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HOMELESS IN THE CITY: Was the Kibera demolition a violation of housing rights?

The brutal and illegal evictions of Nairobi’s poor to make way for infrastructure demonstrates that the city remains true to its colonial origins as a space for the elite. Is Kenya sacrificing humanity for development? BY APRIL ZHU

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HOMELESS IN THE CITY: Was the Kibera demolition a violation of housing rights?

It has been a long time since waist-high concrete beacons dropped down along the middle of the Kibera slum in Nairobi, marking the corridor of a future road and serving as an omen of change. But for almost two years, they stood rather impotently, largely ignored and even vandalised a few times, as no road came. Legal battles had frozen the encroaching highway in its tracks.

The road that was yet to come was Missing Link 12, a Sh2 billion four-lane highway partially funded by the Japanese government, one of many other “missing links” that would connect major highways in Nairobi. In the meantime, life in Kibera carried on for years between the beacons in that 600-metre-long corridor.

This changed on Friday, 20 July, 2018, when Maxwell (who requested that his surname not be used), who lived in Mashimoni, squarely within the road corridor, heard an announcement on the radio: “There will be a demolition on Monday morning.”

Word was starting to get around, but many were still making light of the news. After all, the road had been in the works for years and the Kenya Urban Roads Authority (KURA), the government body responsible for construction of this road, had just completed the first stage towards developing a Resettlement Action Plan (RAP) only days before. Maxwell recalls the radio ads sounding more like warnings for motorists to avoid the area because of possible demonstrations. He felt confident that the residents would be given a stronger warning the day before the actual demolition, but, just in case, he moved his belongings to his cousin’s home in Makina, a safe distance from the demolition zone.

Maxwell made the right call. At approximately 7am on Monday, 23 July, three bulldozers, accompanied by hundreds of heavily armed Administration Police officers, descended on houses, kiosks, churches, and schools from the Ngong Rd end to the Lang’ata Rd end of the corridor. The concrete beacons became marshals for a swift and total demolition.

KURA spokesperson, John Cheboi, told The Elephant that 2,182 structures within the corridor were targeted. According to Amnesty International Kenya, over 10,000 residents were displaced. It was the largest eviction to occur in Kibera since the 2009 relocation of 5,000 people from Soweto East under the Kenya Slum Upgrading Project, for which decanting sites were built in Lang’ata.

Several other Missing Links throughout the city will also require evictions, including at the Deep Sea slum in Parklands, which is scheduled to be cleared to complete Missing Link 15, a mass eviction which may affect another 3,000 people. On 19 July, the Multi-Sectoral Committee on Unsafe Structures released a public notice requesting that residents of Kaloleni, Makongeni, Mbotela, Mutindwa, Dandora, and Kenyatta University (Kamae) move voluntarily in advance of “the removal of all structures”.

KURA spokesperson, John Cheboi, told The Elephant that 2,182 structures within the corridor were targeted. According to Amnesty International Kenya, over 10,000 residents were displaced.

Legal framework on evictions

For a problem that is set to continue, Kenya has a comparatively imprecise legal framework on evictions. “There are enough constitutional provisions that would forbid the government from doing what it did that morning, but there is no eviction law,” says Irũngũ Houghton, the Executive Director of Amnesty International Kenya. Article 43(1b) of Kenya’s Constitution guarantees the right of every person to “accessible and adequate housing” and Article 40(4) affirms that, in the case that the state deprives any person of property, “provision may be made for compensation to be paid to occupants in good faith of land acquired under clause (3) who may not hold title to the land.” The Internally Displaced Persons Act of 2012 also holds that people displaced by “large-scale development projects” are entitled to a human rights-based process of eviction.

In addition, Kenya is party to the International Covenant on Economic, Social and Cultural Rights (ICESCR), the International Covenant on Civil and Political Rights (ICCPR), and the African Charter on Human and Peoples’ Rights. All of these uphold the right to adequate housing and, to varying degrees of specificity, provide guidelines for humane evictions within a human rights framework. Article 2(6) of the Constitution makes any treaty or convention ratified by Kenya part of Kenyan law.

There are also eviction guidelines from the Ministry of Housing that give, for example, conditions under which evictions should not occur, several of which were flagrantly violated in the Kibera demolition: no evictions in inclement weather, while students are in school, or without completion of a Resettlement Action Plan (RAP).

There have also been several major judicial precedents set in the last few years that interpret the Constitution to prioritise human rights, regardless of land ownership or tenancy status. In 2011, police and unidentified youth evicted more than 1,100 residents and destroyed 149 homes on public land near Garissa that was to be used for a road. The High Court, however, ordered the government to restore the evictees to their land, rebuild their homes, and pay Sh220 million in compensation, citing that evictees’ “rights to housing and to be treated with dignity and respect had been violated.”

There have also been several major judicial precedents set in the last few years that interpret the Constitution to prioritise human rights, regardless of land ownership or tenancy status.

Then in 2013, after the railway pension board gave residents of Muthurwa Estate in Nairobi 90 days to vacate before demolition, the High Court ruled that the board had violated evictees’ “rights to adequate housing and sanitation, and human dignity, and violated children’s rights to protection after it sent bulldozers to demolish hundreds of homes at dawn.” Judge Isaac Lenaola, in this ruling, added, “I must lament the widespread forced evictions that are occurring in the county coupled with a lack of adequate warning and compensation which are justified mainly by public demands for infrastructural developments.”

In the case of Missing Link 12, the High Court issued a similar order for Petition 974 (2016) requiring that a full RAP be completed before demolition. Shafi Ali Hussein, the director of the Nubian Rights Forum and one of the petitioners in that case, was present when KURA met with the Kenya National Human Rights Commission, the National Land Commission and Kibera community leaders. KURA agreed to roll out the RAP “with immediate effect”, according to Hussein. In the next few days, KURA staff began enumeration, the first step of a RAP where the number of structures is counted and basic information on affected residents collected.

However, according to Hussein, KURA seemed ill-prepared to carry out the exercise, and the forms that staff members used for the questionnaires did not have serial numbers. Enumeration finished on Friday, 20 July, the same day Maxwell heard the radio announcement warning of evictions. The following Monday, it was to continue by verifying the data that had been collected, the next step necessary for setting up a compensation scheme. “But on Monday, unfortunately, we saw bulldozers,” said Hussein.

According to KURA spokesperson, John Cheboi, residents and owners of structures within the corridor had been notified to vacate by 16 July. When The Elephant asked Cheboi why they began the enumeration exercise days after residents were allegedly told to vacate, he responded that they were called back for the exercise.

Anti-poor urban design

Nairobi has remained true to its origins as a city designed for its elite, leaving for its working class what were literally and now figuratively remain “labour reserves” – unserviced, unrecognised crevices between its formal parts. Though the colonial urban management philosophy that Africans were unfit for city life was in effect a ploy to keep cheap African labour available for European commercial farms in Rift Valley’s “White Highlands”, the result was chronic underinvestment in urban spaces for indigenous Kenyans.

Kefa Otiso, professor of geography at Bowling Green State University, explains that, in addition to other race-based policies that prioritised European and Asian access to land and other economic resources within Nairobi, this “return to the land” policy resulted in many indigenous Kenyans settling in unsafe urban and peri-urban areas; they became, in his words, “the precursor of many modern slum and squatter settlements that are vulnerable to forced evictions.”

Nairobi’s population is set to hit 6 million by 2030, according to the World Bank, and currently 60 percent of its residents live in informal settlements. Much of this growth is propelled by rural-to-urban migration. At the current rate of urbanisation, this means almost half a million new slum dwellers every year. At the same time, land prices in and around Nairobi are skyrocketing due to a growing influx of illicit money laundered primarily through real estate and property markets. For the growing number of low-income, working-class households looking for affordable housing in Nairobi, this leaves few options outside of informal settlements.

In many ways, Nairobi’s anti-poor urban design today is a facsimile of colonial plans. Many low-income households are forced into the city’s “low-quality, high-cost trap”, where landlords are free to pursue economic incentives without administrative oversight or protection for tenants. Lucrative and efficient, slum real estate allows landlords to quickly buy “rights” to build on the land and see a return on investment without truly being held accountable for structural integrity or, in the case of the Kibera demolition, secure location. Landlords actively continued to build within the Missing Link 12 corridor even though there was impending construction, and, with the shortage of cheap urban housing in Nairobi, one could always find tenants.

In many ways, Nairobi’s anti-poor urban design today is a facsimile of colonial plans. Many low-income households are forced into the city’s “low-quality, high-cost trap”, where landlords are free to pursue economic incentives without administrative oversight or protection for tenants.

In the ruling of the 2013 Muthurwa case, Judge Lenaola gave the Attorney General 90 days not only to outline the government’s policies on evictions and explain whether they meet international standards, but also to explain what positive steps they would take to realise the right to accessible and adequate housing as guaranteed in the Constitution. “The right to adequate housing cannot be aspirational and merely speculative,” Lenaola said. “It is a right which has crystallised and which the State must endeavor to realise.”

The everyday, systemic violence that policy wreaks on the urban poor is often obscured by the obvious, photographable violence of events like the July 23 demolition. But even the sensational images – like the viral photograph that uncomfortably compressed into a single frame two Kibera evictees standing on rubble and golfers preparing to tee off just a couple of hundred metres away – sent a simple message worth emphasising: that alleviating the suffering of certain people, even when the opportunity cost is low, is not worth it. A little more humanity – a few more hours’ notice, perhaps – still could not justify delay in progress.

“That breeds a sense of historical injustice, this sense that we’re tenants of the city, we don’t really own it,” says Houghton of conversations he has had with affected residents of Kibera, one of whom said, “The city belongs to others and we just move in and out of the pieces of land that they don’t want, until they want it.” That’s the cynicism that a lot of people in the community have now, according to Houghton.

The images from Monday were perhaps then a more honest reflection of how the city sees its poor, something usually otherwise masked by political mobilisation. The Kibera demolition would not have happened before the elections last year, says Maxwell from Mashimoni, and certainly not before “The Handshake.” Neutralised by bridges and alliances, the local and national leaders, who would have otherwise drawn energy from Kibera, an adversarial hotspot, and taken a staunchly antagonistic position at least in rhetoric, were too quiet.

Rights and laws aside, the Kibera demolition has already happened, and it cannot be disputed that in the moment it rendered, in Houghton’s words, “people indistinguishable from property”: simply a large, inconvenient unit of “unsafe structures” that must be removed to make space for development. It took two days to clear the entire corridor.

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April Zhu is a freelance journalist based in Nairobi, Kenya.

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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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