Monday, March 17, 2014

‘Ballooning wage bill’ the latest national fad

By Lukoye Atwoli
Sunday Nation 16 March 2014

As is the fashion in this country, the attention of all and sundry is now riveted on the latest fad, the ‘ballooning wage bill’. We have now forgotten about the issues surrounding the standard gauge railway, which was given the green light to proceed despite serious misgivings about its cost and viability. We are no longer talking about the starving people in the north. We have moved beyond our outrage after the Auditor-General reported that over Sh300 billion in government expenditure could not be accounted for.

As we now embark on long-winded discussions on the ‘ballooning wage bill’, we are still planning to spend billions of shillings to pay what the government calls ‘ghost workers’. We are going to spend billions to pay the parallel county governments under control of the national government, also known as the ‘provincial administration’ despite the envisaged scrapping of this system by the Constitution.

In each county, several people are doing the job of one person. For instance, in the health sector, each county has a member of the executive committee in charge of health, effectively the county minister for health. Under each of these individuals, there are chief officers in charge of health, effectively the county principal secretaries for health. They control a multitude of staff under them responsible for county health functions. 


Interestingly, the national government has also deployed county directors of medical services and directors of public health to each county, under whom there are district (sub-county) medical officers of health. In many instances, these officers have a parallel bureaucracy under them, effectively duplicating the roles and functions of the county-appointed officers. This confusing structure is duplicated across all the purportedly devolved functions.

So our national government has assembled all the experts in economic affairs, and correctly diagnosed the problem behind our slow economic growth and difficulties meeting our recurrent obligations. The problem, of course, is the ‘ballooning wage bill’! Different percentages are cited, all in an attempt to demonstrate that we are paying our workers way more than they deserve, leading to inadequate funding of development projects and over-reliance on aid from the bitterly-hated West.

And our government, after correctly diagnosing the problem, has come up with the very best solution possible under the circumstances. We must reign in the ‘ballooning wage bill’ if we are to survive imminent economic collapse.

This is because we are unable to shepherd the economy to grow in ‘double digits’ as naively promised during the campaigns, while paying our lowly workers as much as we are currently doing. It has proved difficult to rein in the corruption that costs our economy hundreds of billions of shillings annually, because we are paying our workers way too much.

We cannot deliver on the health, security, infrastructure and education promises to our population, and at the same time pay the health workers the salaries they demand. In fact, according to the brilliant economists advising our government, we may need to retrench some of those workers in order to improve efficiency in service delivery.

According to the government, making the private sector the preferred employer for our top brains is the top priority. The first step, of course, is to institute a pay cut across the board and tame the ‘ballooning wage bill’.

Brilliant, revolutionary stuff, if you ask me! 

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

Tuesday, March 11, 2014

Voters sold their right to health for Sh20

By Lukoye Atwoli
Sunday Nation 09 March 2014

Kenya’s health sector is in a shambles. Hundreds of health workers have now worked for over two months without pay because the national and county governments cannot agree on who is responsible for them. Shortages of medicines and important supplies are rife, even as governors try to outdo each other in ‘flagging off’ lorryloads of medications in their counties. As a result, ordinary Kenyans are suffering.

A few weeks ago, a middle-aged man from my village suddenly collapsed and had to be rushed to hospital. The local hospital could not manage his condition because he needed intensive care facilities that were not available. The nearest referral facility was over a hundred kilometers away in another county, but the family organised quickly to transport him there.

When they got to the hospital, all the intensive care unit (ICU) beds were occupied, and they were informed that the next available ICU beds were at a nearby private hospital. The relatives agreed to have him admitted at the private hospital where after more than a week in the unit, and despite the best efforts of the team managing him, the patient died.

This is when the problems began for the family. Intensive care is very expensive business, and the family was asked to raise over a million shillings to clear the hospital bill. This poor family could only raise a fraction of the cost and had to beg the hospital to release the body for burial. This took a while to happen, and in the meantime the family looked around for someone to take responsibility for their conundrum. Of course doctors and other health workers bore the brunt of their criticism. 


This is not a scenario unique to my village, or indeed to any one part of our country. This is a story every ordinary family of Kenyans has had to live through at some point. Unfortunately, when it happens, we turn against the very same health workers who have struggled in very difficult circumstances to save lives, and accuse them of all manner of ills.

In my discussion with the bereaved family, it struck me that they all could not make the important connection between their own choices and the fate that befell them. I asked them if they had informed any of their elected representatives about their problem. They informed me that the politicians had done their duty before elections, and owed the electorate nothing. Their twenty and fifty-shilling handouts had bought these villagers’ votes, and there was no use approaching them to solve such ‘small’ problems as the health of their constituents, among others.

Flabbergasted, I attempted to demonstrate that if they had voted based on policies and not because of clan, family and handout considerations, perhaps their local hospital would have been better equipped to save their relative’s life. Perhaps the county referral facility would have had well-equipped ICU facilities, with adequate beds to help all those in need.

Perhaps they would have had functioning ambulance services that would have arrived a few minutes after the patient collapsed, and carried out onsite procedures that would have prevented further damage and improved his prognosis. If they had used their vote better, perhaps their relative would not have collapsed in the first place.

I do not know if I managed to convince them, but I hope I did. 

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

Monday, March 3, 2014

Anti-gay law: Lots of smoke and no light

By Lukoye Atwoli
Sunday Nation 02 March 2014

The Ugandan parliament recently passed legislation outlawing “homosexuality” in the country. The law provides for life imprisonment for anyone committing or promoting the “offence of homosexuality”, among many other penalties and prohibitions.

It has been argued that the fact that the Ugandan parliament passed this law and the president assented to it is sad, but does not merit more than just passing comment from anyone who is not Ugandan or directly affected by it. (READ: Kerry calls Museveni over anti-gay law) This is fair enough on the face of it although, in such a digitally connected world, it is difficult to isolate a country and argue for internal self-determination on laws such as this that criminalise behaviour that responsible scientists in the field do not consider abnormal or even harmful.

More pertinent, though, is the fact that the Ugandan action is part of a wave of intolerance being propagated across the continent by forces intent on forcing their own particular brand of morality on African countries. Nigeria recently passed similar legislation, and efforts are gathering pace in Kenya to introduce similar legislation in our parliament. This is the reason I think it is important to make the following points so that when the legislative debate gets here, nobody will argue that we did not raise any opposition to it.

I have encountered, on social media and elsewhere, arguments that opponents of homosexuality are disgusted by the behaviour, or that it is somehow un-African and un-Christian. Many of those supporting such legislation use these arguments to back their viewpoints. We have, before this legislation was even contemplated, discussed all these points with vigour and often agreed to disagree.

However, in order to fully appreciate this matter, it is useful to understand what “homosexual” means. First, it is a form of sexual orientation referring to someone who is sexually attracted to persons of the same sex. Second, it is a form of social identity, whereby an individual identifies with people of homosexual orientation, and perhaps also refers to themselves as being homosexual. Third, it is a form of sexual behaviour involving intercourse or other sexual activity between individuals of the same sex. (READ: Uganda newspaper names 200 'homos' after anti-gay law signed) 


It is important to appreciate that a person may meet one, two or all three definitions of homosexual. For instance, one may have homosexual orientation but never identify themselves as homosexual or engage in homosexual behaviour. Similarly, one may engage in homosexual behaviour without identifying themselves as being homosexual or even while having primary sexual interest in members of the opposite sex.

It is instructive that these “anti-gay” laws are often informed by the third definition only, and criminalise the behaviour on the assumption that this will end the orientation and social identities. Unfortunately mountains of research on this topic suggest that such moves are futile, and homosexuality cannot be “cured” by such moves.

It is also true that the arguments about homosexuality being “disgusting, un-African or un-Christian” are also informed by visualisations of homosexual behaviour, often between males. While I can understand some people’s disgust with this kind of behaviour, it is difficult for me to link this disgust with the law-making process.

We simply do not go out and legislate against behaviours solely because they disgust us. How then is homosexuality different? Surely even the “crime” of homosexuality needs a victim? 

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