Sunday, June 28, 2009

Mental health needs a vote in ministry’s budget

Sunday Nation 28 June 2009, Page 29

The Kenyan budget allocates less than 10 per cent of financial resources to the health sector despite the government’s stated commitment to the Abuja Declaration promising at least 15 per cent of the allocations to the health sector.

Out of this meagre allocation, the ministries of Health jointly allocate less than 0.01 per cent of their expenditure to mental health services countrywide.

Most of the mental health allocation goes to pay Afya House functionaries and provide a few mostly obsolete medications to hospitals in what have often been referred to as the essential drug kits.

The division of mental health at Afya House is woefully understaffed and practically unfunded, and the majority of mental health programmes in this country are funded by non-governmental organisations.

Occurrences in this country since the last days of the colonial administration have left no doubt about the need for a comprehensive mental health policy that adequately addresses the various challenges we face as a nation.

From the Mau Mau concentration camps to the periodic eruptions of collective insanity after elections, evidence abounds on the role of mental ill-health in our national troubles.

The Mental Health Act of 1989 established the Kenya Board of Mental Health as well as District Mental Health Councils to be financed by funds ‘‘voted for the purpose by Parliament’’.

It is unclear whether any of these bodies are operational over 20 years since the Act was passed by Parliament. What is crystal clear is that there is still no vote for mental health in the budget for the ministries of Health!

At the outbreak of the violence that gripped this country last year, there was a mad scramble by various groups to provide ‘‘counselling’’ services in the affected areas. This continued in an environment of poor regulation and many of the so-called ‘‘counsellors’’ did more harm than good to the recipients of their services.

Indeed, the ministry of Special Programmes literally pulled the rug from under the feet of the ministry of Health by creating a department dealing specifically with counselling.

The ministry of Health belatedly published a set of guidelines for offering psycho-social support, but most actors in the field continue to apply disparate standards due to the lack of a clear regulatory framework in this area.

Many of the stated tasks of the government concerning recovery after the violence involve input from mental health practitioners, yet the psycho-social support services in the ministry of Special Programmes have already been terminated for lack of funds.

Every time there is a major disaster in Kenya, organisations and even individuals crawl out of the woodwork to offer counselling services when, in fact, they are on a self-promotion campaign.

This only continues to happen due to lack of a point of reference for such services. As long as the responsible ministry continues to dither and prevaricate on mental health services, this situation is sure to continue and even worsen.

The ministry of Health must move with speed to revamp the division of mental health and expand its composition beyond curative services. The mandate of the division must encompass preventive, promotive and rehabilitative services, quite apart from the provision of curative services in our public hospitals.

Counselling and other services preventing mental illness and promoting mental health are a key frontline domain in mental health, and they must be fully integrated in the mental health division. It remains the responsibility of the division of mental health to produce a strategy for developing and regulating such services in Kenya.

As it is currently, there is no scheme of service for counsellors and psychologists in the civil service. This is a major indictment of the custodians of mental health services at Afya House, and immediate steps must be taken to redress the situation.

Every Kenyan talks about counselling needs whenever tragedy occurs, but when they seek these services in our public hospitals, they end up getting a raw deal. Many of the so-called counsellors have no qualifications to carry out this demanding job.

Additionally, many counsellors do not appreciate their roles on the frontlines of the war against mental illness, and they refuse to send their clients for specialised care. Many try to create a distinction between what they do and ‘‘mental health’’ thus enhancing the stigma many mentally ill patients suffer in the first place.

It is time this confusion in mental health was eliminated through empowerment of the mental health division and expansion of its mandate to encompass all mental health services in Kenya, including counselling!

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s School of Medicine

Sunday, June 21, 2009

Wild goose chase in pursuit of a local tribunal

By Lukoye Atwoli
Sunday Nation 21 June 2009, Page 30

Kofi Annan, the man who reportedly saved Kenya from descending into an abyss last year, recently announced that unless a local tribunal is set up to try the masterminds and other participants in the post-election violence, he would hand over the Waki Envelope to the International Criminal Court (ICC) at The Hague for further action.

The envelope is said to contain names of senior politicians who masterminded the killings and revenge attacks, and The Hague threat has hung over their heads like the proverbial sword of Damocles since the Waki Commission concluded its work last year.

A previous attempt to set up a local tribunal to try these potential war criminals met with resounding failure despite both principals making attempts to herd their supporters behind the Local Tribunal Bill. The main reason for the failure of the bill was that some of those indicted in the Waki Report still sit in the “august” House and even at the pinnacle of power in this country – the Cabinet.

It is now being suggested that the bill be brought back to Parliament before August in a last-ditch effort to resuscitate it and therefore forestall the ICC option. What is unclear is whether the conditions in Parliament have changed much to give the proposed legislation much hope.

Already, many politicians have spoken out against the idea of a local tribunal, arguing that Kofi Annan should just hand over the list to the ICC and get over with it. This argument has brought together strange bedfellows indeed.

Some politicians are opposing a local tribunal in order to delay their inevitable fate while others truly have no faith in the local justice system, even if it is reinforced by foreign “experts”. Because of the loud disagreements among the politicians who will eventually determine the fate of the tribunal, it is highly unlikely that much will come out of the renewed push for a local tribunal.

This Parliament, like others before it, has distinguished itself for the alacrity with which it acts in matters of self-interest. It will delay recess to pass legislation that directly benefits the members and, indeed, difficult matters are often “discussed” in a matter of minutes when the MPs have some personal stake in it.

However, when it comes to matters of great national importance such as the Tribunal Bill, we begin hearing tales about the impossibility of discussing it before the Budget debate is complete. A clear reading of the mood of this country’s wily political elite indicates that nobody is interested in justice regarding the 2007 election and the subsequent conflagration.

Our politicians are only interested in scoring points off their opponents and, as soon as one side concedes on an issue, the other side takes up the cudgels and refutes it! It can, therefore, be said without fear of contradiction that if we rely solely on Parliament and our political leaders it will be difficult to see justice being done for the victims and survivors of the violence we saw last year.

The bigger tragedy, however, is that the common mwananchi has been intimately sucked into the political quagmire and today few arguments end without the protagonists accusing each other of being either ODM or PNU.

Such is the degree of division in this country that in certain areas these political epithets are used as insults! Kenyans have become blind agents of their ethno-political elite, and it is not uncommon to hear politicians threatening each other with their supporters’ rage whenever their designs are thwarted.

Today, Kenya lives under the constant threat of social disintegration because of such blind loyalty, and the politicians are eagerly exploiting the situation to perpetuate their stranglehold on power.

Thus when the Finance minister suggests austerity measures, our politicians are quick to dismiss him, knowing full well that it does not matter what they say as long as they are eventually able to cast themselves as champions of their tribes.

Given that we shall probably never be able to set up a credible local tribunal to try our own ethno-political warlords, the International Criminal Court is an attractive option despite its shortcomings. Even if some of the warlords sleep safe in the knowledge that the process will be so slow as to make no difference in their personal lives, we shall be assured that a verdict shall eventually be reached, and the next generation will finally know the truth about their duplicitous relatives.

It is therefore imperative that Kofi Annan hands over the Waki Envelope to the ICC and saves us the time and energy that will inevitably be expended in the wild goose chase in pursuit of a local tribunal.

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s School of Medicine

Monday, June 15, 2009

Con schemes: Learn lesson and move on

Sunday Nation 14 June 2009, Page 23

Many people are working themselves into a frenzy over the millions of Kenyans who lost money in the ill-fated pyramid schemes, with allusions to dozens who have committed suicide as a result of the losses they suffered.

It is well and good to commiserate with fellow Kenyans and point the accusing finger at the masterminds of the schemes that resulted in such massive losses, but in the interests of truth and honesty, it must be pointed out that the larger portion of blame lies elsewhere.

Many have blamed the government for a weak regulatory framework that allowed rogue “businessmen” to fleece ignorant citizens of billions of shillings. The Central Bank of Kenya has come under withering attack for allowing the schemes to operate. Even the former Cooperatives minister has been dragged into the fray since some of the schemes were registered as cooperatives.

The truth

Despite the fact that it would be impolitic to speak ill of the millions of Kenyans who are nursing massive losses, it is imperative, however, for us to shine some light on the truth about pyramid schemes. At the height of excitement over the huge profits people were making in these schemes, the CBK published a warning in the media, indicating that these organisations were not authorised to take deposits.

This warning, and many others, were dismissed by most “investors” as a case of sour grapes. Some accused the government of standing in the way of citizens out to make an honest shilling. Even as some of the schemes were collapsing, new ones were springing up under different names.

It was even recently reported in the media that one of the collapsed schemes had resurfaced in a neighbouring country and quietly continued fleecing people there before its inevitable collapse. It is therefore the height of hypocrisy for those of us who took a huge risk and lost to turn around and ask the taxpayer to expend resources in investigations and compensation for those losses. As is oft repeated in business circles, a lot of the investment decisions we make have an element of risk.

The risk

What is never highlighted is that the risk is often a real one, and the majority of risk-takers often lose their investment on their way to success in business. It would be better for those who lost money in the pyramid schemes to dust themselves up, learn the lesson and move on.

Asking the government to get involved in investigations and compensation would imply that those who “invested” earlier in the schemes and made huge profits should also be tracked down and asked to return the money. Those asking the Central Bank to make regulations governing pyramid schemes are probably doing so in the heat of the moment, and obviously not much thought has gone into such demands.

Regulating pyramid schemes would be akin to regulating violent robbery – setting up rules and procedures concerning who may be robbed, how they may be robbed and when the robbery may take place. At this point in time the only thing government should do is to investigate if anyone was involved in wrong-doing and punish them appropriately under the existing legislation.

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s School of Medicine.

Monday, June 8, 2009

Oil industry bleeding us dry

Sunday Nation, 07 June 2009, Page 21

Some time late last year, the ministry of Energy promised to institute controls on the price of petroleum products because the oil industry in this country had failed to heed the cry of the common citizen and continued pursuing profits without a social conscience.

The ministry even went ahead and published some complicated formula in the press using taxpayers’ money and asked for comments within a given timeframe after which the regulations would become law.


It is now over six months since the regulations were published and recently the minister for Energy was heard uncharacteristically whimpering that unless oil companies act responsibly, “the ministry will be forced to regulate the price of petroleum products”.

Either the minister is unaware of the progress made since the proposed regulations were published, or he is just being mischievous and hoodwinking Kenyans with meaningless populist statements.

Indeed, such repetitious behaviour has become characteristic of this grand coalition monster, and we were not disappointed last week at the Madaraka Day celebrations when the principals came together to repeat platitudes that meant nothing to anyone but themselves.

The failure to act on regulation of prices of petroleum products is seriously hurting the economy. Indeed, it would even be surprising if the economy will “grow” at the projected 1.7 per cent this year if the current trend continues. The price of petroleum products affects everything from cost and availability of food and other basic necessities to transport, infrastructure and even healthcare.

Yet even as Kenyans continue to suffer unspeakable hardships today, one of the oil companies was recently quoted in the press indicating that the price of oil was inevitably headed north. None of the multifarious explanations given for this ever show why the price of local petroleum products rises within days of some global convulsion, but it drops very slowly if at all whenever the reverse situation obtains.

The dishonest talk of exhausting old stocks seems only to apply when international oil prices drop, but when the prices rise, the “old stock” story becomes irrelevant as Big Oil scrambles for profit.

The oil industry cannot be blamed for playing this cynical game for the companies are not established for charitable purposes. If they had their way they would indeed inflate the prices of their commodities to the highest price possible to still make a sale.

Powerful lobby

It is, however, the responsibility of government to look out for the interest of the citizens on whose behalf it governs. Part of its responsibility is to ensure that as many of its citizens as possible are comfortable, and this includes regulating the prices of essential commodities.

Big Business has a very powerful lobby in this country and this will continue to be the case as long as we worship wealth for its own sake and not for the good that it is capable of.

Assuming that the proposed regulatory mechanisms have not been secretly shelved, Kenyans need to hear from the responsible ministry what progress has been made in ensuring that the price of petroleum products is bearable and does not unduly disrupt economic growth while lining the pockets of a few magnates.

Kenyans also need to demand accountability from this government if we are to stop top public servants from getting away with blatant dishonesty and doublespeak which only results in more Kenyans descending into the clutches of poverty. Pronouncements of a new agenda for jobs and food security such as those made on Madaraka Day must be seen for what they really are – pure hot air.

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s School of Medicine.