Wage bill debate sets stage for law review

By Dr Lukoye Atwoli
Sunday Nation 23 March 2014

Finally, and as predicted, the motive behind the recent wage bill ‘conversation’ is becoming clear. Already there are moves in Parliament to reduce the number of elected representatives ostensibly because someone has determined that they are a major contributor to the allegedly ‘ballooning wage bill’.

Apparently we must get rid of women members of the National Assembly, nominated Members of Parliament, members of the county assembly and even reduce the number of counties in order to reduce recurrent expenditure.

An interesting observation about this whole charade is that it is obviously being led by people who have always been opposed to the new Constitution. They have now repackaged themselves into protectors of our national expenditure, and are proposing moves meant to improve our economic position. Their real goal, as is now becoming evident, is to subvert the currently established constitutional order and revert to the authoritarian model in which all authority vested in the president, who was considered for all intents and purposes to be above the law.

This whole venture is extremely dishonest. Over the last three years or so, health workers have engaged the government in dialogue aimed at rationalising the national health workforce in order to improve service delivery to Kenyans. To this end, they have repeatedly suggested the need to have a health service commission that would register, recruit and deploy all health workers in the country, based on needs identified by the counties. (READ: Team set up to cut costs starts work)

The stock response from the government has been that such a move would require a constitutional amendment allegedly because the Constitution has vested all public human resources in defined constitutional commissions, and the health service commission is not one of them. Further, the Cabinet Secretary for Health is on record claiming, fallaciously one must add, that all health services have been devolved under the Constitution. 

BREAKNECK SPEED

The point of this example is that the political establishment has determined that it is next to impossible to enact legislation addressing key human resource concerns in the health sector, but is now attempting to legislate far-reaching changes in the constitutionally provided structure of government.

Predictably, these bills will move at breakneck speed through the Houses of Parliament as long as they enjoy the support of the ‘owners of government’. (EDITORIAL: Government wastage has become appalling) Politicians have indicated that even if it takes a referendum to enact the changes they are interested in, then that is the route they will take.

All this action is being taken, of course, in the interest of reducing the wage bill. One wonders if anyone else can see the ludicrous chain of reasoning behind such moves.

As has been argued before, more immediate measures can be taken to control expenditure, including cutting fraud, waste and abuse in government offices. Streamlining procurement procedures and consistently punishing corrupt officials will definitely yield dividends that will see the economy grow sustainably. More importantly, though, taking measures to increase our national income and productivity will be the key drivers of economic growth. Cutting public workers’ pay will not.

It would therefore serve our legislators well to focus on keeping the Executive on its toes, instead of wasting time singing the Executive’s chorus whenever they are called upon to do so. All this bickering is only serving to reduce investor confidence in the state, and no amount of wage bill cuts will bring this back. 

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

Marriage Bill harms rights of the mentally ill

By Lukoye Atwoli
Sunday Nation 30 March 2014

Two things caught my eye this past week, and both are worthy of comment. First, our National Assembly passed a Marriage Bill that has elicited all manner of comment, ranging from polygamy to gay marriage. Unfortunately, combing through the Bill, one comes across several instances of senselessly discriminatory clauses, chiefly against people with mental illnesses.

For instance, the effect of Clause 12(a)(ii) of the Bill is to prohibit people with chronic mental illnesses characterised by recurrent episodes from getting married. Similarly, Clauses 66(6)(g) and 73(1)(g) make such mental illnesses legitimate reasons for voiding or annulling a marriage.

The net effect of the Marriage Bill as debated and passed in Parliament is to ensure that a diagnosis of a chronic mental illness would mean that the individual cannot legally get married. It also means that even if one is already married, if they are found to have had a chronic mental illness with a chronic recurrent course, their spouses could legally petition for the marriage to be annulled.

The problem with this bill, as with all legislation that purports to use mental illness as a reason to restrict people’s rights, is that the originators clearly do not have an understanding of what constitutes mental illness. 

CONDEMNED TO A LOVELESS LIFE

Current research evidence suggests that between 10 and 25 per cent of our population suffers from a serious mental illness. The import of the Marriage Bill is that this large segment of our population would be condemned to a loveless life in which any attempt at a long-term relationship would be null and void.

Before he assents to it, the president must subject this bill to thorough scrutiny by mental health professionals in order to cure it of these discriminatory and unconstitutional provisions. However, if he agrees with the intent of the bill, which is to prevent the mentally ill from contracting legal marriages, he must demand a clause that requires that everyone of marriageable age undergo periodic psychiatric evaluations that shall determine whether they can get married, or if already married, whether the marriage may continue to be recognised under the law.

This, of course, means that he will have to budget for the training and recruitment of a huge number of mental health specialists in the coming years to help implement these provisions. Perhaps this is not such a bad thing after all!

The second issue that caught my attention were media reports alleging that Catholic Cardinal John Njue had raised misgivings about a tetanus vaccine aimed at preventing maternal and child illness and deaths related to childbirth. He allegedly termed the mass immunisation campaign “fishy”, and urged his followers to further interrogate this vaccine.

The cardinal, when he speaks, is assumed to be speaking for the Catholic Church. Devout followers of the Church are expected to hang onto his every word, and look up to him for spiritual guidance. When he suggests that a vaccine may be dangerous, at least some of his followers will take him seriously and start refusing it. The result will be potential illness and deaths that would have been prevented by the vaccination.

Before making such potentially harmful statements, religious leaders would be well advised to seek competent guidance from experts in the field, many of whom may be found among the faithful of the church. 

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

‘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. 

PARALLEL 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. lukoye@gmail.com

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. 

TURN AGAINST HEALTH WORKERS

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. lukoye@gmail.com

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) 

SAME SEX

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. lukoye@gmail.com