of healthcare support and administrative staff.

A fourth element of “world class”, which we may have been phased out due to unfocused policy, is matching the disease burden and health needs of the people with the opportunities for training new specialists. This country is only just coming to terms with its prevalence of cancer and many non-communicable diseases, for instance. Our previous leaning on tropical medicine and infectious diseases without keeping a sharp eye on the peripheries has allowed this to feel like it snuck up on us when in reality people have always been suffering: it is just us who didn’t take notice.

We can add to this list the conditions that are considered “rare” and therefore possible to ignore because their sufferers have not reached a number large enough to make macroeconomic investment worthwhile. As such, those with the means are able to get treatment and management in other countries which, whether for free market reasons, solid national planning, or both, enabled spaces where this is available. Often we hear of VIPs who manage public resources having the additional perks of opting out of the care available here, which is almost as though, when it is convenient, they get to stop being the Kenyans they are happy for the rest of us to be. This is not an indictment on everyone who has had the privilege of getting on a plane to places like the UK, India or South Africa to access treatment: it is, however, a recognition of the tragedy in the lives we have lost because so many were not able to access the same options. It becomes pricklier when we consider that sometimes there is room for our national public insurer to pay for people to get care abroad, which is obviously wonderful, but why do we remain unable to do what it would take to avail those options here to all Kenyans? How can we ensure that all lives are viewed as equally valuable?

Often we hear of VIPs who manage public resources having the additional perks of opting out of the care available here, which is almost as though, when it is convenient, they get to stop being the Kenyans they are happy for the rest of us to be. This is not an indictment on everyone who has had the privilege of getting on a plane to places like the UK, India or South Africa to access treatment: it is, however, a recognition of the tragedy in the lives we have lost because so many were not able to access the same options.

A general issue with accessing care abroad is that the great equaliser of persons as regards quality of care becomes emergency services. Regardless of who we are, if we are involved in a road traffic accident or suffer some other acute trauma, we are bound to the nearest facility, wherever it may be, to get the interventions that we need in order to make sure that we buy time and avoid death. During such moments, it is not how much we can pay that matters as much as the assurance that wherever we go, the people in both private and public spaces can give us the exact care we need to keep us alive. Currently that is a difficult assurance to give Kenyans, and so these aspirations towards world-class care are more distractions than they are honest analyses of what is actually possible for us.

Who pays for universal healthcare?

The organic segue when discussing value of life in healthcare is to ask ourselves a few rather philosophical questions. How much are states willing to invest in the life and wellbeing of their citizens? A quantification of the amounts of money a nation’s citizens pay out of pocket for healthcare would be one way to understand that. Understanding where citizens have to plug in from their own net income—and why—may be a more qualitative way to map out any gaps in a country’s healthcare spend.

We have to negotiate the practicalities of actively rolling out what we call universal healthcare. It cannot qualify as universal if citizens cannot access it, or if they are paying a significant part of its cost from their own pockets. It bears explaining that once rolled out, Kenyans may not pay for it, but it is far from free: What it means is that everyone’s care is averaged out and charged to each citizen via the varied taxes we already pay, as well as from the net incomes of a nation from the items it offers for sale to the global market. Basically, we put money in Caesar’s pocket, and it is added to whatever Caesar already has coming in, and then Caesar pays for everyone. The reliance on a central source of funds for our healthcare can be worrying if we consider our rising national debt, and our known tendencies to make monies intended for public expenditure disappear. Furthermore, it has been a long time since Kenya even pretended to spend 15% of its total budget on healthcare, as it pledged in the 2001 Abuja Declaration, so how we move from blatant disregard to even just toeing the minimum will be a matter of the ideal sustained political will that is known to elude us on many other matters of public interest.

The other source of money for healthcare spend is medical insurance, and because of the relatively tiny percentage of people who are privately insured in this country, most of whom access this as a benefit of formal employment. Comprehensive comparisons and analyses have also been hard to come by, but it is the rare client who has not been blindsided or left in the financial lurch by the sudden onset of red tape and small print. Additionally, it is notable that the list of exclusions are not a fair reflection of the disease burden of this population: the alarming number of services that women are unable to easily access as part of comprehensive reproductive health are testament to that. By and large, it is understandable that insurance companies would want to keep a tight handle on spending and payouts, especially when having to work with a relatively small number of customers. It has, however, been disappointing that for professionals who are well versed in betting on the macroeconomics of health and profiting off savvy investments, the clear advantages of a demographic youth boom such as Kenya’s has not created a space in which to partner with the state in more scalable ways to make healthcare available for more people.

It is impossible to consider healthcare without considering the effects of harambee, ubuntu or community contributions. Many Kenyans have reaped the benefits of belonging to a culture that values, for many reasons, coming together to help a person in need. The person does not even have to belong directly to our tribe, religion or family: we will sacrificially find coins to help someone who has been visited by the misfortune of an illness whose treatment surpassed their ability to pay.

However, the intervention of the many is suited to a one-time issue which will hopefully go into remission forever. The burdens of a chronic condition can quickly elicit compassion fatigue in even the most charitable people. Additionally, personal finances are finite, especially in shaky economic times, and the same person who could be generous at one moment can find his circumstances changed radically during a subsequent request. Because of the unpredictable nature of misfortune and the opaque nature of healthcare costs, someone can so easily come from contributing to another’s issue only to find himself the next victim of these particular debts that can so easily impoverish. Moreover, healthcare costs are unrelenting: they don’t care whether the person is working (and in the case of some illnesses and conditions, the sufferer’s ability to do so is actually taken away) or able to pay for them; they just continue to rack up. It is a terrible and cruel thing for any person to have to contemplate whether it is fair that they cannot raise the amount of money they need in order to guarantee healing and well-being in this life.

It is impossible to consider healthcare without considering the effects of harambee, ubuntu or community contributions. Many Kenyans have reaped the benefits of belonging to a culture that values, for many reasons, coming together to help a person in need.

Light at the end of the tunnel

Despite the fact that it would be easy for cynicism to set in, there are actually several things to be optimistic about as regards healthcare in this country. First among these is that we can always hope that the seemingly renewed state commitment to health for all can be a multipartisan agenda whose achievement can transcend the short-term possibilities of political gain for a few. We may, for many reasons, actually get the high political will and follow-through with this that would not only make it a success but also be a shining light for the failures in provision of other public goods for Kenyan citizens. The massive strides forward we are seeing in Makueni County, helmed by its determined governor, Kivutha Kibwana, are practical attempts at universal healthcare that redefine it as possible, not merely as an ambitious pipe dream.

Secondly, the labour conflicts in this sector have illuminated and mapped out the gaps faced by the civil servants who work in it. Because of this, we have a much clearer picture when we look at the issues raised by both them and the patients or service consumers about what is wrong, and are thus in a much better position to look for solutions, with the great advantage of a multidimensional approach.

The presence of devolution is a mixed bag. Many argue that the complexities of healthcare service provision meant that Counties were prematurely bequeathed this responsibility, especially without a data-driven approach to truly understanding the direct concerns of each county. Others had hoped that because each county has such distinctly different needs, the room for and success of innovative solutions that have been created by this separation from national overview can outperform the wide blanket of country-wide strategy by far. Again Makueni County’s innovative methods stand out significantly. All agree, however, that we need a much slower, more deliberate plan to tease out the relationship between the state and the county as regards the healthcare for citizens, especially along the lines of who pays for what.

A fourth advantage is the position of Kenya regionally and continentally as a hub for quality and ambition as regards healthcare policy and practice. Kenya’s public sector is known across the continent for its progressive, almost radical HIV care, treatment and prevention policies. Kenya was the second country in Africa and is still among a minority in the world to roll out pre-exposure prophylaxis to the masses and is deeply involved in research and experimentation towards both a cure and a vaccine.

Another example is our no-nonsense approach to maternal mortality, most recently elaborated as the Beyond Zero campaign led by the Country’s First Lady, Margaret Kenyatta. This campaign has been highly praised globally and is being studied to map out how its implementation can be replicated in other spaces. We’re currently debating and drafting legislature on fertility treatment and surrogacy, and despite our societal and religious conservatism, have been able to shift sexual and reproductive health conversations, especially as part of women’s rights, in very significant ways. The private sector has not been left behind; for many of the region’s citizens, Kenya, and Nairobi in particular, are destinations for quality specialist care and access to services that are not available to them at home. There are definitely ethical concerns in turning a country into a medical tourism hub offering services that are not available for the majority of its own citizens. It is, however, a comfort to note that the ingredients for success are already here.

Kenya’s public sector is known across the continent for its progressive, almost radical HIV care, treatment and prevention policies. Kenya was the second country in Africa and is still among a minority in the world to roll out pre-exposure prophylaxis to the masses, and is deeply involved in research and experimentation towards both a cure and a vaccine.

A follow-up to this is the rising numbers of both facilities and care workers in training. Again, we remain aware that tertiary institutions in this country, and the wider education sector, have also had their struggles with labour tensions, privatisation, underemployment and reduced funding from central government, but that is a whole other article. On the bright side regarding health, there are many more training opportunities available, but the vast majority of these are for first certificates, diplomas and degrees. Specialist training programmes for all cadres of healthcare givers are still inordinately expensive, and the government-sponsored opportunities for those have long waiting lists at both national and county levels.

One other place that Kenya has had some tensions is in negotiating the differences in roles between clinical officers, nurse practitioners and doctors. The facts on the ground remain that we still have a dire shortage of primary care interventionists, and our hybrid approach that allows varied cadres to see patients covers a much larger population base than a purist model would. That being said, we could still do with a more iterative, responsive understanding of who is trained to do what, so that patients are very clear about the clinical boundaries of each cadre.

A final point to note (and this list is by no means exhaustive) is that there is a general change in public attitudes to healthcare, the result of the diffuse access to information that has been occasioned by the Internet. There is more education about topics that were previously covered over by a lot of stigma and ignorance: one example is mental health. Because of this, the public has been empowered to ask more questions and demand timely, satisfactory answers from individual care givers, institutions and the sector at large. A part of it is definitely a more entrenched awareness of their rights as citizens as broken down in the Constitution, which is very explicit about the right to health and even specifically, access to emergency care. Citizens are also able to take to social media streets and host online conversations and debates, which have become offline calls for accountability that have been successful in stopping malpractice and neglect. The media are also taking the need for accessible, comprehensive information more seriously, and there has been a significant rise in health-centred human interest stories, and more expert journalists who are able to unpack complex health issues in ways that Kenyans are happy to learn from, engage with, analyse and debate.

There is a lot of room to stick it out and hope for the better—just because so much has been so bad for so long does not invalidate the good things that have been happening under the radar. All said and done, though, we must wait and see if true universal healthcare is possible within the context of what Kenyan healthcare has been and has the potential to be.

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