Sunday, April 29, 2012

Why I will not vie for presidency just yet

Sunday Nation 29 April 2012

Every ambitious man likes to believe that some citizens, even if only in their dreams, have wondered why he has not “thrown his hat into the ring”, to use parlance that is becoming peculiarly Kenyan.
Today I explain why this should not apply to me. First, I will not run to be president of a country of sore losers.

I cannot countenance participating in an election in which all the candidates believe that there is only one outcome, their victory, and that their opponents cannot win unless foul play is involved. It would be impossible for me to share a platform with hypocrites who mouth democratic platitudes by day and plan war by night, in the event that they lose the election.

No values

Second, I will not vie to be president of a country whose voters have no values or self-respect.
I would not want my campaign’s main preoccupation to be how many coins to carry to a rally in some remote part of the country in order to satisfy some voters’ greed.

I cannot pretend to be addressing the concerns of potential voters while in reality I am sizing them up and deciding how many shillings they are worth. I would literally choke if I had to address a crowd of “supporters” who are in reality armed robbers waiting to collect their loot at the end of my enlightened speech.

The rule of law

Third, I will not waste my time struggling to be the president of a country that does not respect the rule of law. In this country, as long as something makes sense to one, it is the right and lawful thing to do, even if the law says otherwise.

I was recently educated by a friend of mine who possesses a legal education that systems of law are shifting globally, from the law as it is written to the “law of the people”. In other words, whatever the people want is legal and proper, no matter what is written in the law books.

Fourth, I will not vie to be president of a country that has never had a president in the first place, if modern historians are to be believed. According to popular history today, all our presidents have been ethnic jingoists whose tribes came before service to the nation.

This perception persists despite glaring evidence of poverty and deprivation in these men’s political backyards, and the knowledge that even within these ethnic cabals, there was a class division that at the highest levels cross-pollinated with other tribal elites in order to keep the majority in a state of want.

Finally, I will not be president of a nation of cowards who are afraid to speak their minds. I have sat in many political discussions, and whenever people think that the group is ethno-politically homogenous, they engage in such bigoted talk that one is left thinking that should the “enemy” be spotted at that moment, a bloodbath will surely erupt. These same individuals become as meek as lambs when the composition of the group changes to include the so-called “enemy”.

Ethnic other

We blame our leaders and the ethnic “other” for all our tribulations, when indeed the ordinary Kenyan is the author of most of his misfortunes. There will be no meaningful change in Kenya unless these issues are addressed, by the citizens themselves.

Dr Lukoye Atwoli is secretary, Kenya Psychiatric Association and lecturer, Moi University’s school of medicine

Sunday, April 22, 2012

Universal healthcare? Not with NHIF

Sunday Nation 22 April 2012

The National Hospital Insurance Fund (NHIF) is in the process of implementing what they are calling comprehensive cover for all their contributors. The plan is supposed to be in operation for teachers and other civil servants who should, by now, be covered for both outpatient and inpatient services at hospitals all over the republic.

As predicted, the plan is already facing problems, with accusations being made that NHIF has already disbursed funds to non-existent or ill-equipped facilities to render services to its members.

This concern was first publicly raised in this column on January 15 this year, where it was noted that:
“Two of the contracted private providers do not have sufficient facilities of their own, and it is clear that they will only serve as middlemen in the process. Some of the ‘clinics’ identified on their websites are actually non-existent, and it is even doubtful if they have enough workers to offer quality health care to members of Kenya’s civil service”.

These are the same issues now being investigated by various arms of government, and it appears possible that some fraudulent activities may have occurred.

The justification the government has given for rolling out this scheme is that it is part of endeavours to provide universal healthcare to the Kenyan populace. Indeed, this is the thinking behind the plan by NHIF to increase members’ contributions in order to cushion the less fortunate members of our society and improve health care delivery.

The NHIF contribution, being compulsory, constitutes a tax on the employed workforce’s income. Initially, it was meant to assist the contributor to offset hospital costs for themselves and their families.
The intention of raising the contribution, however, is to ensure that all Kenyans gain access to essential healthcare as part of the government’s obligation under the Constitution.

We have argued before that whenever government intends to raise taxes it goes through Parliament, which has the constitutional mandate to oversee the collection and utilisation of taxes on our behalf. NHIF is not following this procedure, citing the Act of Parliament that set up the Fund.

Instead of ramming this increment down Kenyans’ throats, this obvious oversight suggests that perhaps this Act needs to be repealed, and replaced with provisions for a health tax that will guarantee essential healthcare for all Kenyans.

Since NHIF’s expenditures are not directly supervised by Parliament, raising the contribution without consulting the contributors, and intending to use the money for purposes other than providing for the care of the contributors themselves, contravenes the principle of representative government. It is taxation without representation.

As we noted in another article in August 2010, the law allowing NHIF to make such unilateral decisions “is bad law inasmuch as it lets a government institution impose extra taxation on Kenyans without parliamentary approval.”

If NHIF persists in this folly, it is a sure bet that those of us who really desire improvement in the health care delivery system in Kenya will fight for the dissolution of this ill-conceived entity, and raise in its place a National Health Fund to collect and distribute funds for the purpose of providing health services.

The only difference will be that this Fund will raise money through taxation and operate under parliamentary oversight, hopefully preventing pilferage and waste as is now the case.

Dr Lukoye Atwoli is secretary, Kenya Psychiatric Association and lecturer, Moi University School of Medicine

Sunday, April 15, 2012

Place of traditional healers in our hospitals

Sunday Nation 15 April 2012

The ministries of Health have recently become involved in an initiative to regulate the practice of traditional or alternative medicine in Kenya. In the wake of this effort, there have been calls for traditional medicine practitioners to be allowed to work alongside other health workers in our public hospitals.

Before we discuss the merits or demerits of this idea, we need to appreciate the nature of healthcare that is practised in the two settings.

In a hospital setting, there are standardised procedures for assessing patients and planning for their care, often based on algorithms that are, in turn, products of a huge body of research evidence. Unfortunately, training for health workers in formal health care settings does not include training in traditional medicine.
Since these health workers do not know what traditional medicine is all about, it is practically impossible to incorporate the practitioners of traditional medicine within these standardised algorithms.

Traditional medicine, on the other hand, may fall into three main categories. There are diviners who purport to foretell the future and communicate with spirits in order to effect healing by supernatural means. Then there are the herbalists who use plants and their extracts to treat various afflictions. Finally, there are the witches and wizards who purportedly cast spells and claim to be able to reverse them for the right price. Other traditional healers use a combination of these methods to deal with the various problems afflicting a human being.

There is some evidence that at least some of the methods and concoctions administered by traditional healers may be effective under certain circumstances. However, most of this evidence falls in the lowest category of medical evidence known as anecdotal evidence, or word of mouth.

The problem with this type of evidence is that despite spectacular claims of efficacy in a few individuals, it takes very little evidence of harm to render it invalid. It is also difficult to sustain the claims of anecdotal evidence when arrayed against scientific evidence derived from studies with tens of thousands of participants.

Another problem with traditional medicine is that it is difficult to explain to anyone how these methods work.
This is in stark contrast to the so-called conventional medicine which, because of extensive research information, is able to demonstrate the expected effects and side-effects of any treatment that is prescribed.

Traditional medicine practitioners, therefore, have a hurdle that they must overcome before they can be incorporated into the regular framework of the public healthcare system. Firstly, they must open up their methods to scrutiny in a scientific manner. They must keep records of their clients and allow research to be conducted to demonstrate whether their treatments work as purported or not.

Second, they must allow their treatments to be described and standardised, and develop a training system that ensures that the treatments are used in an ethical manner. Finally, they must acquaint themselves with the functioning of the public health system, in order to determine at what level they will fit.

It is obvious that were they to follow the prescription above, they would end up being “modern doctors”, and their treatments would be indistinguishable from “modern medicine”. Perhaps this is the way to go.

As we have observed before, there is neither “traditional” nor “conventional” medicine. There is only medicine that works!

Dr Lukoye Atwoli is the secretary, Kenya Psychiatric Association and lecturer at Moi University’s school of medicine

Tuesday, April 10, 2012

Time to kill this colonial ethnic ideology

By Lukoye Atwoli
Sunday Nation 08 April 2012

General elections are coming up soon, and everybody who wants to have a say in the outcome is organising to ensure that they are heard. All segments of Kenyan society are in ferment, and all sorts of pressure groups and secretariats are being set up to influence the shape of politics in post-referendum Kenya.

Among the groups that have traditionally had influence in political processes in Kenya are the so-called ‘cultural associations’ and their leaders. This has been the case since pre-independence days when the colonial government would not register any national political organisation, and only allowed ethnic or ‘regional’ organisations. The colonial government’s aim, of course, was to ensure that the entire population was divided up into ethnic enclaves forever in conflict with each other, leaving the mzungu government alone to exploit the best of our resources and govern us with only token opposition.

After Kenya’s independence almost 50 years ago, successive governments failed in their stated objectives of uniting the country behind a common cause. A feeble war against tribalism has been sabotaged by its chief promoters who play Dr Jekyll by day and Mr Hyde by night. As recently as the late 1990s, the government encouraged the formation of tribal associations at our universities, with a goal not dissimilar to that of the colonial government over five decades before. 

What is however becoming clearer with each passing day is that younger people, though aware of ethnic stereotypes and prejudices, are more willing to test the waters and go against the ‘tribal chieftain’, if only for the fun of it. Evidence of this will be seen in the various ‘cultural’ associations which are really just covers for ethnic political organisations. Majority of the people at the helm of these organisations grew up before independence, and learnt their politics at the feet of tribal chieftains.

They have emerged with proclamations allowing younger post-independence politicians to lead their tribal voting machines, in the hope that the youth will perpetuate the same toxic environment they grew up in. The elders, by recycling the colonial ideas of political expression by tribe, have demonstrated a form of cerebral bankruptcy that is obviously irremediable. 

The youth must seize the opportunity and try to change this state of affairs in two possible ways.
Firstly, they could reject the wazees’ ideas and decide to organise themselves around ideals that will truly shape the future of this country. This they could do by joining political parties whose ideas they identify with, and actively campaigning for positions within these parties in order to play a role in realising those ideas both within their parties and in the country as a whole. 

This will progressively result in a political system in which ideas count for more than tribe or gender. Eventually, it will encourage politicians to formulate policies that they can implement when they win elections, instead of focussing on tribal alliances whose only goal is to place a few individuals in positions of power for their own good.

Alternatively, young people could join these tribal organisations en masse, and convert them from political vehicles into true cultural associations geared towards celebrating diversity and cohesion. They will thus have destroyed our political dinosaurs’ last political vehicles, allowing them to hopefully fade into oblivion and leave our nation in the hands of true leaders.

Dr Lukoye Atwoli is the Secretary, Kenya Psychiatric Association and a Lecturer, Moi University School of Medicine

Wednesday, April 4, 2012

Government approach to healthcare baffling

Sunday Nation, 01 April 2012

On paper, the Kenya government acknowledges that Kenya is struggling with a very high burden of both communicable and non-communicable diseases. Many policy documents and statements of intent lie on shelves in various government departments, promising that the government will throw all the necessary resources at these health problems in order to achieve a healthy working nation in the shortest time possible.

This is why it is baffling that government health expenditure has been dwindling over the years, and has recently dipped to less than five per cent of total government expenditure. Despite government commitment to the Abuja Declaration binding it to allocate at least 15 per cent of the budget to the health sector, there is little tangible evidence that this is being actively pursued.

This past week the doctors’ union revealed that the government has been dilly-dallying in the matter of hiring doctors who graduated from medical school in December last year, citing lack of funds. Sources at the ministry of Medical Services had indicated that the government intended to hire these doctors in July, over eight months after they sat and passed their last exams in medical school.

In a meeting with the doctors’ union, officials at the Treasury pointed out that the ministry of Medical Services had delayed in requesting for the necessary resources for the hiring of these doctors, and authorisation was given in record time. Hopefully, these doctors should report for duty tomorrow.

Key problem

This incident demonstrates the key problem in our health sector. There are officials in the twin ministries of Health who are fossilised in the status quo, and no significant improvements will be seen in these ministries unless these officials are shown the door.

These officials are the main cause of unrest in the sector, and this country is set to see an exponential rise in the number of strikes and demonstrations by health workers unless the administrative structures in these ministries are reorganised.

I have had the opportunity to interact with these Afya House functionaries at different levels, both as a civil servant and as a member of organisations that deal with the ministries of Health. Unfailingly, in every interaction, there is always a cabal whose main role is to delay progress, plant roadblocks, and foment unrest.

It is unclear whether their actions are sanctioned by their seniors, or whether they are just the product of many years of “service” whose main goal is obfuscation and procrastination.

Another example of this fatal malaise is the ongoing attempt to develop a Health Bill to govern all aspects of healthcare in this country. After endorsing the Taskforce recommendation for a Health Service Commission anchored in the Constitution, the Afya House mandarins are now proposing to create a Health Service Authority to carry out the same tasks this commission is meant to address.

The development of the Bill itself has been shrouded in mystery, and the current draft is top-heavy with bureaucracy that duplicates almost every function envisaged by the drafters. Unless this Bill is closely scrutinised, the rot at Afya House will be transferred intact to the new administration under the new Constitution.

It is therefore time the government cleaned out this veritable Augean stable that sits at the helm of our Health infrastructure in order to forestall any further problems in the health sector.

Dr Lukoye Atwoli is sSecretary, Kenya Psychiatric Association and lecturer, Moi University’s school of medicine