On June 2, 2010, the then Speaker of the National Assembly Kenneth Marende declared the Makadara seat in Nairobi vacant. The MP, the late Dick Wathika had lost the seat after a successful petition by Rueben Ndolo, a former holder of the seat (2002—2007). The by election was slated for September 20, 2010.
Three weeks to the by election, I had an interview with Wathika — popularly known as Mwas, his mtaa (estate) nickname — at a posh Nairobi hotel. He was in his element: exuding an unusual confidence. He boasted to me how he was going to wallop yet again his opponent Ndolo, who was contesting on an ODM ticket.
Finding him vain, I reminded him the fight was no longer between him and his known adversary, but was now going to be a three-pronged battle, which in my view, needed a different tact and strategy. A third contestant had entered the fray and his name was Gideon Mbuvi Kioko alias Mike Sonko.
“Wewe Dauti ni nini sasa…kwani umesahau kule tumetoka?” (You Dauti what’s up with you? You’ve forgotten where we’ve come from?), he chided me. “Huyo ni nani unaniambia stori yake. Ndolo ndiye opponent wangu. na nitam KO.” (Who’s that you telling me about? My opponent is Ndolo and I’ll knock him out). Wathika, in his heydays, just like Ndolo was an amateur boxer, the only difference being Ndolo had taken his boxing a notch higher and fought as a professional.
Within two and a half years, Sonko was transformed from a political neophyte to a juggernaut.
Mwas could afford to get up close and personal with me, because I had known him since childhood. We had grown up together in Maringo estate. In 1991, after former President Daniel arap Moi had repealed the infamous Section 2(a) of the old constitution, multi-party politics had returned to the fold.
The following year, Wathika joined politics through the Ford Asili party which had split from Forum for the Restoration of Democracy (FORD), the first opposition party formed after the political liberalization. Kenneth Matiba formed Ford Asili, while the then doyen of opposition politics Jaramogi Oginga Odinga formed Ford Kenya.
As luck would have it, Mwas was a boy wa mtaa (local boy), all the electorate; young and old who had desired change voted for him and he run away with the popular vote. Wathika was elected as the Maringo ward councillor — defeating the KANU incumbent, Kiura Kirandu — hands down.
Wathika had had a great run as a politician from 1992, when as a 19-year-old elected rookie, he become one of the youngest minted multiparty party era politicians. In between 1992—2010, he had served three terms as a councillor, a mayor for two years and an MP for two and half years, including a stint as Assistant Minister for a year and four months. But his streak of luck would suddenly end with the arrival of Sonko.
Sonko, shot to political prominence, when he was first elected to parliament as Makadara MP on September 20, 2010. To the utter surprise of Wathika and Ndolo, Sonko, then 35 years old and running on a Narc Kenya ticket, caused a major upset by polling 19,535 votes against his closest rival, Ndolo’s 16,613.
Wathika, the incumbent pooled a poor third. “I must admit I did not see the defeat coming…I had had it too easy,” he was later to tell me when we again met in December 2010.
The entry of Sonko into the abrasive city politics immediately did two things: He sent Wathika packing — first to an emotional declaration of quitting politics altogether, and after he had recollected himself, into exile in Mukurweini constituency in Nyeri County. Sonko also confined Ndolo to ODM party politics. Within two and a half years, Sonko was transformed from a political neophyte to a juggernaut.
The naming of his matatus completed the picture and in a somewhat subtle way, told Sonko’s own shady story. They bore names such as — BROWN SUGAR, CONVICT, FERRARI, LAKERS and ROUGH CUTS.
By March 2013, he was so confident he had outgrown his parliamentary seat, he threw his force into contesting the newly created senator seat. He won the Nairobi senator seat by the biggest number of votes cast for any senator or governor countrywide. Running against his closest competitor Margaret Wanjiru, he polled 808,705 votes against the burly priestess’ 525,822 votes.
In Nairobi County, Sonko proved to all and sundry he was the king of politics. Running on The National Alliance (TNA) party, he polled even more votes than either his party boss, Uhuru Muigai Kenyatta, who got 659,490 votes, or he latter’s rival, Raila Amolo Odinga, who received 691,156 votes. It was evident that Sonko had stomped the city politics like no other and, any politician who ignored him could only do so at their own peril.
Who is Sonko and how is it that today he is the most talked about politician, only after President Uhuru Kenyatta and the leader of Opposition Raila Odinga?
Sonko appeared on the Nairobi scene in the early 2000s just like in the movies: with a bang. One day, Nairobian woke up to the sleekest No. 58 matatus operating on the Buru Buru Phase V, IV and III estates’ route. Sonko had invested in a fleet of matatus that came to be known as nganya — a super pimped matatu — a superlative of manyanga, which is an ordinary pimped matatu.
His crew staff did not disappoint: His drivers and conductors were the whippiest lads you could find anywhere in the matatu transport industry. They were funky and wore the latest fashions. Equipped with the latest hi-fi music systems complete with woofers, Sonko’s matatus could be heard a kilometre away.
The naming of his matatus completed the picture and in a somewhat subtle way, told Sonko’s own shady story. They bore names such as — BROWN SUGAR, CONVICT, FERRARI, LAKERS and ROUGH CUTS. His matatus were so hip, trendy Buru Buru schoolkids would not board any other matatus.
Sonko’s investment in the matatu industry has been surrounded with a lot of mystery and allegations of money laundering. He entered the industry with a great deal of razzmatazz, buying many matatus at one go and for a while, the quiet talk among his fellow matatu owners was that the source of his wealth was the illegal drug trade.
Two years after he was arrested and taken to Shimo-la-Tewa Prison, it is said he smuggled in cash in a briefcase into the prison, which his acolytes had passed onto the prison warders.
Indeed, the late Minister of Interior Security, Prof George Saitoti in December 2010, named him in Parliament as one of the country’s drug lords. Talking to one of his close buddies recently, he reiterated that Sonko has never been taken to court over that mention or the allegations that were swirling before and even after. “To the best of my knowledge, the mention by the late Saitoti about Sonko involvement in drugs, has remained just that: a mere mention, nothing, more…nothing less,” he said.
The source of Sonko’s wealth though has never been fully publicly explained. Years before, then known as Gidion Mbuvi Kioko, he was a middle man selling parcels of lands in the Coast region, where he had grown up.
Many a time, it is alleged, he would take off with all the money after a land sale. In 1997, he was accused of having falsified documents relating to land belonging to Eliud Mahihu, the former all-powerful Coast Provincial Commissioner during Mzee Kenyatta’s era.
Two years after he was arrested and taken to Shimo-la-Tewa Prison, it is said he smuggled in cash in a briefcase into the prison, which his acolytes had passed onto the prison warders. They, in turn, are said to have facilitated his escape after he was taken to Coast General Hospital feigning a range of ailments — from epilepsy, HIV/AIDS to Typhoid. Later, in mitigation, Sonko was to argue that he had run away from jail to attend his mother’s funeral.
Just a few years later, Sonko was hanging around then Wab Hotel, at the Buru Buru shopping centre, clad in denim jeans and a T-Shirt, chatting away the boys. His matatus then employed an upward of 50 youth.
In January 2003, after the National Rainbow Coalition (NARC), an alliance dislodged the ruling KANU from its 24-year-old stranglehold of power, President Mwai Kibaki appointed the late John Michuki as the Minister of Transport. Michuki was used to getting his way — from his days as a colonial administrator in the 1950s, when he was a district officer in Nanyuki, up to even when he entered politics. The “Michuki rules” which he initiated immediately he assumed the transport docket and which quickly resonated with the people, remained a diktat, until Sonko went to court in 2006. Sonko won his case because, as the High Court reminded the Transport Ministry, without official publication in the Kenya Gazette, the rules were just that: Michuki “personal rules”. It was only after the court case that the rules were now formally gazetted.
One of Michuki’s more infamous edicts was that of barring matatus from entering the central business district of Nairobi. It was a clearly selfish decree because of the conflict of interest that arose from an exception to the rule, allowing in vehicles belonging to the City Hoppa matatu company in which the Minister had invested heavily.
Listening to him explaining his tribulations, Kenneth inadvertently casts himself as a “choice candidate” who was owed and had been let down by the Jubilee Party cabal at the Pangani headquarters.
Sonko, whose matatus were affected by this unlawful rule, went to court. To the surprise of many, he won the case after a protracted battle. His matatus were allowed back into the city centre, along with a select few from other owners. The judicial victory improved Sonko’s standing among his employees and followers, who viewed him as their “Mr fix it”.
But more significantly, it, catapulted him to the chairmanship of the then amorphous and now defunct Eastlands Matatu Operators Association. The position gave Sonko influence and power commanding then close to 8000 matatus.
From being the darling of the youth, he became the darling of the masses. The passengers who used to be dropped off at the dusty Muthurwa, and who would then have to trek to the city centre — there were no boda bodas at the time — could not thank him enough. It was just a matter of time before he moved to the next level. When the Makadara constituency election was nullified by the High Court in April 2010, an opportunity availed itself and Sonko seized the moment and ran with it.
After becoming MP, Sonko sought to endear himself to his constituents. He would engage the City Council to get his constituents exempted from paying parking fees within Makadara constituency. The court injunction was only temporary but he had made his point: he would always be ready to fight for his people. For a while, he also made it tenuous for slum lords to arbitrarily evict tenants. He would go to court on behalf of the tenants and file a case.
On Sunday March 19, 2017 on national TV, Sonko ranted against Peter Kenneth, then one of his more formidable opponents for the Jubilee Party ticket for the Nairobi gubernatorial contest. From the onset, it was evident in the interview Sonko pulled no punches and held no prisoners when describing Kenneth. His apparent contempt for the former presidential candidate was palpable.
The 51-year-old Kenneth would later quit Jubilee Party, after losing the nomination battle to Sonko, to run as an independent candidate. He came off as a sore loser who had expected his path to the nomination to be smoothened for him. And therein lay his Achilles Heels: entitlement. Listening to him explaining his tribulations, Kenneth inadvertently casts himself as a “choice candidate” who was owed and had been let down by the Jubilee Party cabal at the Pangani headquarters.
But more than giving the implicit impression that he was the favoured son, Kenneth has been unable to shake off the label of being a “political project” or a front for other interests. First, he was a project of the “Murang’a Mafia”. Now, he is viewed as a “Governor Evans Kidero project”. It cannot get worse.
Yet, the project tag is not the only label he is struggling with. When Sonko first taunted him as a foreigner and a Johnny-come-lately to city politics, Kenneth laughed it off and made light of the remark by pointing out that even when he represented Gatanga constituency, he slept in Nairobi.
The bad news for Kenneth is that this refuses to go away. “Peter Kenneth is a foreigner to Nairobi politics”, says a Nairobi lady restaurateur known as Wa Carol. “Where has he been for four years?” the restaurateur, who herself voted for Sonko during the nominations, muses loudly. His goose was cooked the day he announced he was running in Nairobi, she says.
Still, of the 15 mayors Nairobi had between 1963 and 2012, only 4 were non-Kikuyu. Many Kikuyus have therefore come to regard Nairobi city as an extension of Kiambu County
“After PK first announced his bid in January, Maina Kamanda afterwards came over and addressed us Kikuyu business people in Nairobi and told us: ‘we need someone to protect our property and the man to do precisely that is Peter Kenneth’. I thought Kamanda was kidding me. I do not own any property in Nairobi”, says the lady who is in her late 40s.
It is the same reaction that my friend, Elvis Kinyanjui, who has been a street vendor in the CBD for the last three decades, had: “Kamanda is talking of protecting property — whose property?”
The Peter Kenneth who ran for presidency in 2013 is radically different from the man seeking to be the governor of the capital city. In 2013, he projected himself as a de-tribalised, smooth and urbane Kenyan — the poster child of cosmopolitanism with refined features. Barely four years later, he agreed to be repackaged as a Kikuyu sheriff coming to the city with a mission to rescue a propertied class ostensibly under siege.
Pitted against a man — Sonko — who has carved himself a niche as the spokesman for the city’s underclass and defender of their trodden rights, Kenneth’s apparent aloofness and association with the moneyed class casts him as removed from the everyday struggles of the city dweller.
In the nominations that he has bitterly disputed, Kenneth was walloped by Sonko, 138,185 votes to 62,504. Could Sonko have wrestled the power and glory from the Murang’a business elite’s grip on Nairobi, thereby redefining the politics of Nairobi?
Nairobi city politics have always been under the grip of Kikuyu business and political elites save for two major periods — between 1969 to 1970 and 1983 to 1992. In 1969, Isaac Lugonzo took over from Charles Rubia and in 1983, former President Moi disbanded the City Council when Nathan Kahara was mayor to form several commissions till the return of multiparty politics in 1991.
From way back in the 1960s, when the first Minister of Trade and Commerce was Dr Gikonyo Kiano, who like Rubia, the city mayor, hailed from then Murang’a District, the city’s business allocations and licenses tended to favour the Kikuyus from Murang’a. That is why, it not a coincidence that many of the city business godowns in the industrial area are owned by Murang’a tycoons. That is also why many of the buildings in downtown Nairobi, especially on River Road and Kirinyaga Road, are owned by the famous Rwathia group, which has its origin is in Rwathia in Murang’a.
Similarly, many of the small traders — from hawkers to street vendors— are Kikuyus from Murang’a many of whom are today settled in Starehe constituency. It is equally not a coincidence that Maina Kamanda, another Murang’a supremo, started his political career at Ngara West Ward (one of the wards that make Starehe constituency), eventually running for the parliamentary seat. The ward, and indeed the entire Starehe constituency, is populated majorly by Kikuyus from Murang’a.
“The thought of Sonko running the affairs of the biggest economy outside the national government at the City Hall is just frightening”, the earlier quoted businessman confided.
After the re-introduction of multiparty politics, the position of the mayor may have been whittled down, but still, Kikuyu political mandarins controlled the mayoral seat, if not directly, then indirectly. Between 1992, after the first multiparty elections and 2002, the mayors were all Kikuyus. From Steve “Magic” Mwangi, John King’ori, Sammy Mbugua, John Ndirangu to Dick Waweru, whose second term ended in 2002.
The only other time a non-Kikuyu was boss at City Hall was between 2003—2004 when Joe Aketch, a nominated councilor, was mayor. Aketch owed his mayoral seat to Kamanda. The vicious infighting between the Kikuyu councillors at City Hall that ensued after the Narc victory, forced Kamanda, the newly elected Starehe MP, to throw his weight behind Aketch’s candidacy.
Geoffrey Majiwa, then the Baba Dogo ward councillor was the Nairobi mayor after President Mwai Kibaki and Raila Odinga formed the grand coalition government in 2008. George Aladwa served between 2010—2012, after he took over from Majiwa, who had to step aside after he was allegedly implicated in a cemetery land corruption scam. Following the 2013 election, which rung in new constitutional arrangements, especially devolution, Evans Kidero, a Luo, defeated his Kikuyu rivals to clinch the Governorship.
Still, of the 15 mayors Nairobi had between 1963 and 2012, only 4 were non-Kikuyu. Many Kikuyus have therefore come to regard Nairobi city as an extension of Kiambu County due to its proximity, notwithstanding the fact that Kiambu Kikuyus appear to have ceded control of the city businesses to their cousins from Murang’a. In March 2017, a Jubilee Party parliamentary candidate from Roysambu was interviewed on Inooro TV. When asked who should be the governor of Nairobi, his answer was curt. “A Kikuyu of course”. “Why?” posed the interviewer. “We Kikuyus are the owners of the city”.
This reasoning among the Kikuyus is buttressed by the notion that many of the city businesses and investments’ operations are run by Kikuyus. Also, because of the proximity of Kiambu and to a large extent Murang’a Counties, coupled with the fact that the first post-independent government of Mzee Kenyatta encouraged many Kikuyus to come to Nairobi, Kikuyus have always been numerically superior. According to some reports, one in three Nairobians is a Kikuyu.
Since Sonko declared his intention to run for the governor’s seat, a section of the city’s business community has become uneasy and wary of his burgeoning grassroots support across the city electorate. Towards the end of last year, Kikuyu businessmen in the city met and proposed a “sober and mature” person to run for the seat, in the hope of unseating governor Evans Kidero. “We had to act and come up with a name, in view of Jubilee Party’s apparent lack of a saleable candidate,” said one businessman who was privy to the meeting.
That is when they proposed Peter Kenneth. There is no gainsaying the fact the bulk of the most influential Kikuyu businessmen in Nairobi hail from the greater Murang’a County. Before, the carving out of additional districts from the original Murang’a largely by President Daniel Moi, Murang’a District began just after Thika town extending all way to the border of Karatina town, which is in Nyeri District. The urban and thoroughly cosmopolitan Kenneth is from Kirwara sub-location in Murang’a.
When the businessmen argued that they did not know where Sonko came from and what business he does, they were subtly saying he is not one of them. It did not matter that he is a Jubilee Party loyalist. “The thought of Sonko running the affairs of the biggest economy outside the national government at the City Hall is just frightening”, the earlier quoted businessman confided. To calm the Murang’a Mafia fears and sooth their egos, Sonko has picked a mid-career corporate professional, Polycarp Igathe, who hails from Murang’a County as his deputy.
I was informed that Sonko oftentimes sneaks in at night to catch up with wazito — the gangland (heavy weight) leaders, who also boasted of having Sonko’s direct contacts.
Sonko’s mocking of academic papers during his high pitched monologues to Citizen TV host Mohamed Hussein — never mind he has himself rushed to get them — is a testament to how these credentials have come to mean nothing insofar as the governor’s seat is concerned. Dr Evans Kidero with his “excellent” academic papers and “management experience” and presumed “track record” has ensured that these qualifications will not be anything to brag about when canvassing for the governor seat’s votes.
Kidero’s rival was Ferdinand Waititu, a former MP of the larger Embakasi constituency. Waititu started off as a councillor for Njiru ward, which was then part of the constituency. He also deputized mayor Wathika. Waititu is always remembered for his “unparliamentary” behaviour of throwing stones and boxing his constituents.
Yet, in uncanny twist of fate, he outmanoeuvered his competitors to clinch the TNA party ticket. One of the more formidable candidates in the Nairobi governor seat elections in 2013 was one, Jimnah Mbaru who ran on the defunct Alliance Party of Kenya (APK) after he failed to secure the TNA nomination. He performed dismally, coming a distant third.
Like Kenneth today, Mbaru had always been dogged by claims of being elitist and not “a man of the people”, since the first time he entered electoral politics in 1992, when he first ran for a parliamentary seat. Waititu’s chief campaigners in 2013 rode on that narrative to besmirch Jimnah. He was painted by Waititu as a man who would not soil his (well pressed) suits to get into the mud to help the people.
A cursory glance at Sonko’s city support base today quickly reveals a demographic stratum that comprises voters who care nothing about academic qualifications and management experience. Disenchanted with Kidero’s apparent lack of vision for the city — Nairobians were hoping for a makeover and an invigorated capital city — this voter bloc has all but dismissed these “elite” qualifications.
Four months ago, I conducted a reality check in Mathare constituency, one of Sonko’s electoral bastions. Mathare is made up of six wards. In Huruma, the “area boys” told me Sonko was their guy. No doubt. Speaking to me in that lyrical Sheng only spoken in the toughest of the city ghettos, the young men spotting crew cuts dismissed Kenneth as an “impostor”. “Huyo mlami alikuwa wapi hizo siku zote?” Where was the white man all these time? “Kenneth ni candidate wa mababi”. Kenneth is the city’s bourgeoisie choice.
Of course, Mathare is not Sonko’s only voter catchment area. The entire Eastlands area — including the Central Business District — is considered to be his political playground. From the City Stadium roundabout, the area sandwiched between Jogoo Road and Lusaka Road is populated with Sonko’s presumed loyal supporters. This area straddles basically four constituencies: Makadara, Starehe and Embakasi South and Embakasi West.
In Makadara constituency, Sonko’s support is to be found in the larger Buru Buru, Ofafa Jericho and Jericho Lumumba, Maringo, Mbotela and Hamza estates. Add to these estates, Mukuru kwa Njenga slum. In Starehe constituency, Sonko’s biggest support base is in the Mukuru kwa Rueben sprawling slum which is adjacent to the other Mukuru and other scattered slums in the Industrial area. In Embakasi South constituency, his most ardent supporters are in the heavily populated Pipeline area. In Embakasi West, his supporters are to be found in Umoja I and II, Mowlem and Kariobangi South.
Separate from the Jogoo Road/Lusaka Road axis, Sonko also commands great support in the area between Juja Road and Heshima Road, which runs through Bahati and Jerusalem estates. This area mainly encompasses Kamukunji and Embakasi North constituencies. In Kamukunji constituency, his greatest support resides in Biafra, Majengo — popularly known as Kije — and Shauri Moyo estates. Majengo, one of the city’s oldest and most densely populated slums, is heavily Islamized and Swahilised — cultural traditions that Sonko easily identifies with and vice versa.
In Embakasi North, the sprawling Dandora areas I, II, III, IV and V, including Gitare Marigu ghetto are Sonko’s forte. Away from Eastlands, Sonko can also call support in Dagoretti South, a peri-urban and semi-rural constituency.
To the macho ghetto youth, the fact that Sonko spent time in prison, means he is a “made man”. “Sonko ni mtu alikuwa piri…na saa hii yuko wapi?” (Sonko was in prison…now look where he is).
Sonko’s penetration of these urban poor areas was facilitated by his supposedly philanthropic outfit; the Sonko Rescue Team, which would supply the one golden commodity that is scarce to many Nairobians, rich and poor — water. For many of these people, they did not need to see Sonko physically: The SRT vehicles would announce the presence of the unseen Sonko.
Invariably, Sonko’s supporters will not be voting for him because he is in Jubilee — his core constituency is to be found across the ethnic divide and would vote for him wherever he would take them. It is that simple. Nobody cares to remember that Sonko is a Mkamba from Mua Hills in Machakos County.
My street vendor friends — many of them Kikuyus and who ply their trade in the CBD, have told me they are rooting for Sonko. They believe he will be kinder to them. “Sonko ni mtu anaelewa works ya vijana.” (Sonko is a man who understands the struggles of the youth). “Yeye hukuja kutucheki na ametupromise ata deal na mabigi wa hii tao.” (He comes by to say hello, and has promised, he will deal with the city’s bigwigs).
Sonko won the street vendors’ favour, when he confronted the city askaris, who consistently and persistently harassed the vendors. Sonko had been consistently vocal about the violence at least since 2014, and in January 2016, three notorious city askaris, who have since been charged with a spate of murders involving street vendors, were arrested days after he threatened to resign.
Sonko has promised to put the city askaris firmly in their place, should he win. “Sonko alitushow atanyorosha hao makanjo.” (Sonko told us he will straighten up the city askaris — if he becomes the governor).
Typically, nearly all the boda boda riders who operate in the CBD are Sonko’s supporters. Like their counterparts, the street vendors, they regularly fall afoul of the archaic city by-laws, and hence are a perpetual target of harassment by city askaris seeking to extort bribes; oftentimes violently.
Sam Ochieng who is an Advertising Executive, says he will vote for Sonko. “Sonko animates politics in a way no other Kenyan politician does.” My restaurateur friend, Wa Carol, told me she will cast her vote for Sonko, because she believes he is a man of action and will be accessible. “Kidero is a total flop. All he did was to increasingly levy taxies on small enterprises without offering any services. Look at my restaurant’s backstreet: piles and piles of garbage…and every month we are required to pay service charge.”
Away from Sonko’s presumed multicultural support base, his ethnic city support is also as good as assured. It is not for nothing that Mukuru kwa Reuben and part of the Mukuru kwa Njenga slums are solidly behind Sonko: in the city politics’ parlance, they are Kamba ghettos. So is Biafra in Kamukunji, Mbotela in Makadara and Pipeline in Embakasi South.
According to Independent Electoral and Boundaries Commission (IEBC) latest figures on the total registered voters, out of the city’s 2.3 million registered voters, 450,000 are Kambas, the second-largest voting block after the Kikuyus. With his entry into the governor’s race, Sonko has complicated the ethnic arithmetic for Evans Kidero/Jonathan Mueke ticket. The retention of Mueke as a running mate was essentially to tap and harvest this Kamba vote.
Three weeks ago, Johnstone Muthama, one of NASA’s fundraisers and campaigners called for a meeting at City Stadium, where every eligible Kamba voter had an automatic invitation. On the agenda: how to marshall Kamba support for Kidero/Mueke NASA ticket. Regardless, Hannah Mutiso from Buru Buru, told me her vote for the governor is for Sonko and so did Mbula from Pipeline in Embakasi South.
If the Kamba vote will prove to be problematic to Kidero, the Luhya vote may also not be automatic. A City County Luhya employee, who requested anonymity, confided in me that not all Luhyas will vote for Kidero. “We have not forgotten how he caused so much grief for our people when he was the boss at Mumias Sugar Factory.” Kidero has been variously accused of mismanaging and misappropriating the company’s finances, a charge that has yet to be proven in the courts, but which has refused to go away and sticks out of Kidero’s lapel like a rotten flower.
Sonko’s works of charity — though driven more by his need to shore up his votes rather than real philanthropy — in places like Kosovo, another of Mathare’s wards, are seen as actos of noblesse oblige in one of the riskiest slums in Nairobi. There, I was informed that Sonko oftentimes sneaks in at night to catch up with wazito — the gangland (heavy weight) leaders, who also boasted of having Sonko’s direct contacts.
Some of the philanthropic activities that Sonko continues to dazzle Nairobians with include paying school fees for some needy students and providing a free ambulance service. As MP, he claimed to have regularly purchased a geometrical set for every pupil in his constituency who sat for the Kenya School of Primary Education (KCPE) examination.
In six short years, Nairobi politics has seen Sonko capture the aspirations of the hoi polloi sequestered in the dangerous, horrid city ghettos, where in the true Hobbesian fashion, “life is short, nasty and brutish”. If his criminal record is supposed to stick out as a sore thumb, the contrary is true. The record, which he does not shy away from, has proved to be a magnet to the youth — who form the strength of his fundamental support.
To the macho ghetto youth, the fact that Sonko spent time in prison, means he is a “made man”. “Sonko ni mtu alikuwa piri…na saa hii yuko wapi?” (Sonko was in prison…now look where he is).
Cutting the figure of a flashy, flamboyant, jewelry-clad gung-ho, Robin Hood type of a Mafia don, Sonko popularised the street slang name — sonko — connoting a man of limitless wealth. Adored by the millennial and generation Z, whose every day dream is to be a sonko, like the real Mike Sonko, they are expected to come out and vote for him en masse.
Sonko who converses in the “rebel language” of the slum-trodden youth, has impressed on them that you do not need an education to live it up. In the process, he has “sonkonised” the politics of Nairobi.
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.
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