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(D)EVOLVED HEALTHCARE: Makueni’s trailblazing experiment in providing universal health coverage

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(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.

Related stories: Behind the Makueni Healthcare Revolution

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.

LISTENBehind the Makueni Healthcare Revolution

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.

Challenges

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.

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Mr. Gathara is a social and political commentator and cartoonist based in Nairobi.

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MISSING THE FOREST FOR THE TREES: Mathare’s environmental apartheid

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MISSING THE FOREST FOR THE TREES: Mathare’s environmental apartheid

On 12th May 2018, President Uhuru Kenyatta launched the National Tree Planting Day under the slogan “Panda Miti, Penda Kenya”. It was another of those Jubilee-ese slogans that ring hollow. The event took place in Kamkunji sub-county at the Moi Forces Academy in the Eastlands part of Nairobi. This was the government’s knee-jerk response to the heavy long rains season that sparked an environmental crisis around the country. There were 32 counties affected and over 300,000 Kenyans were displaced. In his official speech, the President repeated the familiar pledge to achieve at least ten per cent forest cover, as required by the constitution, and to mitigate the effects of climate change.

The news reporting of the event focused on the power politics between Nairobi governor Mike Sonko Mbuvi and Environmental Cabinet Secretary Keriako Tobiko. Two weeks after the launch, news reports were awash with the latest financial scandal. Sh2 billion allocated to establish the green school project in all 47 counties under the auspices of the Kenya Forest Service (KFS) had been embezzled. A task force chaired by Marion Wakanyi Kamau of the Green Belt Movement released a report that revealed that Kenya’s forest depletion occurred at an alarming rate of about 5,000 hectares annually and which implicated KFS personnel. Kenyans, numbed by the numerous other cases of grand theft in the Jubilee government, hardly reacted.

Kenya, the birthplace of the Green Belt Movement and its illustrious founder, Nobel laureate Wangari Maathai, remains stuck in the optics of environmental activism. Reforestation is an activity that the media reduces to a “tree planting exercise” and has evolved into an elite pastime where prominent personalities pose for photo opportunities in formal dress next to freshly planted trees. Public forests have been privatised and primed for plunder by those tasked to protect them while corporates, NGOs and politicians plant thousands of trees in cosmetic public relations and corporate social responsibility activities without evoking any of the ecological consciousness that Wangari Maathai dedicated her life to raising. Of the several Wangari Maathai quotes I regurgitate, this particular one sticks:

“Anyone can dig a hole and plant a tree. But make sure it survives. You have to nurture it, you have to water it, you have to keep at it until it becomes rooted so that it can take of itself. There are so many enemies of trees.”

Planting trees is easy. Taking care of them requires a different level of commitment. This was Wangari’s enduring message and the one lesson my country fails to learn. This much I know because I have been involved in an urban afforestation project with Mathare Green Movement (MGM), a campaign of the Mathare Social Justice Centre ( MSJC).

Public forests have been privatised and primed for plunder by those tasked to protect them while corporates, NGOs and politicians plant thousands of trees in cosmetic public relations and corporate social responsibility activities without evoking any of the ecological consciousness that Wangari Maathai dedicated her life to raising.

The two Nairobis

In August 2017, a group of concerned Kenyans from Mathare got together and decided that they were going to plant trees in memory of all their colleagues who fell to police bullets. Over months, the activity evolved into a concerted effort at ecological and social justice using the tree as a symbol of regeneration and resistance to structural oppression.

Planting trees in Mathare is a process and not an event because the soils of this informal settlement have lost their capacity to sustain trees. Mathare Valley is an infamous slum, a crucible of suffering where white tourists arrive in droves to marvel at the resilience of its residents and to photograph the miracle of optimism. The shanty structures, a canopy of rusty brown mabati roofs separated by narrow alleys dropping down precarious rocky slopes, is home to multitudes. Broken souls exist alongside delightful children. Complete despondence rides alongside cheerfulness and the kaleidoscope of intense human interaction has made Mathare a location of extremes with no middle ground to stand on.

The physical environment is devoid of life-sustaining features. The further east you go in Nairobi, the poorer the neighbourhoods become. The absence of basic amenities and greenery and the human congestion and neglect evoke caricatures of a dystopian city. Martin Oduor, a member of MGM, tried to conduct a tree census and came to the disturbing estimate of about one tree for every 1,200 residents.

The Mathare river is turbid, dark grey and sickly – an open sewer that occasionally turns rogue on its residents, sweeping all in its path. The extent of the long-term socio-environmental damage has created the existing spectacle of human suffering that draws in “saviours and observers” from around the world fascinated by the resilience of the residents. Children, accustomed to the white benevolent visitor on a poverty safari, switch character to become entitled beggars peddling the currency of hopelessness.

Mathare is a perfect illustration of Nairobi’s environmental segregation. The informal settlement is surrounded on both sides by a leafy green belt. To get a sense of what I prefer to call environmental apartheid, one only has to shift one’s gaze to the thick wall of green that is the Muthaiga suburb to the west of Mathare.

The wealthy districts of Nairobi abut its poorer districts from where they draw much of their domestic labour: Muthaiga has Mathare, Karen has Kibera, Loresho has Kangemi, Lavington has Kawangware. A similar pattern is observed in the city’s greenery. From an aerial point of view, the classes are separated by a green belt. All of Nairobi’s best-kept public green spaces – Karura Forest, Nairobi Arboretum, City Park – are in the affluent parts of the city and maintain restricted access. The neighbourhoods to the east of the city centre have minimal public spaces and, where available, we find dusty fields with no green cover.

Mathare is a perfect illustration of Nairobi’s environmental segregation. The informal settlement is surrounded on both sides by a leafy green belt.

The reality of trees as the markers of aristocratic privilege in Nairobi’s urban spaces is rooted in the colonial state. Between 1906 and 1926, Nairobi was colonised to serve the interests of the white settler population. Eighty per cent of the city’s residential land was reserved for its white elite. The two Nairobi’s were divided into residential areas for Europeans and Asians, and peripheral housing for African labour as an afterthought. One white half of Nairobi was serviced and the other black half was neglected. The colonial zoning policy created a pattern of racial and class segregation and social stratification that persist to this day.

The 1948 Master Plan for a Colonial Capital and the 1973 Metropolitan Growth Strategy employed segregation principles to maintain racial and class divisions. After independence in 1963, the white neighbourhoods of Karen, Lavington and Muthaiga became accessible to the emerging moneyed African and Asian upper classes who, rather than reverse the social apartheid, opted for the retention of colonial governance structures.

To cater for the unserviced poor masses, an informal modernism emerged in Nairobi, created with the sole intent of exploiting vulnerable city residents. Rural-to-urban migration brought a large influx of people to the city in search of a better life who found themselves trapped in “slums” and denied social mobility by the rigid class structures. The lack of formal housing gave rise to informal settlements operating outside the legal framework and, therefore, subjected to gross violations of rights and a culture of exploitation.

Kenyan filmmaker Tosh Gitonga illustrates the desperation of rural-to-urban migrants and the plight that awaits “shags-modos” in the brutal class-restricted spaces of Nairobi in the captivating film, Nairobi Half Life. Today the primitive accumulation and land expropriation of the post-colonial state has led to 70 per cent of Nairobi’s population of 4 million living on 5 per cent of the city’s land area. Mathare’s 500,000 residents fight for dignity in an area that is barely 3 square kilometres.

Anti-human environmentalism

In his forthcoming book, Paracitations: Genre, Foreign Bodies, and the Ethics of Co-habitatation, Kenyan scholar Samson Opondo describes the economic security and greenness (which had previously been a manifestation of whiteness) becoming inscribed on a class-based identity complete with a rhetoric of “threat”. When we see trees from the purely conservation ideology of the state, we fail to problematise the socio-economic and historical contexts within which possession and disposssesion and threats emerge.

The environmental culture in Kenya is essentially anti-human. The native continues to be a threat to green spaces and must be forcibly relocated to the reserves and this access to greenery must be monitored. Public forests are protected by armies with guns and access is restricted by high fees. Opondo futher notes in his 2008 paper, “Genre and the African City: The Politics and Poetics of Urban Rhythms, that Nairobi’s hides (in the open) an ugly history of racial segregation based on the South African model of Ebenezer Howard’s Garden City concept where greening of the city corresponded with creation of structures of racial exclusion.

The environmental culture in Kenya is essentially anti-human. The native continues to be a threat to green spaces and must be forcibly relocated to the reserves and this access to greenery must be monitored.

In both South Africa and Kenya, the impoverished masses cluster in shanty towns where environmental rights only come to bear during hostile weather crisis management. Gacheke Gachihi of Mathare Social Justice Centre says, “ Our suffering is invisible.” In Kenya’s election cycle, the slum areas are hotspots that are heavily policed and a ready tinder box of ethnic rivalry, police brutality and gang violence. After every election cycle, we witness the cessation of hostilities, the withdrawal of corporate media from the spectacle of mass violence of poor against poor, state crackdown on protesting poor masses, and lockdowns.

Elections spell death, destruction and despair for the residents of Mathare. In the lead-up to August 2017 bungled elections, Mathare was marked as a “hotspot” that was heavily policed by rogue units who relish brutalising residents under siege. When it all simmers down, the politicians invariably end up negotiating new pacts, leaving residents to fall back on resilence. As soon as they turn their backs, the slow violence resumes, felt only by those within who are invisible to those on the outside – a violence that is exaceberated by an environment that is metaphorically lined with unexploded landmines. The environmentally dispossessed only make the news in the midst of great tragedy and calamities.

Hunting grounds

In the book, Slow Violence and the Environmentalism of the Poor, author Rob Nixon shed lights on the inattention to calamities “that are slow and long lasting, continuously dispensing devastation but without the necessary spectacle required to raise public outrage or sustain the fleeting attention (that) spans breaking news corporate media spectacles.”

Therefore, it is no surprise that the Kenyan public remains unaware of the humanitarian crisis in the form of extrajudicial killings in Nairobi’s slums. The MSJC brought this to light in 2017 after the launch of “Who is Next: A Participatory Action Report Against the Normalisation of Extrajudicial Executions in Mathare”. Between 2013 and 2015, over 803 cases were documented.

The report was the first major concerted effort by a grassroots movement to raise awareness about the reality of extrajudicial executions. Despite the moderate buzz created in human rights spaces, the killings have not stopped. The policing culture persists. In the month of May 2018, for instance, Wilfred Olal of the Dandora Justice Center reported that 15 young men had been gunned down. Justice for the victims is a long shot. Wangui Kimaru, a researcher at MSJC, told me that there have been only 4 convictions despite 9,000 cases being forwarded to the Independent Policing Oversight Authority (IPOA).

Human rights defender Kennedy Chindi says that there are between 10 to 15 cases of young men reported missing or killed by police every month in Nairobi’s informal settlements. Cases of police threats and intimidation deter the aggrieved from coming forward with information. “Everyone knows the killers but no one even dares call them by their names,” says Wyban Mwangi, a young musician. Instead, they use a codename, “Mjamaa”, for even in a valley of hundreds of thousands, the walls have ears. The names Hessy of Kayole and Rashid are whispered and the youth live in dread of who is next?

The Bill of Rights in the Kenyan constitution guarantees every person the right to life. Howeve,r in an unequal society, the rights of the poor come with no guarantees. The normalisation of the extrajudicial killings is an existential generational crisis. Amnesty International, Haki Africa and emerging grassroots organisations in Mathare, Dandora and Kayole have harrowing documentation of enforced dissapearances and deaths that are often atrributed to the police.

Encounter killings have turned urban ghettos into legalised hunting grounds, no different from the death match in the dystopian Hunger Games trilogy by American novelist Suzanne Collins. Or perhaps District 9, a South African sci-fi feature by Neill Blomkamp that astutely explores social segregation in a scathing satirical analysis of urban populations treated with the level of vile contempt reserved for pests. In Kenya, Tosh Gitonga’s Nairobi Half Life dramatises this unofficial routine killing of young males in a complex narrative of the cyclical violence of toxic masculinity where the line between the criminal and the police is blurrry.

Researcher Naomi Van Stapele, in her book Respectable “Illegality”: Gangs, Masculinities and Belonging in a Nairobi Ghetto, explained that the killings in Mathare continue without raising any public outrage because the dead are labelled as criminals or thugs, which justifies the executions. “Let the police do their work”, is the divorced public response. No one advocates for the killing of perpetrators of grand theft, but the children of the poor, the petty criminals (vermin) must be eliminated on the strength of suspicion. In the words of Trevor Noah, they are “born a crime”. In middle class circles, a conversation with a journalist friend turned into a sermon heavy on class snobbery. “Kenya’s ghetto mentality is what is holding those people in slums back.” Then he cherry-picked the example of musician Juliani as the mascot of possibility.

No one advocates for the killing of perpetrators of grand theft, but the children of the poor, the petty criminals (vermin) must be eliminated on the strength of suspicion. In the words of Trevor Noah, they are “born a crime”.

Local media has made a profession of reporting poverty through derogatory frames. Therefore, the numerous reports, occasional protests against police harassment and demonstrations do not draw media attention or public solidarity beyond the spectacle of tragedy.

Structural violence

These examples show that the slum ecology harbours systemic and structural violence that is silent. Johan Galtung, the celebrated Norwegian mathematician and sociologist, coined the term “structural violence”, which may be described as a form of violence wherein some social structure or social institution may harm people by preventing them from meeting their basic needs.

Like soil erosion, the effects of structural violence are not immediately obvious. Because its consequences only become evident in the distant future, there is little incentive for long-term solutions. Zangi, a resident of Mathare notes that it does not matter who comes to power; the problem is the system and the police culture. The problem is also the enabling physical environment that legitimises extrajudicial killings.

The Kenyan version of “electoral democracy” thrives in violent geographies. The problems of social justice are too many, too complex and not sexy enough for short-term political strategists who live for the optics in between elections to sustain popularity. Remedial environmental policy takes years. The benefits cannot be accrued in one political cycle and are certainly not bankable in the transactional nature of Kenyan politics. Article 42 of the constitution confers the right to a clean and healthy environment but is yet to interrogate systemic issues. The issues of the environment may be important but they not urgent.

The Kenyan version of “electoral democracy” thrives in violent geographies.

Therefore, to muster the political will needed to implement real change is difficult in a country where leaders cannot think beyond the next election. There are no immediate political rewards for planning to avert a human catastrophe. In nature terms, no one wants to plant a tree under whose shade they won’t sit or whose fruit they won’t eat. Long-term benefits may accrue for others and that is just not smart business in this instant gratification culture where exploitation and extractation is a privatised enterprise.

It is this context that we have to broaden the idea of what violence is. Personal violence is a consequence of structural violence. Lack of basic resources leads to competition that degenerates into violence in the quest for dominance. Gangs in urban ghettos organise around resources that leverage power and influence. Public toilets, garbage collection, water points, electricity connection and security are centres of frequent conflict. Kenyans awake to the economic and political realities of the 80s and 90s can track back how the slow violence of neoliberal policies began as a benign condition known as Structural Adjustment Program.

Beyond counting and documenting the victims of slow daily violence, the Mathare Green Movement is conscripting nature’s healing powers to challenge and alleviate the long-term effects of and sustain attention towards social injustice causes. Those grassroots environmental activists that Wangari Maathai called “foresters without degrees are at the forefront of plotting new futures, imagining new worlds and planting ideas of hope. Wangari Maathai underscored the need to keep environmentalism connected to global questions of human rights and social justice.

In a letter smuggled from a Nigerian jail, the writer-activist Ken Saro-Wiwa wrote: “The environment is man’s first right. That notion seems to have been forgotten in urban ecologies and serves as a focal point in articulating the experiences of oppressed people who are rendered invisible in the national economy and silenced when they demand to be heard.

Seeds of peace

Wangari Maathai’s Green Belt Movement brought a new discourse to the public consciousness, linking the slow violence of environmental degradation to its consequences, while at the same time proposing a public participatory methodology to advance environmental recovery. The Mathare Green Movement’s focus is young men facing the threat of extrajudicial executions who plant trees to reclaim lost life and dignify in the memory of peers labeled as criminal and forgotten after death.

The lesson of the Green Belt Movement is that poverty does not operate in a vacuum. Prof. Maathai’s brilliance was making clear the link between the collapse of the environmental economy and its support systems, on the one hand, and its revival as a strategy for eradicating poverty, on the other. She correctly diagnosed that corrupt exploitation of resources impacted vulnerable masses directly and insisted that environmentalism of the poor is inseprable from redistributive justice

Like the Green Belt Movement, the theatre of the tree gives the Mathare Green Movement a new vocabulary that is loaded with civic duty. Prof. Maathai called it “doing my little thing”. It is fitting that the new millennial generation of her disciples would emerge from Kenya’s marginalised urban spaces. Planting, not merely trees, but the seeds of life, healing, ideas, courage, hope and solidarity.

Prof. Maathai’s brilliance was making clear the link between the collapse of the environmental economy and its support systems, on the one hand, and its revival as a strategy for eradicating poverty, on the other.

The greening campaigns create the connection between environmental injustice and the erosion of social justice; the link between a healthy environment and quality of life. A tree has a right to grow to maturity, to fruit and bloom as every young life does in Mathare.

Planting trees in this spirit is more than a public relations exercise; it is work towards changing spaces so that they are less vulnerable to the elements and the forces that exploit the sense of deprivation. Importantly, it is the deliberate and conscious action of engaging in intergenerational optimism and responsibility, and accepting that we may never sit under the shade of the trees we plant.

Just as violence in Nairobi’s urban ghettos is continous and slow, so does healing through tree planting have to be a continous process. Urban reforestation that is people-centred is the primary symbolic vehicle for demanding ecological and social justice. The slow and deliberate effort of rehabilitating green spaces forces one to examine the systemic challenges that sustain these conditions. These young men choose to be eco-warriors, creating an enabling environment, restoring dignity and demanding the right to life from a state that minimises their existence. Wangari Maathai called it planting “seeds of peace” to stop the poverty profiling that disproportionately targets the poor. The existing structures of slow violence is why politicians consistently exploit the tensions in Nairobi’s slums during election cycles, easily igniting violence because below the surface, old antagonisms linger unresolved.

The Chipko movement, which originated in the Himalayan region of Uttar Pradesh in India in the 1970s, gained notoreity as a non-violent social and ecological movement whose members protected trees by hugging them to discourage loggers.

They are no trees to hug in Mathare. However, following in the footsteps of Wangari Maathai, the young people of Mathare will one day pass down trees of peace that stand for their right to security and protection from a state that terrorises its own citizens.

The lasting solution to ending direct and indirect violence against young lives is by adddressing the conditions that perpetuate the cycle of violence. Planting trees we must, but we can no longer fail to see the forest.

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NAIROBI: A city in which ‘contempt for the resident is everywhere apparent’

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NAIROBI: A city in which ‘contempt for the resident is everywhere apparent’

“The people are the city.”Citizens in William Shakespeare’s Coriolanus

At the crack of dawn, roughly between 5a.m and 7a.m, the “Great Trek” in Nairobi begins. Hordes of security guards, domestic workers, office cleaners, factory workers, vegetable hawkers, office messengers and jua kali artisans, among others, start their journey to work – on foot. It is a scene to behold. Thousands of people purposefully walking on roads meant for cars – sometimes for as long as three hours – to report to work by 8a.m., if not earlier.

These are the forgotten people, the ones the city’s urban planners have not catered for since Nairobi came into existence more than a century ago – when the city was planned as an apartheid city, built for a minority white elite that owned cars. Since then Nairobi has been characterised as a city that lacks pavements. Road builders either fail to build pavements during construction or pavements are so small or dilapidated that people have to use the road when walking.

However, even the roads meant for cars are failing the city’s residents. Traffic jams have become so normal in Nairobi that people plan their days around them. Moreover, recent proposals to have “car-free” days will not have the desired impact because those who use private cars are unlikely to walk to work or use public transport. To make matters worse, the frenzied construction of apartment blocks in residential areas has not been accompanied by a commensurate increase in the number of roads and pavements. On the contrary, the construction of office blocks and apartment buildings in many neighbourhoods has led to the uprooting of precious green spaces.

A World Bank study estimates that around 40 per cent of trips in Nairobi are made on foot. Matatus and minibuses account for 30 per cent of these trips while buses account for 10 per cent. Only slightly more than 10 per cent of the city’s population uses private cars. Unlike in many European cities, where walking is considered a lifestyle choice, and where pedestrian pathways and public transport is part of the transport infrastructure, in Kenya a large number of people walk because they can’t afford any other means of transport. Urban transport here is, therefore, not only deeply related to poverty and inequality but also to poor or non-existent transport infrastructure, including sufficient roads and pavements.

A World Bank study estimates that around 40 per cent of trips in Nairobi are made on foot. Matatus and minibuses account for 30 per cent of these trips while buses account for 10 per cent. Only slightly more than 10 per cent of the city’s population uses private cars.

According to Streets as Public Spaces and Drivers of Urban Prosperity, a UN-Habitat report published in 2013, Nairobi has allocated just 11 per of land to roads, which is way below the optimum level of around 30 per cent. (About a third of the land in Manhattan, for instance, is allocated to roads and pavements.) Moreover, the scarcity of roads is evident in both rich and poor neighbourhoods. For example, only 3 per cent of the land in both the up-market Muthaiga and the low-income Kibera is made up of streets. This is worrying because roads and pavements are not just important for mobility, they are also important for the development of related infrastructure, such as water and sewerage systems, which are usually laid down along existing road networks. According to the report, fewer roads and poor road connectivity make cities less prosperous.

Build it and they will come?

But will the construction of more roads improve mobility in the city? Not necessarily. Evidence suggests that more roads in urban areas can actually make mobility more difficult. During the Mwai Kibaki administration, for example, there was a concerted effort to build more roads and highways in Nairobi, ostensibly to ease congestion and improve transport infrastructure. The irony is that despite having more roads in the city, traffic in Nairobi has reached nightmare proportions

This contradiction was predicted some years ago by Enrique Penalosa, the former mayor of the Colombian capital Bogota, when he gave a public lecture at Nairobi University a few months before the construction began. Penalosa said that expansion of the road network in many cities had shown that instead of reducing vehicular traffic, the traffic actually increased. This could be attributed partly to the “build it and they will come” logic that is based on the idea that the building of infrastructure is itself an incentive for more people to use it.

In Nairobi, there has also been a marked increase in the number of private vehicles and matatus on the roads. The construction of highways has also improved connectivity with satellite towns, which has increased traffic flow into the city. These are probably some of the reasons why, despite the construction of several bypasses on Mombasa Road, Uhuru Highway remains the most congested main artery in the city at all hours of the day. The construction of the Thika Superhighway has had a similar effect: the highway has led to urban sprawl as satellite towns have emerged along it, with the result that more commuters from peri-urban areas are now using the highway.

The former mayor of Bogota said that instead of making more room for cars, cities should make more room for pedestrians, cyclists and mass rapid transit systems. This would encourage residents to use alternative forms of transport, which would lessen traffic on the roads.

When he was mayor of the Colombian capital Bogota between 1998 and 2001, Penalosa created a bus rapid transit system featuring bus-only lanes. Penalosa will also be remembered for building an extensive network of bicycle paths and pedestrian-only streets at a time when cities such as London and Paris had not even thought of them. (Now both London and Paris are emulating the Bogota example.)

Penalosa believes that today’s cities need to be totally re-designed to cater for pedestrians and cyclists. In an interview with the online Citiscope magazine, he stated: “For 5000 years we designed cities for people without cars. When cars appeared, we should have begun designing totally different cities. We did not. We just made bigger roads.”

When he was mayor of the Colombian capital Bogota between 1998 and 2001, Penalosa created a bus rapid transit system featuring bus-only lanes. Penalosa will also be remembered for building an extensive network of bicycle paths and pedestrian-only streets at a time when cities such as London and Paris had not even thought of them.

Streets as public spaces

In Nairobi, planners and policy makers are planning for vehicles, not pedestrians. This is in sharp contrast to trends in Europe where citizens are reclaiming their streets as “public spaces” by re-designing streets so that they are accessible only to pedestrians and cyclists. For instance, London has made parts of the famous Trafalgar Square inaccessible to cars and many European cities, including Copenhagen and Amsterdam, encourage the use of bicycles. Apart from the health and environmental benefits, the reclamation of streets as public spaces has immense social benefits. Streets become the great levellers where people from all walks of life meet and interact. This promotes social inclusion.

The idea that streets should be public spaces gained momentum in the mid to late 20th century when American urbanists, such as Jane Jacobs, suggested that “you need to walk a city’s streets to see its soul”. More recently, the American economist Edward Glaeser suggested that the most successful cities in the world are those that “enable us to work and play together” in close proximity and through physical interaction. These interactions are only possible when people mingle on streets and public spaces.

Penalosa is also a great advocate of public spaces, such as parks and playing fields. He notes that New York City created Central Park in 1860 when the city was much poorer than it is today, and that London, a heavily built-up city, has 1,500 public football fields that are open and free to all residents. (In contrast, Nairobi County Governor Mike Sonko had at one time suggested that Uhuru Park – Nairobi’s largest public park – be turned into a matatu stage. Neither under Sonko nor under any of the city’s former leaders have there been plans to build more public parks in the city. What’s worse, in recent years land grabbers have even attempted to steal playgrounds in Nairobi’s public schools.)

The idea that streets should be public spaces gained momentum in the mid to late 20th century when American urbanists, such as Jane Jacobs, suggested that “you need to walk a city’s streets to see its soul”.

Nairobi, like many African and Asian cities, seems not to have learnt lessons from European and other cities where there is a growing “liveable cities” movement that emphasises reduced dependence on motorised transport by making streets more accessible to cyclists and pedestrians. Nairobi’s streets are clogged with cars, matatus and private vehicles, and pavements are fast disappearing or are in a dilapidated state. Many streets do not even have pavements, and those that do are often encroached upon by hawkers and even by motorists. As one Kenyan commented on Twitter, “If there were pavements in Nairobi, motorists would drive on them.” The lack of adequate pavements and bicycle paths has also resulted in unnecessary deaths of pedestrians and cyclists; in fact, cycling and walking are considered among the most dangerous forms of transport in Kenya.

Penalosa is also against the new trend of shopping malls (which has become a rage in Nairobi), which he says deprives city dwellers of walking in and enjoying their city. Local corner shops disappear as the rich flock to enclosed malls. In Nairobi social apartheid that separates the urban rich from the urban poor is now becoming increasingly apparent in these up-market malls and gated communities.

Kenya Urbanization Review, a World Bank report published in February 2016, says that Nairobi is at a particular crossroad and can go down one of two main routes: It can either build its way out of congestion by building more roads to serve the increasing motorisation rate, or it can invest in public transport networks to promote a more compact and environmentally friendly city. “Either way,” says the report, “the fundamental priority is to avoid a trade-off between access and sustainability” that will lock Nairobi into highly land-consuming and car-dependant development patterns.

Devolution: Challenges and opportunities

Like most African cities, Nairobi did not grow as a result of a grand master plan – much of the city has grown spontaneously and haphazardly. Even when there were plans, they were largely ineffective because they did not reflect the reality on the ground and did not anticipate the rapid urban growth rate (driven largely by rural-to-urban migration) after independence in 1963.

For instance, if urban planners and policy makers understood that a large proportion of the city’s 4 million or so residents walk to work (because they cannot afford public transport), they would be ensuring that there would be more and wider pavements in the city and more affordable mass public transport. Urban planners are also in short supply. According to the World Bank report, in 2011 there were only 194 accredited urban planners in the whole of Kenya, compared to 1,690 in South Africa.

Nairobi has ambitions to become a “world class city”, but these ambitions are being hampered by the city’s delusional sense of its own importance that fails to recognise that more than half of the city’s population lives in overcrowded slums with few amenities, such as piped water or electricity. It is estimated that only 36 per cent of households in the city’s informal settlements have direct access to piped water. The urban poor in the city also pay more for water than rich households, as water has to be purchased from water vendors who sell them by the litre. Slum dwellers in Nairobi do not even have access to sanitation and are forced to use makeshift pit latrines. It is estimated that only 18 per cent of Kenya’s total urban population has access to a sewer system; 70 per cent of urban dwellers rely on septic tanks or pit latrines.

Tunku Varadarajan, writing in Forbes in September 2009, described Nairobi (along with Lagos, Karachi, Lima, Cairo, Jakarta, Dhaka, Caracas and Manila) as “an utterly charmless city” – “edgy, aggressive and inhospitable”, a city in which “contempt for the resident is everywhere apparent” and where there are “few parks and sidewalks, and scarcely any of the amenities that comprise the core of urban civilization”. Varadarajan’s assessment of the city may appear harsh, as other observers have commended the city for its vibrant culture and cosmopolitan nature. (Lonely Planet, for example, has described Nairobi as one of the best cities in the world, and has praised it for its “excellent nightspots and good music scene”). However, it is clear that Nairobi lacks the one thing world class cities have – a safe, affordable, reliable and well-regulated public transport system.

Tunku Varadarajan, writing in Forbes in September 2009, described Nairobi (along with Lagos, Karachi, Lima, Cairo, Jakarta, Dhaka, Caracas and Manila) as “an utterly charmless city” – “edgy, aggressive and inhospitable”, a city in which “contempt for the resident is everywhere apparent”

Poor leadership and corruption have further contributed to creating an urban culture that lacks vision. If Nairobi was a place that catered for the majority of its residents’ needs, there would be more pavements, bicycle paths, public parks, public toilets and playing fields in the city. But a land grabbing frenzy has ensured that even the few green spaces (and even public toilets) in the city have now become concrete blocks.

The fundamental reason why Nairobi is so dysfunctional is because its dysfunction is self-perpetuating. Urban dwellers do not demand better infrastructure and services and expect little from the authorities, which leads of a vicious cycle of low expectations, little infrastructure investment and low productivity. When the city fails to provide services, such as garbage collection, those residents who can afford it hire private garbage collectors. The same applies to security, water provision and other essential services. This has resulted in widening the gap between the haves and the have-nots.

Devolution may have actually contributed to the city’s woes as there is no longer a City Council or Ministry of Local Government to blame. The 1963 Local Government Act created 175 local authorities in Kenya, which were abolished under the new constitution that was promulgated in 2010. As required by Article 184 of the constitution, national legislation should provide for the governance and management of urban areas.

The Urban Areas and Cities Act (Revised 2015 edition) does provide for a system of city and municipal boards and town committees that are tasked with adopting urban policies and strategies, including on service delivery and land use. However, the criteria for the creation of these boards are rather restrictive, and could serve as a deterrent to the formation of such boards, especially in poor and largely rural counties.

One of the conditions for the creation of a city or municipal board is that the city or town should have the capacity to generate sufficient revenue to sustain its operations, which is difficult for many of the poorer counties that rely on the national government to carry out operations, including the building of roads that are not part of the national highway network. Nairobi, Kenya’s largest and wealthiest city, collected Sh11.7 billion in revenue in 2015/16, but it is the exception in a country where the majority of towns have populations of less than 250,000 and where urban-based activities are not the mainstay of largely rural economies. Another condition is to have the capacity to effectively and efficiently deliver services, which is a tall order for most smaller towns in Kenya.

One of the pitfalls of devolution is that urban areas may suffer under a system where devolved funds are being used to cater mostly for rural populations in the counties, rather than to the needs of urban dwellers. While this is understandable, given that the majority of counties are predominantly rural and considering the marginalisation of several regions under the previous centralised system, neglecting urban areas may come to haunt counties in the future.

As the World Bank’s Kenya Urbanization Review report concluded, Kenya’s ambitious experiment in devolution holds great promise and comes at an important period but aspects of the process may weaken urban centres at a time when they need to be strengthened. “On balance,” says the report, “Kenya still has an opportunity to leverage urbanization to drive economic growth. It is in the early stages of urbanization, and evidence suggests that cities can drive economic development – especially when they are developed through a ‘system-of-cities’ approach and where devolution empowers counties…to develop strong urban centers.”

One of the pitfalls of devolution is that urban areas may suffer under a system where devolved funds are being used to cater mostly for rural populations in the counties, rather than to the needs of urban dwellers. While this is understandable, given that the majority of counties are predominantly rural and considering the marginalisation of several regions under the previous centralised system, neglecting urban areas may come to haunt counties in the future.

Urbanisation and economic growth

The 2009 Kenya census shows that nearly one-third of the country’s population is now urban, but urbanisation levels are still way below those of other African countries. In fact, along with Burundi, Rwanda and Uganda, Kenya has among the lowest urbanisation levels in the world. This has implications for the country’s economic prospects.

Nairobi, and Kenya as a whole, need an urban strategy that increases productivity and promotes inclusion. Studies have shown that there is a direct correlation between levels of urbanisation and economic growth – in general, most countries do not attain middle income status until they are at least 50 per cent urban. In 2009, the World Bank published a report by the Commission on Growth and Development that showed that there is a clear and robust relationship between urbanisation and per capita income in nearly all countries. The report stated that to achieve middle-income status, countries need to have at least half their populations living in urban areas and that “in all known cases of high and sustained growth, urban manufacturing and services led the process”.

The first challenge, of course, is to make cities and towns sites of high-productivity industries. The second challenge is managing the negative consequences of growth on urban areas, including congestion, pollution, inequality and slum formation. Both challenges require investments in infrastructure – but only if that infrastructure does not contribute to other problems (like pollution and congestion) and if it contributes to making productivity more efficient.

In its current state, the transport infrastructure in cities like Nairobi has proved to be an impediment to productivity as most workers spend more time commuting than engaging in productive activities. Over-dependence of private mini-buses (matatus) has also led to a situation where other forms of public transport have been crowded out, leading to increasing congestion and air pollution.

Building more roads has not helped either because the roads fail to cater for the majority of residents who walk, cycle or use public transport. As Edward Glaeser reminds us in his book, Triumph of the City: How our greatest invention makes us richer, smarter, greener, healthier and happier, “The folly of building-centric urban renewal reminds us that cities aren’t structures; cities are people.”

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AN ODE TO SILENCE: The Church’s abdication of its role in society

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AN ODE TO SILENCE: The Church’s abdication of its role in society

The Church in Kenya struggles in silence while endemic corruption ravages the public and private sectors of the country.  On this matter, I’d rather lament with Prophet Jeremiah when he supplicated the appalling backsliding of his people by asking: “Is there no Balm in Gilead? Is there no physician there? Why is the wound of my people not healed?”, rather than sing in faith, the Negro spiritual affirming: “There is a balm in Gilead to heal a sick, sick soul…”

Wounds inflicted by corruption on this nation will need a more “potent balm”, yes, more than an “expert physician”, for neither the laws enacted so far nor the commission instituted to deal with the scourge have proven effective.

The law is clear: Corruption, active and passive bribery, abuse of office and bribing a foreign public official are outlawed under the Anti-Corruption and Economic Crimes Act 2003, which is further reinforced with the Bribery Act of 2016 ostensibly to aid in the fight against the supply side of corruption.

Comprehensive enforcement of Kenya’s anti-corruption framework, however, remains a challenge because of weak and corrupt public institutions.

But in choosing silence in the face of this obscene level of corruption, perhaps at the counsel of the English poet Thomas Carlyle (“Silence is Gold”) or the American rock song by the Tremeloes (“Silence is Golden, but my eyes still see, Silence is Golden, but my eyes still see…”), the Kenyan Church is abdicating its unique and vital role in society. What has become of the once-vibrant voices within the Church who challenged the draconian Moi rule, risking their lives for a just cause?

Then the Church took a radical and militant approach. It was not afraid to say, like the prophets of old: “Thus says the Lord…” It had clarity on matters of national importance affecting the people, unlike its counterparts today, who are even failing to define their own mandate.

Pope Benedict XVI is emphatic about the role the Church should play in society.  He defines the Church’s role in the political sphere as primarily education (understood not as schooling, no matter how important that is): “The Church must awaken man’s receptivity to the truth, to God, and thus to the power of conscience. It must give men and women the courage to live according to their conscience and so keep open the narrow pass between anarchy and tyranny, which is none other than the narrow way of peace.”

Then the Church took a radical and militant approach. It was not afraid to say, like the prophets of old: “Thus says the Lord…” It had clarity on matters of national importance affecting the people, unlike its counterparts today, who are even failing to define their own mandate.

He also highlights the need for society, both local and global, to recover the divine element in our humanity, which includes moral consensus, without which society flounders and humanity is endangered.

There are some though, who would rather have an aloof Church and one that is measured in contentious matters of public concern. Stephen Carter, the Yale scholar, in his book, The Culture of Disbelief, laments that “our public culture more and more prefers religion as something without political significance, less an independent moral force than a quietly irrelevant moralizer, never heard, rarely seen.”

Could it be that the dearth of the prophetic voice is a sign of a Church struggling to define itself and its societal role in the post-2003 era? Kenya needs to hear what the Church is thinking and saying on corruption. The Church cannot extricate itself from politics because it cannot refrain from the task of reflecting on the implications of its faith within our political context. It has reason to intervene, for we cannot afford the haemorrhaging of this country through corruption.

A 2016 survey released by Pricewaterhouse Coopers (PwC) indicated that the rate of economic crimes in Kenya is 25 per cent above the global average. It further revealed that every record set against stealing is broken. In the year 2015 alone, economic crimes rose to 61 per cent from 52 per cent in 2014 and maybe worse today. Philip Kinisu, a retired auditor and a former chairman of the Ethics and Anti-Corruption Commission (EACC) told Reuters: “Kenya is losing a third of its State budget – the equivalent of about $6 billion (KShs. 608 billion) – to corruption every year.”

Our plight did not escape the notice of former United States President Barack Obama during his visit in 2015. He rightly criticised Kenya’s corruption, inequality, and tribalism before an audience, which included President Uhuru Kenyatta and his Cabinet, at Kasarani Sports Centre in Nairobi.

Obama quoted a study showing that every year corruption costs Kenya 250,000 jobs. He said rising prosperity in the economy was leaving out the vast majority of the people, the burden of which is borne by the poor.

This is exactly what Samuel Paul of the Public Affairs Centre in Bangalore established in “Corruption: Who Will Bell the Cat?” His study found that in five Indian cities, poor households were much more likely to pay “speed money” for public services than households in general. Consequently, when access to public goods and services requires a bribe, the poor may be excluded. Given their lack of political influence, the poor may even be asked to pay more than people with higher incomes. Furthermore, when corruption results in shoddy public services, the poor lack the resources to pursue “exit” options, such as private schooling, health care or power generation.

We can learn from the struggles of the 1980s, during which Galia Sabar, Professor of African Studies at Tel Aviv University, observed that limited political association paralysed the process of transforming information and ideas into action. As such, she gave credence to the emergence of informal individual activism and the culture of defiance that was growing day by day.

On the frontline of Kenya’s individual Church activism during the Moi era were the Anglican Church’s Bishop Henry Okullu of Maseno South Diocese, Bishop Alexander Muge of the Diocese of Eldoret, Bishop David Gitari, the Anglican prelate of Mt. Kenya East diocese, and Rev. Timothy Njoya, a moderator in the Presbyterian Church of East Africa (PCEA). These clerics triggered the much-needed change in the country through their political engagements.

Citing the February 1990 edition of Finance magazine, Sabar in “Politics and Power in the Kenyan Public and Recent Events: the Church of the Province of Kenya, said: “Irrespective of how much we might belittle their social standing, the clerics represent the most cohesively structured, the most firmly organised and the most solidly unified institution in the country.”

Stephen Kapinde, a lecturer at Pwani University’s Department of Philosophy and Religious Studies, observes how the vitality of the pulpit as a stable platform for change and the sermons of Bishop Gitari (at a time when the state had censored nearly everyone and proscribed gatherings of more than three people) gave credence to the Church in political discourses. The prelate and his peers developed a culture of resistance through the pulpit.

Prof. Robert Press, in his book, Peaceful Resistance: Advancing Human Rights and Civil Liberties, gave more insight into this culture by observing that:

Individual activists can only do so much in their role as ice-breakers in the reform process. Organizational activists build on their advances but need the presence of members of the public at their events to make a serious bid for reforms. The public, in turn, needs the forum for the activists to express their discontent. Together the resistance sends signals to the regime, the public and international officials and agencies that the demands for change have substance and visible public support.

For this reason, the clergy blazed the trail for democratic reforms from their pulpits. Amazingly, such activism was thought by many to defile the pulpit, while in essence, the clerics used the space to liberate the people of Kenya, thereby living up to their calling to be “salt” and “light” in the world.

The contrast is huge today – pulpits are not as sacrosanct and neither are their messages. The frequency with which politicians have graced churches with goodies from corruption, coupled with the silence of clerics, is troubling.

For this reason, the clergy blazed the trail for democratic reforms from their pulpits. Amazingly, such activism was thought by many to defile the pulpit, while in essence, the clerics used the space to liberate the people of Kenya, thereby living up to their calling to be “salt” and “light” in the world.

For instance, Deputy President William Ruto has been a darling of Churches during funds drives, notwithstanding the fact that he has been named in a litany of corruption-related scandals. Indeed, former Prime Minister Raila Odinga in 2015 described him as “the high priest of corruption in Kenya.”

The Anglican Church had an explicit stand on the widespread habit of inviting public figures as guests of honour at fund-raising events. Following the Provincial Board of Christian Community Services consultation on “The Theology and Philosophy of Development” held at St. Julian Centre between 11th and 13th May, 1983, the Church issued protocols to protect the likely erosion of the Church’s prophetic role in society:

Inviting public figures as guests of honour at Church harambees or giving them prominence in a church function merely because of the money they bring is not in accordance with our Christian principles. It tends to silence the prophetic voice of our church leaders (A report of the CPK Consultation on Theology and Philosophy of Development, 1989: p. 5, ¶4).

Today, however, several Anglican Churches have overlooked this protocol and indulged the said politicians on their pulpits, thus diluting their prophetic voice. How would they escape the tag of being an accomplice to corruption? They should have heeded Joseph Kamaru’s warning in his song, J. M. Kariuki, “gûtirí múicì na mùcudhìríria” (there is no difference between a thief and a mere observer).

The contrast is huge today – pulpits are not as sacrosanct and neither are their messages. The frequency with which politicians have graced churches with goodies from corruption, coupled with the silence of clerics, is troubling.

According to British evangelist and theologian G. Campbell Morgan, “Sacrilege is defined as taking something that belongs to God and using it profanely. But the worst kind of sacrilege is taking something and giving it to God when it means absolutely nothing to you.” If we accept this, then the Church would have committed double sacrilege in this indulgence: Knowingly giving platform to sanitise corrupt money in the name of God, and perpetuating delusion that that is investing in heaven.

How do I answer my friend Joe Kobuthi’s query: “What does it mean when the Church goes quiet or turns a blind eye to corruption to the extent that a politician like Ruto can claim his contributions to churches to be ‘investing in heaven’”?

The Church, by indulging in questionable money being “invested” in its programmes, undermines its own ability to help the poor. Proper “investing in heaven” is investing in Christ. St. John Chrysostom (347-407 AD), one of the greatest Early Church Fathers of the 5th century, warned: “Of what use is it to weigh down Christ’s table with golden cups when he himself is dying of hunger? First, fill him when he is hungry; then use the means you have left to adorn his table. Will you have a golden cup made but not give a cup of water? What is the use of providing the table with cloths woven of gold thread and not providing Christ himself with the clothes he needs? What profit is there in that?”

How do I answer my friend Joe Kobuthi’s query: “What does it mean when the Church goes quiet or turns a blind eye to corruption to the extent that a politician like Ruto can claim his contributions to churches to be ‘investing in heaven’”?

How about using one’s position in government to save the annual 250,000 jobs lost to corruption? Wouldn’t that give many Kenyans opportunities to feed their hungry, and not to leave them to stare at Church tables embellished with gold? Investing in heaven would mean putting to proper use the US$6 billion lost to corruption to provide for proper health services and housing for homeless Kenyans.

The Kenyan public is livid at the multi-million-dollar scandals that have failed to result in high-profile convictions. They accuse politicians and top government officials of acting with impunity and encouraging graft by those in lower posts.

Again, Kinisu opines the real drive to stamp out corruption has to come from public pressure for change. Yet in an environment of fear and intimidation by corruption cartels and politicians, it becomes nearly impossible to set up any social movement against corruption.

A curious episode in J.R.R. Tolkien’s The Fellowship of the Ring is instructive, as it well depicts our challenge on corruption:

“I wish it need not have happened in my time,” said Frodo.

“So do I,” said Gandalf, “and so do all who live to see such times. But that is not for them to decide. All we have to decide is what to do with the time that is given us”.

It is not freedom from corruption, but rather the freedom to take a stand against it, that we must all pursue. If the Church is to retain its credibility and relevance, I believe it needs to utilise its eminent position to influence public opinion on matters affecting the nation. I would like to believe that, sooner or later, it will recover its earlier prophetic fervour for the sake of the public good and provide the moral leadership we so desperately need today in the epic fight against corruption.

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