Sunday, May 27, 2012

We must protect Kenya from the government

Sunday Nation 27 May 2012

Observing events in Kenya today, I am reminded of a story one of my medical school teachers told me during my undergraduate training. Hopefully retelling this story will help us reflect on the weight of responsibility on the shoulders of the common citizen of this country. So here goes.

In a certain European country’s teaching hospital, the tradition had it that a group of trainees, including undergraduate and postgraduate medical students, would arrive early in the ward to prepare for the teaching ward round, presided over by a senior consultant. One morning, he arrived bright and early, and proceeded to the first bed in the children’s ward. He then listened keenly as a postgraduate student gave a summary of the patient’s condition and what had been done for him so far.

The consultant, as usual, asked probing questions meant to help the students learn, and equip them with the right mix of knowledge, skills and attitudes for their future practice. At the end of this presentation, however, the consultant did something completely unexpected. He took out a large scalpel from his pocket and proceeded to slowly and painstakingly slit the child’s throat, in full view of all the students and staff.

Although they were all shocked, none of the observers made any effort to stop the consultant and, astonishingly, they proceeded to the second bed where he repeated the action on another patient.

Fourth bed

It was only on the fourth bed that one of the students asked the consultant to explain what he was doing, at which point he looked up quizzically, as if coming out of a trance, and blinked in confusion. Only then did the rest of the staff in the unit realise that something was wrong, and they took the consultant away. He was later found to be suffering from a mental illness, but the damage had already been done.

With this story, my teacher taught me to constantly scrutinise every action or utterance by an individual on its own merits, rather than on the basis of authority or some other affiliation. In my opinion, Kenyans would do well to take this lesson to heart as well.

We must realise that leadership does not give one access to the fountain of eternal wisdom, and that our leaders make mistakes too. Indeed, a mistake made by a leader has the potential to harm several times more people than the mistake made by a common mwananchi.

It is time, therefore, for us to put our leaders under a microscope, lest we wake up and discover that they have killed our children’s future while labouring under some delusion or other. We must learn to tell them to desist from raiding the national coffers whenever they need some money for their own purposes, and punish them appropriately whenever they do so.

Point out

We must point out to them instances when they make laws and regulations that fly in the face of our Constitution. We must be the voices that they hear last as they go to bed, reminding them constantly that they serve only at our pleasure, and that we can snatch their positions from them when this pleasure runs out.

As Thomas Paine is reputed to have observed, it is the duty of every patriot to protect his country from its government.

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

Tuesday, May 22, 2012

Kenyans should answer the ethnic question

Sunday Nation 20 May 2012

Lately, the National Cohesion and Integration Commission (NCIC) has been in the news discussing the ethnic composition of various national entities and arguing for redistribution to show the ‘face of Kenya’.
Their mandate is derived from the National Cohesion and Integration Act as well as from the Constitution, which requires that all public institutions demonstrate an ethnic balance in their staff complement to prevent any one ethnic community from dominating positions in government.

All these measures were informed by a historical view that previously in this country, election or appointment into public office resulted in an ethnic feasting orgy, where all jobs were allegedly distributed among village-mates and friends of the individual wielding the power. These measures were legislated to attempt to redress the imbalance and prevent similar occurrences in future.

Additionally, the NCIC has developed a draft Ethnic and Race Relations Policy document and circulated it for discussion, providing guidelines on how Kenya should eventually become a more ethnically integrated society. Numerous policy statements in this document address diverse issues from the national language to the production of periodic reports on ethnic and racial diversity.

In this regard, the NCIC has done a commendable job and it behoves all Kenyans to interrogate this draft policy and make suggestions on how it can be improved. However, the NCIC currently labours under the somewhat comical tag of ‘national tribal monitor’ that has only busied itself with counting members of ethnic communities in public institutions. It will be necessary for the Commission to shed this comical image if anyone is to take its pronouncements seriously.

For instance, recently, the commission required all public institutions to provide information on the ethnic composition of their workforce. This was done without providing any guidelines on how this would be done and what parameters would be used to determine ethnicity.

The result is that many institutions simply went into their human resource records and used the surnames of their employees to deduce their tribes without further consultation. The resulting report has been dismissed by some observers as ‘shallow’ and ill-thought out, and nobody seems to be taking it too seriously.

Another example of the nonsensical nature of this type of tribal census arose during interviews for the Gender Commission, where some applicants were denied positions based on their assumed ethnicity.
An applicant with Kamba, Kikuyu and Luhya heritage was locked out on the basis that her ‘tribe’ was already over-represented in other commissions. Her argument that nobody had asked her what she considered to be her ethnicity was dismissed as being merely academic.

It is therefore commendable that the NCIC has recognised that one’s ethnic heritage can only be determined by asking them, and has provided for ‘self-identification’ as the key method of ethnic identification.

There is an unintended positive outcome to this approach. If we are all honest with ourselves, at the next census most Kenyans will identify themselves as either ‘multi-ethnic’ or simply ‘Kenyan’. It is conceivable that entirely new categories of ethnicity will arise, leading to a situation where it will no longer make sense to conduct an ethnic survey of employment practices in public and private institutions.

Hopefully this will also eliminate the all-important ‘tribal arithmetic’ from the calculations of our ethno-political demagogues as they plan their next election strategy.

Dr Lukoye Atwoli is the secretary, Kenya Psychiatric Association and lecturer at Moi University’s School of Medicine; Twitter: @lukoyeatwoli

Tuesday, May 15, 2012

National Health Insurance: The way forward

By Lukoye Atwoli
Sunday Nation 13 May 2012

The stated intention of the expanded National Hospital Insurance Fund (NHIF) programme was to provide Kenya’s uninsured poor access to health services, partly in fulfilment of the constitutionally guaranteed right to health. Unfortunately, there was little information given about the administration of the scheme, and exactly who it would benefit.

Opposition to the new scheme was based on a number of considerations.

Firstly, it was felt that if the NHIF were allowed to raise the monthly premiums at will, a situation could arise where they would become a major drain on the incomes of Kenyans without serious oversight from the contributors’ representatives or parliament. Arguments have been advanced that majority of contributors were represented on the NHIF board by various organisations. However, a cursory glance at the board would show that this is not the case. 

It was top-heavy with government functionaries- permanent secretaries, the Director of Medical Services and the government-appointed Chief Executive Officer. Most members of the board were either government appointees or appointees of institutions that derived only indirect mandates from their constituents. Out of fourteen members (including the CEO) eight were directly appointed either by the president or the minister in charge of health. 

Secondly, the expanded scheme was opposed due to the knowledge that the selected facilities lacked the capacity to administer the scheme. As early as January this year, it was clear that the clinics that were being allocated funds by NHIF to take care of civil servants (who were similarly allocated to the clinics!) were either non-existent in many parts of the country, or lacked facilities to carry out their mandate. Despite flagging the issues four months ago, they were ignored until a few days ago when everyone started acting as if the problem had just been noticed.

Finally, the ability of NHIF to manage the huge amounts of money that would be collected from contributors was in doubt. NHIF has been audited in the past and found to be a wasteful insurer that uses an inordinately large amount of money in administration, with a smaller percentage used to provide care for contributors. Indeed, evidence of the expanded inefficiency came in claims that workers at NHIF had been promised huge salary increments as soon as the new rates were operational.

Given that we all acknowledge that the government has a constitutional responsibility to provide healthcare to all citizens, one would have thought that the easiest way of doing so would be to legislate for a Health Fund. This fund would be made up of 15% of government expenditure (as passed in the Abuja Declaration), as well any other monies collected for the purpose, such as a specific Health Tax on income, taxes on harmful consumables such as alcohol, tobacco and even confectioneries.

The fund would then be used to build, equip and staff health facilities within reach of all Kenyans, and to also provide for promotive, preventive and rehabilitative health care. A law could then be passed requiring all employed persons to have health insurance of their choice, with the default insurer for those who may be either unable or unwilling to get commercial insurance being the NHIF.

With parliamentary and public oversight, this system would be easier to manage and more acceptable than the opaque behemoth that was trying to steal from us in broad daylight!

Dr Lukoye Atwoli is the secretary, Kenya Psychiatric Association and a lecturer at the Moi University School of Medicine.; Twitter: @LukoyeAtwoli

Sunday, May 6, 2012

Culture of duplicity continues in our politics

Sunday Nation 06 May 2012

In the beginning, it was very difficult for Kenyan leaders to resign honourably from positions in government.
However, with the advent of the new constitutional dispensation, leaders are having less difficulties resigning from posts in order to pursue other interests. This is a commendable development, and must be encouraged.

Indeed, Kenyans should require all the members of Parliament who have defected from their sponsoring parties to quit Parliament and seek a fresh mandate from their voters. This is not just idle opinion, but is actually required by the law. It should be made clear that their persistence in disobeying the law only demonstrates that impunity continues to reign supreme in our governance structures, and it will take a major thought revolution to slay this monster.

In this regard, of course one may interrogate the positions of the two deputy prime ministers of Kenya. For varying reasons, both have resigned from their ministerial portfolios as well as their party positions and joined or are in the process of joining other parties in their quest for the country’s presidency.

Curiously, though, they have both cited the National Accord that was embedded in the previous Constitution as the justification for remaining in office as Deputy Prime Minister. Specifically, they have cited the provisions of section 4 (4) of the National Accord and Reconciliation Act 2008, which provides that:

“The office of the Prime Minister and Deputy Prime Minister shall become vacant only if-
(a) the holder of the office dies, resigns or ceases to be a member of the National Assembly otherwise than by reason of the dissolution of Parliament; or
(b) the National Assembly passes a resolution... that the National Assembly has no confidence in the Prime Minister or Deputy Prime Minister, as the case may be; or
(c) the coalition is dissolved.”

In citing this law, the two leaders have either forgotten or overlooked one small detail that would resolve this matter once and for all. Having resigned from their other Cabinet positions, what stops them from resigning from their positions as Deputy Prime Minister?

Does the National Accord bar them from resigning from these positions? Does the law tie their hands and force them to serve in the coalition government to its end? The answer to these questions is a resounding no.
If their resignation from their other positions was meant to be a mark of integrity allowing them to pursue their presidential bids unencumbered, their refusal to completely leave the Cabinet takes them back to square one.

It suggests that they only resigned in order to gain bragging rights on integrity, and not because they were following any moral or ethical injunctions. The law prohibits one from campaigning or popularising a party while belonging to another. It also provides that a member of Parliament loses their seat if they switch allegiance to a party that did not sponsor them to Parliament.

Going by these provisions alone, the two deputies to the Prime Minister and many members of Parliament should relinquish their parliamentary seats and any Cabinet posts they hold in order to face the voters again. If the law were strictly applied, Parliament would have been dissolved a long time ago for lack of quorum, and we would have had a General Election sooner than the March 2013 date given by the Electoral Commission.

Dr Lukoye Atwoli secretary, Kenya Psychiatric Association and lecturer, Moi University school of medicine; Twitter @lukoyeatwoli