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COVID-19: Uganda Must Take Robust Measures to Defeat the Coronavirus Pandemic

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The coronavirus pandemic will end but without strong public services, Uganda will remain vulnerable to the next epidemic, pandemic or extreme climate event. The health, water and sanitation and all other sectors must be transformed into robust, life-enhancing government services.

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COVID-19: Uganda Must Take Robust Measures to Defeat the Coronavirus Pandemic
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The onset of the COVID-19 pandemic has challenged the public service infrastructure as never before. We commend the government for the efforts it has made to limit the contagion. In particular, we commend health service personnel for their tireless round-the-clock monitoring, testing and treatment of those affected by the disease.

I appreciate the 300 water points rolled out by the National Water and Sewerage Corporation and Kampala Capital City Authority on Friday 27 March. NWSC must be funded to enable them to continue to offer handwashing points in urban areas.

It is heartening to observe the positive public response to the Ministry of Health guidance and directives. I join the President of Uganda in emphasising that the contagion can only be stopped if we collectively practice physical distancing, frequent handwashing and avoiding touching our faces. These are the only preventive measures possible. There is no cure available so far.

The Director of the World Health Organisation, which is at the forefront of the fight against the pandemic, has described lockdowns as “extreme social & economic restrictions”.

In Uganda, our first confirmed case of COVID-19 was detected on 21 March 2020. As of Friday 3 April, Uganda had 48 confirmed cases. It is not easy for public servants and it is not easy for the ordinary citizen, but if we continue to cooperate, the pandemic will end. Uganda is among the countries with fewer than 100 cases and we stand a good chance of overcoming this crisis if we make the right policy choices now.

We agree with the WHO that the lockdown provides a window of opportunity to curb and finally defeat the disease but also to prevent a resurgence of infections once the lockdown is lifted. We believe it is necessary to “Refocus the whole of government on suppressing and controlling Covid19”, as Dr Tedros Ghebreyesus, Director-General of the WHO, has advised.

The World Health Organisation, which is at the forefront of the fight against the pandemic, has described lockdowns as “extreme social & economic restrictions”

We agree that “on their own, these measures will not extinguish epidemics”. We adopt the recommendation that, to be effective, the lockdown must be accompanied by measures aimed at strengthening the health service. It is our view that Uganda’s response to this pandemic can lay the foundations for a healthier and better-prepared country.

In everything we do, we must prioritise the safety of the health workers at the frontline. We therefore propose that they are provided with daily transport, risk and other duty-facilitating allowances, as well as personal protective equipment (PPE). In his address to the nation on 31 March, the President reported that health workers in upcountry facilities are avoiding suspected COVID-19 cases because they lack protective gear. This is unfortunate and must be addressed immediately at all Regional Referral Hospitals. It was shocking to hear in the Presidential Address on Friday 3 March that Uganda only has 10 per cent of the PPE required at this time.

We also support the call by some members of Parliament to pay health workers a motivational allowance, on time and during this crisis, not in arrears.

It may not be possible in the short term to expand, train and deploy our healthcare and public health workforce as recommended but the recruitment process can begin. The news that hundreds of healthcare workers are being recruited at all levels is welcome. Hopefully, the majority are clinicians and nurses.

What is possible in Uganda in the short-term is to continue efforts to “find, isolate, test, treat and trace” those who may have been exposed to the virus and who together with their families are at risk. Of the 48 cases, nearly all were incoming travellers and contacts of travellers arriving mostly from Dubai, 15 from the United Kingdom, three from the United States, one from Kenya. By 28 March, only three confirmed cases were not incoming travellers. We wish them all an easy recovery.

Uganda is among the countries with fewer than 100 cases and we stand a good chance of overcoming this crisis if we make the right policy choices now

In the two weeks prior to the airport closure, 2,661 high-risk travellers entered the country. Also, there are others that had not been identified before Dubai emerged as a high-risk country. Less than 1,000 of these people have been quarantined and tested. It would help to offer amnesty to the hundreds remaining to encourage them to come forward. The security services need only be deployed if there is further failure to cooperate after the amnesty is announced. In any event, the forces should endeavour to treat citizens with the respect they deserve. Wanton violence of the type we have seen contributes nothing to disease control and undermines faith in the government to lead us out of this crisis.

As has been noted, the more tests done, the greater the number of positive diagnoses. While we appreciate the donation of testing equipment from the WHO and Jack Ma, we note that we remain vulnerable as long as our capacity to test depends on donations. We recommend that Uganda seeks short-term measures to find funds for test kits. The public needs to be informed whether all the tests being used are WHO-approved. There is some concern about the potential for false negative results and, being a “fragile State” that is receiving multiple donations, we need assurance that all equipment is up to par.

Regional Referral Hospitals, and Naggulu and Mulago Specialised Hospitals, have been tasked with the management of COVID-19 cases. The input of the Uganda Medical Association, whose members are at the frontline of this battle, is required in signing off those entities equipped to take on the task. This will ensure healthcare workers at those designated facilities have adequate equipment, drugs and PPE. It is hoped that funds will be made available to provide testing facilities in hospitals outside Entebbe.

Wanton violence of the type we have seen contributes nothing to disease control and undermines faith in the government to lead us out of this crisis

Biosafety professionals should be involved in setting up any quarantine sites outside hospital settings to avoid healthcare-associated infections after the pandemic passes. The same should apply to General Hospitals and all Health Centre IVs if the need arises. Regional quarantine and treatment centres are needed to ensure everyone has a good chance of survival wherever in the country they may live as transporting patients across the country puts health workers at risk. Moreover, disinfection of markets, taxi parks and, where possible, other public places should take place before the lockdown is lifted.

Funding the fight

To fund the interventions we request that money currently allocated to Ministries, Departments and Agencies for non-essential activities be reallocated to increasing the number of tests carried out per day and providing transport and PPE for health workers. For example, fuel expenditure saved by grounding government vehicles and cancelling bench-marking trips, conferences, and treatment abroad for ailments that are treatable in Uganda, should also be reallocated to the health sector. Above all, we should minimise waste; expenditure on advertising in the media, printing official bulletins and so on, is not a priority. As WHO recommends, the way forward is “find, isolate, test, treat & trace”.

Most challenging, however, is the third recommendation from WHO: “Expand, train & deploy your health care & public health workforce”. Currently, we have five hospital beds per 10,000 people, 200 intensive care units and less than one (0.9) doctor per 10,000 people. To further complicate matters, other affected countries will seek to import our doctors to combat COVID-19 in their countries. The United States has already invited work visa applications from doctors. The US has 25.9 doctors per 100,000 people but 300,000 COVID-19 cases. Robust interventions on our part will serve in the current crisis and during any future health crises.

As WHO recommends, the way forward is “find, isolate, test, treat & trace”

The immediate sizeable source of funds would be the suspension of the Lubowa Specialised Hospital Project targeting health tourists. The total project cost is Sh1.4 trillion ($379 million). After the first payment of Sh327 billion ($87million), there remains a balance of Sh139 billion. These funds are needed to provide primary healthcare, intensive care and emergency care for Ugandans. (The existing budget for the 41 hospitals to be built in 39 districts is Sh1.3 trillion.) The reallocation from Lubowa Hospital should take place as soon as possible and should the lender decline, the rest of the loan should be cancelled.

Easing the Economic Impact of COVID-19

The majority of Ugandans are employed in the informal sector. In fact, 83 per cent of non-agricultural workers are in the informal sector (World Bank Databank). The majority of workers (75.2 per cent) are classified as being in “vulnerable employment” (Human Development Report 2019, UNDP). What this means is they do not have health insurance and are unlikely to have savings or any other form of social safety net. For the fishermen and small traders who pay annual licence fees, Uganda Revenue Authority could consider extending the validity of those licences to take account of trade lost during the pandemic.

Borrowers from the Youth Livelihood Programme and the Women’s Entrepreneurship Programme present a problem. The 83,000 participants in the government-funded loan schemes such as the Youth Livelihood Programme were already having difficulties making repayments and the majority defaulted. During this time we request that the government suspends the pursuing of defaulters and resumes collections when normal work resumes.

Those in debt to micro-finance companies can be assisted by freezing interest accumulation during the lockdown and extending repayment periods once work resumes. Boda boda riders who have bought their motorcycles on credit fall into this category.

Formal Small and Medium Enterprises face similar loan repayment challenges and require similar consideration. The Bank of Uganda has the responsibility to use those mechanisms as are within in its powers to maintain economic stability. It should ensure that SMEs are not forced out of business by enabling banks to extend repayment periods for loans. In this connection, borrowers forced to default should not be penalised and listed by the Credit Rating Bureau.

Both the formal and informal sectors increasingly use digital means to do business. To reduce the use of potentially infectious money, and to make transactions more affordable, we request that the government lift the OTT tax (excise duty on over-the-top services). The government is also urged to reach an agreement with Telcos to further reduce their rates for all telephony.

Mortgages and rent

Without work, the informal sector and struggling SME owners may be unable to pay rent and may face eviction. Bear in mind landlords too may rely on the rent to repay building loans and cater for their families. Therefore, for those in the informal sector we request that the government works out an arrangement with landlords to grant a month’s grace period for those forced to default on rent. The government could take on the debt for the period of the lockdown. For those in the formal sector, the government should consider guaranteeing the rent and mortgage payments and later recover them from salary or from the National Social Security Fund (NSSF) savings of the tenant. Moreover, the NSSF Act needs to be amended to give members access to their savings during emergencies in future.

Utilities

Payment of electricity and water bills will become more difficult in the days ahead. The National Water and Sewerage Corporation has explained that it is unable to waive water charges because it too must meet its obligations to employees and suppliers.

What is needed are subsidies for consumers in difficulty. Two options are possible for a fixed period: a VAT waiver on water and electricity or selective subsidies through Yaka credits and water credits for those most in need. It should be possible to apply online or to regional offices and be granted these credits according to criteria agreed upon between the government and the utilities providers.

Social protection of the most vulnerable

We note the relief being distributed to the vulnerable in Kampala and Wakiso districts. It is true that many urban dwellers have been suddenly deprived of incomes and require support. However, rural people in vulnerable employment are also affected by the lockdown through loss of income. Many depend on roadside markets between towns and cities, traffic which no longer exists.

The elderly are the most vulnerable because globally fatalities have been most prevalent among this demographic and also because their caregivers will be unable to provide for them as before. Yet many of the elderly are themselves caregivers to grandchildren and employers of farm workers. The government has already compiled a list of the aged to which it pays a monthly grant. This Senior Citizens’ Grant is vital in keeping the rural economy afloat and for children being cared for during this time and therefore it must be paid in full and in a timely manner.

The incapacitated and those whose caregivers are themselves incapacitated by illness will need to be added to the list of the vulnerable as will the unemployed who will lose caregiver support. Nearly all Ugandans are at risk of financial disaster if they were to become seriously ill. The Human Development Report states that 75 per cent of Ugandans are at risk of catastrophic expenditure – expenditure which wipes them out financially – were they to require surgery. COVID-19 may not require surgery but in the worst cases (should they appear) it will require intensive care. With a reported 200 ICU beds nationally and most probably all occupied, the situation is dire.

In the absence of public transport, a special public transportation plan for patients and expectant mothers travelling to hospitals and medical centres should be put in place. The beginnings have been difficult as travel passes have not been easy to obtain. We propose hiring and branding vehicles for delivering COVID-19 patients to health facilities. The modalities can be worked out by the Joint Task Force. People Power Co-ordinators will be available to assist in locating those who require transport to health facilities.

The 21 per cent of people living in poverty forms a large part of the vulnerable section of the population. Undernourishment (caloric intake below minimum energy requirements) has been steadily rising for the last 14 years, from 29 per cent to 41 per cent. We have been advised by the Ministry of Health that people have a better chance of surviving COVID-19 infection if they are adequately nourished. To exclude them from the lockdown-affected persons requiring assistance is unfair and counter-productive as they are more likely to succumb to infection.

Disaster preparedness

We cannot afford not to be prepared for other disasters. The shortage in medical masks, respirators, gowns and goggles caught Uganda unprepared yet this was forecast by the World Health Organisation on 27 February.

A resurgence of the desert locust plague in the region was forecast to begin in early May. A swarm entered Amudat district for the second time on 3 April. If it grows, there will be food shortages.

Extreme climate events such as mudslides this rainy season cannot be ruled out either. Our preparedness should reflect the seriousness of the situation and funds set aside to deal with any eventualities. A government statutory contingency fund must be put in place with immediate effect.

On an individual level, to increase food security, owners of uncultivated land are requested to either plant staple foods or allow food to be planted on their land during this rainy season. This arrangement would be limited to this season that is coinciding with the lockdown period.

Funding the safety net

To fund the social safety net, it will be necessary for the government itself to get debt relief on the national debt. Currently over 65 per cent of revenues goes towards debt payment. While we appreciate the World Bank’s call for suspension of debt repayments to development partners and offer of a loan package to finance the campaign against COVID-19, this is not a time to acquire more debt. Lenders are aware that Uganda is a fragile state and, therefore, negotiations for debt cancellation to enable us to provide a social safety net must go ahead and they must succeed. The absence of a social safety net is the direct result of ill-advised development policies.

Long-term interventions: Rehabilitation of the Health Care System

People Power has long argued that the stagnation in health and other services must be addressed as a matter of urgency, not in 2022 or in 2026 but now. This pandemic will end but without strong health and other public services, we shall remain vulnerable to the next epidemic, pandemic or extreme climate event. So we would like all interventions to go beyond the COVID-19 pandemic to cater for future needs.

The health, water and sanitation and all other sectors must be transformed into robust, life-enhancing government services.

Health expenditure

Our expenditure on health decreases nearly every year. That trend must be reversed. We must go from spending 6 per cent of GDP on the health service to spending the 15 per cent we signed up to in the Abuja Declaration.

Not surprisingly, a review of the hospitals around the country reveals that the majority have faulty equipment. To finance a health service that meets national requirements, the health insurance scheme that has been in the pipeline for over a decade needs to be rolled out.

We must go from spending 6 per cent of GDP on the health service to spending the 15 per cent we signed up to in the Abuja Declaration.

We need to develop the capacity to manufacture items for clinical use, e.g. protective gear for health workers. We have the capacity. In 2019 young Ugandans developed life-saving and cost-saving bio-medical equipment. All are important because of the nationwide shortage of medical equipment especially in rural areas. Olivia Koburongo and Brian Turyabagye developed the Mama-Ope smart jacket for digital pneumonia diagnosis. In 2018 Phyllis Kyomuhendo invented M-Scan a portable ante-natal ultrasound device. Brian Gitta and colleagues developed a bloodless malaria test (Winner of the Africa Prize for Engineering Innovation, founded by the Royal Academy of Engineering in the UK); we often cannot afford reagents used to test blood. In 2014 Dr Chris Nsamba developed an incubator for premature babies which he donated to the government. It is in use at Mukono Health Centre IV whereby last year it had saved the lives of 243 critically ill babies. Uganda has one of the highest rates of premature deaths in the world.

In 2019 young Ugandans developed life-saving and cost-saving bio-medical equipment

However, Dr Nsamba failed to get any government funding although a government agency later claimed to have sponsored the development. The government should make a firm commitment to support local innovators by buying their products while following procurement rules to give all innovators a competitive chance.

Water and Sanitation

Only 18 per cent of the population has access to basic sanitation services with which to keep themselves and their homes healthy. Of every 100,000 deaths, 31 are related to unsafe water and poor sanitation and hygiene services. Of every 100,000 deaths, 159 are caused by household and air pollution (Human Development Report 2019, UNDP).

In the long term, there needs to be an investment in the water sector that meets the needs of the 82 per cent without access to basic sanitation services.

We are grateful for the government’s transparency in admitting that the limited water supply to homes has been caused by “poor planning and implementation of programmes over the years”. As a result, the water and environment sector now needs at least nine times the present level of funding every year for the next 12 years to meet national development targets (Budget Monitoring and Accountability Unit Briefing Paper 30/19, Ministry of Finance, June 2019).

Environment

During the lockdown many will struggle to get fuel for cooking. Under normal circumstances, less than 1 per cent of Ugandans has access to clean fuels and technologies for cooking. Apart from being unsustainable environmentally, the daily search for firewood, like the daily trip for water, takes away time children would otherwise have spent in school, acquiring skills to innovate for our survival as a people.

Human Development

We have an opportunity to reflect on the type of nation we want to be. Are we willing to invest in our human development and well-being or will we forever belong to WHO’s category of “the most fragile and vulnerable countries”?

Human development costs money. We will only see a change if we manage our resources better, this goes both to government and to the population. We must eliminate non-essential expenditure; expenditure on salaries of political appointees and on electioneering – cash handouts in return for votes. We must eradicate waste; last year vehicles were bought at a cost of $5.5 million for the Commonwealth Parliamentarians Conference. It was said that they would thereafter be used for government work but they have not been surrendered to the pool for use in fighting COVID-19. The recent budget proposals for the desert locust emergency, especially by the ICT ministry, show that we have not learned this yet.

As a Nation, we need to reflect on the wisdom of splintering the country into tiny entities paying salaries for MPs, and public service but remaining financially unable to maintain decent health centres, hospitals or roads, or to deliver quality education in most local government institutions.

As individuals, each one of us must have as much integrity as we expect from our leaders. In the last four years, Uganda lost Sh28 billion in the Youth Livelihood Programme. An audit of a sampling of Youth Livelihood Project groups which received loans found that 64 per cent were non-existent (representing 71 per cent of the value of the loans). Another 25 per cent had embezzled the funds. This means that repayments were not available for re-lending to new Youth Interest Groups.

We must never again be found without sufficient medical facilities. We must never again find ourselves lacking water with which to wash our hands and prevent disease.

The physical environment in which we live and work can and must be transformed. Unsanitary working conditions in markets and other public places must be addressed beginning with the NWSC/KCCA handwashing points which we expect will become a permanent feature.

We must never again find ourselves lacking water with which to wash our hands and prevent disease.

A durable solution to the broken public transport system is needed, especially in cities and towns. This pandemic has taught us that public transport is a public good that must be supplied, regulated, maintained and sanitised by the government. Supplementary systems are well and good, but the primary responsibility for public transport lies with the government.

On behalf of the millions of People Power foot soldiers across the country, I call upon the government of Uganda and all Ugandans to reflect and consider the proposals I have laid out here.

For God and My Country.

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Robert Kyagulanyi Sentamu, AKA Bobi Wine, is the Member of Parliament for Kyadondo East and leader of Uganda’s People Power Movement.

Politics

A Dictator’s Guide: How Museveni Wins Elections and Reproduces Power in Uganda

Caricatures aside, how do President Yoweri Museveni and the National Revolutionary Movement state reproduce power? It’s been 31 years.

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Recent weeks have seen increased global media attention to Uganda following the incidents surrounding the arrest of popular musician and legislator, Bobi Wine; emblematic events that have marked the shrinking democratic space in Uganda and the growing popular struggles for political change in the country.

The spotlight is also informed by wider trends across the continent over the past few years—particularly the unanticipated fall of veteran autocrats Muammar Gaddafi in Libya, Hosni Mubarak in Egypt, Yaya Jammeh in Gambia, and most recently Robert Mugabe in Zimbabwe—which led to speculation about whether Yoweri Museveni, in power in Uganda since 1986, might be the next to exit this shrinking club of Africa’s strongmen.

Yet the Museveni state, and the immense presidential power that is its defining characteristic, has received far less attention, thus obscuring some of the issues at hand. Comprehending its dynamics requires paying attention to at-least three turning points in the National Resistance Movement’s history, which resulted in a gradual weeding-out of Museveni’s contemporaries and potential opponents from the NRM, then the mobilisation of military conflict to shore up regime legitimacy, and the policing of urban spaces to contain the increasingly frequent signals of potential revolution. Together, these dynamics crystallised presidential power in Uganda, run down key state institutions, and set the stage for the recent tensions and likely many more to come.

The purge

From the late 1990s, there has been a gradual weeding out the old guard in the NRM, which through an informal “succession queue,” had posed an internal challenge to the continuity of Museveni’s rule. It all started amidst the heated debates in the late 1990s over the reform of the then decaying Movement system; debates that pitted a younger club of reformists against an older group. The resultant split led to the exit of many critical voices from the NRM’s ranks, and began to bolster Museveni’s grip on power in a manner that was unprecedented. It also opened the lid on official corruption and the abuse of public offices.

Over the years, the purge also got rid of many political and military elites—the so-called “historicals”—many of whom shared Museveni’s sense of entitlement to political office rooted in their contribution to the 1980-1985 liberation war, and some of whom probably had an eye on his seat.

By 2005 the purge was at its peak; that year the constitutional amendment that removed presidential term limits—passed after a bribe to every legislator—saw almost all insiders that were opposed to it, summarily dismissed. As many of them joined the ranks of the opposition, Museveni’s inner circle was left with mainly sycophants whose loyalty was more hinged on patronage than anything else. Questioning the president or harboring presidential ambitions within the NRM had become tantamount to a crime.

By 2011 the process was almost complete, with the dismissal of Vice President Gilbert Bukenya, whose growing popularity among rural farmers was interpreted as a nascent presidential bid, resulting in his firing.

One man remained standing, Museveni’s long-time friend Amama Mbabazi. His friendship with Museveni had long fueled rumors that he would succeed “the big man” at some point. In 2015, however, his attempt to run against Museveni in the ruling party primaries also earned him an expulsion from both the secretary general position of the ruling party as well as the prime ministerial office.

The departure of Mbabazi marked the end of any pretensions to a succession plan within the NRM. He was unpopular, with a record tainted by corruption scandals and complicity in Museveni’s authoritarianism, but his status as a “president-in-waiting” had given the NRM at least the semblance of an institution that could survive beyond Museveni’s tenure, which his firing effectively ended.

What is left now is perhaps only the “Muhoozi project,” a supposed plan by Museveni to have his son Muhoozi Kainerugaba succeed him. Lately it has been given credence by the son’s rapid rise to commanding positions in elite sections of the Ugandan military. But with an increasingly insecure Museveni heavily reliant on familial relationships and patronage networks, even the Muhoozi project appears very unlikely. What is clear, though, is that the over time, the presidency has essentially become Museveni’s property.

Exporting peace?

Fundamental to Museveni’s personalisation of power also has been the role of military conflict, both local and regional. First was the rebellion by Joseph Kony’s Lord’s Resistance Army in northern Uganda, which over its two-decade span enabled a continuation of the military ethos of the NRM. The war’s dynamics were indeed complex, and rooted in a longer history that predated even the NRM government, but undoubtedly it provided a ready excuse for the various shades of authoritarianism that came to define Museveni’s rule.

With war ongoing in the north, any challenge to Museveni’s rule was easily constructed as a threat to the peace already secured in the rest of the country, providing an absurd logic for clamping down on political opposition. More importantly, the emergency state born of it, frequently provided a justification for the president to side-step democratic institutions and processes, while at the same time rationalising the government’s disproportionate expenditure on the military. It also fed into Museveni’s self-perception as a “freedom fighter,” buttressed the personality cult around him, and empowered him to further undermine any checks on his power.

By the late 2000s the LRA war was coming to an end—but another war had taken over its function just in time. From the early 2000s, Uganda’s participation in a regional security project in the context of the War on Terror, particularly in the Somalian conflict, rehabilitated the regime’s international image and provided cover for the narrowing political space at home, as well as facilitating a further entrenchment of Museveni’s rule.

As post-9/11 Western foreign policy began to prioritise stability over political reform, Museveni increasingly postured as the regional peacemaker, endearing himself to donors while further sweeping the calls for democratic change at home under the carpet—and earning big from it.

It is easy to overlook the impact of these military engagements, but the point is that together they accentuated the role of the military in Ugandan politics and further entrenched Museveni’s power to degrees that perhaps even the NRM’s own roots in a guerrilla movement could never have reached.

Policing protest

The expulsion of powerful elites from the ruling circles and the politicisation of military conflict had just started to cement Musevenism, when a new threat emerged on the horizon. It involved not the usual antagonists—gun-toting rebels or ruling party elites—but ordinary protesters. And they were challenging the NRM on an unfamiliar battleground—not in the jungles, but on the streets: the 2011 “Walk-to-Work” protests, rejecting the rising fuel and food prices, were unprecedented.

But there is another reason the protests constituted a new threat. For long the NRM had mastered the art of winning elections. The majority constituencies were rural, and allegedly strongholds of the regime. The electoral commission itself was largely answerable to Museveni. With rural constituencies in one hand and the electoral body in the other, the NRM could safely ignore the minority opposition-dominated urban constituencies. Electoral defeat thus never constituted a threat to the NRM, at least at parliamentary and presidential levels.

But now the protesters had turned the tables, and were challenging the regime immediately after one of its landslide victories. The streets could not be rigged. In a moment, they had shifted the locus of Ugandan politics from the rural to the urban, and from institutional to informal spaces. And they were picking lessons from a strange source: North Africa. There, where Museveni’s old friend Gaddafi, among others, was facing a sudden exit under pressure from similar struggles. Things could quickly get out of hand. A strategic response was urgent.

The regime went into overdrive. The 2011 protests were snuffed out, and from then, the policing of urban spaces became central to the logic and working of the Museveni state. Draconian laws on public assembly and free speech came into effect, enacted by a rubber-stamp parliament that was already firmly in Museveni’s hands. Police partnered with criminal gangs, notably the Boda Boda 2010, to curb what was called “public disorder”—really the official name for peaceful protest. As police’s mandate expanded to include the pursuit of regime critics, its budget ballooned, and its chief, General Kale Kayihura, became the most powerful person after Museveni—before his recent dismissal.

For a while, the regime seemed triumphant. Organising and protest became virtually impossible, as urban areas came under 24/7 surveillance. Moreover, key state institutions—the parliament, electoral commission, judiciary, military and now the police—were all in the service of the NRM, and all voices of dissent had been effectively silenced. In time, the constitution would be amended again, by the NRM-dominated house, this time to remove the presidential age limit—the last obstacle to Museveni’s life presidency—followed by a new tax on social media, to curb “gossip.” Museveni was now truly invincible. Or so it seemed.

But the dreams of “walk-to-work”—the nightmare for the Museveni state—had never really disappeared, and behind the tightly-patrolled streets always lay the simmering quest for change. That is how we arrived at the present moment, with a popstar representing the widespread aspiration for better government, and a seemingly all-powerful president suddenly struggling for legitimacy. Whatever direction the current popular struggles ultimately take, what is certain is that they are learning well from history, and are a harbinger of many more to come.

This post is from a new partnership between Africa Is a Country and The Elephant. We will be publishing a series of posts from their site once a week.

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Politics

The Enduring Blind Spots of America’s Africa Policy

America should move way from making the military the face of its engagement with Africa and instead invest in deepening democracy as a principled approach rather than a convenient choice.

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The Enduring Blind Spots of America's Africa Policy
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While Donald Trump’s administration completely neglected America-Africa relations, the blind spots bedeviling America’s Africa policy preceded his 2016 election. Correcting the systemic flaws of the past 30 years will require a complete rethink after the controversial President’s departure.

To remedy America’s Africa policy, President Joseph Biden’s administration should pivot away from counterterrorism to supporting democratic governance as a principal rather than as mere convenience, and cooperate with China on climate change, peace, and security on the continent.

America’s Africa policy 

America’s post-Cold War Africa policy has had three distinct and discernible phases. The first phase was an expansionist outlook undergirded by humanitarian intervention. The second was nonintervention, a stance triggered by the experience of the first phase. The third is the use of “smart” military interventions using military allies.  

The turning point for the first phase was in 1989 when a victorious America pursued an expansive foreign policy approach predicated on humanitarian intervention. Somalia became the first African test case of this policy when, in 1992, America sent almost 30,000 troops to support Operation Restore Hope’s humanitarian mission which took place against the background of the collapse of the Somalia government in 1991.

On 3-4 October 1993, during the Battle of Mogadishu, 18 US servicemen were killed in a fight with warlords who controlled Mogadishu then, and the bodies of the marines dragged through the streets of Mogadishu. The media coverage increased pressure on the politicians and six months later America withdrew from Somalia — a case of the New World Order meeting the harsh reality of civil conflict.

The chastening experience resulted in America scaling back its involvement in internal conflicts in far-flung places. The result was the emergence of the second phase — non-engagement when Rwanda’s Genocide erupted in 1994 and almost a million people died in 100 days revealed the limitations of over-correcting the Somalia experience. This “non-interference” phase lasted until the twin Nairobi and Dar es Salaam US embassy bombings by Al Qaeda in 1998.

This gave way to the third phase with the realisation that the new threat to America was no longer primarily from state actors, but from transnational non-state actors using failing states as safe havens. The 2002 National Security Strategy states: “the events of September 11, 2001, taught us that weak states . . . can pose as a great danger to our national interests as strong states.”

Counterterrorism training and equipping of African militaries is the central plank of this new security policy. As a result, counterterrorism funding has skyrocketed as has America’s military footprint in Africa. As a result, Africa has become the theatre in which the Global forever War on Terror is fought.

The counterterrorism traps 

The reflexive reaction to the events of September 11 2001 spawned an interlocking web of covert and overt military and non-military operations. These efforts, initially deemed necessary and temporary, have since morphed into a self-sustaining system complete with agencies, institutions and a specialised lingo that pervades every realm of America’s engagement with Africa.

The United States Africa Command (Africom) is the vehicle of America’s engagement with the continent. Counterterrorism blurred the line between security, development, and humanitarian assistance with a host of implications including unrelenting militarisation which America’s policy establishment embraced uncritically as the sine qua non of America’s diplomacy, their obvious flaws notwithstanding. The securitisation of problems became self-fulfilling and self-sustaining.

The embrace of counterterrorism could not have come at a worse time for Africa’s efforts at democratization. In many African countries, political and military elites have now developed a predictable rule-based compact governing accession to power via elections rather than the coups of the past.

“Smart” African leaders exploited the securitised approach in two main ways: closing the political space and criminalising dissent as “terrorism” and as a source of free money. In Ethiopia, Yonatan Tesfaye, a former spokesman of the Semayawi (Blue) Party, was detained in December 2015 on charges under Article 4 of Ethiopia’s Anti-Terrorism Proclamation ((EATP), arguably one of the the country’s most severe pieces of legislation. But Ethiopia has received millions of dollars from the United States.

The Department of Defense hardly says anything in public but gives out plenty of money without asking questions about human rights and good governance. Being a counterterrorism hub has become insurance policy against any form of criticism regardless of state malfeasance.

Egypt is one such hub. According to the Congressional Research Service, for the 2021 financial year, the Trump Administration has requested a total of US$1.4 billion in bilateral assistance for Egypt, which Congress approved in 2018 and 2019. Nearly all US funding for Egypt comes from the Foreign Military Finance (FMF) account and is in turn used to purchase military equipment of US origin, spare parts, training, and maintenance from US firms.

Another country that is a counterterrorism hub in the Horn of Africa is Ethiopia. For the few months they were in charge, the Union of Islamic Courts (ICU) brought order and stability to the country.  Although they were linked to only a few of Mogadishu’s local courts, on 24 December 2006, Ethiopia’s military intervened in Somalia to contain the rise of Al Shabaab’s political and military influence.

The ouster of the ICU by Ethiopia aggravated the deep historical enmity between Somalia and Ethiopia, something Al Shabaab — initially the youth wing of the ICU — subsequently exploited through a mix of Somali nationalism, Islamist ideology, and Western anti-imperialism. Al Shabaab presented themselves as the vanguard against Ethiopia and other external aggressors, providing the group with an opportunity to translate their rhetoric into action.

Ethiopia’s intervention in Somalia could not have taken place without America’s blessing. The intervention took place three weeks after General John Abizaid, the commander of US forces from the Middle East to Afghanistan, met with the then Ethiopian Prime Minister Meles Zenawi.  The intervention generated a vicious self-sustaining loop. Ethiopians are in Somalia because of Al Shabaab, and Al Shabaab says they will continue fighting as long as foreign troops are inside Somalia.

America has rewarded Ethiopia handsomely for its role as the Horn of Africa’s policeman. In both Ethiopia’s and Egypt’s case, on the score of human rights and good governance, the net losers are the citizens.

Drone attacks 

In keeping with the War on Terror being for forever, and despite departing Somalia in 1993, America outsourced a massive chunk of the fight against Al Shabaab to Ethiopia primarily, and later, to AMISOM. America is still engaged in Somalia where it has approximately 800 troops, including special forces that help train Somalia’s army to fight against Al Shabaab.

America carried out its first drone strike in Somalia in 2011 during President Barack Obama’s tenure. Under the Trump administration, however, the US has dramatically increased the frequency of drone attacks and loosened the oversight required to approve strike targets in Somalia. In March 2017, President Trump secretly designated parts of Somalia “areas of active hostilities”, meaning that the high-level inter-agency vetting of proposed strikes and the need to demonstrate with near certainty that civilians would not be injured or killed no longer applied. Last year, the US acknowledged conducting 63 airstrikes in the country, and in late August last year, the US admitted that it had carried out 46 strikes in 2020.

A lack of transparency regarding civilian casualties and the absence of empirical evidence that the strikes lead to a reduction in terrorism in Somalia suggest that expanding to Kenya would be ill-advised. The US has only acknowledged having caused civilian casualties in Somalia three times. Between 2016 and 2019, AFRICOM failed to conduct a single interview with civilian witnesses of its airstrikes in Somalia.

Despite this level of engagement, defeating Al Shabaab remains a remote possibility.

Containing the Chinese takeover 

The Trump Administration did not have an Africa policy. The closest approximation of a policy during Trump’s tenure was stated in a speech delivered by John Bolton at a Conservative think tank decrying  China’s nefarious activities in Africa.  Even with a policy, where the counterterrorism framework views Africa as a problem to be solved by military means, the containing China policy views African countries as lacking the agency to act in their own interests. The problem with this argument is that it is patronising; Africans cannot decide what is right for them.

Over the last decades, while America was busy creating the interlocking counterterrorism infrastructure in Africa, China was building large-scale infrastructure across the continent. Where America sees Africa as a problem to be solved, China sees Africa as an opportunity to be seized.

Almost two years into the Trump administration, there were no US ambassadors deployed in 20 of Africa’s 54 countries even while America was maintaining a network of 29 military bases.  By comparison China, has 50 embassies spread across Africa.

For three consecutive years America’s administration has proposed deep and disproportionate cuts to diplomacy and development while China has doubled its foreign affairs budget since 2011. In 2018, China increased its funding for diplomacy by nearly 16 per cent and its funding for foreign aid by almost 7 per cent.

As a show of how engagement with Africa is low on the list of US priorities, Trump appointed a luxury handbag designer as America’s ambassador to South Africa on 14 November 2018. Kenya’s ambassador is a political appointee who, when he is not sparring with Kenyans on Twitter, is supporting a discredited coal mining project.

The US anti-China arguments emphasize that China does not believe in human rights and good governance, and that China’s funding of large infrastructure projects is essentially debt-trap diplomacy. The anti-China rhetoric coming from American officials is not driven by altruism but by the realisation that they have fallen behind China in Africa.

By the middle of this century Africa’s population is expected to double to roughly two billion. Nigeria will become the second most populous country globally by 2100, behind only India. The 24-country African Continental Free Trade Agreement (AfCFTA) entered into force on 30 May 2019. AfCFTA will ultimately bring together all 55 member states of the African Union covering a market of more than 1.2 billion people — including a growing middle class — and a combined gross domestic product (GDP) of more than US$3.4 trillion.

While Chinese infrastructure projects grab the headlines, China has moved into diversifying its engagement with Africa. The country has increased its investments in Africa by more than 520 per cent over the last 15 years, surpassing the US as the largest trading partner for Africa in 2009 and becoming the top exporter to 19 out of 48 countries in sub-Saharan Africa.

Some of the legacy Chinese investments have come at a steep environmental price and with an unsustainable debt. Kenya’s Standard Gauge Railway is bleeding money and is economically unviable.

A fresh start

Supporting democratic governance and learning to cooperate with China are two areas that will make America part of Africa’s future rather than its past.

America should pivot way from making the military the most visible face of its engagement with Africa and instead invest in deepening democracy as a principled approach rather than a convenient choice.

Despite the elegy about its retreat in Africa, democracy enjoys tremendous support. According to an Afro barometer poll, almost 70 per cent of Africans say democracy is their preferred form of government. Large majorities also reject alternative authoritarian regimes such as presidential dictatorships, military rule, and one-party governments. Democracy, while still fledgling, remains a positive trend; since 2015, there have been 34 peaceful transfers of power.

However, such positive metrics go hand in hand with a worrying inclination by presidents to change constitutions to extend their terms in office. Since 2015, leaders of 13 countries have evaded or overseen the weakening of term limit restrictions that had been in place. Democracy might be less sexy, but ignoring it is perilous. There are no apps or switches to flip to arrest this slide. It requires hard work that America is well equipped to support but has chosen not to in a range of countries in recent years There is a difference between interfering in the internal affairs of a country and complete abdication or (in some cases) supporting leaders who engage in activities that are inimical to deepening democracy.

The damage wrought by the Trump presidency and neo-liberal counterterrorism policies will take time to undo, but symbolic efforts can go a long way to bridging the gap.

America must also contend with China being an indispensable player in Africa and learn to cooperate rather than compete in order to achieve optimal outcomes.

China has 2,458 military and police personnel serving in eight missions around the globe, far more than the combined contribution of personnel by the other four permanent members of the UN Security Council, Russia, the US, France and Britain. China had more than 2,400 Chinese troops take part in seven UN peacekeeping missions across the continent — most notably in Mali and South Sudan. Of the 14 current UN peacekeeping missions, seven are in Africa, consuming two-thirds of the budget.

Climate change and conflict resolution provide opportunities for cooperation. Disproportionate reliance on rain-fed agriculture and low adaptation to the adverse impact of climate change make Africa vulnerable to the damaging effects of climate change, the consequences of which will transcend Africa. Through a combination of research, development, technological transfer and multilateral investment, America and China could stave off the impact of climate change in Africa.

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Hijacking Kenya’s Health Spending: Companies Linked to Powerful MP Received Suspicious Procurement Contracts

Two obscure companies linked to Kitui South MP Rachael Kaki Nyamai were paid at least KSh24.2 million to deliver medical supplies under single-source agreements at the time the MP was chair of the National Assembly’s Health Committee.

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Hijacking Kenya’s Health Spending: Companies Linked to Powerful MP Received Suspicious Procurement Contracts
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Two obscure companies linked to Kitui South MP Rachael Kaki Nyamai were paid at least KSh24.2 million to deliver medical supplies under single-source agreements at the time the MP was chair of the National Assembly’s Health Committee, an investigation by Africa Uncensored and The Elephant has uncovered.

One of the companies was also awarded a mysterious Ksh 4.3 billion agreement to supply 8 million bottles of hand sanitizer, according to the government’s procurement system.

The contracts were awarded in 2015 as authorities moved to contain the threat from the Ebola outbreak that was ravaging West Africa and threatening to spread across the continent as well as from flooding related to the El-Nino weather phenomenon.

The investigation found that between 2014 and 2016, the Ministry of Health handed out hundreds of questionable non-compete tenders related to impending disasters, with a total value of KSh176 billion including three no-bid contracts to two firms, Tira Southshore Holdings Limited and Ameken Minewest Company Limited, linked to Mrs Nyamai, whose committee oversaw the ministry’s funding – a clear conflict of interest.

Number of Suppliers Allocated BPAAlthough authorities have since scrutinized some of the suspicious contracts and misappropriated health funds, the investigation revealed a handful of contracts that were not made public, nor questioned by the health committee.

Mrs Nyamai declined to comment for the story.

Nyamai has been accused by fellow members of parliament of thwarting an investigation of a separate alleged fraud. In 2016, a leaked internal audit report accused the Ministry of Health — colloquially referred to for its location at Afya House — of misappropriating funds in excess of nearly $60 million during the 2015/2016 financial year. Media stories described unauthorized suppliers, fraudulent transactions, and duplicate payments, citing the leaked document.

Members of the National Assembly’s Health Committee threatened to investigate by bringing the suppliers in for questioning, and then accused Nyamai, the committee chairperson, of blocking their probe. Members of the committee signed a petition calling for the removal of Nyamai and her deputy, but the petition reportedly went missing. Nyamai now heads the National Assembly’s Committee on Lands.

Transactions for companies owned by Mrs Nyamai’s relatives were among 25,727 leaked procurement records reviewed by reporters from Africa Uncensored, Finance Uncovered, The Elephant, and OCCRP. The data includes transactions by eight government agencies between August 2014 and January 2018, and reveals both questionable contracts as well as problems that continue to plague the government’s accounting tool, IFMIS.

The Integrated Financial Management Information System was adopted to improve efficiency and accountability. Instead, it has been used to fast-track corruption.

Hand sanitizer was an important tool in fighting transmission of Ebola, according to a WHO health expert. In one transaction, the Ministry of Health paid Sh5.4 million for “the supply of Ebola reagents for hand sanitizer” to a company owned by a niece of the MP who chaired the parliamentary health committee. However, it’s unclear what Ebola reagents, which are meant for Ebola testing, have to do with hand sanitizer. Kenya’s Ministry of Health made 84 other transactions to various vendors during this period, earmarked specifically for Ebola-related spending. These included:

  • Public awareness campaigns and adverts paid to print, radio and tv media platforms, totalling at least KSh122 million.
  • Printed materials totalling at least KSh214 million for Ebola prevention and information posters, contact tracing forms, technical guideline and point-of-entry forms, brochures and decision charts, etc. Most of the payments were made to six obscure companies.
  • Ebola-related pharmaceutical and non-pharmaceutical supplies, including hand sanitizer
  • Ebola-related conferences, catering, and travel expenses
  • At least KSh15 millions paid to a single vendor for isolation beds

Hacking the System

Tira Southshore Holdings Limited and Ameken Minewest Company Limited, appear to have no history of dealing in hygiene or medical supplies. Yet they were awarded three blanket purchase agreements, which are usually reserved for trusted vendors who provide recurring supplies such as newspapers and tea, or services such as office cleaning.

“A blanket agreement is something which should be exceptional, in my view,” says former Auditor-General, Edward Ouko.

But the leaked data show more than 2,000 such agreements, marked as approved by the heads of procurement in various ministries. About KSh176 billion (about $1.7 billion) was committed under such contracts over 42 months.

“Any other method of procurement, there must be competition. And in this one there is no competition,” explained a procurement officer, who spoke generally about blanket purchase agreements on background. “You have avoided sourcing.”

The Ministry of Health did not respond to detailed questions, while Mrs Nyamai declined to comment on the contracts in question.

Procurement experts say blanket purchase agreements are used in Kenya to short-circuit the competitive process. A ministry’s head of procurement can request authority from the National Treasury to create blanket agreements for certain vendors. Those companies can then be asked by procurement employees to deliver supplies and services without competing for a tender.

Once in the system, these single-source contracts are prone to corruption, as orders and payments can simply be made without the detailed documentation required under standard procurements. With limited time and resources, government auditors say they struggle especially with reconciling purchases made under blanket agreements.

The agreements were almost always followed by standard purchase orders that indicated the same vendor and the same amount which is unusual and raises fears of duplication. Some of these transactions were generated days or weeks after the blanket agreements, many with missing or mismatched explanations. It’s unclear whether any of these actually constituted duplicate payments.

For example, the leaked data show two transactions for Ameken Minewest for Sh6.9 million each — a blanket purchase order for El Nino mitigation supplies and a standard order for the supply of chlorine tablets eight days later. Tira Southshore also had two transactions of Sh12 million each — a blanket purchase for the “supply of lab reagents for cholera,” and six days later a standard order for the supply of chlorine powder.

Auditors say both the amounts and the timing of such payments are suspicious because blanket agreements should be paid in installments.

“It could well be a duplicate, using the same information, to get through the process. Because you make a blanket [agreement], then the intention is to do duplicates, so that it can pass through the cash payee phase several times without delivering more,” said Ouko upon reviewing some of the transactions for Tira Southshore. This weakness makes the IFMIS system prone to abuse, he added.

In addition, a KSh4 billion contract for hand sanitizer between the Health Ministry’s Preventive and Promotive Health Department and Tira Southshore was approved as a blanket purchase agreement in April 2015. The following month, a standard purchase order was generated for the same amount but without a description of services — this transaction is marked in the system as incomplete. A third transaction — this one for 0 shillings — was generated 10 days later by the same procurement employee, using the original order description: “please supply hand sanitizers 5oomls as per contract Moh/dpphs/dsru/008/14-15-MTC/17/14-15(min.no.6).

Reporters were unable to confirm whether KSh4 billion was paid by the ministry. The leaked data doesn’t include payment disbursement details, and the MOH has not responded to requests for information.

“I can assure you there’s no 4 billion, not even 1 billion. Not even 10 million that I have ever done, that has ever gone through Tira’s account, through that bank account,” said the co-owner of the company, Abigael Mukeli. She insisted that Tira Southshore never had a contract to deliver hand sanitizer, but declined to answer specific questions. It is unclear how a company without a contract would appear as a vendor in IFMIS, alongside contract details.

It is possible that payments could end up in bank accounts other than the ones associated with the supplier. That is because IFMIS also allowed for the creation of duplicate suppliers, according to a 2016 audit of the procurement system. That audit found almost 50 cases of duplication of the same vendor.

“Presence of active duplicate supplier master records increases the possibility of potential duplicate payments, misuse of bank account information, [and] reconciliation issues,” the auditors warned.

They also found such blatant security vulnerabilities as ghost and duplicate login IDs, deactivated requirements for password resets, and remote access for some procurement employees.

Credit: Edin Pasovic/OCCRP

Credit: Edin Pasovic/OCCRP

IFMIS was promoted as a solution for a faster procurement process and more transparent management of public funds. But the way the system was installed and used in Kenya compromised its extolled safeguards, according to auditors.

“There is a human element in the system,” said Ouko. “So if the human element is also not working as expected then the system cannot be perfect.”

The former head of the internal audit unit at the health ministry, Bernard Muchere, confirmed in an interview that IFMIS can be manipulated.

Masking the Setup

Ms Mukeli, the co-owner of Tira Southshore and Ameken Minewest, is the niece of Mrs Nyamai, according to local sources and social media investigation, although she denied the relationship to reporters. According to her LinkedIn profile, Ms Mukeli works at Kenya Medical Supplies Agency, a medical logistics agency under the Ministry of Health, now embroiled in a COVID procurement scandal.

Ms Mukeli’s mother, who is the MP’s elder sister, co-owns Icpher Consultants Company Ltd., which shares a post office box with Tira Southshore and Mematira Holdings Limited, which was opened in 2018, is co-owned by Mrs Nyamai’s husband and daughter, and is currently the majority shareholder of Ameken Minewest. Documents also show that a company called Icpher Consultants was originally registered to the MP, who was listed as the beneficial owner.

Co-owner of Tira Southshore Holdings Limited, Abigael Mukeli, described the company to reporters as a health consulting firm. However Tira Southshore also holds an active exploration license for the industrial mining in a 27-square-kilometer area in Kitui County, including in the restricted South Kitui National Reserve. According to government records, the application for mining limestone in Mutomo sub-county — Nyamai’s hometown — was initiated in 2015 and granted in 2018.

Mukeli is also a minority owner of Ameken Minewest Company Limited, which also holds an active mining license in Mutomo sub-county of Kitui, in an area covering 135.5 square kilometers. Government records show that the application for the mining of limestone, magnesite, and manganese was initiated in 2015 and granted in 2018. Two weeks after the license was granted, Mematira Holdings Limited was incorporated, with Nyamai’s husband and daughter as directors. Today, Mematira Holdings is the majority shareholder of Ameken Minewest, which is now in the process of obtaining another mining license in Kitui County.

According to public documents, Ameken also dabbles in road works and the transport of liquefied petroleum gas. And it’s been named by the Directorate of Criminal Investigations in a fuel fraud scheme.

Yet another company, Wet Blue Proprietors Logistics Ltd., shares a phone number with Tira Southshore and another post office box with Icpher Consultants Company Ltd., according to a Kenya National Highway Authority list of pre-qualified vendors.

Family LinksMrs Nyamai and her husband co-own Wet Blue. The consulting company was opened in 2010, the same year that the lawmaker completed her PhD work in HIV/AIDS education in Denmark.

Wet Blue was licenced in 2014 as a dam contractor and supplier of water, sewerage, irrigation and electromechanical works. It’s also listed by KENHA as a vetted consultant for HIV/AIDS mitigation services, together with Icpher Consultants.

It is unclear why these companies are qualified to deliver all these services simultaneously.

“Shell companies receiving contracts in the public sector in Kenya have enabled corruption, fraud and tax evasion in the country. They are literally special purpose vehicles to conduct ‘heists’ and with no track record to deliver the public goods, works or services procured,” said Sheila Masinde, executive director of Transparency International-Kenya.

Both MOH and Ms Mukeli refused to confirm whether the ordered supplies were delivered.

Mrs Nyamai also co-owns Ameken Petroleum Limited together with Alfred Agoi Masadia and Allan Sila Kithome.

Mr Agoi is an ANC Party MP for Sabatia Constituency in Vihiga County, and was on the same Health Committee as Mrs Nyamai, a Jubilee Party legislator. Mr Sila is a philanthropist who is campaigning for the Kitui County senate seat in the 2022 election.

Juliet Atellah at The Elephant and Finance Uncovered in the UK contributed reporting.

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