Monday, June 25, 2012

MPs’ greed is a recipe for a revolution

Sunday Nation 24 June 2012

The Kenyan citizen is approaching a watershed moment in her struggle against a tyrannical plutocracy. Our Members of Parliament are in a staring contest with the rest of us, and they are confident that we will blink first.

It was clear to all of us why the old constitution needed to be changed, and the urgency of this change was brought home by the horrendous violence that followed our last election. We were clear that we did not want a system where any one individual or institution could lord it over the rest of us with impunity. We wanted a government in which we had a say, and where the voice of the citizen could be heard and obeyed.

Checks and balances

We set up in the Constitution what we thought was a system of checks and balances, with the ultimate check for all arms of government being the sovereign, the people collectively. The Executive, the Legislature, the Judiciary and the independent commissions could exercise oversight over each other, but mwananchi stood head and neck above all of them.

Indeed, the Constitution recognised the supremacy of the people, and provided, in the very first article, that: “All sovereign power belongs to the people of Kenya, and shall be exercised only in accordance with this Constitution”. All organs of state therefore operate only on delegated or donated power, and the citizenry have the implicit authority to recall that power and reassign it as they will.

It is, however, becoming clearer with every passing day that our MPs are hell-bent on reversing these provisions. They have embarked on a scheme to bankrupt the people by providing for perks and emoluments that were never contemplated in the Constitution.

They have provided for enhanced allowances for themselves, and given themselves a retirement package as if being an MP is a profession from which one retires. They have further demonstrated that they are willing to change the law to suit their desires, including tampering with the requirements for leadership and integrity provided for in the Constitution and other written law.

The stock excuse, which would be untenable in any other self-respecting society, has been that they are operating under the old constitution. It, therefore, appears that there are two sets of constitutions in existence in Kenya today – one for the politicians and another for the common citizen.

This, in my opinion, is the surest route to a true revolution in this country. In a country where the ruling elite consider themselves to be above the dictates of law or morality, a society where laws are either changed or broken to suit the whims of a small clique, the lowly citizen has nothing left to lose.

As we learnt from the Arab Spring, this hapless citizen will immolate herself if that will ensure that her children and grandchildren will stand a better chance after the ensuing revolution. In many instances, the spark of a revolution is a solitary act of despair, a final acceptance of defeat involving the elimination of oneself from the equation.

Our politicians must not sit pretty and think the suffering masses are eternally powerless. They are immensely powerful, and only require a shove in the right direction before they start an avalanche that will only be stilled when there is no more space to occupy.

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

Monday, June 18, 2012

IDPs still suffering poor mental health

Sunday Nation 17 June 2012

Last year, we conducted a study on the mental health of internally displaced persons (IDPs) in parts of Uasin Gishu County. The findings from this study are compelling insofar as they demonstrate serious inadequacies in our disaster response and management of the mental health consequences of disasters.

A relatively well-coordinated response was mounted in 2008 to address the mental health and psychosocial needs of the displaced populations in Uasin Gishu County. Considering that there are regions in this country where the response was not as robust or organised as it was in Uasin Gishu, it is highly likely that, were we to repeat this study in the rest of the country, the results would be significantly worse.

Two findings stood out in our study.

Firstly, the IDPs had significantly higher prevalence rates of depression compared to a control group consisting of people who did not experience internal displacement. Indeed, one group of IDPs, those still living in camps, were found to be four times more likely to be suffering from depression than the control group. Integrated IDPs and those that have already returned to their farms had lower prevalence rates of depression, but their rates were still two to three times higher than the rate in the control group.

Secondly, IDPs were almost twice as likely to be suffering from post-traumatic stress disorder (PTSD) as the control group. PTSD is an anxiety disorder that arises among some of the people exposed to events they consider to be traumatic, and the symptoms may be so severe as to result in serious problems in daily life.
Instructively, over three-quarters of the IDPs who had returned to their homes were suffering from PTSD at the time of the study.

In this study, the commonest traumatic events associated with these disorders were the sudden death of a loved one, and witnessing the killing or serious injury of another person. During post-election violence, these events became so common that, at some point, someone described the televised killing of a protester as the stuff of Rambo movies.

The first lesson we learn from this study is that short-term interventions in disaster situations are often not very useful and may, in fact, be harmful. Early on in the intervention, we clarified that any organisation intending to deal with mental health and psychosocial support in the region had to have a long-term plan for both the immediate and delayed consequences of exposure to traumatic events.

However, due to dependence on limited donor funding, none of the programmes had a proper long-term plan for addressing chronic mental health and psychosocial issues for the IDPs. The government itself has continued to dither and prevaricate on the fate of IDPs and, as demonstrated by our study, this has had a very adverse impact on their mental well-being.

Secondly, we have learnt that it is important to integrate mental health and psychosocial support services into the overall disaster response mechanism, right from the apical coordination level. Absence of competent professionals at the planning levels results in substandard services and programmes being offered, resulting in more harm than good.

Finally, we now know that unless governments develop programmes to address the mental health needs of their populations, violence and instability will remain prominent features on our landscape.

Dr Atwoli is secretary, Kenya Psychiatric Association, and lecturer, Moi University School of Medicine.; twitter @LukoyeAtwoli

Sunday, June 10, 2012

Laying out the issues at play over NHIF scam

Sunday Nation 10 June 2012

The Parliamentary Committee on Health finally handed in its report on the National Hospital Insurance Fund (NHIF) scandal, recommending investigations into the role various people played in channelling contributors’ money to organisations that did not have capacity to deliver the required services. The Director of Public Prosecutions has also weighed in with instructions to the police and the Ethics and Anti-Corruption Commission to jointly investigate the scam.

Unfortunately, due to the magnitude of this scandal and the amounts of money involved, it was not completely unexpected that behind-the-scenes manoeuvres would be made to influence the course of the investigations. Allegations have been made about bribery attempts by individuals linked to any of the several players in the scam, targeting members of the parliamentary committee itself. Further, the parliamentary committee itself noted that one of the organisations involved sent an individual with an unclear identity to represent it as the chief executive, and the ownership of the institutions remains unclear.

For the sake of posterity, therefore, we need to lay out the issues at play, even if the eventual investigations are compromised and come up short.

Firstly, questions were raised about how the private providers were selected. Emerging information that they were the ones involved in the pilot scheme soon after they were registered only serves to solidify the suggestion that they had inside information and were formed solely for the purpose of fleecing NHIF contributors.

Secondly, the procedure of disbursement of money to these institutions raised serious questions. These institutions were paid on the basis of “capitation” which was touted as being in line with “international best practice”. Under this arrangement, the institutions were allocated a number of civil servants and paid in advance for each of them and their families.

A key issue arising from this arrangement is freedom of choice for the civil servants in the selection of facilities. Although the NHIF insisted that civil servants were given the opportunity to select facilities of their choice, many civil servants, including doctors who should know best, discovered that they had been allocated to facilities without being consulted. Those that doubt this assertion need only compare this situation with the registration of political parties, where many Kenyans are complaining that they have been registered as members without their consent.

The capacity of these private providers to administer the scheme was also questioned. Although they advertised their presence countrywide at the beginning of the scheme, many of the advertised facilities turned out to be non-existent, as has now been established by the parliamentary committee. Despite this fraudulent misrepresentation, the providers were given money to provide services at their non-existent facilities. Indeed, a scrutiny of the lists of civil servants allocated to one of the facilities found a number of “ghost” civil servants who had long ago left the service!

Finally, despite all the praise it has received, “capitation” is simply not provided for by the NHIF Act. Unless it was secretly amended, section 22 of the Act provides only for payment against services actually rendered. Under what legal regime was “capitation” even considered?

Dr Lukoye Atwoli is the secretary, Kenya Psychiatric Association, and a lecturer at Moi University’s school of medicine.; twitter @LukoyeAtwoli

Monday, June 4, 2012

We are not all responsible for 2008 mayhem

Sunday Nation 03 June 2012

In an attempt to sound reconciliatory and avoid inflaming passions one way or another, many commentators have taken to asking Kenyans not to point fingers at those they think are responsible for our ethnopolitical crises, including post-election violence after the 2007 General Election. Most have argued that all of us are to blame for these problems, having contributed to the current state of near-total state failure in one way or another.

This phenomenon is not new, however. The claims climaxed some time in 2008 as everyone who could be heard in the public space was busy emphasising peace and reconciliation, and discouraging those of us who thought we had an idea about what had happened to our country from speaking out. Telling us that if we search deep within ourselves we would find some reason to be guilty was their way of silencing us and buying space for whatever they were calling peace and reconciliation.

Let me be the first one to remove myself from this herd of murderers and arsonists, if no one else will speak out for me.

On the morning of December 27, 2007, my family and I used the Kisumu-Eldoret road via Nandi Hills on our way to Eldoret town where we were registered to vote. All along the way, it was already evident that all was not well. Burnt tyres, logs and rocks blockaded parts of the road in some areas, evidence that some demonstration or riot had already taken place even before Election Day.

People milled by the roadside at most urban centres we passed and, in some places, there was a bit of shouting and sloganeering that we assured ourselves was born of the usual electoral euphoria. On the outskirts of Eldoret town, we learnt from the news on the radio that some vehicle had been torched in town, suspected of carrying marked ballot papers.

As we voted, we were acutely aware of the tension, and the possibility of post-election violence. Subsequent events, as they say, are inscribed in the history books.

Two weeks before the 2007 General Election, I had penned an article denouncing acts of violence that had been labelled “political violence”. I rejected this tag, instead characterising looters and arsonists as common criminals using politics as a convenient cover. But for the context set in the campaign period, anyone reading that article today would be forgiven for thinking it was discussing the post-election violence.

I was, therefore, utterly shocked when almost everyone feigned surprise and claimed that the post-election violence was unforeseen and caught them by surprise, when all indications before the election had been that a peaceful outcome would be the exception, not the rule.

With this background, I challenge these “peacemakers” to point out what I did to be held responsible for the violence that erupted after the election, and the subsequent dysfunctional government that was rammed down our collective throat. As a matter of fact, my colleagues and I were intimately involved in designing a response to deal with the physical, psychological and social outcomes of the violence after it broke out.

This habit of rushing to implicate whole populations betrays a mindset that is comfortable with a herd mentality of crime and punishment, which is antithetical to the liberal democracy we are apparently forging in Kenya.

Dr Lukoye Atwoli is the secretary, Kenya Psychiatric Association and a lecturer at Moi University’s school of medicine.; twitter @LukoyeAtwoli