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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
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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.

Politics

Harsh Economic Times, Political Uncertainty…and Now Corona

Kenyans were already struggling with tough economic conditions and political tensions when COVID-19 appeared. Lockdowns and dwindling incomes have now made their lives much more difficult, even as they pray for the virus to be vanquished.

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Harsh Economic Times, Political Uncertainty…and Now Corona
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Our live were ruined among the leaves,
We decayed like pumpkin in a mud field
~ Mazisi Kunene, South African anti-Apartheid poet

They say when it rains, it pours, and calamity comes with its brother. The revelation that the dreaded coronavirus had, about two weeks ago, finally found its way into Kenya threw the country into a state of pandemonium. Until then, Kenyans viewed the virus as a devastating but “alien” disease.

It was not until the quasi-lockdown was ordered by the government that Kenyans realised that beyond the confusion and panic, a much worse situation was threatening to compound and exacerbate an economic meltdown they have been experiencing for the last 20 months or so. The “alien” ailment has not only brought with it bewilderment, but is threatening to lock them down, literally, to starvation.

The virus, of the genus corona, was first detected in Wuhan Province in China in December 2019, hence the name COVID-19 (coronavirus disease of 2019). Three months later, when Kenyans first heard about a disease that was killing the Chinese quicker than flickering fireflies, they brushed it off as one of those phenomena that occur in far-off countries in the East.

The disease could not have come at a worse time for Kenyans. Experiencing harsh economic times and political uncertainty, many Kenyans concluded that the gods have conspired to punish them. “For how else do you explain the disease coming to Kenya at a time when we are faced with the toughest of economic hard times?” posed a woman.

That plane from China

“This is the modern Armageddon, the end of times is nigh because we’ve deviated from God’s ways. It is a message from God who is angry with us. We’ve sinned too much and this is a sign from God who is asking us to turn from our wicked ways and repent of our sins,” prophesied a street vendor in Nairobi selling tree tomatoes, popularly known in Kiswahili as matunda damu. But after this revelation of a messianic message, the woman admitted that the hint of a complete lockdown by the government was a sure way of strangling the livelihoods of people like her.

“Ndiraikara mucii nacio ciana irie ke?” You’re asking me to stay at home, what will my children eat? “Ako corona niguturaga, reke tukuire guku bara-ini”. If the coronavirus is going to kill us, let us then die on these streets, hustling. President Uhuru Kenyatta’s government has already killed our businesses, now he is asking us to stay at home – tumurie kana twikie atia? We feed on him? Or how does he propose we should fend for our families?

The vendor was angry that the president exhibited a laissez-faire attitude towards battling the deadly virus. “Why didn’t he stop the plane that came from China? If he had done that, we wouldn’t be in this bad situation and our livelihoods would not be threatened.”

The plane that she was referring to was a China Southern Airlines flight that was allowed to land at Jomo Kenyatta International Airport (JKIA) on 26 February 2019. The flight had arrived in Nairobi despite a directive forbidding flights originating in China to land in Kenya due to the outbreak of COVID-19 in China. Kenya Airways had also by that time suspended all its flights to and from China. This particular plane carried 239 passengers, many of whom were Chinese nationals. The airport employee who posted a video of the plane landing was suspended (and later reinstated through a court order), which suggested that the plane had the government’s permission to land. The reference to this plane and the anger it has generated among the people I talked to was evident throughout all my interviews.

The vendor was angry that the president exhibited a laissez faire attitude towards battling the deadly virus. “Why didn’t he stop the plane that came from China? If he had done that, we wouldn’t be in this bad situation and our livelihoods would not be threatened.”

The weekend before the quasi-lockdown decreed by the government on Monday, 23 March 2020, I was in Nakuru County. My first stop was at the Java House located in CK Patel House in central Nakuru town. It was 10.00 a.m. and there was absolutely no customer. I found the manager sipping her coffee latte. “What’s up?” I asked her. “There’s no one in the house”.

The nonplussed manager said the coronavirus was bad for business. “Look, it is mid-morning, a peak time when customers should be flocking in for their refill, yet we’ve an empty house.”

The coffee house closes at 5 p.m., which is normally a peak hour when commuters wait for the traffic jam to ease off before heading home. “This is not a harbinger of good times,” said one of the lady waiters. “If this situation persists long enough, who knows, the management could easily send us home…this, by the way, is not good at all.”

“The incompetence of this government and President Uhuru is mindboggling,” said a lady I was meeting in Nakuru town. “Why, in God’s name, did he allow the plane from China to land at JKIA?” she furiously wondered aloud. “He should have ordered the plane to turn back, the way it came and never to allow the passengers to disembark. Do we know how many of those passengers could have been infected all the way from China? Do we know how many people they, indeed, could have infected once here in the country? Who knows where those people are and which corner of the country they are in? Did the government ever track them down?”

The lady was convinced that if the government had refused the landing of that plane, it is probable that we would not be so afraid now and there would not really have been a case for a (quasi) lockdown.

“The government now is all over issuing edicts – it must always do the wrong thing first before it turns around to sound the alarm bells,” she said. People seem to be impressed by the new Cabinet Secretary for Health, Mutahi Kagwe, I’m not. What ordinary Kenyans want to know is how, in the event of a complete lockdown, they will earn a living. Period. Endless press conferences threatening us with damnation are neither here nor here. The President recently threatened us, saying the government will crack down on anybody not adhering to the stay-at-home edict. This is uncalled for as well as unhelpful. Does he have any concrete plans for ameliorating the situation and ensuring Kenyans who live from hand to mouth are cushioned?”

Later in the evening, I was at Garden Villa, located on the western side of town as you head to Shaabab residential area. It was completely empty and the waiters were just lounging around. Garden Villa is an expansive nyama choma eatery, as well as a “watering hole” with appropriate cushioned-seat cubicles for groups of people or couples. It was glaringly in its emptiness.

Beatrice, our waitress, was not amused by coronavirus coming to Kenya: “It is no longer a death scare; it has come to actually destroy our livelihoods. I’ve three children – two in university and one is finishing high school. My job has really sustained me, I’ve been able to educate my children so far with the tips that I collect here and there from patrons like you. When there are no customers, we are finished. I’m really worried. If this situation continues like this, we’ll all be declared redundant. What will happen to my children?”

Back in Nairobi, I went to one of my usual Java House haunts. The security guard was forthright: “Hii kitu itauwa watoto wetu. Sijui leo nita peleka nini nyumbani.” This thing called coronavirus will kill our children. Today I don’t know what I will take home.

The main work of security guards like one at Java House is to ensure that patrons enjoy their house coffee without probing eyes and disturbance from the city centre’s “undesirables”, and to usher patrons inside the coffee house. They help customers find car park spaces and guard the automobiles from hoodlums. They will also offer concierge services to patrons, such as carrying stuff to their vehicles. At the end of the day, they have enough pocket money to pass through the supermarket and buy some milk and bread for tomorrow morning’s breakfast. He told me the lack of patrons meant that he would go home empty-handed. “Mungu asaidie afukuze hii coronavirus, kama siyo hivyo tumeisha.” The almighty should intervene and clear this coronavirus as quickly as possible, otherwise we’re all finished.

Prayer warriors

In the city centre, at the famous Jevanjee Park, I met a group of four middle-aged women. They were talking with each other. On the day the government ordered the people not to leave their houses after 7 p.m., they disobeyed and trooped to town. “I’m staying in the house and then what happens?” posed one. “Are my children going to feed on me?”

The women were “professional” casual labourers. Lately they have been getting manual jobs from the Nairobi County as grass cutters and street sweepers.

“We live on a day-to-day basis” said one of the women. “How on earth does the government expect us to survive?”

“Tell you what,” ventured one of the women, “yesterday I went to church because our pastor had sent word around that we must not fail to go church.” She told me she attends a Kenya Assemblies of God (KAG) church. Their pastor told them that coronavirus had come to Kenya to remind Christians that, indeed, these were the last days.

Back in Nairobi, I went to one of my usual Java House haunts. The security guard was forthright: “Hii kitu itauwa watoto wetu. Sijui leo nita peleka nini nyumbani.” This thing called coronavirus will kill our children. Today I don’t know what I will take home.

“Coronavirus is not going to be defeated by worshippers staying at home,” claimed the pastor. “It is going to be wrestled down to the ground by prayer warriors. We must condemn the evil-doer, we must never doubt our faith. We must never doubt our God, Is this the time to let our able God down? Are we doubting Him?”

“I’m a Catholic and we went to church. The parish priest, through jumuia [small community groups], sent word that we must all be in church on Sunday without fail,” said one of the woman. “The priest said the body of Christ is asking us, ‘Are you not going celebrate with me? For is this the time to forsake me?’ It is always fundamentally important to remember to keep the faith.’”

“The churches cannot, even for once, pretend that they care for our welfare,” said another woman. “In these times of economic turbulence and the coming of the corrosive coronavirus, all what the churches can tell us is to still go and congregate in congested spaces. And all what this government can tell us is to sanitise our hands. The church and the government’s work is to fleece us, the people.”

In the evening, I caught up with the same quartet outside Charlies’ restaurant that faces City Hall. It was now past five and they were hungry and angry. “How are we going home?” asked one of them in concealed desperation. All of them lived in the sprawling slums of Nairobi. Seated on the stone bench of the restaurant, they resorted to begging money from any passing man they thought they could remotely recognise.

“The churches cannot, even for once, pretend that they care for our welfare,” said another woman. “In these times of economic turbulence and the coming of the corrosive coronavirus, all what the churches can tell us is to still go and congregate in congested spaces. And all what this government can tell us is to sanitise our hands…”

The following day, I found myself in bustling Kawangware, where the coronavirus threat is real. Kawangware was deserted – many businesses were shut and the human commotion that is usually associated with the sprawling residential area was absent. I dropped in at Sakina’s kibanda (food kiosk-cum-shed) in the Coast area (Mombasani) where she sells very pocket- friendly fresh food to construction workers, bachelors, spinsters, and all manner of casual labourers. Sakina shared the kibanda with her mother, but her mom was not there on that day.

“Where’s your mother?” I asked Sakina.

“She took the kids [her four children] to shags [her rural home],” she responded. (Sakina’s rural home is right in the middle of Nyeri town, at Meeting Point.) “Business is slowly grinding to a halt and we didn’t want to take chances. At least at cucu’s [grandma’s] place, there’s food to eat…this coronavirus has dealt us a huge blow…but alhamdulillahi, it is going to be defeated by Allah.”

In times like this, said Sakina, it’s important to be steadfast and to anchor your whole self in the great faith.

A disease of the rich

At Zambezi trading centre, 19 kilometres from the city centre on the Nairobi-Nakuru Road, Nyambura, a chicken legs and liver vendor, was preparing her foodstuff for her evening customers.

“Are you not afraid of the coronavirus?” I asked her.

“Indeed I am,” she replied. “But can I eat fear? Can my children eat fear? I cannot stay in the house. I must get out to fend for my family. My husband is a salaried worker. He has to wait for 30 days to be paid his paltry pay. We cannot wait for that. It is my responsibility to supplement the ugali he brings home,” said the lady with a great chuckle.

“[President] Uhuru doesn’t care about us small farmers. He has been careless and is playing dice with our lives. After ruining our lives, he has now let this coronavirus invade our country. Why couldn’t he stop that plane from China? Its good coronavirus is infecting the rich and the powerful. They should all perish. They have caused us enough agony,” said Nyambura.

“But trust me, this coronavirus is not going to finish us because our Lord Jesus Christ is on the throne. In the name of Jesus, I condemn the disease,” she added.

She said coronavirus, like the most incompetent government she had lived through, had conspired to kill the spirit of Kenyans. “Yesterday, I paid 100 shillings from 87 to here. Can you imagine? Ordinarily the matatu fare from 87, just after Uthiru to Zambezi, is 30 shillings. For how long can one afford that kind of fare?” She said that from the Old Nation House roundabout stage to Zambezi, passengers were being charged 150 shillings. I hooked up with my freelance tout friend Davy to confirm whether it was true.

“What do you expect when the matatus have been ordered to carry half the seating capacity of their vehicles?” said the freelance tout.(The government has directed that public transport vehicles observe social distancing among their passengers, which means that these vehicles are forced to carry fewer passengers per trip.) Davy told me that many matatu proprietors had grounded their vehicles. “Hakuna haja ya kufanya kazi ya kirai”. It’s pointless to engage in an unprofitable business.

From the city centre to Zambezi, the fare is ordinarily 80 shillings during peak hours and 50 shillings during off-peak hours. “Think about it,” explained Davy. “The matatus that have chosen to be on the road are being fair.”

A 33-seater is now carrying 16 passengers. So passengers are paying 150 shillings instead of 80 shillings in normal times. The Nissan shuttles that ferry 14 passengers are now having to carry just 8 passengers. Davy said if the government was considerate, it would, at least for now, reduce the price of fuel. That way the matatu owners would not be forced to adjust the fares.

“How many people can afford to be paying 300 shillings every day to town?” asked Nyambura. “What is it then you are working for? You’ve not even eaten. And President Uhuru, instead of telling us how the government can come up with ways of helping us alleviate this burden, has gone on air to tell us about the merits of 4G Internet speed. (On March 23, President Kenyatta addressed the nation live on air, extolling the virtues of the business deal between Telcom Kenya and Google Loon, which would now allow for faster speed and easy interconnectivity.)

In the political sphere, Nakuru residents believe that the coronavirus appeared just in the nick of time to save President Uhuru and the Building Bridges Initiative (BBI) team the embarrassment of a looming contest and showdown that was to take place in town at Afraha Stadium. On 21 March 2019, BBI had organised a rally to popularise its agenda. But every indication showed that this was not going to be a walk in the park for the BBI mandarins.

A 33-seater is now carrying 16 passengers. So passengers are paying 150 shillings instead of 80 shillings in normal times. Davy said if the government was considerate, it would, at least for now, reduce the price of fuel. That way the matatu owners would not be forced to adjust the fares.

“This coronavirus has just given the president some reprieve,” said a Nakuru boda boda (motorcycle rider) from Maili Sita trading centre (popularly known simply as Sita) on the Nakuru-Nyahururu Road. The rider opined that had the BBI rally taken place, the William Ruto wing of the Jubilee Party would, most certainly, have upstaged the BBI brigade. It was going to be battle a between BBI and the deputy president’s “Tanga Tanga” band of supporters.

When on 28 January 2019 President Uhuru was in Nakuru town to open a cement factory in Rongai, he detoured to Bahati constituency, where at Sita he lambasted the area MP, Kimani Ngunjiri. As he was castigating him, Ngunjiri was several metres away from the president’s motorcade. “When he left, the boda boda riders came to Ngunjiri and they were high-fiving him and laughing excitedly,” said the boda boda rider. “They promised him that when BBI lands in Nakuru, they would show President Uhuru who ruled Nakuru.”

With all the laments, speculation and tantalising gossip, it is still not clear what impact the coronavirus pandemic will have on the lives of ordinary Kenyans. Many are in still in disbelief and more worried about their livelihoods than about falling ill or dying. But what is clear is that Kenya after corona will not be the same again.

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Inside the Quarantine: Fears of Further Spreading the Virus Haunt the Confined

Perhaps, it won’t take much longer before the country knows whether the mandatory quarantine strategy helped spread or stop COVID-19.

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“We were flying over Juba when the announcement was made”. Chris*, not his real name, recounts to me his whereabouts when Kenya’s Cabinet Secretary for Health, Mutahi Kagwe, made the announcement that mandatory quarantining of all persons flying into Kenya would begin with immediate effect. It was early evening in Nairobi and a likely anxious nation tuned in for what was the tenth briefing from the ministry about the global COVID-19 pandemic that had made its way to Kenya, on the wings of an aircraft much like the one that ferried Chris back from a work trip to London.

Chris and I spoke a day after his arrival. He was in a hotel turned government-sanctioned quarantine facility, the Boma Hotel. The hotel, one of four Kenya Red Cross hotels that had just weeks before been placed under receivership, was dusty, with some rooms not having been cleaned for a while. Dead flies lined his windowsill. Chris complained that layers of dust on his pillowcase and bedsheets caused him discomfort. That was a minor inconvenience in comparison to the subject of our call.

Inside the Quarantine: Fears of Further Spreading the Virus Haunt the Confined

Their flight, which arrived at the Jomo Kenyatta International Airport on the night of Monday, March 23rd, carried what was, in Chris’s estimation, about 60 people.

“After being screened and filling out immigration forms, we were told about the Ministry of Health’s directive. We protested the directive because some of us had made arrangements to self-quarantine. Among those on our flight were students who, I think, wouldn’t have taken the flight if they thought that they would be taken into mandatory quarantine.”

Their protests would seem vain in the face of the government’s efforts to slow the spread of the COVID-19 virus, which has overwhelmed some of the world’s best-equipped healthcare systems, but the response to these complaints from Ministry of Health officials was even more strange.

“The government relented and allowed us to leave the airport and go home, with orders that we report to the Kenya Medical Training Centre (KMTC) at 11:00 a.m for tests.”

Chris was picked up by his driver and recalls reaching his home at about midnight on the 23rd of March.

As he was falling asleep, Doris*, also not her real name, was on a fairly empty flight from Germany, a country hard-hit by the COVID-19 pandemic, via Amsterdam, back home.

“I was alone on my row, the two rows behind me were empty and the lady in the row next to mine also sat alone.”

Her flight touched down in Nairobi on the morning of 23rd March and taxied in. In the nine hours between the landing of Chris’ flight and Doris’, the information that passengers were given had differed.

“Our temperature was taken, then we filled a form saying that we would self-quarantine. Then we filled the older, yellow immigration form. As we did so, there was a lady shouting that we should all go to KMTC at 11:00 am for testing. That was it.”

Doris had already made plans to self-quarantine. She had found an apartment on an online booking site, AirBnB, where she says she was going to stay for the recommended 14-day quarantine. She booked an Uber, made the trip across town to her apartment in Kileleshwa, showered, changed and then booked another Uber to the KMTC.

Before they got to KMTC, if Chris and Doris were carriers of COVID-19 and were contagious, they may have spread the disease to at least three people each. Neither of them has been asked to account for their movements or the people that they came into contact with; termed by the World Health Organisation as contact-tracing. They do not yet know whether or not they have the virus, because they have yet to be tested for it. They weren’t alone on their flights home, and sadly, their experience was not unique to them.

Infection within the quarantine facilities

Both Doris and Chris are worried about the possibility that they contracted COVID-19 while they were in the throes of evident lapses and confusion that they found at the Jomo Kenyatta International Airport, and at the KMTC, where they would go as ordered, on the 24th of March, at 11 am.

“When we turned up at the KMTC, they closed and barricaded the gates behind us, and said that we were officially under mandatory quarantine,” Chris remembers.

Doris witnessed the furore of the now hundreds of passengers grow, with them crowding around Ministry of Health officials for answers, having just been stung by the news. She tried to hang as far back as she could to avoid coming into contact with the virus.

“We were then given three options for places that we would undergo quarantine. Boma Hotel (where Chris would eventually go), the KMTC and the Kenya School of Government (KSG) in Lower Kabete, Nairobi,” she remembers.

“Boma would cost us USD 100 (Kshs 10,000) a night (this figure was later revised downwards), and the conditions at KMTC were just awful, so I chose KSG. When we got to KSG the director of the campus told us that it would cost us USD 40 (Kshs 4,000) a night. People protested again and crowded around the officials telling us this. They then relented and said we would be charged USD 20 (Kshs 2,000) a night.”

A video taken by one of the passengers shows the proximity of the passengers to the officials, and to one another. Again, Doris wisely chose to hang back and wait until things calmed down so that she could get a room.

Chris chose to stay at the Boma hotel.

When Chris’s cohort of travellers arrived at the Boma hotel, he says there was just one receptionist at hand to meet them.

“We all herded around the reception area waiting to be checked in. I am very afraid that we may have been exposed while we were getting into quarantine!”

Later that evening, Chris heard the sounds of sirens outside his window.

A hotel staffer told him that ambulance workers in hazmat suits were there to evacuate a fellow traveller, an elderly lady who allegedly fell ill.

“We are all so worried”.

Even with the inconveniences they have experienced, both Doris and Chris’s worry extends to the unanswered question they both have – were they both complicit in some way in the spread of COVID-19?

“If the government was serious about a mandatory quarantine, why did they let us go home first?” Chris asks, the tone of his voice deep and serious, unfettered by the muffles and crackling on the phone line.

“There were people on our flight who took public transport from the airport and to KMTC. How many people have they been in touch with?”

The question of how the virus spreads is no longer in contention, but there are concerns about the handling of passengers who were being put in isolation in order to contain COVID-19’s spread in Kenya.

Dr Ahmed Kalebi, the founder and CEO of Lancet Laboratories, which is among Kenya’s first private laboratories to offer PCR tests for COVID-19 (Polymerase Chain Reaction tests detect the genetic material of COVID-19, called RNA), shares his worries about the possible contagion that people in the mandatory quarantine may be facing.

“For me, it is a big scare. I am privy to what has been going on in some of those facilities and it has been a bit of a mess.”

“If two hundred people go into a hotel and three or four of them have COVID-19, by keeping them in close proximity we are creating an incubating chamber (for the virus).”

Dr Kalebi believes that in late April, Kenyan cases of COVID-19 will have risen exponentially. Government models publicized on Monday 30th March put Kenya at possibly having 10,000 cases by that time.

Several accounts from persons currently in mandatory quarantine speak to the potential for this, especially as they were being transferred into quarantine facilities. Doris, who was being quarantined at the Kenya School of Government facility, Chris at the Boma hotel, and Caleb* (not his real name), a traveller who is currently in quarantine at the Kenyatta University Conference Centre, all give similar accounts about how risky the first day of their return was.

They were all supposed to be part of a Ministry of Health-led mass testing campaign of the over two thousand Kenyans currently in quarantine facilities, being carried out beginning the weekend ending March 29th.  Chris took a photo of a Ministry of Health official in a Hazmat suit from a common area at the Boma hotel.

Inside the Quarantine: Fears of Further Spreading the Virus Haunt the Confined

Doris, Chris, Caleb and other travelers in quarantine that I spoke to all say that they feel healthy, save for a few coughs and sniffs which they hope are signs of a cold rather than COVID-19, but they may not be out of the woods, even as the days wind down to the end of their quarantine.

“The Coronavirus takes between two to fourteen days to incubate,” says Dr Kalebi.

“If tests were done at day seven, which is what the government is doing this weekend (weekend ending March 29th), you may have only a few people testing positive, who would be taken to more stringent quarantine facilities. Then you wait another week. Assume more people get infected. On day 14, when you are releasing them, people may have been infected in quarantine.”

Fears that the government quarantine facilities may become petri dishes for the spread of the virus are valid, but over-estimated, according to Professor Omu Anzala, who specializes in virology and immunology. He’s also part of the taskforce set up by the government to deal with the COVID-19 outbreak in Kenya.

“There is that possibility but we have not seen anybody go more than 14 to 15 days without having come down with the disease. We have not seen anybody who has gone more than 15 days who is not showing symptoms but is secreting the virus.”

He does say that these still are early days and that the government, like all governments, is learning as it goes deeper into fighting the virus.

It won’t be long before Doris and Chris get out of quarantine. Perhaps, it won’t take much longer before the country knows whether the mandatory quarantine strategy helped spread or stop COVID-19.

This article was first published by Africa Uncensored.

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A Short History of Constitutions and What Politicians Do to Them

History, again, seems to be repeating itself. A system of government established in a constitution is in danger of being radically changed for the benefit of politicians. But this is not new, argues Prof. Yash Pal Ghai. In fact, a peer into the history of constitution-making in Kenya reveals a tendency of the political class to subvert theses processes for their own benefit.

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1963 and Jomo

Kenya has gone through multiple systems of governance, starting with the British and their occupation of our country. There is little point in discussing the British period, though in some important ways it seems that our rulers have been inspired by the ethos of the colonial British. Britain did try, at the demise of its rule, to establish in Kenya, a Westminster parliamentary system but at the same time incorporating special provisions for the protection of minorities. Despite the resistance of the leaders of dominant tribes, particularly Jomo Kenyatta, they had to accept the rights of minorities (mostly indigenous), even though the proceedings took an enormously long time.

The major difference in the negotiations for the 1963 Constitution was over whether Kenya should be a unitary state or divided into regions (majimbo). It became clear to those opposing majimbo that this was the price for independence. The deep divisions among Kenyans (divisions created to a considerable extent by colonial policy) might have led to Kenya’s disintegration, but for pressure from Britain. Jomo realised that it was worth conceding to the British terms: so long as he became prime minister (with Britain out of the way), when he could dispense with majimbo. This he did within a year, with other major changes, making the state highly centralised—and under his control, not as prime minister but as executive president. Jomo, it has to be said with sadness, set an extraordinarily bad example for a head of state, with no respect for democracy or integrity. We still suffer from these ailments, which his son has promised to remove—with BBI?

1978 – 2002 and Moi

Daniel arap Moi, successor to Jomo (accepted only on the understanding that the Kikuyu politicians would be dominant), set no better example, adopting largely his master’s style of administration and lack of integrity. Jomo and Moi had no respect for the Rule of Law, a central virtue of the constitution giving us independence. Politics ceased to be about policies but instruments of violence (of even honest and nationalist Kikuyus). The popular Tom Mboya, a minister regarded by many as the rightful successor to Jomo was killed. It was widely believed by government agents.

2002-5 Kibaki and the Bomas Draft Constitution

The end of the Cold War and considerable agitation from the younger generation of Kenyans and pressure from West (formerly supporters of corrupt and cruel politicians rulers, here as elsewhere) led to the preparation of a new democratic and fair constitution. There were considerable discussions among the public on the values of the new constitution in which some kind of consensus emerged. But there was little discussion at first among politicians, but in due course, the then opposition parties came around to the idea of moving towards a new constitution. Moi’s party remained scrupulously out of any discussion.

Eventually, a committee of scholars and activists was appointed to undertake the process of wide consultations and to draw a draft of the constitution for consideration of a constituent assembly, consisting of a wide cross-section of Kenyans, in regional and professional terms. After nearly four years of consultations and negotiations, a draft constitution was agreed—and adopted, by the constituent assembly (“Bomas” after its venue, the Bomas of Kenya cultural centre). Its values included: national unity, rule of law, democracy, participation, a wide range of human rights (with special provisions for the marginalised), good governance, integrity, transparency, and accountable development.

Jomo and Moi had no respect for the Rule of Law, a central virtue of the constitution giving us independence. Politics ceased to be about policies but instruments of violence.

Needless to say that it received wide acclamation but not from that eminent Kenyan, Mwai Kibaki. Kibaki provided a very good example of the self-centred Kenyan politician. A senior minister once (in Kenyatta’s time), he had fallen out with President Moi by the time the process for adopting a new democratic constitution.

Initially, Kibaki probably thought that his chance of getting back into power was through the parliamentary system. He and his party (assisted by Kiraitu Murungi) were among the first to make submissions to the Constitution of Kenya Review Commission (CKRC). He urged it to adopt the parliamentary system—even though he had been the beneficiary of presidential system politics under Jomo and Moi. He made a spirited denunciation of what he called “the imperial presidency”. He appeared to stick to this position during much of the Bomas Constitutional Conference process.

Meanwhile the members of Bomas were debating the CKRC proposals – made after intensive consultations with Kenyans of all kinds, throughout the country. The membership of Bomas (officially 629) comprised all the parliamentarians (222), representation of all the districts (chosen by the District Boards), and civil society and professionals (with fair representation of women and people with disability). A broad consensus was emerging in favour of a parliamentary system: with a President having a largely formal role except for minimal powers to counterbalance possible abuses by the government, and a Prime Minister, with the support of Parliament, as head of government.

Kibaki and his team, however, changed tone at this stage and started arguing for the executive presidential system. Having defeated Moi’s chosen successor (Uhuru) in 2002 he had begun to realise the “virtues” of the presidential system that gave him as President so much power.

Kibaki and his team started more or less to boycott Bomas. And rumours suggested that Kibaki and his team were engineering a challenge to the entire Bomas draft – and as Chair a leading lawyer warned me, confidentially, that this was taking the form of a court case, which would go against the Bomas process. I increased the pace of the Bomas discussions, even at the cost of foregoing refinement of the provisions of the draft constitution on devolution.

…Kibaki and his team started arguing for the executive presidential system. Having defeated Moi’s chosen successor (Uhuru) in 2002 had begun to realise the “virtues” of the presidential system that gave him as President so much power.

The remaining Bomas members worked extremely hard, burning the midnight oil, with good discussion, to conclude the agenda and in the presence of a large audience (in addition to the Constitutional Conference members themselves), the draft constitution was adopted in accordance with the prescribed rules, by an overwhelming majority.

The court case and its consequences

Sure enough, a few days later, the High Court decided that there was a fundamental flaw with the whole Bomas process. There were major problems with the litigation. It was started three and a half years after the start of the process, when the draft constitution was nearly done.

The identity of the presiding judge caused a good deal of comment. At the time he was in the running for one of two prominent positions: as head of a new post of a new anti-corruption body, carrying the highest salary in the land, or promotion within the judiciary. After the case he was offered, and accepted, the former, a position essentially in the gift of Kiraitu Murungi who held a senior ministerial post. That judge’s lengthy judgment designed to demonstrate the faults in the procedure of Bomas, was full of references to cases and arguments that had not been raised by the plaintiff.

Bomas was killed thus. This enabled the government to take over the whole process, amend the document to take away the parliamentary system – returning to a largely presidential system. But the government’s butchered version of the constitution was rejected by the people in a referendum – as much motivated by disappointment with the regime as by the detail of the constitution. Nevertheless, no-one in the government mourned this referendum result: it left them with the old, discredited constitution, complete with its imperial presidency.

Returning to the old authoritarian system led to discrimination, ethnicity driven deceits and conflicts. Elections under the old system predictably gave rise to disputes. The 2007 elections were the most critical, with Kibaki and Odinga as the front runners—Odinga the supporter of Bomas constitution and Kibaki favouring the old model. The campaign was organised purely on ethnic lines (Kikuyu versus Luo). The campaigns of Odinga and, especially, Kibaki were conducted largely in their own tribal areas, each carefully avoiding the other’s territory. It is generally accepted that Odinga ran an impressive campaign, supporting the values implicit in the Bomas draft, not narrowing his support to his own tribe, travelling widely.

As the historian Charles Hornsby put it: Odinga personified a popular movement for radical change, while Kibaki was positioned as leader of a reactionary, tribalist, old guard that had mismanaged Kenya in the past. Odinga fought hard for integrity, while Kibaki was suspected of corruption.

Outwardly, it seemed that Odinga was winning by a huge majority, with wide national support, while Kibaki’s support was restricted to Kikuyu, Embu and Meru areas. Odinga’s team had won widely throughout the country. The mode of the counting of votes seemed increasing dubious as the results were announced—or not announced till the last minutes. Gradually Odinga’s huge initial lead over Kibaki started to give way to Kibaki’s lead. In the elections for Parliament, the victory of Odinga’s party, the ODM was overwhelming (presumably the counting was at this level). It was widely believed that Odinga had been cheated of his victory; there was ample evidence to this effect, acknowledged by the head of the electoral body itself. But the false result prevailed.

As historian Hornsby put it: Odinga personified a popular movement for radical change, while Kibaki was positioned as leader of a reactionary, tribalist, old guard that had mismanaged Kenya in the past.

Kenyans were so shocked by the extent of this deceit and it led to the greatest outburst of anger—and, shortly after, violence. As the historian Hornsby noted, “Kenya cracked apart in the worst outbreak of ethnic violence in the country’s history”—ironically in the interests of the candidate who had destroyed the Bomas draft which sought to eliminate ethnic conflict in our country. There was vast destruction of property—and worst, enormous number of killings. Kibaki had succeeded not only in killing Bomas constitution; but in nearly destroying the state of Kenya. Kenyan “leaders” were completely unable to bring the country under control. As a scholar said, “Kenya had seen the increasing use of violence as a political tool and the emergence of mono-ethnic youth militia”.

The county got into a situation in which its leaders could do nothing to bring it to peaceful resolution. African states and the international community had to intervene. An African team led by the former Secretary-General of the UN, Kofi Annan, was convened to bring the county to some order. We had no choice but to be guided by them. Kofi Annan himself advised strongly for the revival of the Bomas Constitution—which the local “leaders” had to accept. For the interim, Annan and his team were able, with great support from Western states, to overcome the resistance of Kibaki to form a coalition government in which Odinga would be the Prime Minister, and Kibaki remaining as the President—and Uhuru Kenyatta as Deputy Prime Minister! The Cabinet was formed by the agreement of Kibaki and Odinga! Meanwhile, discussions proceeded on a permanent constitution, mindful of Kofi Annan’s advice to enact the Bomas draft.

Finalising Bomas

The Bomas draft formed the basis for the work of the Committee of Experts, which was formed to carry forward the constitution project. And the parliamentary system of government – because of its inclusive and ultimately more democratic nature – became again the central proposal, so far as the system of government was concerned. But at the final stage the politicians took over control—and unexpectedly and arbitrarily decided on a presidential rather than a parliamentary system of government. Calculations about who– meaning which individuals – would benefit from which system of government again figured prominently in the reasoning that led to these results. The parliamentary committee had the power to make recommendations, not make decisions. But the Committee of Experts felt, unwisely, that it had to accept what the politicians “recommended” on the questions that touched on political power.

But why rehash this old history? Because history, again, seems to be repeating itself. A system of government established in a constitution is in danger of being radically changed for the benefit of politicians.

2018-20 The Building Bridges Initiative (BBI)

The government (or rather Uhuru and Raila) having created a so-called “Task Force” feel they or we are about to solve our problems.

At first it looked as though their mandate from Uhuru-Raila was broader than who held political power. What seemed to be needed was the fulfilment of the Constitution (which Uhuru and Raila professed to revere). And the Building Bridges Initiative (BBI) Task Force’s report is long and discusses much that touches on other issues. About nine of their proposals need changes to the Constitution; nearly 30 would require changes to ordinary law. Many others are just “let’s do what the law already requires”. The real concerns of our political leaders seem to be revealed by the decision announced at one stage to appoint a group of constitutional experts to assist the Task Force to “fine-tune” the BBI report (though this idea seems to have faded away). The discussion about a “referendum” also lays bare the real concerns. Under our law and Constitution the only situation that requires, or even contemplates, a referendum is constitutional reform. And the constitutional reform that is being focussed on is – and you have noticed it – is on the system of government. In other words, on who gets to hold political power – that political power that it is the sovereign right of the people of Kenya to allocate.

…History, again, seems to be repeating itself. A system of government established in a constitution is in danger of being radically changed for the benefit of politicians.

A reasonably competent team, in the form of the Task Force, listed a large list of constitutional and other violations—but every Kenyan knows these violations and that are mostly perpetrated by the state (including politicians).

Instead of taking any action, the government has extended the life of the Task Force (in the New Year), to educate Kenyans on the problems facing Kenya and how they could be solved.

The outcome of all this is continued feuding among political groups of little significant interest to most Kenyans. The major issue concerns leaders of major tribes as to political, legal arrangements after the end of the present terms of office. And the current solution for our problems is to ensure a prominent, prestigious, post for the major 5 or 6 tribes or more accurately for their leaders (against the terms of the Constitution). What has been canvassed with vigour is the retention of the President, as at present, outside Parliament, one Prime Minister with two deputy prime ministers with, perhaps responsibilities of their own. Raila, having been vocal in support of a full parliamentary system with the Prime Minister as head of government, more recently seems to have shifted to favour the BBI’s Tanzanian model of a weak Prime Minister as a side-kick to the President.

2020 The real problems facing Kenya

In brief, we all know that there are repeated and gross violations of the Constitution. The strength of the current Constitution is clear from Art. 10, especially 10(b) which prescribes national values and principle of governance. Some key provisions are national unity, democracy (including participation of the people, human dignity, equity, social justice, human rights – which include abolition of poverty and protection of the marginalised).

There is massive violation by political parties and the IEBC of electoral laws as well as of provisions on the nature of political parties under the Constitution. Article 91 sets out the rules governing political parties (such as having a national character, promote and uphold national unity; abide by democratic principles). A party cannot be founded on a religious, linguistic, racial, ethnic, gender or regional basis; engage in bribery or other forms of corruption, or use public resources to promote its interests or its candidates in elections.

The outcome of all this is continued feuding among political groups of little significant interest to most Kenyans. The major issue concerns leaders of major tribes as to political, legal arrangements after the end of the present terms of office.

There are massive violations of the Constitution by state agencies, from the office of the President to the lowest public officer. This is now widely acknowledged by President Uhuru and many other state officials.

But, yet again, our politicians have reduced our problems to “their” problems – those who call themselves politicians. The concerns are with who gets into power, not with how that power is used for the people of Kenya, in accordance with the Constitution in which Kenyans have placed so much faith, and into which they put so much effort. Our politics go no further than conflicts between politicians.

Handshake and BBI: Demise of the 2010 Constitution?

My view of Handshake and BBI is very different from what the President and Honourable Odinga claim it is—as creating peace and harmony among us all, moving away from ethnicity; catering to the needs of Kenyans. Perhaps I have become too cynical about politicians to believe that they are ever driven by the desire to help Kenyans—rather than only themselves. But I did work with them for four years, and met party leaders at least once a fortnight to report on and discuss the progress or otherwise of the constitution-making process. I could give you some examples of their selfishness (like claiming expenses for Bomas meetings when they did not attend the sessions—I did recover that in due course, under threat of going public!) and changing their strong position on a constitution proposal without any qualm or embarrassment if they see some advantage in doing so. The crude and embarrassing way they are changing their partners now over the BBI is an example.

…our politicians have reduced our problems to “their” problems – those who call themselves politicians. The concerns are with who gets into power, not with how that power is used for the people of Kenya, in accordance with the Constitution…

Knowing Raila as I have done, I was not surprised at the initiation of BBI. At that time BBI seemed to be a project to ensure the full implementation of the 2010 Constitution. He had identified 9 objectives and values of the Constitution, directly at the welfare of the people, that the Government had not implemented. That was it. This did not surprise me because I knew of his commitment to the welfare of the people. Over the years he has fought for their rights—and had suffered a long period in jail during the regime of Moi, because he fought for a fair administration, which respected the rights of Kenyans. He had been active in politics all his life for this cause. So my expectation was that, together with Uhuru, with his access to state resources and power, the Government would immediately deal with those gaps, particularly the provisions on human rights, and scrupulously and diligently address those issues (an impression I got from the only meeting that I had with their technical team) that the nine areas of the violation of the Constitution would be covered—and we would all be happy thereafter. But this did not happen—clear and simple as this might be, and as the Government is bound by the Constitution to implement them. Instead he and Uhuru set forth on a complex, expensive, and (as it turned out) tortuous path to achieve a long and complex strategy—but strategy for what?

The fault for the misery of millions of Kenyans is surely with Uhuru and his government. It is extraordinary that the powerful President (in office over six years) with control over a huge bureaucracy and resources should say that they need to consult people on their needs. Surely we know, and the President knows, the hardships that the people suffer constantly–in defiance of the  Constitution. What they would like the state do for them was conveyed to CKRC and is reflected in the Constitution, as the President knows well.

I am totally puzzled by his and Raila’s strategy—if this is the objective. I could understand the appointment of a technical team—and several members are indeed well qualified for the job. I assumed that they were to liaise with the relevant ministries, responsible to make good the Nine Deficiencies in the implementation of the Constitution. However, it became clear soon that this was not the intention—the team were advisers to Uhuru and Raila (I should have known from their composition!). Meanwhile I saw little remedial policies from the relevant ministries. Instead shortly later, Uhuru and Raila embarked on a tour of the country, explaining to the people (and to other politicians) the purpose and nature of BBI (by which title the whole project became known). Their entourage was itself of no mean size. It was not clear to me what really was being conveyed to the audiences.

The fault for the misery of millions of Kenyans is surely with Uhuru and his government. It is extraordinary that the powerful President with control over a huge bureaucracy and resources should say that they need to consult people on their needs.

Instead, what worried me most was the enormous expense that this exercise was incurring. It was not clear under what authority the huge sums of money were being expended. In any case funds were running out—until our benefactor, that sharp minded President of the USA, Trump, apparently voted us huge sums of money (gift or loan?). In the end, rumour has it, this became the major source of funds for this exercise—to keep up these tours, with huge audiences but less and less of any meaning.

Meanwhile their advisory team went around the country—with a clear mission. As I understand, they sought the views of ordinary Kenyans as to the hardships they face in everyday life and how their lives could be improved—for which purpose they could have examined people’s submissions to the CKRC as how their lives could be improved as well as the Constitution (particularly the Bill of Rights).

Before long, the focus of the grand BBI project shifted away from the needs of the people to the concerns of politicians—led by Uhuru and Raila and their entourage. At this stage the sharp conflict between two wings of politicians—Uhuru versus Ruto, became fully clear. It seems that Ruto has not given much attention to constitutional reform/change, more to political conflicts. So his clashes with Uhuru lacked reference to what had become constitutional matters of debate. The debate between the two is truly abysmal. Perhaps even Uhuru has lost track of the many amendments to the Constitution proposed by other politicians. The BBI has moved to a new level—of critical amendments to the Constitution—a long way from the politicians’ original apparent concern with fulfilling the Constitution to plans for fundamental changes in its structures. Whether the broad objectives of BBI have been replaced by other considerations or merely a complex system to achieve the same objectives, remains to be seen. We turn to that now.

Proposing Change to the Constitution

If BBI started with strengthening the Constitution, it ended by trying to weaken it. As mentioned earlier, the objective of their amendments was to move away from ethnic pre-occupation/domination of politics and state structures (consistently with the Constitution). Whether their intentions changed is unclear—but you will see.

It seeks to change the Executive and Parliamentary system. The office of the Presidency and the Deputy would remain. There would be posts of Prime Minister and two Deputy Prime Ministers, chosen by the largest party in Parliament. If that party is that of the President, as is likely, it will greatly increase the authority of the President, compared to the current situation (in which the President is already regarded too powerful). A point to note is that the number of key posts for politicians will more likely be 5: from the 5 largest tribes? It is also interesting that the key actors in the BBI are from these 5 tribes!

Before long, the focus of the grand BBI project shifted away from the needs of the people to the concerns of politicians—led by Uhuru and Raila and their entourage. At this stage the sharp conflict between two wings of politicians—Uhuru versus Ruto, came fully clear.

How the system will work is hard to foresee. Certainly not like the parliamentary prime minister—originally so dear to Odinga. In the event that the President and the Prime Minister come from different parties, because the dominant party in Parliament is not that of the President, there could be serious conflicts between two major political parties in the legislature—and more broadly.

There seems to be an assumption that, in order to prevent the rigging of elections, every leader of a major ethnic group should have an important office. This is a strange way to move away from ethnicity to nationhood – and hardly consistent with the sub-title of the BBI Report: “From a nation of blood ties to a nation of ideals”.

Another unsatisfactory proposal is that members of the IEBC should be appointed by political parties. This means giving up on the idea of an independent electoral commission, it assumes a fixed pattern of parties, but Kenyan parties change frequently. It is would almost certainly be unworkable, unstable, and prone to irregularities.

How democratically arrived at these proposals are is evident that the Speaker of Parliament prevented any debate on these proposals—no doubt not to give MPs of Ruto’s school an opportunity to voice their views.

There are various other proposals. One is to reduce the health responsibilities of counties, by establishing a National Health Service Commission to employ medical staff. True there have been counties in which health care has been deplorable. Others have provided a model for the national governments universal health care plans.

Appointing Ministers (a return to the old terminology rather than Cabinet Secretaries taken from the US system when we took their model of government) from Parliament responds to the ambitions of MPs who hate being confined to the role of legislator.

A very revealing proposal is that the person who comes second in the presidential poll should get an automatic seat in Parliament and be Leader of the Opposition. This responds to politicians’ frustration at failing to become president and then not even being an MP. There are various practical problems. First, the balance of parties in the National Assembly would be affected by the introduction of a member of a party who was not elected (a minor point unless numbers of MPs was very close for the two top parties/groups). But suppose the runner up in the presidential election is actually from the largest party in the National Assembly? It’s not impossible. What happens? The presidential runner up is both PM and leader of the opposition? Surely not. People from the same party are PM and Leader of the Opposition? Ludicrous.

A very revealing proposal is that the person who comes second in the presidential poll should get an automatic seat in Parliament and be Leader of the Opposition. This responds to politicians’ frustration at failing to become president and then not even being an MP.

Part of the problem is that the BBI recommended two solutions from similar problems – the sense of exclusion of the narrowly defeated.

I do not think that all the proposals have no merit. I think that a distinct status for Nairobi City as the capital of the country is not a bad proposal. It was actually recommended in the CKRC and Bomas drafts – but without details, these being left to an Act of Parliament.

But this and all the other ideas need very careful consideration, not the half-baked discussion in this report.

Need for a process

Whenever a constitution is to be considered for amendment there is need for a very thorough process. We would need much more detailed public participation, published proposals, giving Kenyans ample time to examine and discuss them. We would need national discussions, observing the best practices of public participation. In other words, something much more like the CKRC process, not this amateurish effort of a process and mishmash of proposals.

The whole process so far shows the tendency of politicians to mess around with the Constitution to their own benefit.

Raila Odinga has suffered for democracy in this country. He achieved a wider degree of public support, less pegged to ethnicity, than any other Kenyan politician in a democratic context. He has genuinely believed in ideologies and policies.

But is this where he would want to end his distinguished career in a shoddy and clumsy process, designed for the benefit of himself and a few others and for the exclusion of others?

I want to acknowledge gratefully Jill Cottrell Ghai’s assistance in this article.

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