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.
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.
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Do You Know What Is on Your Plate?
You may not know it but you’ve probably been ingesting carcinogenic, mutagenic and neurotoxic chemicals along with your ugali, sukuma wiki and kachumbari.
I had never really given much thought to what I ate and how it was produced. That is until, in the early 90s, an outbreak of Bovine Spongiform Encephalopathy – BSE, more commonly known as mad cow disease – led to the slaughter of 4.4 million head of cattle in the United Kingdom in an effort to contain the disease, and to a decade-long ban of British beef exports that ruined that country’s beef industry. The BSE outbreak is thought to have been caused by the practice of supplementing cattle feed with meat-and-bone-meal (MBM) rendered from the remains of other animals. The disease soon crossed over to humans through the consumption of BSE-contaminated beef, a new version of the neurological Creutzveld-Jakob Disease (vCJD) that took its first victim in May 1995 and has killed 177 people to date. In 2013 researchers reported that one in 2,000 people in the UK are carrying the human form of mad cow disease.
That same year, in February, a government livestock inspector was assassinated outside his home in the Belgian Flanders; Karel Van Noppen had been investigating the illegal trade in synthetic growth hormones that unscrupulous beef farmers were using to speed up the fattening of beef cattle and turn a quick profit. The use of synthetic growth hormones in cattle rearing has been found to have adverse effects on human health. I was living in Belgium at the time and I started asking myself what I had been eating. I wasn’t the only one; by the end of the decade, astute beef farmers were turning a tidy profit from the sale of organic beef to consumers like me who had become wary of the factory methods of production that had led to the BSE crisis.
With the appearance of organic beef on Belgian supermarket shelves, other organic produce soon followed and the shelf space dedicated to organic foods steadily grew. IFOAM-Organics International defines organic agriculture as “a production system that sustains the health of soils, ecosystems, and people. It relies on ecological processes, biodiversity and cycles adapted to local conditions, rather than the use of inputs with adverse effects. Organic Agriculture combines tradition, innovation, and science to benefit the shared environment and promote fair relationships and good quality of life for all involved.”
Today, in the West at least, it is perfectly possible to eat, drink and even dress only organic; but you must have deep pockets because organic produce is more expensive than conventionally grown produce.
The right to adequate food is recognised in the 1948 Universal Declaration of Human Rights and is enshrined in the 1966 International Covenant on Economic, Social and Cultural Rights of which Kenya is a signatory. The Office of the High Commissioner for Human Rights of the United Nations clarifies that the right to adequate food implies that food must be available, accessible and it must also be adequate, meaning that “the food must satisfy dietary needs . . . be safe for human consumption and free from adverse substances, such as contaminants from industrial or agricultural processes, including residues from pesticides, hormones or veterinary drugs . . . .” The irony is that even though produce that is certified organic meets all of these requirements, it is not produced in sufficient quantities and where it can be found, it is beyond the reach of most consumers, whether they are in the West or here in Kenya.
Having jumped on the organic consumers’ bandwagon back in Brussels after the 1998 dioxin- contaminated chicken crisis finally convinced me to abandon conventionally-grown produce, I was keen to maintain the lifestyle once back in Kenya, only to find the limited choice of produce that is certified organic prohibitively expensive. I did the next best thing and decided to grow organic fruits and vegetables, both for my own consumption and for sale to the end consumer, and thus did I come into close contact with the world of farming.
City girl born and bred, and never having grown so much as a blade of grass, I needed all the help I could get and turned to Mr John Wanjau Njoroge, founder and director of the Kenya Institute of Organic Farming and a pioneer of the organic movement in Kenya. Mr Njoroge sent me a recently graduated young couple who set me on the road to organic farming. It has been a steep learning curve; after a first successful crop of greenhouse tomatoes, bacterial wilt decimated the second one.
Kenyan smallholder farmers produce 80 per cent of the 400,000 tonnes of tomatoes produced annually — representing 7 per cent of all horticultural produce grown every year — but commercial production of the fruit is fraught with difficulties; if it isn’t tuta absoluta, it is fusariam wilt, or if you’re really unlucky, it is both. And so, to control these and other pests and diseases, farmers reach for chemical pesticides and fungicides.
The trade in pesticides in Kenya is largely in the control of private sector distributors and retailers who import and distribute the products to the Kenyan end-user, but there appears to be a training deficit in the safe use of these chemicals. Farmers rely on agrovets and agricultural extension officers for information on pesticides, yet the Kenya Organic Agriculture Network (KOAN) has reported that “they are recommending pesticide products that are toxic to human health, bees and fish”.
An analysis of pesticide residues in tomatoes and french beans from Murang’a and Kiambu counties found the presence of omethoate in tomatoes, an active ingredient whose use in vegetables is banned in Kenya, suggesting “poor pesticide handling practices by some tomato farmers in the two counties”.
And the situation is not much better in Laikipia County where a 2019 study of pesticide application and pesticide residue levels in kales and tomatoes in the Ewaso Narok wetland found that the majority of farmers had no training in the use of pesticides. The study also found chlorpyrifos and diazinon residues in the tomatoes sampled; both these active ingredients are banned in the European Union.
It is particularly worrying that chlorpyrifos — a pesticide that is harmful to the brains of foetuses and young children — can still be found on the Kenyan market. Chlorpyrifos was banned in the EU in February 2020 but it is also one of the seven active ingredients in the pesticides and fungicides that were found by KOAN to be in use in Kirinyaga and Murang’a counties.
KOAN reports that “The pesticides withdrawn in Europe are mostly used on tomatoes (15 active ingredients), followed by kale (14), maize (14), cabbage (10), coffee (10) and french beans (6). Since tomatoes, kale, maize and cabbage are part of the daily Kenyan diet, there is a real and significant threat to food safety.” The study found that tomatoes had the highest toxicity score, followed by kales and maize, all foods eaten by Kenyans daily.
It is particularly worrying that a pesticide that is harmful to the brains of foetuses and young children can still be found on the Kenyan market.
But even more worryingly, KOAN reports having found high residue levels of acephate and methamidophos in the tomatoes sampled. Acephate, which has been withdrawn in Europe, is registered by the Pest Control Products Board for use on roses and tobacco. Methamidophos is not registered for use in Kenya.
The reason why active ingredients which have been withdrawn in the EU (or whose use is restricted) find their way to Kenya is because of the so-called Double Standard; EU Regulation EC304/2003 allows EU companies to produce and export to other countries pesticides that are banned or restricted in the EU, effectively protecting EU citizens while exposing non-EU citizens to the ravages of dangerous chemicals and infringing on their right to food that is safe for human consumption. Indeed, the United Nations Special Rapporteurs on Toxic Wastes and the Right to Food have found that “widely divergent standards of production, use and protection from hazardous pesticides in different countries are creating double standards, which are having a serious impact on human rights.”
And while the Rotterdam Convention requires an exporter based in an EU member state to indicate their intention to export banned or severely restricted chemicals to a non-EU country so that the latter is alerted, this arrangement is hypocritical and merely serves to enable EU companies to continue manufacturing dangerous chemicals for sale in non-EU countries while providing them with the ready excuse that importing countries are aware of the nature of the chemicals they are bringing in.
Domesticating the 1966 International Covenant on Economic, Social and Cultural Rights, Article 43 (1) (c) of the Constitution of Kenya 2010 states that, “Every person has the right to be free from hunger, and to have adequate food of acceptable quality.” In line with this last requirement, and in the face of the dangers presented by the poorly regulated trade in pesticides, the Route to Food Initiative (RTFI), Biodiversity and Biosafety Association of Kenya, Kenya Organic Agriculture Network and Resources Oriented Development Initiative petitioned the National Assembly in September 2019 to withdraw harmful pesticides from the Kenyan Market.
In their petition, they reported that there are products on the Kenyan market which are classified as carcinogenic (24), mutagenic (24), endocrine disrupter (35), neurotoxic (140) and many others which have been shown to have an effect on reproduction (262). The petitioners argued that, while the volume of imports of insecticides, herbicides and fungicides had grown 144 per cent between 2015 and 2018, there was no data available concerning pesticide use and its impact on food and the environment, and also noted that the increase in pesticide use had not been accompanied by the necessary safeguards to control their application.
The petitioners also said that by failing to publish information in its possession on the levels of pesticide residues in food samples collected, and to put in place a monitoring system, the Kenya Plant Health Inspectorate Service (KEPHIS) was acting in contravention of Section 15 of the Pest Control Products Act. The petitioners also accused the Pests Control Products Board (PCBP) of failing to adhere to the international codes of conduct of the World Health Organization (WHO) and the Food and Agriculture Organization (FAO).
In its report on the petition tabled a year later in October 2020, the National Assembly’s Departmental Committee on Health responded that a blanket ban “without due consideration or risk assessment will not help, especially in the tropical conditions and areas experiencing an invasion of pests and diseases throughout the year.” The committee also argued that “severe limitation of the number of products available . . . will make sustainable use of plant protection products difficult, particularly managing the development of resistant pest populations.” The committee claimed that such a ban would threaten food security, lead to expensive food and reduced farmer incomes due to insufficient production.
The committee did however recommend that the PCPB develop regulations to ensure that only licensed and registered persons run agrovet outlets, and that the Ministry of Agriculture, Livestock and Fisheries undertake an analysis of the products on the Kenyan market in order to exclude those that are carcinogenic, mutagenic, neurotoxic and endocrine disruptors, and recommend the withdrawal from the Kenyan market of harmful and toxic pesticides. All this was to take place within 90 days.
Well, I visited two agrovets in our little township here in Nyandarua County who both told me that PCPB inspectors came calling last year to ensure that licence fees were paid and to ascertain that the products on their shelves had the PCPB logo indicating that they are authorised for sale in Kenya. Neither has been informed of any changes in the PCPB list of pest control products registered for use in Kenya and I could have bought pesticides and fungicides containing all but two of the active ingredients that KOAN found on produce in Kirinyaga and Murang’a counties: chlorpyrifos, which as I have mentioned above is harmful to the brains of foetuses and young children; diazinon, a neurotoxic organophosphate; permethrin, a neurotoxin that is also highly toxic to animals, particularly fish and cats; bifenthrin, which has been classified as a possible carcinogenic; and carbendazim, a mutagenic fungicide that can cause birth defects and damage fertility. These active ingredients — all of which are banned in the EU — are among the top ten most harmful ingredients in terms of toxicity for humans and the environment.
Route to Food, which has done a study on pesticide use in Kenya, notes that, “Pesticides can persist in the environment for decades and pose a global threat to the entire ecological system upon which food production depends. Excessive use and misuse of pesticides results in contamination of surrounding soil and water sources, causing loss of biodiversity, destroying beneficial insect populations that act as natural enemies of pests and reducing the nutritional value of food.”
If we are agreed that access to safe food is a human right, then we must reject food production methods that endanger our health and put our lives in peril, that pollute our water and our environment and jeopardise our biodiversity, methods that put the profits of the shareholders of companies domiciled in foreign countries before the wellbeing of Kenyan consumers.
It is ironical that Kenya goes to great lengths to meet the phytosanitary conditions and Maximum Residue Levels (MRLs) imposed by the EU – Kenya’s main market for horticultural exports – while at the same time exposing its own citizens to the dangers of toxic pesticides manufactured in the EU.
If we are agreed that access to safe food is a human right, then we must reject food production methods that endanger our health.
We are not condemned to remain on the path of industrial agriculture, which has proven to be so devastating to the environment and to human health. As Daniel Maingi notes, “Perhaps it is time we looked to nature and farmers’ know-how in using another branch of science called agroecology” which, as the Food and Agriculture Organization (FAO) has recognised, is “holistic, balancing focus on people and the planet, the three dimensions of sustainable development – social, economic and environmental – while strengthening the livelihoods of smallholder food producers.”
We must therefore be vocal in our support of the endeavours of organisations such as the Route to Food Initiative, Biodiversity and Biosafety Association of Kenya, the Kenyan Organic Agriculture Network and Resources Oriented Development Initiative, in order to ensure that the recommendations of the National Assembly’s Departmental Committee on Health do not remain a dead letter but form the basis of a fundamental change in the way we produce the food we eat.
How Biotechnologies are Shaping Kenya’s Food Ecosystem
Kenya has severally taken the top spot in “enabling the business of agriculture” annual rankings, opening its doors to patent-protected biotechnologies that could lead to the effective loss of our food sovereignty.
It has been said that he who controls the food, controls the people. But others have added that he who controls the seed, controls the food system. The race by multinational corporations (MNCs) to own and register patent protection on seeds and genetic traits, including DNA sequences, has led to a hierarchy of big players who now dominate the global markets through national and international legal instruments.
We have reached the stage where only four corporations dominate the global seeds and genetic traits markets, as they roll out patent-protected biotechnologies to both large and smallholder farmers worldwide. This is seen as a critical step in shaping food ecosystems here in Kenya and elsewhere in the world.
Power relations and roles in the biotech industry
During the last three years the world has witnessed spectacular mergers and acquisitions amongst the biggest actors in the industry — DowDuPont now Corteva, Bayer-Monsanto now just Bayer, and Syngenta/ChemChina. Together with BASF, these merged MNCs now control over 70 per cent of the global seed and pesticides market.
Their far-reaching wealth and power has been enabled by states and government actors working with global organisations such as the WTO (World Trade Organization) and UPOV (Union for the Protection of New Plant Varieties). The consequences have been a concentration of market share and influence, capital accumulation, and unprecedented economies of scale which have led to the marginalisation and the disinheritance of our common seed and genetic resources. The process of agricultural investment in so-called biotech innovation has come to be known as “the Green Revolution” or, increasingly now, the “Gene Revolution”.
Green Revolution (GR) is best understood as the wide-scale adoption and use of disruptive agricultural research and various technologies, including biotech, that are intended to increase agricultural productivity. Green revolutions therefore effectively convert farming and agriculture into an industrial system, because of the extensive adoption and use of new high-yielding seed varieties that often must be accompanied by the intensive use of mechanisation, large volumes of water and expensive irrigation infrastructure, pesticides, and fertilisers. The seed is a critical piece of GR and is the first portal to creating large-scale bio-economies, and imposing and enforcing patent and breeders’ rights protection through national and binding international laws.
The larger GR endeavour was initiated by Norman Borlaug. With funding from the Rockefeller Foundation, Borlaug helped develop high-yielding dwarf varieties of rust-resistant wheat. The Green Revolution’s early success in India was led by the agricultural scientist M. S. Swaminathan. He is known as the “Father of Green Revolution in India” for his role in introducing Borlaug’s dwarf varieties of wheat and rice in India. One of the impacts of this green revolution was that the yields of wheat and rice doubled, but the production of other food crops such as indigenous rice varieties, sorghums, millets, and pulses declined. This led to the loss of distinct indigenous varieties from cultivation and also caused the extinction of others.
Seed biotechnologies have profoundly changed consumption patterns over the years; the dietary diversity of India’s population has decreased as Indians eat more wheat and rice devoid of nutritive value. Studies have shown that traditional coarse cereals (complex carbohydrates, high protein) have been permanently replaced by more white wheat and polished rice diets (simple carbohydrate, low protein), with the accompanying effects of obesity and malnutrition. An overweight population (BMI>25) has emerged as a new public health challenge, and this is most evident in large-landholding households, especially in the high-input agriculture areas.
In Africa, the first green revolution was a failure and efforts have been underway for a relaunch. The Alliance for a Green Revolution in Africa (AGRA) was founded in 2006 to bring high-yield agricultural practices and biotechnologies to millions of smallholder farming households. Bill Gates has an absorbed relationship with the wonder of computers and technologies. Fascinated by the possibilities of big data and biotechnologies as the centerpiece for a new disruptive revolution in Africa’s agriculture, Bill Gates, through the Bill & Melinda Gates Foundation, together with partners including the Rockefeller Foundation, have collectively pumped more than US$1 billion in funding to the Nairobi-based AGRA.
Indians now eat more wheat and white rice devoid of other nutrients that used to come from the inclusion of sorghum, millet and mung beans in traditional diets.
To the delight of agribusiness corporations, GR means an expansion in the use of new biotech seeds, fertilisers, pesticides and, of course, irrigation infrastructure and the related mechanisation. To ensure that new seed technologies are adopted and used on a larger scale, Bill Gates has also channeled significant funding to entities such as the African Agricultural Technology Foundation (AATF), African Seed Trade Association, Kenya’s seed trader associations, and private companies. The goal is to influence and catalyse the transformation of agriculture policies and legislations and open up Kenya for commercial agriculture.
Together with the World Bank, the Gates Foundation has funded local stakeholders to lobby and advocate for reforms to remove “obstacles” in policies, laws, and regulations in agriculture, in what they term as “enabling the business of agriculture” (EBA). The annual ranking of countries is closely watched by investors and used by the World Bank, USAID, DfID, and other bilateral donors, to guide their funding. As a result, EBA drives the race to deregulate. Governments in poor countries compete with each other to “reform and change their agricultural laws” so that they can be ranked among the “Doing Business” best performers. Kenya’s performance in these rankings is also keenly followed by pro-biotech advocacy lobby groups.
The technology is the seed
Seeds carry the genetic traits or DNA sequences claimed as proprietary rights by the breeders or corporations that control them. The technology is in the seed and is the seed. Through stewardship agreements, farmers purchase seed, promise and sign on the dotted line that they are merely renters of the biotechnology and not owners. As such, they cannot multiply that seed for replanting; new seed must be purchased. They can also not store, give to others or even sell their harvested seed. Failure to adhere to these terms is a violation punishable by national and international laws. This means that MNCs are effectively controlling what food ecosystems emerge once a country decides to rely on biotech-gene seeds. It is an effective loss of food sovereignty and an abuse of farmers’ rights to seed, including the right to food at the household level.
Unfortunately, there have been many incidences where seed corporations systematically replace indigenous seeds with their proprietary hybrids through “generous donations”. After a few seasons, faced with a lack of alternative sources, the users must purchase patent-protected seeds.
Such is the case of the recently rolled-out Bt. cotton hybrids in Kenya. Dubbed first-generation biotech crops, Bt. traits focused on increasing market share and profits to patent holders by promising to eliminate the need for pesticide sprays against a limited range of insects. Another GM crop resistant to Round-up herbicide sprays caused enormous increases in Bayer’s sale of its herbicide, resulting in massive increases in market dominance. Once these crops become entrenched in the market and food ecosystem, farmers are often faced with a serious challenge as there are no alternative versions from other competing companies. In Kenya — as in India — Bayer-Mahyco has absolute power and market control, a situation enabled by the government with little public discourse.
Through stewardship agreements, farmers must purchase seeds and promise by signing on the dotted line that they are merely renters of the seed and not owners.
In the second-generation biotech crops, there was a focus on the traits desired by farmers, and much of the research was funded by public-private partnerships, as opposed to being funded only by the private sector, as was the case for first-generation GMOs. Virus-resistant cassava and sweet potato, together with GM banana in Uganda, are candidates in the former category, which is seen as an attempt by MNCs to repair their public image with the help of philanthro-capitalists like Bill Gates. These Biotech crops are vegetatively propagated (not grown from seed), and are not amenable to traditional plant breeding, creating an opening for a GM approach. Critically, vegetative propagation also means that farmers do not need to repurchase seed every year. What effect these second-generation feel-good biotech crops will have on the food ecosystems is yet to be ascertained. Second-generation GMOs in agriculture include “functional” plants designed to produce pharmaceuticals, fuels, and industrial compounds. It is doubtful that these new biotechnologies will have a role in Kenya’s food ecosystem.
The future of GR in Kenya’s food system
In India, GR technologies were rolled out in 1967 when dwarf and rust-resistant wheat varieties were released. The results were so fast and so significant that, just three years later, Norman Borlaug was awarded the Nobel Peace Prize in 1970 in recognition of his contributions to world peace through increasing food supply. It is claimed that he saved a billion people from starvation.
In Africa, it has now been 15 long years since the new GR was launched. AGRA pledged in self-declared milestones that it would double the earnings of 20 million small farmers by 2020 while halving food shortages in 20 African countries. A Tuft University study found little evidence of significant increases in productivity, income, or food security for people in the 13 main AGRA target countries, but rather, demonstrated that AGRA’s Green Revolution model is failing. Between 2013 and 2015, AGRA and CIMMYT released at least 25 water-efficient drought-tolerant maize hybrids (WEMA) for farmers in Kenya. To date, there have not been any magical yield increases as was evident in India when the hybrid wheat and rice varieties were released. Despite the widespread use of these biotech varieties, the increased use of pesticides and fertilisers, and the extensive use of tractors, GR remains a dream in Kenya’s food economies.
There have been many incidences where MNCs systematically replace farmers’ own indigenous seeds with their proprietary hybrid seeds by providing “generous seed and fertiliser donations”.
Why is it so difficult to ignite a green revolution in Africa? AGRA has funded projects and lobbied African governments for the development of policies and market structures that promote the adoption of Green Revolution technology packages. Kenya has taken the top spot in enabling the business of agriculture, opening its doors to these biotechnologies. It has won praise and accolades from donors and partners. What else is there to be achieved? It is highly doubtful that affixing Bayer’s Bt. insect toxin gene to the drought-tolerant WEMA (now TELA) trait will be the launch of Kenya’s green (maize) revolution. It is also highly uncertain that Kenyans will suddenly change their modern dietary habits and start eating biotech cassava, engineered, not for high yields, but to resist viruses.
There is a wave of “new genetic modification techniques” touted to lead to the third generation of GMOs. These include genome editing using various tools such as special enzymes to cut, repair, or even bring new segments into the DNA of living food organisms. Such technics appear to be science visioning, with biotech supporters saying that one will be able to delete allergy traits from the DNA of peanuts and make lactose-free milk to the joy of lactose-intolerant populations. These modification techniques have already been tested out in the current roll-out of mRNA-mediated covid-19 vaccines, and appear poised to make a thundering entrance into Kenya’s and Uganda’s food ecosystem through cassava that is protected against viruses. Noteworthy is that citizen resistance against this GMO technology will be met with a stern and stark reminder that it is the same GM technology that was used to protect us from the coronavirus and its associated mutations. The new GM technology skipped many important safety and risk assessments and the vaccines were released under public emergency orders worldwide.
In 1967, Norman Borlaug’s GR varieties undoubtedly averted food shortages albeit temporarily. But they were unable to deter poverty. In fact, GR technologies might have added to it. The high-yielding seeds demand expensive fertilisers and more water. In India, GR led to rural impoverishment, increased debt, social inequality, and the displacement of vast numbers of peasant farmers.
What then must we do to ensure a just and equitable food system in Kenya? What is the way forward for gene and green revolutions in Kenya? It appears that our experts and technologists have had every room and resource to make Kenya food-secure using all forms of modern biotechnologies yet there have been no significant results to phone home about. Perhaps it is time to cut our losses and shirk the industrial-agricultural model that is based on industrial principles. Climate change is not helping Kenyan farmers. Researchers have been unable to come up with solid biotechnologies that can sustainably overcome stresses from our unique harsh farming climates. Perhaps it is time we looked to nature and farmers’ know-how in using another branch of science called agroecology.
GR agriculture increased farmer debt, which resulted in increased social inequality, and the displacement of vast numbers of peasant farmers who had to make way for larger farms.
Agroecology encourages the building of resilience through crop and varietal biodiversity on the farm. Monocrops are to be avoided to reduce pests and diseases. Farmers and extensionists teach that planting mixed varieties of locally adapted maize on the same farm creates resilience against pests like stem borers and fall armyworms that GMO Bt. maize seeks to control. Farm-level diversity is the key to survival. Seeds with many traits – drought resistance, early ripening tendencies – make for greater ability to adapt to climate change. Relying on just a few varieties is dangerous and making unending royalty payments to the holders of those food varieties is worse as it undermines food sovereignty at the farm level.
Agroecology encourages the defense of farmers’ rights, the rights to nature, and demands the renegotiating of the contract between state and society as stipulated in our 2010 constitution. Farmers have a right to seed for food and livelihoods. They should be able to freely keep, further develop, sell or even gift their planting material as is culturally accepted. The government should be at the forefront of protecting their rights – and not creating skewed power relations between farmers and farm input providers.
Good agroecology practices further demand an accelerated shift towards local food production and short supply chains. The emphasis is on local food sufficiency that encourages ethical consumerism.
There is an urgent need to review, reform, and reconfigure the UN’s agri-food agencies to be more responsive to the poor and disadvantaged in the food system. The FAO (Food Agriculture Organization) and the CGIAR (Consultative Group on International Agricultural Research) have received funding from the World Bank and the Bill & Melinda Gates Foundation, swaying research and policy priorities towards more biotechnologies in our food systems. Dr Agnes Kalibata, President of AGRA and board member of the International Fertilizer Development Center, has been appointed as the UN Secretary General’s special envoy to the 2021 UN Food Systems Summit to be held in September 2021. This signals that the summit will be yet another forum that advances the interests of MNCs and agribusiness at the expense of farmers.
It is time to put the seed back into the hands of the farmers. Remember, he who controls the seed controls the food system. If Kenya is to take back control of its food system and reassert its sovereignty over its agriculture, its citizens — free from corporate influences — must be at the forefront of any restructuring of the food system. This is the only path to a just and sustainable food bio-economy that is not subject to the whims and fancies of corporate controllers of biotechnologies.
The Extraordinary Journey of J. P. Magufuli and Comparative Perspectives of Dog-Eat-Man Regimes
Tanzania and Kenya represent two of the continent’s more closely matched territories. But the contrast between the two countries remains among the most intriguing examples of post-independence Africa’s political comparison.
In 2015 John Pombe Magufuli became Tanzania’s accidental President. Colourful and charismatic, Magufuli charmed the masses during his five years in office. He demanded results and pulled off successes that were elevated to the status of minor miracles. He channeled his inner Julius Nyerere to revive Tanzania’s distinctive internal self-reliance-based identity.
The state was back, and the state was Magufuli. He used his campaign against the mabepari class to grandstand on a regular basis, and the coronavirus pandemic provided the former chemist with an opportunity to elevate his anti-imperialist credentials. His controversial stance won him approval across the region: several of my colleagues remarked that “Magufuli is the only African President to speak truth to the pandemic”.
Then his government ministers began getting sick. Magufuli disappeared from public view. After two weeks of rumour and speculation, Tanzania’s Vice President announced his passing due to a chronic heart condition. Corona or coronary? Magufuli’s outsized sending off soon overtook conjecture about the cause of his death.
It began with the usual laudatory speeches by his fellow African heads of state. The dead president then set off on a grand tour that took him across the country by land, sea, and air. The wananchi paid homage by throwing their clothes on the road in front of the motorcade escorting the casket. People lining the road chanted, “jeshi, jeshi!”
The lionisation of the dead president was a fascinating trope, amplified by the mellifluous High Swahili commentary accompanying the televised coverage of the Magufuli hegira. My wife had become a Samia Suluhu Hassan fan. She insisted that the TV remain tuned to the Tanzania Broadcasting Corporation channel.
The stature of Tanzania’s domestic Shujaa grew over the course of the week. Like the mythical wrestler Anteus, who grew stronger when he touched the ground, Hayati Rais appeared to be drawing new power from the landscape as the conquering hero’s body made the long journey from Zanzibar to Chato, his lakeside home.
By day three of the roadshow, Tanzania’s state media was praising the departed leader, as Jabali ya Africa, “the rock who stood up to the West”. But Twitter was providing an interesting counter-narrative; for Tanzania’s online opposition, the “Jabali” was “Jiwe”, the “stone” who terrorised his critics and pummeled the political opposition. Day four brought the claim by a Chama Cha Mapinduzi party sycophant that the Magufuli show was attracting an audience larger than that of the last two World Cups.
I was looking forward to seeing Chato, the village that during Magufuli’s tenure had been transformed along the lines of Houphouët-Boigny’s Yamoussoukro birthplace in Côte d’Ivoire, and Mobutu Sese Seko’s Gbadolite home in the Congo. I was not able to catch the end of the journey because of a close friend’s funeral. But I did witness the dead president’s final apotheosis, which led me to pause on my way out the door: “With due respect to our respective religions”, one of the TBC commentators was remarking, “it should be recognized that President Magufuli was a Nabii.”
The roadshow that followed was a skillfully executed event that provided the Bulldozer’s inner circle with the breathing room needed to ring-fence the new President.
Nabii is the Swahili term for prophet. The proof of his prophethood (unabii wake), the commentors went on to explain, lay in the fact that President Magufuli was the only world leader God sent to warn us that the pandemic is a crisis manufactured by the global elite to extend the hegemony of Big Pharma and other agents of the international capitalist order.
The real news for some of us was Vice President Samia Sulubu Hassan’s swearing in as the Republic’s sixth Head of State. Tanzania’s record of relatively seamless political succession was further enhanced by her status as a female Muslim from a minority community. My wife, who is from Lamu and has never seen anyone of her background in a position of power, declared, “Samia is my president.”
It is hard to envision a similar sequence occurring in Kenya, or for that matter in any other country in the Horn of Africa.
Dog eat dog versus man eat nothing
“No contrast, no information”, my field linguistics professor used to tell us. The large number of African states and the interesting dyads they form makes for a lot of information. Nigeria and Ghana, Mozambique and Angola, Egypt and Sudan, Guinea and Sierra Leone, are examples that come to mind. But the Kenya-Tanzania contrast remains among the most intriguing examples of post-independence Africa’s political comparison.
Tanzania and Kenya represent two of the continent’s more closely matched territories. They are linked by centuries of interaction on the coastal strip and a common history that gave rise to Swahili as the region’s lingua franca. Together they host the world’s most famous concentration of wildlife. Artificially divided into two countries by European powers, the modern nations created by imperial intervention were shaped by the same colonial model. Both gained independence under leaders inspired by the spirit of Pan-Africanism.
Tanzania’s record of relatively seamless political succession was furtherenhanced by her status as a female Muslim from a minority community.
Tanzania’s more uniform geography supported the intricately networked small-scale societal adaptations documented in Kjekjus’s classic study, Ecology Control and Environmental Management in East Africa. Kenya’s physical environment conditioned the country’s more complex ethno-economic composition diversity; late precolonial era migrations contributed to Kenya’s more variegated population of Bantu-, Nilotic-, and Cushitic-speaking communities.
Where the harshness of the German occupation in Tanzania inoculated the population with a healthy dose of anti-colonial consciousness, many Kenyan communities welcomed the Pax Britannica, in part due to the disruptions of the decade preceding it. Efforts to force peasants to cultivate cotton for export in Tanzania triggered the Maji Maji rebellion in 1905, and the movement rapidly spread across southern and parts of central Tanganyika until its brutal suppression.
The commercial economy introduced by Kenya’s colonial rulers created new opportunities and avenues for accumulation. The first stirrings of anti-colonial opposition only emerged after World War II. The ethnic base of the Mau Mau insurgency contrasted with the nationalist focus of Tanzania’s liberation politics. The new countries nevertheless came into existence driven by a common vision of the future and its possibilities.
It was a time of idealism and political experimentation. Shared orientations propelled Kenya, Tanzania, and Uganda to form the East African Community soon after independence. The union represented a practical first step towards Kwame Nkrumah’s vision of a United States of Africa—before political liberation gave way to an era of competing ideologies, superpower patronage, and military coups. Much of the ideological superstructure of that period ended up either dissipating gradually or collapsing for reasons that have been rigorously documented.
Technically, both Kenya and Tanzania subscribed to the third path option championed by the non-aligned movement, but their economies were moving on diverging paths. The East African Community foundered, undermined by economic differentials fueled by Kenya’s colonial economic legacy and Tanzania’s Fabian socialism. The ideological bifurcation saw Kenya and Tanzania become proxies for the struggle between the world’s capitalist and socialist systems.
The clash between Jomo Kenyatta’s conservatism and Julius Nyerere’s idealism highlighted their contrasting political ideologies and the external support they attracted. In 1975 the submerged tensions between the two countries surfaced in an exchange of words between Tanzania’s President Julius Nyerere and Kenya’s Attorney General, Charles Njonjo. Nyerere referred to Kenya as a “dog eat dog” society; Njonjo retorted by describing Tanzania as a “man eat nothing economy”.
The ideological bifurcation saw Kenya and Tanzania become proxies for the struggle between the world’s capitalist and socialist systems.
There is a simpler explanation. Where Kenya retained the hierarchical Anglo-colonial template after independence, Tanzania adopted the more integrative Swahili model of nation-building. As Jomo Kenyatta once told his fellow East African presidents after Milton Obote adopted the socialist Common Man’s Charter in Uganda, “I cannot experiment with [the] lives of my people.”
Donor-mandated structural adjustment policies of the 1990s brought the countries’ economies into closer alignment. But the different trajectories pursued by Kenya and Tanzania continued to reflect their contrasting developmental strategies, and the delicate balance of competition and cooperation defining the two countries’ bilateral relations.
Kenya and Tanzania’s ideological differentials are sufficient but not necessary explanations of the two nations’ post-independence divergence.
Crawford Young’s seminal work published in 1981, Ideology and Development in Africa, confirmed as much for the two decades following independence. Young concluded that the strong ideological groundings informing Africa’s capitalist, socialist, mixed, and Afro-Marxist economic models, although important, did not significantly influence their performance. This is consistent with historical studies that show how countries within a geographical region tend to converge over time.
This trajectory appears to hold for the comparison examined here. Tanzania has recorded impressive economic growth under the neoliberal policy regime. Although Kenya is still East Africa’s strongest economy with an annual GDP of US$37 billion versus Tanzania’s US$28 billion, Tanzania’s per capita GDP is now only US$200 less than Kenya’s (US$1,600 vs. US$1,400). Some 50 per cent of Kenya’s population is below the poverty line in contrast to 33 per cent in Tanzania, which also performs better in several categories of social development.
Tanzania was catching up to Kenya in the Transparency International annual corruption rankings until Tanzania’s position improved slightly after Magufuli took office. His anti-corruption campaign saw hundreds of civil servants lose their jobs, but only a few cases of prosecution. The offensive targeting international investors and domestic business interests took up the slack. The state charged international investors and domestic businessmen in court for underpaying taxes and other violations.
Barrick Gold Corporation, the Canadian mining company that has helped make gold the country’s leading export commodity, received a notice claiming it owed US$190 billion in fines and unpaid taxes. Many of these cases resulted in negotiated settlements and revisions in the terms of their contracts. Barrick ended up settling by paying US$300 million and increasing the government’s stake in their operations to 50 per cent.
Some 50 per cent of Kenya’s population is below the poverty line in contrast to 33 per cent in Tanzania, which also performs better in several categories of social development.
Both of these campaigns, and Magufuli’s rejection of China’s debt diplomacy and IMF loans, enhanced the President’s reputation as the “Bulldozer”, but did little to effect the structural changes needed. Tundu Lissu, the head of Tanzania’s main opposition party, reported that many of the settlements were actually shakedowns initiated by the President’s CCM faction. Such behind the scenes venality accounts for Magufuli’s silencing of Tanzania’s media and the intensified persecution of the opposition during last year’s national elections.
Sources on the ground report a more complicated picture than the pumped-up legacy conveyed by state media. Although Tanzania joined the ranks of lower middle-income societies in 2020, the improved household income generated by the pro-market policies enacted by Magufuli’s predecessors is being eroded by the rising cost of living, while demographic growth is increasing pressure on the country’s land and natural resources.
Presidential activism failed to arrest the downward drift of conditions across Tanzania’s rural areas. Magufuli’s opposition to international capital limited smallholder access to the contract-farming arrangements that have enabled Kenya’s small-scale producers’ participation in global supply chains. While the benefits of contract farming are contested in academic circles, participation in out-grower schemes has led to improvement in producer terms in a number of cases, and improved access to inputs while diversifying livelihood options for many rural households.
The revival of the East African Community in 2010 was boosting both countries’ commodity exports to each other until tit-for-tat border disputes contributed to a drop to pre-2010 levels. Bilateral trade is a sub-set of the policy frame promoting regional integration, which has in turn triggered a scramble to upgrade the infrastructure facilitating trans-national linkages. This brings us to the governments’ penchant for mega-projects like Kenya’s grandiose Lamu Port-South Sudan-Ethiopia-Transport corridor project (LAPSSET) and Tanzania’s Southern Agricultural Growth Corridor (SAGCOT).
LAPSSET came to be viewed as a cash cow for Kenya’s state-based cartels before it stalled due to the withdrawal of once enthusiastic international investors. Analysis of the SAGCOT corridor indicates it has generated mainly just-for-show benefits while facilitating the entrance of large-scale agribusiness actors at the expense of local smallholder communities. Both countries are beneficiaries of economically dysfunctional Chinese railroads, contrasting monuments to that country’s contribution to regional linkages over the years.
Even in the presence of more comprehensive analyses of the two countries’ development, it is difficult to arrive at definitive conclusions about the efficacy of the Kenya and Tanzania models. They are more connected — Kenya-based companies are the second largest source of foreign investment in Tanzania — than at independence, yet seem even farther apart now with respect to their political sensibilities.
Local folk models provide more succinct perceptions of the differences. Talk to Kenyans and they will characterise Tanzanians as laid back, loquacious, and xenophobic; talk to Tanzanians and they will tell you their neighbors are arrogant, aggressive, and hopelessly tribal. But if you pursue the conversation further, most will show that they understand their neighbours better than formal analyses like the one above convey. Informants on each side of the border will probably concede that their governments have become dog-eat-man regimes.
Political theatre and executive revisionism
Is Magufuli’s hyper-nationalism at odds with Kenya’s constitutionally mandated federalism? In reality, each of these shifts from the previous status quo have been manipulated to reinforce the two states’ tradition of top-down governance. Both governments face an ongoing crisis of constitutionalism, and both have resorted to elaborate exercises of political theatre to camouflage their respective political elites’ strategies to remain at the top of the food chain.
Kenya’s Building Bridges Initiative began with the handshake marking the reconciliation between Uhuru Kenyatta and Raila Odinga, then morphed into a comprehensive gambit to revise the nation’s new constitutional order. Two years later the government released an eloquently worded BBI task force report that was long on promises to fix long-festering problems, but short on how they would be implemented.
Informants on each side of the border will probably concede that their governments have become dog-eat-man regimes.
The provisions to double the seats in the senate, create 80 new parliamentary constituencies, and create positions for a prime minister and four deputy presidents are hard to justify for a country that already expends 48 per cent of its budget on state salaries. Unlike his father, Uhuru Kenyatta is not averse to experimentation. But the circus orchestrated by the BBI’s political beneficiaries has worked to redirect attention away from such inconvenient details.
Since the handshake the Kenyan public has been subjected to an unrelenting procession of media publicity, traveling pep rallies, and tactics used to herd reluctant politicians into the BBI corral. The campaign has been an amped up version of the Moi playbook, featuring theatrics reminiscent of the anti-Nyayo charade the former President used to outmaneuver his opponents during his early days in office.
The rapid deterioration of Magufuli’s health clearly caught his CCM faction by surprise. The media coverage of the President’s elevation from politician to prophet contrasted with the opaque treatment of his last two weeks on earth — or was it actually one week, as the intelligence that he actually passed away on the 10th of March claimed?
The Nabii failed to prophesise his departure from the stage. The roadshow that followed was a skillfully executed event that provided the Bulldozer’s inner circle with the breathing room needed to ring-fence the new President, who receded into the background after her eloquent speech at the funeral. In the meantime, critics were pointing out how the new government’s key appointments violated the process mandated in Tanzania’s constitution.
These games, however cynical, are part of a larger contest being waged across the larger Horn of Africa region, pitting executive power at the centre against distributed governance. Museveni’s Uganda presidency has dynastic ambitions, Rwanda is a developmental dictatorship, and Farmajo wants to restore the same kind of centralised state in Somalia that led to its collapse in 1991. Ahmed Abiy’s ugly war in Tigray is linked to his ambition to reverse the devolution established by the 1994 constitution that declared all sovereign power resides in the Nations, Nationalities and Peoples of Ethiopia.
The strategies to bolster control at the centre that we are witnessing in Kenya and Tanzania may be benign by comparison, but the actions taken to muzzle the press and critics of government policies, along with political impunity, and institutionalised corruption, are not. They differ from the efforts to recentralise the state elsewhere by degree, not in kind.
Reimagining the African state?
The trend is part of a wider global pattern. Since 2017 opposition to heavy-handed governments and their policies has erupted across the world, occurring mainly in authoritarian and authoritarian-leaning states. These surging protests correlate with the reversal of gains in democratisation, respect for human rights, and increased local autonomy across the world.
Liberalisation catalysed a universal movement towards self-determination and the deconcentration of political power. Twenty years ago, scholars were even predicting the end of the nation-state as we know it. In recent years the state has fought back with a vengeance. Recent African developments, for example, reflect the influence of the surveillance state in China that is now challenging the democratic values guiding the post-1945 world order.
There was near-universal belief in the monolithic state at independence, and in the assumption that Africa’s leaders would use its power for the benefit of their populations. By the end of the 1960s these beliefs and assumptions were in tatters. African nations’ largely trial-and-error efforts to balance the nation-building equation since that time still represent the prerogative to adapt the state to the continent’s unique initial conditions.
The unique combination of scholarship, deep historical inquiry, and political imagination that flourished during the post-independence period, at least in theory, remains a useful resource for navigating Africa’s developmental future. The reforms of the post-1989 period come over as dismal and devoid of spirit in comparison, incapable of generating the creativity and passion inspired by the ideas that preceded them.
Tanzania was one of the continent’s leading exemplars of that era’s critical thinking. To his credit, John Pombe Magufuli fought to establish an equitable relationship with international capital while his counterparts in Kenya were drinking the foreign debt Kool-Aid. Theory is useful but trial and error empiricism is the best teacher. We hope that President Samia Suluhu Hassan will use the information generated by the two countries’ contrasting experience to negotiate an adaptive middle path without too much fanfare.
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