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AFRICA’S MEDICAL POVERTY TRAP: Why the continent is getting sicker and poorer

9 min read. Corruption, waste and a reliance on Western charity have conspired to leave Africa dealing with 25 per cent of the world’s diseases with under 1 per cent of global health resources. By CLAUDIO BUTTICÈ

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AFRICA’S MEDICAL POVERTY TRAP: Why the continent is getting sicker and poorer
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Medicine never stops evolving, and the never-ending efforts of millions of researchers around the world have provided humanity with some amazing technologies in the last few years. From artificial intelligence (AI)-based doctors that can outperform their human counterparts to the development of “smart” cancer vaccines, the race for medical innovation never stops.

However, these technologies come at a steep price, and very few countries – namely, the most industrialised ones – can afford to use them and make them accessible to the general population. Treatment disparity between the richer Western countries and the poorest African regions becomes wider every day. Countless Africans keep falling into the so-called “poverty trap”, generating a vicious circle of deterioration where ill health, epidemics, and poverty interact and mutually reinforce each other.

In an ideal world, everyone should have access to medical treatment regardless of his or her ability to pay. The reality, however, is much grimmer. When sickness occurs in a low-income household, not having the capacity to pay for medical expenses can have devastating consequences for the patient and the entire family. If access to healthcare and treatments is lacking (such as if there are no hospitals in a rural area), the individual right to health is violated, and his or her ability to work is denied. When access is granted, but the medical expenses are too steep, the consequences are no less catastrophic.

Treatment may come at the cost of financial and social well-being: the family may have to pull children out of school and push them into labour; food spending may be cut with obvious detrimental effects; and adults could be forced to work under strenuous conditions, increasing the risk of additional health issues. People who are more vulnerable to poverty are the same ones exposed to a higher risk of falling sick, such as the elderly, children, and women. Poverty increases the likelihood of becoming sick, and ill people are at a greater risk of becoming poor, generating a vicious circle that widens the disparities between the poor and the rich. When people are forced to sell what assets they have, such as livestock and land, to pay off medical debts, a financial disaster ensues, and a household may face poverty that can be dragged across the next generations. The outcome – known as the “medical poverty trap” – is a self-reinforcing mechanism that causes poverty to persist.

The medical poverty trap is particularly persistent in sub-Saharan countries such as Uganda, where low-productive agriculture, high transport costs, and small markets make the high number of rural households even more vulnerable. High economic growth rates are not sufficient to defuse the issue, however, as the cycle of health and poverty is influenced by many factors other than just economic ones. Less educated population groups are often those who have the lowest incomes, and cultural barriers can prevent them from seeking proper medical treatment when access is scarcely available. Superstition, religious beliefs, and social customs may convince them into preferring a shaman or quack over a real doctor. Ritual and herbal remedies may somewhat be part of the so-called “traditional medicine”, but they are practised with no regard to scientific procedures and are often ineffective when not directly harmful. And if the main earner of the family dies because he or she is not properly treated, the consequences for the household could be even more dramatic.

The medical poverty trap is particularly persistent in sub-Saharan countries such as Uganda, where low-productive agriculture, high transport costs, and small markets make the high number of rural households even more vulnerable. High economic growth rates are not sufficient to defuse the issue, however, as the cycle of health and poverty is influenced by many factors other than just economic ones.

Africa and healthcare – An overview of the numbers

Just a handful of few lucky individuals around the globe have access to life-saving medications and adequate healthcare. Sixteen per cent of the entire world’s population consumes a whopping 78 per cent of the total medicines produced. According to the World Health Organization (WHO), however, usage of essential medicines is similar across all countries regardless of the income category, at about between 25 and 35 per cent. This means that in low-income countries, essential medicines are used at similar rates as in higher income countries, no matter how high their price is or how burdensome it is to buy these drugs for a household. For example, to purchase the basic 7-days course of treatment with ciprofloxacin required to treat an adult respiratory infection, in Kenya a worker must pay the equivalent of over a month’s salary. In Italy, the cost of this same treatment is roughly €6, less than the hourly pay of the average unskilled labourer.

In the Millennium Development Goal (MDG) 8-E, the global community, in cooperation with pharmaceutical companies, committed to ensuring that access to essential affordable drugs would be achieved in most low- and middle-income countries by 2015. An increase in public expenditure or a widening of health insurance coverage were deemed necessary to reach this goal. Only a government may, in fact, possess the economic power to provide an entire population with sufficient coverage to afford (at least) essential drugs and treatments.

Today, in 2018, the current situation is not particularly encouraging, and most African governments are quite distant from achieving this goal. In highly industrialised countries, the average health expenditure per capita is estimated at $3100 – more than one hundred times more than in sub-Saharan Africa, where the average per capita expenditure is just a meagre $37. A single regional health centre serving 100,000 patients in a developed country administers a budget which is roughly equivalent to the budget of a country with a population of 10 million. In South Africa, to intensively treat only 60 per cent of all diabetes patients, the volume of metformin and sulfonylureas distributed by the public sector should be increased, respectively, by 366 per cent and 495 per cent. When essential drugs are not available in the public sector, patients must necessarily purchase them in the private sector at a much higher price, or forgo treatment altogether.

When only wealthier people can afford to pay for treatment, richer patients quickly become those who use the most healthcare. At the same time, newer medical technologies increase the number of treatable diseases and improve productivity by reducing illness, therefore widening socio-economic disparities. Does that mean that in low-income countries medical technologies and advancements are an enemy of equality instead of ameliorating the quality of life of the general population? The answer is no, but let’s dive in a little deeper.

The perfect recipe for disaster

Fifty per cent of children under the age of five who die of pneumonia, tuberculosis, malaria, diarrhoea, measles, and HIV across the world are in Africa. All these diseases are defined as “preventable” since they could have been easily treated if the patient had access to adequate health care services and affordable drugs or vaccines. But the average African patient must face several barriers to have access to what the international community defines as “adequate care”.

According to the World Bank, about 80 per cent of low- and middle-income Africans need to rely on public health facilities, whose situation is dire at best. Most primary care facilities suffer from a constant shortage of fundamental medications, such as in Zimbabwe, where painkillers are administered to patients suffering from all kind of diseases as a “treat-all-drug” since they are the only ones available. Patients are frequently referred to the big hospitals, but these larger facilities are limited in number, and very few families can afford to pay for their services. Many of them are inaccessible to those living in remote rural areas since they require many hours of walking in those regions where transport infrastructure is severely lacking.

Fifty per cent of children under the age of five who die of pneumonia, tuberculosis, malaria, diarrhoea, measles, and HIV across the world are in Africa. All these diseases are defined as “preventable” since they could have been easily treated if the patient had access to adequate healthcare services and affordable drugs or vaccines.

Some facilities, on the other hand, simply do not exist. Except for South Africa, in all of sub-Saharan Africa, a region where over 650 million people live, there are hardly any facilities specialising in neurology. A population that is equivalent to Europe’s and Russia’s together has little access to facilities that can be found in almost every medium-sized German, British or Spanish city.

Skilled personnel will never be available if proper training is unavailable. Even the few fortunate (and wealthy) ones who can afford the higher education required to become a specialist choose to emigrate and live in richer countries where they can hope for better wages, a superior quality of life and more chances of career growth. Still, shortage of resources and the lack of skilled personnel are just the tip of the iceberg.

For years, many African governments relied on charity projects financed by the international community to help them improve their healthcare systems. However, these plans have been mired by a constant lack of coordination, and frequently became an occasion for corrupt governments to siphon funds. The amount of resources wasted is simply depressing. For instance, over 75 per cent of all medical devices sent by Western countries remain unused because they cannot properly function outside of their natural context. The more advanced a medical technology is, the lower is the chance of it to be used properly in hospitals where no personnel have the technical expertise needed to understand its function. What’s the use of advanced digital technologies in facilities where there’s no Wi-fi or even just Internet connectivity available? The vast majority of medical devices and drugs sent cannot be transported into inaccessible areas such as deserts or inland regions, or just expire and become unusable because of the improper storage conditions. In the last decades, the “Western helping hand” did nothing but fill large warehouses with expired drugs, deteriorated vaccines and unused medical devices.

Skilled personnel will never be available if proper training is unavailable. Even the few fortunate (and wealthy) ones who can afford the higher education required to become a specialist choose to emigrate and live in richer countries where they can hope for better wages, a superior quality of life and more chances of career growth. Still, shortage of resources and the lack of skilled personnel are just the tip of the iceberg.

Most of the solutions offered by the many non-governmental organisations (NGOs) that operate in Africa seem nothing but failed attempts to patch over the shortcomings of a system that is not looking to solve its problems in the long term. For example, every time a humanitarian health crisis or a natural disaster occurs, the International Red Cross quickly implements a large mobile field hospital and dispatches many medical units to address it effectively. That’s nice, but these solutions can only momentarily solve an epidemic outburst, but cannot improve the country’s medical infrastructure or address any of its underlying issues. All those foreign specialists who voluntarily offer their services as doctors, nurses, pharmacists, and technicians may seem like angels and heroes, but their presence is too volatile to fix any of the complexities of the existing situation. As soon as the Western angels are gone, public health facilities face their usual shortages of critical drugs and devices once, and countless patients die of easily curable diseases.

Getting to the heart of the issue

Almost 20 years after the Abuja Declaration of 2001, very few African Union countries have been able to reach their target of allocating 15 per cent of their GDP to improve the health sector. Some of these countries have even reduced it. And when the funds are so low that just salary and personnel expenditures eat up to 70 per cent of hospital resources, it’s no surprise if there’s nothing left for other expenditures, such as purchasing essential drugs and medical devices, especially when the price of these medications and medical technologies is much higher in Africa than in every other well-developed country.

Understanding why this happens is the only way to cut this Gordian knot. Today, Africa produces less than 2 per cent of the drugs it consumes. Imported medications cost more than locally produced ones, and if the money invested in healthcare by the governments stays the same, this means that hospitals can buy fewer drugs, and that more sick people will die because they will not have access to the treatments they need. Africa has almost no capacity for pharmaceutical research and design (R&D) and local drug production. The only exception is South Africa, where some active pharmaceutical ingredients are produced. In every other country, even the ingredients must be imported. And the devil is in the details, because importing these ingredients would be already costly in Europe and North America, but it is ten times more in Africa, where procurement practices are plagued by a terrible transport system and general lack of adequate storage facilities.

Today, Africa imports 70 per cent of its pharmaceutical products, and many governments must spend a disproportionate amount of their already meagre resources on inefficient procurement procedures. But why can’t Africa can’t produce its own drugs like every other country (even developing ones, such as India)? Once again, there’s nearly not enough specialised personnel available. (High-scale drug production requires a high level of technical specialisation that must be supported by strong financial and educational investments – investments that repay themselves in due time, as happened in Cameroon where the $24 million-worth local generic drug manufacturer Cinpharm-Cameroon started producing antibiotics that are now much more affordable even for low-wage earners.)

Today, Africa imports 70 per cent of its pharmaceutical products, and many governments must spend a disproportionate amount of their already meagre resources on inefficient procurement procedures.

As a side note, the international community doesn’t seem to be so happy about Africa gaining its own economic independence. The biggest global pharmaceutical companies that are often so vociferous when they spend a minimal amount of their enormous fortunes to appease Africa with charity rear their ugly heads when their interests are threatened. Back in 2001, 40 pharmaceutical companies (yes, forty), among the world’s largest and most influential, dragged the South African government to court to stop it from producing generic HIV/AIDS drugs that would have significantly reduced their exorbitant prices. Eventually, most of these companies dropped the case, but thinking that they would have left millions of Africans to face certain death only to keep their profits intact is nothing less than a monstrosity.

A few words to the wise

Africa deals with 25 per cent of the world’s disease burden by spending less than 1 per cent of global health expenditure. There’s no need to assess how insufficient this amount is, especially knowing how much of it is wasted by inefficiency. Sickness means poverty; health brings growth and socio-economic well-being. It’s just as simple as that. If Africa wants to grow, it must invest in healthcare. And it must do it today, no matter how many challenges it may (and will) face.

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Dr. Claudio Butticè, Pharm.D., has written on topics such as medicine, technology, world poverty and science. Many of his articles have been published in magazines such as Cracked, Techopedia, Digital Journal and Business Insider. Dr. Butticè has also published pharmacology and psychology papers in several clinical journals, and works as a medical consultant and advisor for many companies across the globe.

Politics

‘You’re Not Welcome Here’: How Europe Is Paying Millions to Stop Migration From Africa

8 min read. Instead of addressing the root causes if illegal migration to Europe – including the exploitation of the Global South by the Global North – EU countries are evading the problem by paying off African countries to intercept the migrants before they reach European shores.

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‘You’re not welcome here’: How Europe Is Paying Millions To Stop Migration From Africa
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It is a known fact that Europe has been struggling with a serious migrant crisis in the last ten years. What is less known is that the ghost of a tremendous accusation is hovering over the plans established by the European authorities to contain the apparently unstoppable flow of immigrants. According to some sources, the funds that have been allocated to control the migratory flows have been diverted to support paramilitary forces or other nefarious organisations involved in human trafficking.

These forces allegedly act as a buffer that prevent people from reaching Europe by all means (even the most violent ones) rather than addressing the root causes of irregular migration. The European Union (EU) authorities denied all the accusations, and even suspended some of these funds, a move that has been seen by some as an admission of guilt. Although cutting the proverbial Gordian knot and finding the truth may be impossible right now, let’s try to clarify what is happening today by providing a better overview of the current scenario.

Europe and the 2015 migrant crisis

Every year, hundreds of thousands of displaced people and refugees from Africa, Eastern Europe, and the Middle East flee complex emergencies, natural disasters, and wars. They join the already immense river of humans who try to escape poverty and desperation by immigrating to the Old Continent. The reasons for this huge flow of humans are many, ranging from the recent political turbulence following the Arab Spring, to the evolution of the many conflict theatres and the harsh consequences of climate change.

Even if a solution could be found to stop each one of these different scenarios, it would require many years before it could bring any tangible change or impact. A lot of rhetoric ensued until a huge divide split the cacophonous political debate into two entrenched factions whose opinions cannot seem to be reconciled anytime soon. For some, these people are an invaluable resource that can rejuvenate a dying continent suffering from a chronic lack of a fresh young unspecialised workforce. For others, they are just parasites who can undermine the very roots of the Christian-based European culture, endangering the entire social fabric of a society that has based its wealth upon slavery, colonialism, and the exploitation of people for centuries.

However, an indisputable problem still had to be dealt with – the number of irregular immigrants reaching Europe was way too high to be managed. With over 2 million illegal crossings detected between 2015 and 2016, it was clear that the old containment policies were desperately failing in so many ways that they held no water whatsoever. Extremist and right wing political forces took advantage of this crisis to pull the whole continent into a populist drift, with racism and segregation running rampant to fuel hate, fear, and ancient religious rivalries. For the first time in decades, the European Union (EU) was facing the risk of having to deal with a widespread social crisis that could destabilise the entire political and economic asset. A plan that could address the different root causes of these never-ending migratory flows could hardly be imagined.

But the EU authorities had to find a rapid solution. They didn’t have the time (nor the interest) to tackle the reasons why these people were desperate and poor. Rather than caring about the lives of these masses of destitute individuals who were immigrating to Europe, they decided to stop them in their tracks before they could cross the borders. To put it bluntly, desperate and poor people from Africa, Eastern Europe, and the Middle East were still left desperate and poor – they only had to be desperate and poor somewhere else.

Turning a blind eye to the massive human crisis

The measures taken to manage the migrant crisis have been incredibly effective, and in less than five years, the number of migrant arrivals to Europe dropped by 90 per cent, from over 2 million to just 150,000. But at what price?

In a nutshell, the overall plan was quite simple: the EU authorities would ask other countries to “keep the migrants away” while they turned a blind eye on the methods used to achieve this goal. In theory, they were distributing hefty amounts of money to African and Middle Eastern countries to counter “human trafficking and smuggling” by breaking their “business model” in order to “offer migrants an alternative to putting their lives at risk”. In practice, these funds often ended in the hands of unscrupulous militia forces and shady organisations that prevented the most vulnerable people from reaching the borders of the EU member states with any means necessary – including the most inhumane ones.

One of the most important steps of this plan to “contain irregular migrants” was making arrangements with Turkey and Libya to prevent refugees from reaching the Old Continent’s borders by blocking all their land or sea routes. On top of that, whenever a migrant was caught crossing the Mediterranean to the nearby Greek islands, Spain or Italy, he or she would be sent back to Turkey or Libya to be “temporarily” locked in some prison. But the scenario that originated from these pacts was less than ideal at best, and eventually forced thousands of refugees to endure months of detainment in inhumane conditions in dilapidated detention centres.

The measures taken to manage the migrant crisis have been incredibly effective, and in less than five years, the number of migrant arrivals to Europe dropped by 90 per cent, from over 2 million to just 150,000. But at what price?

Several organisations, such as Amnesty International, Human Rights Watch, the United Nations Human Rights Council, and the European Council on Refugees and Exiles have alreay denounced the “degrading” conditions suffered by the detainees in Libya. Men and women are raped, abused, and beaten on a daily basis; some have spent months or years locked up. People are exposed to contagious diseases, such as tuberculosis, and often die from sickness, malnourishment, or neglect while in detention. The UNHRC went so far as to determine that the conditions in some of these detention centers may even “amount to torture”.

Despite being fully aware of the inhuman conditions faced by these migrants, the EU keeps contributing to this massive process of human exploitation in many ways. The Libyan authorities have been provided with the necessary funds and resources to intercept men, women, and children at sea. Italy donated several patrol boats to the Libyan coastguard and the training required to operate them as efficiently as possible during Operation Sophia. Even the Visegrad Group countries (Hungary, Poland, Slovakia, and the Czech Republic) provided an additional 35 million euros on top of the 10 million handed over by the EU. It comes as no surprise since their borders are constantly under the pressure of the thousands of immigrants who hope to escape poverty and find a chance for a better life.

One word – interception – has become the answer to the whole migrant crisis rather than reception. What happens to these people once they are stopped from reaching the borders of the richer First World countries doesn’t matter anymore. One may wonder whether this choice was just the result of a somewhat short-sighted strategy that only cared about reducing the death toll of people drowning in the Mediterranean sea. Maybe it is a component of a more complex (and inhumane) plan of externalising border control to Northern African countries. A strategy to keep poor people from escaping the poor countries where they live.

The Khartoum Process

Another action taken by the EU to stem the number of people reaching their coasts and borders was establishing the so-called “Khartoum Process”. Amidst the 2015 crisis, African and European leaders met in Malta during the Valletta Summit on Migration to discuss a common plan to address the problem. After the summit was over, the EU agreed to provide the African countries who accepted to help out in the crisis with an Emergency Trust Fund that was worth billions of euros. The fund was set up “to foster stability and to contribute to better migration management, including by addressing the root causes of destabilisation, forced displacement and irregular migration.”

Many projects eventually fell under the banner of the Emergency Trust Fund, such as the Operation Sophia mentioned above, as well as the less known but no less opaque Khartoum Process. Once again, this initiative consists of a series of financial incentives provided by the EU member states to African countries who can help in the fight against human trafficking and people smuggling. The only difference is that these funds are provided to prevent exploitation along the migration route between the Horn of Africa and Europe. The countries involved include Djibouti, Eritrea, Ethiopia, Kenya, Somalia, Sudan, South, Sudan, Uganda, and Tanzania.

One word – interception – has become the answer to the whole migrant crisis rather than reception. What happens to these people once they are stopped from reaching the borders of the richer First World countries doesn’t matter anymore.

Sudan, in particular, has been used as a buffer zone to exert effective extraterritorial control of the migration routes used by people who want to reach Europe from across Africa. Just like Italy did with Libya, Germany started a project to train Sudanese police officers and border guards, and an intelligence centre was founded in the capital Khartoum.

So, why did the EU announced the suspension of these projects in July, some of which were halted at least since March?

This time, some Sudanese and Eritrean rights groups accused Donald Tusk, the president of the European Council, of cooperating with “regimes and militia forces that are entirely unaccountable” and are “known for systematic abuses”. The funds have been, in fact, used to deploy the infamous Rapid Support Forces (RSF) – the heirs of the brutal Janjaweed led by Mohamed Hamdan “Hemeti” Dagolo. We already talked about the violence that the Janjaweed unleashed upon Sudanese civilians during the recent uprising, as well as the war crimes and genocide they committed in Darfur back in 2003. The RSF fighters found their own solution to stop migrants – they tortured them, forced them to pay bribes, and in some instances, even smuggled them (possibly if they paid enough).

So, in a nutshell, the EU paid smugglers to stop human smuggling and traffic – and they were fully aware of that. It was even noted that the RSF could divert resources “for repressive aims”. Just like in Libya and Turkey, Europe knew what was happening, but preferred to simply look the other way.

This time, some Sudanese and Eritrean rights groups accused Donald Tusk, the president of the European Council, of cooperating with “regimes and militia forces that are entirely unaccountable” and are “known for systematic abuses”.

Even if the project is now suspended, and the EU maintains that the RSF forces have never been funded or equipped, the Sudanese police received training and significant financial resources (40 million euros). This is the same Sudanese police that brutally repressed the pro-democracy, anti-government demonstrators during the last months of protest. Once again, all the projects that fall under the Khartoum Process umbrella do not address any of the “root causes” of uncontrolled migration and human trafficking. Without going so far as to say these projects are a true travesty, it can’t be denied that right now they’re nothing but extraterritorial disguised control of the borders.

Not my brother’s keeper

Today, Europe is simply turning a blind eye to one of the largest humanitarian crisis of this century. But hoping that desperate people will bring their misfortune somewhere else is not just a cowardly policy, it is a downright cruel choice made by people with no traces of humanity. It is highly hypocritical for Western countries to claim that they want to address the “root causes” of the tremendous strife that brings so many people to leave their homelands. In fact, most of these “root causes” originate from the endless exploitation of lands and resources of the Global South that seemingly sustains the whole capitalist system. In fact, when over 37,000 people are being forced to flee their homes every day, it doesn’t look like the situation has improved in any way. Today, the developed countries host just 16 per cent of these refugees, while the vast majority of them are found in Turkey, Pakistan, Uganda, and Sudan.

When the Roman Empire had to deal with the massive migrations that occurred during the fourth century A.C., the Emperors simply preferred to close their borders, leaving countless displaced people to die of sickness and starvation in front of their doors. Open revolt ensued, however, when those masses of destitute people became so desperate as to kill Emperor Valen, eventually causing the fall of the entire Roman Empire.

History teaches us that everything that happened once may happen again – especially if so many people are driven up the wall for so long.

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Politics

The Fire Next Time: ‘Bedroom’ Politics in the Kibra By-Election

11 min read. The Kibra by-election was not so much about the 24 contestants that took part in the race, but was more about a competition between the two biggest political parties, and between two bitter rivals, Raila Odinga and William Ruto. It was also a dress rehearsal for the 2022 elections, which, if this by-election is anything to go by, promises to be highly contentious.

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The Fire Next Time: ‘Bedroom’ Politics in the Kibra By-Election
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Something startled where I thought I was safest. – Walt Whitman

My Dungeons Shook – The Fire Next Time by James Baldwin

On Saturday 9, 2019, two days after the hotly contested Kibra by-election had taken place and the dust had settled, Raila Odinga, aka Baba, was in an ecstatic mood: he gathered around some of his closest associates that had helped him campaign to retain the Kibra seat by hook or crook for a toast-up at his Karen home.

The ODM party candidate had triumphed over an onslaught that had threatened to torpedo Raila’s iron-grip stranglehold over a constituency that had, over time, become synonymous with his name and political career. But it was a victory that been won with “blood”: Bernard Otieno Okoth, aka Imran, took 24,636 votes while his closest nemesis, McDonald Mariga Wanyama, an international footballer-turned-betting-billboard-face, had carted away 11,230 votes. Although there were no casualties, voters had been roughed up and beaten.

As one of ODM’s foot soldiers from Ololo (Kaloleni estate, off Jogoo Road in Makadara constituency) later confided in me, “There was no way those rural folks (referring to William Ruto’s gang of MPs, mainly from western Kenya, and their supporters) were going to storm our grounds. Hii tao ni yetu, tumekuwa na mzae tangu 90s, na tumepingana vita nyingi sana…hao watu walikuwa wanacheza na nare.” This is our turf and we’ve been with Raila ever since the 90s, and we’ve fought many bloody wars, those people were stoking a war and playing with fire.

As a diehard supporter of Raila Odinga, the stocky foot soldier, now in his late 30s (he is a former bantamweight boxer)m said he had not slept for three consecutive days: “Kibra ni bedroom ya mbuyu na wewe unaleta mbulu pale…utatembea buda.” Kibra is the old man’s bedroom and you want to desecrate it…you’ll pay for it.

He said in those three days, all the foot soldiers’ work was to screen all “foreigners” entering Kibra. This was evident to me because I had also been forewarned by my minders that I should now be extremely careful when going to Kibra for my journalistic work.

And that is all that mattered. The rest of other 22 contestants were neither here nor there, including ANC’s Eliud Owalo, a one-time Raila’s confidante who collected 5,275 votes.

According to IEBC (Independent Electoral and Boundaries Commission)’s 2017 figures, Kibra has 118,658 registered voters and 24 polling stations. In the just-concluded by-election, a paltry 41,984 people voted, constituting 35 per cent of the electorate. In the 2017 presidential election, 18,000 people voted for Uhuru Kenyatta, the Jubilee Party’s presidential candidate. The Jubilee Party candidate Doreen Wasike got 12,000 votes. The 6,000 extra votes that increased Uhuru’s number to 18,000 came from the Nubian community resident in Kibra.

As Raila and his friends were sipping champagne on a sunny Saturday afternoon, Ruto was gnashing his teeth, furious to the point where he refused to meet with the buddies he had campaigned with, according to media reports. However, his chief noisemaker, the rabblerouser Dennis Itumbi, denied that his boss was in a foul mood after the by-election.

Kibra constituency, formerly part of Langata constituency, has been a hotbed of political contests ever since Raila opted to stand in the constituency in 1992, the year the country returned to multiparty politics. Two years before that, in 1990, Raila, who had been exiled in Norway, had come back to Kenya to be part of the “Young Turks” who agitated and pushed for political reforms. He had stood in what was then known as Kibera constituency in the first multiparty general election and from then on Kibera became his enclave. That is why, in the run-up to the by-election, Raila “privatised” the constituency and called it his bedroom, in a (desperate) effort to rally around his troops to vote for Imran and to affirm to his current biggest political rival, William S Ruto, that Kibra was impenetrable to the latter’s political whims.

According to IEBC (Independent Electoral and Boundaries Commission)’s 2017 figures, Kibra has 118,658 registered voters and 24 polling stations. In the just-concluded by-election, a paltry 41,984 people voted, constituting 35 per cent of the electorate.

That is why the Kibra by-election was not so much about the 24 contestants that took part in the race, but was more of a competition between the two biggest political parties, the ruling party Jubilee and ODM, and between Raila Odinga and William Ruto. Imran and Mariga were just pawns in a much bigger and wider plot linked to the 2022 presidential succession political chess game in which the two have staked their ambitions and claim.

Three weeks to the by-election, I met with one of Ruto’s bosom buddies who was coordinating the campaign behind the scenes. “If we wrestle the Kibra seat from the kitendawili (riddles) man, we’ll have completely changed the political map of not only Nairobi County, but of the country,” he had said to me. “We will configure national politics and consign Raila to a corner. And then relish to face him in 2022.”

The Ruto man told me that in the lead-up to 2022, their chief tactic is to draw Raila into a two-horse race, in which case, “I can assure you, we’ll pulverise the enigma [one of the monikers used to describe Raila] once and for all”.

It understandable, hence, for Ruto to have taken the defeat personally and Raila to have gloated – but for how long?

In many ways, the by-election was a curtain raiser, a preamble and a showdown of what to expect in 2022, the year Kenyans once again go to the polls to elect a new president. The violence witnessed in Kibra will be multiplied at the national level. The money that was thrown at the electorate in little Kibra will seem like cash for an afternoon picnic as the chief contestants in 2022 open their war chests to woo an even hungrier electorate, ready to settle scores and be manipulated. The shadow line-ups that we saw falling respectively behind the protagonists will be reshaped many times over before 2022.

The by-election was also about the “big boys” (Raila and Ruto) settling scores and about cementing the burial rites of the already dead NASA (National Super Alliance), the fledgling and motley coalition that brought together Raila Odinga, Kalonzo Musyoka, Moses Wetangula, and Musalia Mudavadi. In addition, it was about the extension of the supremacy battles being fought between the Jubilee Party wing of President Uhuru Kenyatta and its rival that is being led by his deputy – in essence, the trooping of colours between #Kieleweke group and the #Tanga Tanga brigade.

Could this by-election also have signalled the death knell of the Jubilee Party as currently constituted?

The Ken Okoth factor

The by-election was a function of several variables, including what can be referred to as the Ken Okoth factor. Okoth, who died from colon cancer at the age of 41, was the Kibra MP when he succumbed to the killer disease on July 26, 2019.

Okoth was elected in 2013 in the newly created Kibra constituency, which was hived off from the larger Langata constituency to Raila’s chagrin. (This is a public secret.) Even though Okoth was elected on an ODM ticket, he was not Raila’s first choice. Okoth was an independent-minded politician and a popular and well-liked local boy. Home-grown and well-educated, he understood the problems of the infamous Kibera slum like the back of his hand. He was suave, well-spoken and a terribly likeable man.

When he became the MP, he charted an even more independent path: he decided he was not going to be anybody’s protégé. So he cultivated his political friendships across party divisions. As a man who understood the power of education (he was the recipient of a sound education from Starehe Boys’ Centre, where he was educated on a full bursary), he invested heavily in education in Kibra. A good secondary education, like he used to say, had saved him from the clutches of poverty.

Okoth built eight secondary schools in Kibra and expanded many of the primary schools to have a secondary school wing. He rightly argued that since many Kibra parents could not afford to take their children to boarding schools, he would lighten their burden by constructing local secondary schools. He also gave out lots of bursaries to parents who struggled with fees. Any pupil who got 350 points or more in his or her KCPE (Kenya Certificate of Primary Education) exam got full bursary to transition to high school.

Even though Okoth was elected on an ODM ticket, he was not Raila’s first choice. Okoth was an independent-minded politician and a popular and well-liked local boy. Home-grown and well-educated, he understood the problems of the infamous Kibera slum like the back of his hand.

Juliet Atellah, a Kibra resident from Gatwekera village in Sarang’ombe and a double maths and statistics major from the University of Nairobi can attest to this. “When Okoth become MP, he told us education was the key to success. He implored us to work hard in school as he also worked hard to ensure Kibra youth interested in education benefitted from a bursary.” It is something that Okoth continually preached till his death.

Okoth, also, through his Jubilee Party networks, tapped into the National Youth Service (NYS) resources to create some employment opportunities for the youth of Kibra. This cross-cutting political parties’ engagement would land him into trouble with ODM mandarins who accused and suspected him of cavorting with the enemy. “By opting to work with Jubilee Party functionaries, Okoth looked at the bigger picture: what mattered most, according to him, was how best to improve the quality of lives of Kibrans. If the help would come from his presumed ‘political antagonists’ so be it,” said a friend of the late MP.

He relegated the work of managing the bursaries through the Constituency Development Fund (CDF) to his brother Imran. Little wonder then that his brother clinched the ODM ticket, but not without loud grievances. According to my sources within the ODM party, Peter Orero (popularly known as mwalimu), the Principal of Dagoretti High School, and also the former principal of Upper Hill High School, had won the ticket, but to stem the fallout that was going to befall the party as it faced its greatest onslaught from Ruto, a man who was staking his all to capture the seat, Raila opted to hand the ticket to the former CDF manager.

Disgruntled followers

Kibra constituency residents are some of the most politically “woke” electorate that this country has ever produced. Their political consciousness is high and battle-hardened from their brutal fights with the Kanu regime in the 1990s. The people of Kibra know their politics well. This is courtesy of Raila Odinga, who for a long time championed the political struggle for equity and social justice in the country. As their MP, Raila encouraged Kibra voters to fight for their rights and to demand no less than his rightful representation.

But the burden of the “handshake” between Raila and Uhuru Kenyatta had reared its ugly head and it was evident that Raila struggled when campaigning in his former constituency. “With the handshake, Raila commercialised the struggle,” said a politician who has known him since the multiparty struggles of the 90s. “The handshake had confused his base, angering many and disillusioning a great deal of people who had stood with him all the way. Until, the death of Okoth, Raila had not stepped in Kibra to explain the handshake. Instead, when he shook Uhuru’s hand, he headed to Kondele in Kisumu to appease his other equally fanatical base, 300 kilometres away.”

The politician said that Kibra people have yet to enjoy the handshake’s dividends. “Many of the youths who were shot at by police when defending Raila were from Kibra, yet the handshake projects have all been taken to Kisumu. Although the Kibra electorate is still fanatically loyal to Raila, they were also passing a subtle message to him – it about time you re-evaluated your politics with us.”

Kibra constituency residents are some of the most politically “woke” electorate that this country has ever produced. Their political consciousness is high and battle-hardened from their brutal fights with the Kanu regime in the 1990s.

Hence, it was not lost to keen observers that for the first time since Raila began campaigning in Kibra in 1992, he had been forced to solicit for votes beyond Kamukunji in Sarang’ombe ward. “For the first time,” said a resident of Sarang’ombe, “Raila had been forced to campaign in Bukhungu in Makina, Laini Saba, and Joseph Kange’the in Woodley.” As the area MP, Raila would campaign only in Kamukunji grounds and with that he would seal his victory and close that chapter. The rest of the voters would fall in place.

Sarang’ombe ward has the largest number of voters, largely comprising Luos and Luhyas. The Luos are concentrated in Kisumu Ndogo village, while the Luhyas are to be found in Soweto and Bombolulu villages. There are about 6,000 registered Luhya voters in both the villages, while there could be about 20,000 Luos in Kisumu Ndogo. The other large concentrations of Luhyas are located in Lindi and Makina. Hence the reason why Raila went to campaign in Makina. He also campaigned in Woodley on Joseph Kange’the Road, because it has a large population of Kikuyu voters.

New alliances and 2022 politics

If campaigning on “virgin” territory was not too much of a stretch, Raila had to enlist the support of seven governors: Alfred Mutua of Machakos, Ann Mumbi Kamotho (previously known as Ann Waiguru) of Kirinyaga, Charity Ngilu of Kitui, Kivutha Kibwana of Makueni, James Ongwae of Kisii, John Nyagarama of Nyamira and Wycliffe Oparanya of Kakamega. “Ruto with his loads of money was piling pressure on Raila and he wasn’t going to take any chances,” explained one of Raila’s associates.

So, on October 30, 2019, nominated MP Maina Kamanda, Kigumo MP, Ruth Mwaniki and David Murathe (President Uhuru Kenyatta’s hatchet man) met with Raila to ostensibly pledge the Kikuyu electorate’s and President Uhuru’s support for the ODM candidate Bernard Otieno Okoth aka Imran. At the meeting, Mwaniki hinted that McDonald Mariga Wanyama, the Jubilee Party candidate, had been forced on the party leadership and President Uhuru: “I don’t know why some leaders [referring to Deputy President William Ruto] in Jubilee dragged Mariga into the race.”

In the spirit of the handshake, Kamanda said he would rally the Kikuyu voter to throw his lot with Imran: “When you see me here, know that President Uhuru Kenyatta is here.”

On the previous day, the former Starehe MP had told the Kikuyus in Kibra, “On November 7, please come out in large numbers to vote for Imran. Imran’s victory will be a big win for the unity of this country.” He was referring to the now mercurial political handshake that President Uhuru and Raila cemented on March 9, 2018. The handshake between the two bitterest rivals gave birth to the Building the Bridges Initiative (BBI). The acronym has been baptised many things, the latest one being Beba Baba Ikulu. Take Raila to State House.

On that same day (October 30), Raila had separately met with Kikuyu and Kisii opinion shapers from Kibra at his office in Upper Hill, before descending to Kibra again in the evening, three days after he had held a rally there on October 27, a Sunday. This same day, as Raila met with the respective community leaders, he confided in a mutual friend who he had lunch with at Nairobi Club that Ruto was breathing down his neck, and giving him a run for his money in his erstwhile constituency that he had represented for a quarter of a century.

During the time that Raila stood in Kibra, the Luhya community had also stood with him. They voted for him to the last man, “but when Okoth died, the Luhya nationalists in Kibra and elsewhere thought ‘it was their time to eat’”, a Luhya politician who stood as a senator in western Kenya said. “The Luhya felt the time was ripe to get paid for standing with Raila all these years since 1992.” The politician reminded me that even when Michael Wamalwa died in August, 2004, the Luhyas remained strong supporters of Raila.

Feeding on this Luhya nationalism, Ruto and his band of Luhya MPs from western Kenya landed in Kibra, and hoped to hype this reigning scepticism to maximum effect. So when Bernard Shinali, the MP for Ikolomani, was caught by the hawk-eyed ODM foot soldiers dishing out money to potential voters in Kisumu Ndogo three days before voting day, he, like the former Kakamega Senator, Bonny Khalwale, wanted to prove to their boss Ruto that they were ready to deliver the Kibra Luhya vote to him. The other Luhya MP from western who would be deployed to Kibra was Benjamin Washiali of Mumias and Didmus Barasa MP of Kimilili.

In all probability the Kibra by-election offered Kenyans a trailer of how the 2022 presidential elections will be and how they will will be fought. Will that election be a contest between Raila and Ruto? If the parading of the troops from both sides is anything to go by, the sneak preview of the troops’ formation promises many shifting alliances.

Wavinya Ndeti, the former MP for Kathiani and a governor candidate for Machakos County in 2017 on a Wiper Democratic Movement (WPM) ticket – but nonetheless aligned to Raila – allegedly moaned loudly, after seeing Mutua in Kibra. Had Raila dumped her by inviting the Machakos governor into his “bedroom?” Kalonzo Musyoka, one of the four NASA co-principals is mum, but when he said he would be supporting the Ford Kenya candidate Ramadhan Butichi, he invited opprobrium from ODM mandarins. My friends in ODM hinted to me that Kivutha is the man to checkmate Kalonzo. What about Musalia Mudavadi, the other NASA co-principal principal? Is Oparanya being propped up to replace him?

The fact that President Uhuru Kenyatta has not made any comment on the by-election, and has not appeared anywhere near Kibra to campaign for the Jubilee Party candidate speaks volumes about whether indeed Mariga was a Jubilee Party candidate, I told a close associate of the deputy president that Ruto and Mariga had camped at State House for two days to get the president’s audience. It was only on the second day that Ruto showcased Mariga to the president, who fitted Mariga’s football head with a Jubilee cap. “That is all true,” agreed the associate, “but the president is a grown up, how do you force anything onto a grown up?”

What is clear, however, is that as 2022 fast approaches, the Kibra by-election of November 7 marked the unofficial commencement of the 2022 campaign season in Kenya with Ruto’s aggressive raid into Odinga’s “political bedroom”. Now, as pundits, political analysts, and the media try to explain what this political drama will mean for the future of Kenya’s politics, the central question that Kenyans need to ask is what role they will play in shaping a prosperous future.

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Kibra: The Face of Kenyan Politics to Come?

4 min read. What does the Kibra by-election portend for the future of Kenya’s politics? Renowned photographer CARL ODERA captures the sights.

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“The most painful state of being is remembering the future, particularly the one you’ll never have.”― Søren Kierkegaard

Located about 6.6 kilometres from Nairobi city centre, Kibra is a sprawling informal settlement with an estimated population of about 200,000 people. Majority of Kibra residents live in extreme poverty. Unemployment rates are high, persons living with HIV/AIDS are many, and cases of assault and rape common. Clean water is scarce. Diseases caused by this lack of water are common. The majority living in the informal settlement lack access to basic services including electricity, running water, and medical care.

But this photo essay is not about the peddled quintessential cliché narrative depiction of Kibra as Africa’s biggest slum’ – itself a false assertion. Rather, Kibra has historically been Nairobi’s most vibrant political constituency; its residents often at the forefront of agitation for expansion of political space in Kenya; and, the most enthusiastic demonstrators at political meetings where the opposition is pitched against an apparently recalcitrant ruling elite. The Kibra by-election is also the political backyard of Raila Odinga, leader of the Orange Democratic Movement and the most enduring fixture in opposition leadership since the early 1990s. Currently, in an alliance with the President Uhuru Kenyatta, the Kibra by-election was occasioned by the death on the 26th of July 2019 of Ken Okoth, 41, the area’s dynamic, popular and highly effective MP.

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The demise of Ken Okoth left the seat open for a contest directly between Raila Odinga, whose family has dominated the area for decades and the Deputy President William S. Ruto who is determined to entrench himself as the only viable successor to Kenyatta who is currently serving his last constitutionally mandated term. As such the Kibra by-election of November 7 marked the unofficial commencement of the 2022 campaign season in Kenya with Ruto’s aggressive raid into Odinga’s ‘political bedroom’.

Deputy President William Ruto and Jubilee candidate McDonald Mariga in Kibra's DC Grounds on Sunday.

Deputy President William Ruto and Jubilee candidate McDonald Mariga in Kibra’s DC Grounds on Sunday.

ODM leader Raila Odinga with party flag-bearer Bernard Imran Okoth (left) sings the national anthem at a rally on Kiambere Road.

ODM leader Raila Odinga with party flag-bearer Bernard Imran Okoth (left) sings the national anthem at a rally on Kiambere Road.

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The by-election to fill the position left vacant following the death of the area MP, Okoth, attracted 24 candidates, ODM candidate Imran Okoth, Jubilee’s McDonald Mariga and Eliud Owalo of Amani National Congress, were the dominant players.

Endorsed football star McDonald Mariga

Endorsed football star McDonald Mariga

 Rally to drum up support for Imran Okoth, ODM's candidate for Kibra by-election.

Rally to drum up support for Imran Okoth, ODM’s candidate for Kibra by-election.

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Days to the parliamentary by-election there were reports of fracas between warring factions. Rowdy residents, for instance, kicked former Kakamega senator Boni Khawale out of Kibra upon his arrival in Laini Saba ward, claiming it was ODM’s bedroom.

Destruction of property was also reported.

Milly Achieng, a tailor-resident of Kibra told the Elephant that supporters of an opposing candidate recently went and attacked one of her friends and fellow party member and demolished her house. She was forced to flee Kibra with her children.

A family house demolished in a political violence encounter in Kibra.

A family house demolished in a political violence encounter in Kibra.

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The Kibra by-election received wide support from leaders across the political divide. Governors Charity Ngilu, Alfred Mutua, Kivutha Kibwana and Anne Waiguru joined Raila Odinga and the ODM party in drumming up support for its candidate, Imran Okoth. The leaders announced that this by-election was the beginning of a new political movement that would drum up support for the Building Bridges Initiative (BBI) and ultimately forge an alliance for the 2022 General Election.

Charity Ngilu campaigning in Kibra to get the vote for ODM candidate Imran Okoth within the Kamba community

Charity Ngilu campaigning in Kibra to get the vote for ODM candidate Imran Okoth within the Kamba community

Governor Waiguru at Joseph Kangethe Grounds in Kibra on Sunday the 3rd of November to drum up support for the ODM candidate

Governor Waiguru at Joseph Kangethe Grounds in Kibra on Sunday the 3rd of November to drum up support for the ODM candidate

Raila Odinga and Machakos Governor Alfred Mutua arriving for a rally organised to woo Kamba voters to rally behind ODM candidate for Kibra constituency.

Raila Odinga and Machakos Governor Alfred Mutua arriving for a rally organised to woo Kamba voters to rally behind ODM candidate for Kibra constituency.

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On November 7, 2019, the polling stations across the constituency were opened by 6 am to a smooth start of voting throughout the day amidst a reportedly low voter turnout. The voting stations were closed immediately after the voting exercise was concluded and voter tallying began thereafter. Residents stood in groups waiting for the results.

A man carries his disabled friend to a polling station in Kibra's Laini Saba.

A man carries his disabled friend to a polling station in Kibra’s Laini Saba.

ODM leader Raila Odinga at Old Kibera Primary school polling station to cast his vote.

ODM leader Raila Odinga at Old Kibera Primary school polling station to cast his vote.

An election official marks an indelible ink stain on Amani Congress Party's candidate Eliud Owalo at Old Kibera.

An election official marks an indelible ink stain on Amani Congress Party’s candidate Eliud Owalo at Old Kibera.

Amani Party Congress party leader Musalia Mudavadi (right) accompanies party candidate Eliud Owalo at Old Kibera Primary school to cast his vote.

Amani Party Congress party leader Musalia Mudavadi (right) accompanies party candidate Eliud Owalo at Old Kibera Primary school to cast his vote.

A man shows his finger marked with phosphorous ink after voting

A man shows his finger marked with phosphorous ink after voting

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As counting of votes for Kibra by-election continued on the night of November the 7, Jubilee candidate McDonald Mariga conceded defeat to Orange Democratic Movement (ODM) party aspirant Imran Okoth.

In a Twitter post, Mariga called Okoth and congratulated him for his victory and promised to work together after the elections.

According to the results announced by the Independent Electoral Boundaries Commission (IEBC) on Friday, November 8, Imran Okoth garnered 24,636 votes beating Mariga by over half the total number of counted votes standing at 11,230 votes. ANC’s Eliud Owalo was a distant third, managing to garner a paltry 5,275 votes out of the 41,984 votes cast.

A child in Kibra celebrating Imran Okoth’s victory

A child in Kibra celebrating Imran Okoth’s victory

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Though the Kibra by-election has been deemed a win for Raila Odinga and the handshake and a loss for Ruto and the “tanga tanga” movement, these political battles have yet to translate into tangible benefits for the ordinary mwananchi whom they purport to fight for.

Nancy Akinyi, a resident of Sarang’ombe Ward, Kibra constituency

Nancy Akinyi, a resident of Sarang’ombe Ward, Kibra constituency

Written by Joe Kobuthi

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