Monday, August 30, 2010

Case for a health professionals council

Sunday Nation 29 August 2010

Now that the new Constitution is well on its way to full implementation, Kenyans must remain vigilant to ensure that they are not short-changed in this process.

It is time the church and others opposed to certain provisions in the Constitution accepted the will of the majority and suggested ways of implementing the document to the satisfaction of all Kenyans.

To this end, it may be necessary to find creative ways of dealing with some of the more emotive issues raised by the church and others in the ‘No’ camp during the campaigns.

One such issue concerned the provisions allowing health professionals to terminate a pregnancy if the mother’s life or health is in danger or she is in need of emergency treatment.

During the process of writing this constitution, health workers were very vocal in demanding a Health Services Commission entrenched in the constitution to regulate the health sector and ensure that providers are properly qualified and offer high quality services.

One of the functions of the proposed Commission would have been to license health professionals and provide for the sort of educational and other qualifications they needed to practise.

In my opinion, this would have been the body to determine who a health professional is in the context of the abortion clause, removing any ambiguity and laying the clergymen’s fears to rest.

Unfortunately, this proposal was rejected at some point in the process despite there being no obvious objections from all those involved. However, even in the absence of this Commission, all is not lost.

Although most health workers do not think the abortion clause allows for “abortion on demand” as articulated by the clergy, it is necessary to address their fears in the spirit of reconciliation and in order to bring everyone on board the implementation train.

Parliament should move with speed to set up a Health Professionals’ Council that will, among other things, determine who health professionals are and what sort of training they require to offer health services.

This would include making a determination as to who is allowed to make a decision that the life or health of a mother is in danger and the pregnancy needs to be terminated.

The same Council would license health professionals and outline what level of service delivery they should be involved in, and would bring together all the regulatory bodies in the health sector.

Apart from dealing with the abortion issue, this council would act to safeguard the health rights of the citizens, by giving meaning to such terms as “emergency treatment”, “the right to health” and other health related issues in the constitution.

The upshot of this is that in coming up with the Commission on the Implementation of the Constitution, Parliament must look beyond the traditional areas of expertise.

It has been customary for such commissions to be crammed with lawyers and very few other experts, if any, even though it is agreed that the constitution covers a wider range of issues than lawyers alone can handle.

The Commission should be broad-based and should include social scientists, health professionals and educators among others. This is the only way to ensure that the document is implemented practically and holistically, safeguarding the interests of all Kenyans.

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

Monday, August 23, 2010

Hospital fund tax is a sick decision

Sunday Nation 22 August 2010

In the late 18th century, someone in the then American colonies coined a catch-phrase that has survived through the years as a clarion call for democracy and representation.

The Americans, protesting against the principle of being taxed by the “mother” country without having any say in the way they were governed or how the tax money was used, cried out that there should be “no taxation without representation”.

Most modern democracies now provide that all taxes on their citizens must be approved by their elected representatives, and that any use the money is put to must also be approved in a similar fashion.

This is the philosophy behind the annual budget ritual in Kenya and other similarly governed nations.

It has also lately become the basis for the international push for true universal suffrage where all people that are eligible to pay tax in a particular jurisdiction are also entitled to vote for their leaders.

Presumably, this is the same reasoning that recently drove a Kenyan court to assert that even prisoners have a right to vote at the referendum, and even at future General Elections.

It is, therefore, a grave anomaly that in this day and age, there exist certain organs of state that have the power to tax Kenyans and decide how that tax money is used without approval from parliament.

The recent decision by the National Hospital Insurance Fund to increase the monthly membership “contributions” by over 600 per cent has served to open the eyes of Kenyans to this anomaly.

Whether it is allowed by law or not, how can an institution unilaterally decide how much money to deduct from a worker’s payslip without negotiating with the worker or an elected representative?

How can the same institution have the power to vary those deductions without a process of consultation involving the workers or their representatives?

It is insufficient to argue, as the hospital fund has done, that workers and other “stakeholders” are adequately represented on the organisation’s board.

The increased deductions will not only affect the members of the “stakeholder” organisations, and it is imperative that a process of consultation involving the peoples’ elected representatives be used to determine the amount of money anyone should pay to NHIF.

The benefits must similarly be audited both by Parliament and by the government’s own auditing mechanisms to ensure that it is commensurate with the payments and that it is sustainable in the long run.

As matters stand now, the hospital fund has only indicated to workers through the press that their deductions will increase beginning next month.

Nobody in formal employment has received any direct communication asking for their opinion on this increase.

In any case, it is being argued that the increased rates are much higher than those offered by private insurance companies for similar insurance cover.

If the law allows the National Hospital Insurance Fund to make such unilateral decisions, then it is bad law inasmuch as it lets a government institution impose extra taxation on Kenyans without parliamentary approval.

In my opinion, it is imperative that the directive be rescinded pending a more consultative method of determining deductions and benefits.

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

Sunday, August 15, 2010

Debunking myth of R. Valley’s ‘No’ vote

Sunday Nation 15 August 2010

Soon after the historic referendum on the constitution one-and-a-half weeks ago, some campaigners on the ‘No’ side went to town with claims that the Rift Valley voted overwhelmingly against the new constitution.

This information was meant to force fresh negotiations on what they consider to be contentious issues in the newly passed document, in order to engineer another constitutional review circus to last us another lifetime.

Of course it should be clear by now that no one has any discretion on how the new constitution may be amended once it is promulgated. Any negotiations or processes aimed at amending the new constitution must follow the provisions laid down in Chapter 16 of the document.

As it was so eloquently pointed out by various commentators last week, the era of backroom deals is behind us, hopefully for good.

The media have been largely complicit in propagating this myth by analysing the referendum vote as a constituency vote, rather than a national one.

Reports abound of ‘Yes’ or ‘No’ wins in this or the other constituency, yet each individual vote counted towards the final result, no matter which constituency it came from.

Ideally, when people vote at a referendum, it is only the votes ‘for’ that matter. Indeed, the emphasis is often on what percentage of votes the document must garner to pass, and not on the percentage that votes against it.

Alluding to a possible ‘No’ win or a ‘No’ loss is therefore fallacious, given that the ‘No’ camp was not presenting any proposal capable of winning or losing. They were simply expressing opposition to the then Draft Constitution.

The referendum result was therefore only going to be twofold — a ratification, or a rejection of the draft.

Looking at the results as published on August 6 by the Interim Independent Electoral Commission, it becomes clear that the reality on the ground is radically different.

The number of votes contributed to the ‘Yes’ basket by voters in the Rift Valley Province was 971,331, constituting about 16 per cent of the total ‘Yes’ vote.

Of all the provinces, only Central (1,274,967) and Nyanza (1,174,033) produced more votes in favour of the new constitution than Rift Valley.

Saying that the Rift Valley voted almost to a man against the constitution is therefore extremely misleading, and those peddling this myth might actually harbour ulterior motives.

To further illustrate the point, one only needs to look at Eldoret North constituency, represented by the ‘de facto’ leader of the political wing of the ‘No’ campaign. Over 40,000 voters in this constituency supported the new constitution, and no amount of whitewashing can change this fact.

This pattern was repeated in most constituencies in the Rift Valley, with ‘Yes’ votes being found even in the most ethnically homogenous areas.

Rather than demonstrating the homogeneity of the Rift Valley as far as electoral politics is concerned, this referendum actually shattered this myth, and the residents of the Rift Valley can look to the future with pride, as co-authors of their own collective fate and contributors to the great moment that changed Kenya forever.

In any case, the process of dismantling the provinces will soon begin, and future generations will only speak of constituencies and counties.

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer, Moi University School of Medicine.

Sunday, August 8, 2010

This is a clean break with the past

Sunday Nation 07 August 2010

One quiet August morning 28 years ago, a six-year-old boy ventured from his house on Muyuyu Street in Eastleigh to go to the nearby kiosk to buy milk and bread as was his daily routine.

On this day, things seemed different. He did not manage to buy the provisions he had been sent to get because he found that all kiosks were closed and, instead, all he could see were heavily armed uniformed soldiers everywhere on the street.

He went back home and explained to everyone why he had been unable to get milk and bread, but had difficulty understanding the significance of the armed fellows at every street corner.

Today, he remembers sitting on the floor in his bedroom, scared stiff, as explosions went off at the nearby Eastleigh Airbase. Leonard Mambo Mbotela’s voice still rings in his mind as he announced on the then only national radio station that ‘‘serikali imepinduliwa. Polisi wanatakiwa wakae kama raia’’ (the government has been overthrown and the police are advised that they are now civilians).

He remembers the soldiers who later visited his home and went from room to room looking for ‘‘subversive material’’, some of which, like The Green Book by Muammar Gaddafi, had been hidden away in advance.

Publications from the then Soviet Union on communism and socialism had also miraculously disappeared from the bookshelves long before the soldiers came calling.

He remembers later that evening watching on television as the President, dressed in jungle fatigues and flanked by a contingent of soldiers, announced that the elected government was back in control.

This boy lived through the transformation of the Moi regime from a benign paternalistic government into a violent dictatorship.

This past week has brought back all those memories as the country marked the 28th anniversary of the 1982 attempted coup and at the same time voted to radically alter the governance landscape for the first time since independence.

History will record August 4, 2010 as the day when Kenyans spoke up unequivocally to change every aspect of their governing institutions, giving themselves greater say in matters of state.

Although it is fair to assume that the majority of the voters did not vote on the basis of their reading of the proposed constitution, the overwhelming ‘Yes’ vote maintains the reform momentum that has built up since the chaotic 2007 General Election.

Kenya is now irrevocably set on a path to institutional reform that may yet prove to be the most fundamental change in the history of our young republic.

We must not rest on our laurels. The country faces perhaps the most dramatic times since independence and the citizens must not relax their vigilance in ensuring both the legislature and the executive arms of government fulfill their responsibilities as outlined in the new constitution.

The little boy of 1982 is now an adult Kenyan, trying to do his bit to ensure that history does not repeat itself.

I know a lot about that little boy because, in 1982, that little boy was me.

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer, Moi University School of Medicine.

Sunday, August 1, 2010

Cyberterrorism over ‘Yes/No’ campaigns

Sunday Nation 1 August 2010

There are only three short days to go until Kenyans go to the ballot to decide whether we shall have a new constitutional dispensation or not.

The truth of the matter, as has been articulated by various commentators on this issue, is that in the referendum we shall be choosing between the current Constitution and the proposed constitution. There is no Bomas draft, no church draft and no ‘No’ draft to compare with the two documents above.

At this point, presumably everyone who is going to vote has already made up their mind how they will vote, and very little can be done to change these positions.

This is why I was so stunned early last week when I fell victim to a phishing scam perpetrated by someone sympathetic to one of the sides in the referendum campaign.

In view of the fact that the attack was so brazen and many others may have fallen victim to similar schemes, I will disclose the full particulars of the attack, and hope that something can be learned from it.

Early last week, I received a message on Facebook from someone claiming to have sensitive information concerning funds secretly wired to the ‘No’ campaign. She invited me to open a certain link to access the information.

The link seemed to be pointing to a website going by the curious name “”. For a while I dismissed the message as a piece of propaganda given that, if such information existed, I would hardly be the first person to hear about it.

Eventually, however, curiosity got the better of me, and I resolved to try and open the message, and at the same time change my password just in case it was a phishing scam.

I did both, but as it turns out, I was a few seconds too late in changing my password. Shortly after discovering the message was indeed a cyberterrorist attack, I lost control of my Facebook account. Soon I started receiving email messages indicating that I had posted something outrageous on my profile.

I managed to momentarily regain control of the account, and discovered that the hacker had posted something to the effect that I had decided to publicly express my reservations about the proposed constitution, giving completely ridiculous reasons such as that the Draft supports abortion and homosexuality and similar inanities.

It took me over three hours to be able to regain full control of the Facebook account, as well as of my alternate email address (which they had also hacked into), by which time the hacker had engaged at least one of my friends in some sort of conversation about “my” reasons for the apparent change of heart.

This incident brought home to me the degree of desperation in these campaigns.

The final point demonstrated by this attack is the misconception that many hold about the draft constitution and entire referendum — that the outcome hangs on the opinions of some influential individuals in society, and not on those of individual Kenyan voters.

The country today stands on the cusp of history, and if we throw away this opportunity at re-engineering the architecture of the state, we might as well give up and let the next generation do it for us.

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