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THE NEW SCRAMBLE FOR EAST AFRICA: How rising debt and IMF loans have shielded kleptocrats and stunted human development in the region

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THE NEW SCRAMBLE FOR EAST AFRICA: How rising debt and IMF loans have shielded kleptocrats and stunted human development in the region

“National liberation, the struggle against colonialism, the construction of peace, progress and independence are hollow words devoid of any significance unless they can be translated into a real improvement of living conditions.”
Amilcar Cabral, African Party for the Independence of Guinea and Cape Verde

Given the disparity between Uganda’s economic growth and the increasingly precarious existence of most of her citizens, Ugandan economists need to devise a measure of economic growth that reflects the needs and aspirations of the indigenous population.

Economic growth, as measured by the International Monetary Fund (IMF) in Uganda, is not synonymous with access to life-supporting conditions. GDP is primarily used as an indicator for aid decision-making by investors. Investors – whether charter companies, venture capital funds or multinational companies – have served to create employment and to raise living standards in their countries of domicile. Debt is the means by which net outflows of wealth from developing countries is achieved.

Human development indicators stand outside GDP and may or may not be considered (and are usually not considered) in the measurement of progress. What is required is an indicator of economic growth that is linked to the health, well-being, education and general prosperity of Ugandans. To have any real use, the measure would also have to factor in the impact public debt repayments have on household access to basic requirements, such as water, food and useful education.

Insisting, as the government and international lending agencies do now, that debt repayments are sustainable as long as they remain under 50% of GDP masks the fact that even with that debt-to-GDP ratio, the prevalence of undernourishment in Uganda remains high and access to improved water and sanitation remains low. Uganda’s debt repayments stand at 38% of GDP and between 26% and 36% of the population is undernourished. Now that public debt has risen to 50% of GDP, it is misleading to paint a rosy picture of the economy.

The IMF’s World Economic Outlook of April 2018 reported Uganda’s annual economic growth rate to be 5.2%, compared to 5.5% for Kenya, 6.4% for Tanzania and 7.2% for Rwanda. The East African Community’s other members, Burundi and South Sudan, were reported to have low or negative economic growth rates (0.1% for Burundi and a negative rate of -3.8% for South Sudan), the result no doubt of the ongoing internal conflicts in these countries.

Insisting, as the government and international lending agencies do now, that debt repayments are sustainable as long as they remain under 50% of GDP masks the fact that even with that debt-to-GDP ratio, the prevalence of undernourishment in Uganda remains high and access to improved water and sanitation remains low.

However, growth statistics reported for Uganda and the East Africa region may really be a reflection of the activities of and benefits enjoyed by multinational corporations, other investors and political elites and could have little relation to the average Ugandan or East African. An East African or Ugandan Economic Statistics Review Group could usefully be set up to find more meaningful measures, including non-monetary factors, that would reflect the improvement, deterioration or stagnation of the standard of living. It is a major in-built weakness in governance to rely on external entities (whose priorities are not necessarily our priorities) to manage and report on the economy.

Against the background of inadequate human development, Roger Nord, the deputy head of the IMF, approved the findings of Uganda’s Debt Sustainability Analysis of December 2016. As is now known, that report stated erroneously that Uganda was at low risk of debt distress and that there was no risk of domestic debt undermining the country’s ability to meet debt repayments.

Adam Mugume, the executive director for research at the Bank of Uganda, thought differently. He warned that falling commodity prices and the sliding value of the shilling had the potential to worsen an already precarious debt position. More recently, the Central Bank has warned that sovereign default remains a real danger. The Auditor General weighed in with a warning that interest payments on domestic debt are pushing the country towards debt distress. However, the IMF’s opinion prevailed for reasons that go back to the 1884-1885 Berlin ‘Scramble for Africa’ Conference and all that came after it.

The IMF followed up its misleading assurances in April 2017 when Mr Nord said on KTN that although the economic outlook for Africa was generally subdued, the one bright spot was East Africa where regional integration was progressing. He cited the flow of goods, services and people without indicating how IMF policies have impacted those flows since 1986/7 when the structural adjustment programme (SAP) began. Integration in to one economic bloc, Nord said, would make East Africa an even more attractive destination for foreign investment in much needed but expensive infrastructural development – a message of encouragement to investors that took no account of human development.

Federation has clear advantages connected to economies of scale in developing infrastructure. What is argued here is that integration could also consolidate corruption and the accompanying means of repression. Loans already spent have not always yielded value for money, a fact the IMF does not acknowledge. As it is, there is a need to be hypervigilant at the national level in monitoring debt and the terms and conditions under which it is incurred. Uganda would have done better to strengthen her own governance before embarking on ever closer union with other countries.

Foreign direct investment is often financed by credit made available to investors under government schemes in their own countries for projects that they propose to the target countries. Recently, the UK launched the Export Finance (UKEF) line of credit under which the government of Uganda borrowed €270 million to build an airport. The condition is that British companies are to be used to do the work.

Federation has clear advantages connected to economies of scale in developing infrastructure. What is argued here is that integration could also consolidate corruption and the accompanying means of repression. Loans already spent have not always yielded value for money, a fact the IMF does not acknowledge.

Britain now produces 60% of her food requirements and imports 30% of the rest from the European Union. Her emergency reserve is good for five days. Britain has a perpetual balance of payments deficit which will only be made worse after Brexit when imports from the EU will become more costly. It made sense therefore to offer British companies credit and so far, in addition to an airport, from which GBP100 million worth of exports to Uganda is expected to result, the UK won contracts in Uganda worth over US$2 billion in 2017 alone.

Whether Ugandan leaders looked beyond the easy availability of the credit and considered with enough rigour the prioritisation of an airport, the strength of the technical proposals or the relative cost remain to be seen. What is almost certain is that no effort was made to ensure that Ugandan businesses and professionals participated in those development projects and that there was a transference of skills.

The history and purpose of federation

Britain’s reasonable interest is to maintain employment to enable her workers to purchase food. One MP summed up the situation up as: “We have to buy our food from outside, and in order to buy our food we have to exchange manufactured articles, but before we can exchange manufactured articles we have also to buy from outside the raw materials from which to manufacture them.”

East African federation has always been seen as a solution to Britain’s economic challenges. During the slump of the 1920s, UK’s parliament considered possible solutions. These included encouraging the three million unemployed to migrate to the Dominions and to the colonies and creating more jobs in the textile industry by creating a larger source of cheap cotton to substitute the more costly American variety. This was to be done by investing in a railway and harbour through which to export the cotton from Uganda and Kenya. The beauty of it was that it would be paid for out of cotton taxes and native poll tax paid by the growers.

Federation was first formally considered for East and Central Africa by parliament in 1925. An early triumph or regional cooperation was the co-financing of the Mombasa port and the Uganda Railway. The benefits were not evenly distributed – Kenyan customs collected and retained the duties paid for Uganda’s trade through Mombasa for the first ten years. The Uganda Railway itself began and ended in Kenya from where a steamer completed the journey.

Later there was a movement in colonial Kenya to break away from Britain and form an autonomous state similar to the Union of South Africa. Kenyan settlers who dominated the Legislative Council proposed that Kenya be allowed to spend GBP80,000 (roughly the equivalent to the annual budget of the Colonial Office) to build the East African High Commission as the future administrative building for an expanded Kenya.

The anticipated self-governing federal state was to incorporate Uganda and Tanganyika. There was talk of uniting a future East African Federation with the Central African Union (of Rhodesia and Nyasaland). From Uganda’s point of view, this was undesirable because European settlers in Kenya had already planted the seeds of apartheid-style economic domination; they were exempt from income tax; they had exclusive rights to the cultivation of profitable crops like maize and coffee granted by British government ordinances (thereafter claiming entitlement to privileges because they carried the economy); they were entitled to use forced labour and the pay scales were lower for Africans than for Europeans and Asians. Salaries were usually calculated on the basis of a single man living in a hostel near a mine or a farm. In this way, poverty became entrenched as families left behind on Native Reserves tried to eke out a living on the increasingly over-populated Reserves.

The cost of Kenya’s colonial administration was much higher than anywhere else in the region because, as explained at Whitehall, the administration had to be predominantly European to service the settler community. An example given was that a European suspect could not be expected to submit to arrest by an African policeman, therefore expatriate policemen paid on an expatriate pay scale were needed.

Some high-cost social services for use by the Kenyan settler population were paid for with ‘loans’ from the Ugandan treasury. Examples include Hill School, Eldoret, a boarding school for European pupils from the region and the Mombasa Municipality water supply financed in 1959 by a 15-18 year loan to Kenya of GBP1 million. In Uganda there were already segregated educational, medical and recreational facilities for Europeans, Indians and Goans.

To attract more settlers to Kenya, especially from among the unemployed, the Imperial government offered them an existence in which their interests took precedence over those of the indigenous population. Collateral damage to Africans included involuntary population transfers as commercial farms were established, compulsory labour, child labour, flogging, exploitation of women and abandonment of their children and venereal disease.

In 1932 the parliamentary Joint Select Committee on Closer Union in East Africa was set up to examine the issue. The opposition argued that settlers could not be entrusted with the welfare of the Africans and that Britain should continue to play their self-arrogated role of trustee. As in 1925, the committee recommended that the prevailing model in the region be maintained i.e. that the British government through the Colonial Secretary maintain the authority to intervene directly in the affairs of the East African colonies.

Post-independence African leaders entrusted with the welfare of the indigenous population act as middle-men, receiving support for their elections and monetary benefits in return for serving external economic interests. Investors need only secure physical access to leaders or their relatives before emerging with tax-holidays, waivers of environmental law, hectares of free land and permission to displace any local communities in their way.

How different is the subjugation of the interests of the general population by those pre-independence elites from the current situation in which potential investors are offered incentives that are ruinous to the local economy? The only difference between pre- and post-independence multinational corporations is that instead of dealing with colonial administrators they now deal with African kleptocrats.

The East African Legislative Assembly will be able to approve loans. East African federation makes the region more attractive to investors because larger collateral spanning the entire region can be extracted. Having failed to reign in a national parliament that consistently fails to keep public debt at manageable levels and on reasonable terms, there is little reason to expect the East African Legislative Assembly to act any more prudently.

How different is the subjugation of the interests of the general population by those pre-independence elites from the current situation in which potential investors are offered incentives that are ruinous to the local economy? The only difference between pre- and post-independence multinational corporations is that instead of dealing with colonial administrators they now deal with African kleptocrats.

In pushing for regional integration to boost foreign direct investment without paying at least as much attention to raising living standards, the IMF is carrying on from where the Imperial government left off.

The evidence of deepening regional cooperation cited by Mr Nord was “growth remaining quite high and investment proceeding” and regional integration evidenced in the launch of the single passport for East African citizens. Regarding the criteria countries are required to meet before joining the Union, Mr Nord said, “Debt levels are all within – uh – limits. Fiscal deficits remain still on the high side but in most countries are heading down.” He expects a monetary union by 2024. Meanwhile, Uganda’s fiscal deficit is growing.

What the IMF omits from its glowing investment portfolio for East Africa is the fact that all debts incurred by corrupt leaders are likely to be audited. Wherever it is found that they led to abuse of civil rights or that they yielded insufficient value for money, they are liable to be repudiated. Non-ethical investment no longer makes financial sense.

Mr Nord’s condescendingly vague remarks offer little justification for his optimism. (He is often referred to as the ‘Super Minister of Finance of Uganda’.) Civil unrest is constantly simmering in Uganda, Kenya, Rwanda and Burundi. Sudan reverted to all-out war after a hiatus of only two years. The fact is that post-independence East Africa is being set up for exploitation on a new level by foreign corporations and vampire investors aided and abetted by its leaders.

Civil unrest and state brutality

As in colonial times, the current social unrest is symptomatic of underlying problems, chief among which is the lack of economic advancement of the vast majority of East Africa’s population. Civil unrest and state violence are critical economic indicators. This was understood in the past by some British MPs, two of whom are quoted below:

Why is it that the Colonial Office still permits in new ordinances, restrictions on the civil and industrial rights of the peoples of the Colonial Empire? In Sierra Leone, there has been a new spate of legislation designed to increase the powers of the Government in regard to the literature that may be read, in respect to deportation orders and trade union organisation. Recently, there was a new Sedition Law in Trinidad. If these Colonies have been able to get on for scores of years without this legislation being necessary, what new factors are there in the situation which require that these new ordinances of a repressive and restrictive kind should now be passed? Is it that at last the people are demanding that justice should be done, and therefore, it is necessary to put further checks on their powers of expression?

Arthur Creech Jones MP, contributing to the Colonial Office debate in the House of Commons on 7 June 1939

 

I ask any hon. Member opposite if he thinks millions of people engaged under conditions like that, having to work for miserably low wages like that, including sometimes some amount of food, can be expected to be in a state of contentment with affairs as they are? Does any hon. Member opposite blame them if occasionally they are inclined to break the law to try to make things better? If the Colonial Secretary tried to look at those problems in that way, instead of bringing down on these people, with all his might and main, every possible policeman, he would be a success.

–Wilfred Paling, MP during the Affairs in Africa debate, 16 December 1953

 

Sixty years later, failure to gain access to the most basic requirements of decent living, while others live in fear of losing the access they enjoy, it is no wonder there is disaffection among the population. Where there is disaffection, repression is to be expected because Kenya and Uganda retained repressive colonial laws enacted as a response to agitation for independence.

That the IMF deems this state of affairs ‘progress’ is sad but not surprising. Illicit transfers of wealth on the current scale can only be continued by force. From the point of view of an organisation whose primary aim is to secure the signatures of African leaders on contracts committing the region to debt regardless of its sustainability, East Africa is a success. The five strongmen leaders and President Nkurunziza of Burundi are kept in power by foreign aid, which is used to provide the services for which the government should be responsible.

As in colonial times, the current social unrest is symptomatic of underlying problems, chief among which is the lack of economic advancement of the vast majority of East Africa’s population.

The IMF’s campaign of disinformation provides the façade of ethical investment while foreign corporations siphon out the wealth of the African continent.

Beyond austerity to destitution

The latest available figures show that, on average, one third of the population of East Africa is undernourished. (This figure excludes Burundi and South Sudan for which no figures are available but reliable refugee sources have spoken about feeding stations in the towns in both countries.) Despite having the highest economic growth rate in East Africa, nearly half of Rwanda’s population is undernourished. (Rwanda succeeded Uganda as the exemplar of the rightness of structural adjustment.)

The prevalence of undernourishment in Uganda rose by 13% to the current 39% of the population between 2006 and 2015. In addition, Uganda has pockets of prevalent stunting, a high primary school drop-out rate, and low access to improved sanitation facilities (19% for Uganda, 30% for Kenya, and 15% for Tanzania. These three countries, the original East African Community, have been applying IMF-prescribed economic policies for much longer than Rwanda and Burundi where access to improved water and sanitation stands at 61% and 41%, respectively.)

Prevalence of undernourishment (% of population)

Fig. 1

Source: World Bank Health Nutrition and Population Statistics. No undernourishment data on Burundi. Last Updated: 12/18/2017

The prevalence of undernourishment in Uganda rose by 13% to the current 39% of the population between 2006 and 2015. In addition, Uganda has pockets of prevalent stunting, a high primary school drop-out rate, and low access to improved sanitation facilities (19% for Uganda, 30% for Kenya, and 15% for Tanzania.)

Hunger is endemic in parts of the East and Karamoja and the population there is fed and watered by the World Food Programme. Periodic influxes of refugees from South Sudan only serve to exacerbate the problem. At the current growth rate, coupled with the downward spiral in commodity prices and the fall of the shilling to half its 1990s value, it is unlikely that the level of undernourishment or the lack of access to safe water will be significantly reduced.

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Mary Serumaga is a Ugandan essayist, graduated in Law from King's College, London, and attained an Msc in Intelligent Management Systems from the Southbank. Her work in civil service reform in East Africa lead to an interest in the nature of public service in Africa and the political influences under which it is delivered.

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INVISIBLE CITIZENS: Branding Kenya for foreign investors and tourists

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

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INVISIBLE CITIZENS: Branding Kenya for foreign investors and tourists

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

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

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

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

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

Hegemony

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

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

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

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

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

Between the investor and the tourist

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

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

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

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

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

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

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

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

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

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

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

Daily and institutional violence

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

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

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

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

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

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

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

Starting afresh

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A savage inspiration

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

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

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

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

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

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

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

Enter the Africans

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

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

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

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

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

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

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

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

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

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

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

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

Conquest, China and African superpowerdom

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

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

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

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

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

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

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

White nationalism and the Age of Trump

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

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

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

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

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

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

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

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

An ode to indigenous peoples

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

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

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

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

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

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

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

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

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

Becoming a patient

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

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

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

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

Where we go to find help

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

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

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

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

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

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

The case against being “world class”

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

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

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

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

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

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

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

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

Who pays for universal healthcare?

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

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

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

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

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

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

Light at the end of the tunnel

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

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

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

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

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

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

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

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

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

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

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