Tanzania, a country that produced Julius Nyerere, is a country tottering on the precipice of a pandemic catastrophe. The philosopher-president ruled for 23 years and put the nation on the international map as a frontline state that stood up to Apartheid South Africa and helped liberate modern Uganda by ridding it of Idi Amin.
With the abrupt death of its populist president John Magufuli on March 17, 2021, ostensibly from a COVID-19 related ailment, Tanzania finds itself at a crossroads, insofar as tackling the devasting disease is concerned. Magufuli who was the commander-in-chief of the armed forces, became the denier-in-chief of COVID-19. The disease has decimated scores of Tanzanians, including top government officials.
Magufuli was hailed as a tough anti-corruption crusader, as he entered state house in 2015. Ordinary Tanzanians initially saw him as their saviour in the fight against institutionalised state corruption. The international media also saw him as a man keen on tackling state corruption, “but Magufuli was all about optics,” said a Tanzanian journalist. “He wasn’t fighting state corruption pers se, what he was doing was to get rid of Jakaya Kikwete’s (immediate former president) networks in the government and replace with his own. So, it was just a matter of time before Tanzanians and the world realised Magufuli was just interested in musical chairs.”
Magufuli was re-elected on October 28, 2020 in one of the most controversial post-Nyerere’s Tanzania elections with a whopping 84 percent. His “true colours” revealed themselves after Benjamin Mkapa’s death in July 2020. After mourning the ex-president, Magufuli turned his attention to the business of crippling the opposition.
Magufuli was a protégé of Mkapa who served as president between 1995–2005. It was Mkapa, who in 2015, prevailed on the ruling Chama Cha Mapinduzi (CCM, ‘Party of the Revolution’) national executive council (NEC) to pick newcomer Magufuli as its flagbearer for what was to be a hotly contested general election in October 2015. Magufuli was then primed to run against Edward Lowassa, a CCM stalwart, who had bolted to Chama Cha Democrasia na Maendeleo (CHADEMA), after not clinching the CCM ticket, in which he was touted as one of the hot favourites.
The “true colours” was the ruthlessness with which Magufuli pursued the opposition in the lead-up to the presidential elections. That massive victory came in the backdrop of President Magufuli’s continuous campaigns since being inaugurated as the fifth president in 2015. “Magufuli never stopped campaigning,” said a Tanzanian journalist: “He rode on the wave of populism – dishing out money and favours to select supporters and well-choreographed individuals wherever he went.”
The 2020 Magufuli campaigns were a mirror-image of his mentor’s similar campaigns in 2000. Just like Mkapa’s mission was to presumably pulverize the nascent opposition, Magufuli’s mission 20 years later was similarly to ensure that the “irritating” opposition is no more and is, literary ran out of town. Mkapa in the October 2000 elections unleashed so much violence on the opposition that many of its supporters sought exile in neighbouring Kenya, after the elections.
Mkapa’s use of unmitigated force by Jeshi la Polisi (Tanzania has a police force, as opposed to a police service) and Field Force Unit (FFU), a paramilitary outfit much like Kenya’s dreaded General Service Unit (GSU) was unprecedented in Tanzanian politics. Just like Magufuli, it seems Mkapa’s “true colours” were revealed only after his mentor’s death the previous year on October 14, 1999. Mkapa was a protégé of the founding father Julius Kambarage Nyerere.
It was Nyerere who held Mkapa’s hand in 1995, after influencing his nomination by CCM, and single-handedly campaigned for him throughout the country. Tanzania held its first multiparty general elections in 1995, pitting CCM against a disparate opposition for the first time since its formation in 1977.
He dished out money and favours to select supporters.
Revisiting this unparalleled violence orchestrated on fellow Tanzanians, Mkapa, the former journalist-turned-diplomat-turned-president in his memoirs: My Life, My Purpose – A Tanzanian President Remembers published in January 2019, regretted the 2000 election ordeal. To some Tanzanian journalists and political analysts, Mkapa and Magufuli are today referred to as the chief advocates and perpetrators of state violence in post-independent Tanzania.
Both the presidential elections of 2000 and 2020 happened under a cloud of America’s own election problems: In 2000, it was the “Florida fiasco.” Florida was then governed by the Republican’s presidential candidate, George Bush’s brother, Jeb Bush. Bush was running against the Democratic Party’s Al Gore. Jeb was allegedly accused of rigging on behalf of his elder brother.
Like the Americans say, the electoral college vote was too close to call: the vote was not only going to determine who was going to be the winner of the states’s 25 votes, but the next president after Bill Clinton. A recount was called by the Democrats and for a brief moment, the democrats believed they had taken it, only for the Republicans to also ask for their own recount. Bush won with a razor thin win vote. The democrats were not persuaded. To cut a long story short, the sunshine state’s case found itself in the supreme court, where the republican-led court declared George Bush the eventual winner.
In 2020, with both the Tanzania and US elections being held days apart, America once again came under the world spotlight after the “Pennsylvania problem”, in which President Donald Trump claimed his votes had been tampered with and paid for a recount. The MAGA Republican Party candidate was defending his seat against “sleepy Joe” a derogatory tag given by Trump to Joe Biden.
The citing of both examples here is to emphasise that America in 2000 and 2020 could not claim a moral compass to the Tanzania government’s excesses in its elections. Covering the 2000 elections, I remember in Dar es Salaam, a CCM top official telling us journalists that America could not lecture Tanzania on matters election – “they should first deal with their own election rigging in Florida, before accusing us of unleashing violence and rigging the islands’ results.”
Nyerere had always been opposed to the twin islands of Pemba and Zanzibar’s divorce with the mainland Tanganyika – a sticking sore thump between the mainland and the islands, since the republic turned to plural politics. But he never advocated state violence, instead, he sued for dialogue and persuasion.
Magufuli was determined to put the opposition in its place this time round: In a parliament of 261 members, the opposition only won seven. “By the time I’m through with Tanzania, there’ll be no opposition in the country,” said the deceased in one of his campaign rallies.
There is not a doubt that he loathed the opposition, so much so that he warned the regional commissioners and election officials, “I don’t pay you so that you can allow opposition to win.” Tume la Uchaguzi (National Election Commission) flatly refused any presidential debates and told the opposition it could debate among itself if it so wished.
“In Tanzania, CCM ni tasisi,” a local journalist reiterated to me. Literary it means the ruling party CCM is an institution. Figuratively it means, CCM is Tanzania and Tanzania is CCM. Anybody going against the “wishes of the party” would be crushed. The CCM’s propaganda machinery against the leading opposition figure Tundu Lissu of CHADEMA was geared to pulverize all his efforts of running a successful campaign. “He was being hunted down like a wild animal,” said the journalist.
Magufuli claimed Lissu was a supporter of LGBTQ and that he was a tool of the West being used to campaign for mashoga, homosexuals’ rights. Several African presidents during their re-election campaigns have turned the hot-button issue of LGBTQ, their favourite bogeyman: In the terribly conservative African societies, nothing evokes emotions of antipathy like suggesting gay-ism could be mainstreamed. Yoweri Museveni has done it, John Magufuli did it, just like Robert Mugabe did it before him.
CCM being Tanzania and Tanzania being CCM, not even the bravest of private media would dare report on the opposition or against Magufuli and CCM. “There was total blackout on the opposition by the media. All what Tanzanians could read and listen to, on politics, was on the ‘indefatigable Magu’ and his infrastructural developments,” said my Tanzanian journalist friend. Hence, Tanzania media did not report on politics – it reported on Magufuli, the person.
By the time I’m through with Tanzania, there’ll be no opposition in the country
Being heavy users of social media, Tanzanians turned to VPN – virtual private network. Found as an app in many smart phones, it protects one’s communication from snoopers like government agencies and hackers. What VPN does when activated is to bypass the conventional internet service providers (ISP) when connecting to the internet. In the case of Tanzania’s government shutting down its ISP, tech savvy Tanzanians resorted to VPN to access facebook and especially Twitter, to fend off the states’s eavesdropping.
This is the reason why Magufuli ordered all social media outlets shut, said the journalist. All what the Tanzania Communication Authority needed was a nod from Magufuli. A consumer of foreign news outlets, Tanzanians also resorted to BBC, Deutsche Welle (Sauti ya Ujerumani) and VOA, to stay informed on their country’s politics. “This is how many of them were informed and kept tabs on Lissu’s campaigns,” said the journalist.
Even after being sworn-in for the second term, President Magufuli pursued the browbeaten opposition. Chief opposition figure Lissu had to escape the country a second time. “Run or be run over, these people are not joking,” Lissu was ostensibly warned by his intelligence team. In September 2017, Lissu had survived an assassination attempt in Dodoma, that saw his vehicle sprayed with bullets by “unknown” assailants, as he left parliament for his house for lunch. On November 7, 10 days after the elections were over, he hid at the German embassy, then onwards to Brussels, where he had been recuperating for three years after treatment in Nairobi.
The former MP for Arusha Urban Godbless Lema also skipped the country and sought refuge in Kenya after claiming government people were after him. Lema, with his family was granted asylum in Canada.
Nyerere’s CCM may have operated in the one-party era during the cold war, but many Tanzanians of the post-independent generation remember those days with nostalgia. “The party was more democratic and free, unlike today,” said a former CCM mkereketwa (party diehard).
Magufuli’s populism was laced with autocratic tendencies. He told fellow Tanzanians msinijaribu mimi ni jiwe (don’t try me, I’m as tough as a rock), meaning he prided himself in being tough-headed.
“Magufuli’s CCM in the era of multiparty brooks no dissent, is dictatorial and dangerous, while Nyerere’s CCM preferred a palaver type of democracy where party issues were discussed until it arrived at a consensus,” said a University of Dar es Salaam don.
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Capitalism Is Killing Us
Anyone who lives in fear of getting sick exists in a state of unfreedom.
What makes something tragic? This predominantly philosophical question has spawned a variety of answers stretching back two millennia and concerning broad topics such as the role of tragedy in art, politics, and ethics. But the word has a more straightforward, ordinary usage, and in the past year it has repeatedly been invoked to describe the overwhelming extent of death produced by COVID-19 and its effects. People are not only perishing due to the virus itself, but from the accumulation of distress that comes with the pandemic’s hardships, both economic and psychological. For lack of a better word, many think of the ongoing state of affairs as being, in some deep sense, tragic.
The past few weeks have seen a particularly devastating chapter. A day after the world learned that American rapper DMX was no more, South Africans learned that Johannesburg-based medical doctor Sindisiwe van Zyl had also passed. Trained as an HIV clinician and affectionately known as “Dr. Sindi” or “The People’s Doctor,” she rose to popularity for using her social media platform to answer people’s medical questions. Not only did she spread information via radio appearances and public writing, she also often extended her services to those in need of them free of charge.
Dr. Sindi was diagnosed with COVID-19 at the start of the year and was later hospitalized after developing chronic breathing problems. In the week leading up to her passing, her husband, Marinus van Zyl, launched a crowdfunding initiative to raise funds to cover her steep medical bill, which by that point was in excess of about R2 million (US$136,000). South Africans were more than willing to chip in, and a week later, half of the targeted amount was raised. The campaign was rendered futile shortly thereafter, when she died at age 45.
This turn of events makes Dr. Sindi’s story a classically tragic one. Tragedy is usually thought of as apolitical, involving a virtuous individual who comes up against unforeseen or unstoppable forces that cause them deep, usually irrevocable harm, despite their best intentions and efforts to avoid it. Her story resonates as all the more outrageous considering the fact that she was a medical doctor who not only fell deeply ill, but in the process was unable to fully afford the medical care required to get better. She was presumably financially secure and a sign of black “excellence.”
However, one tricky fact about Dr. Sindi’s case is that she was treated in a private hospital. In South Africa, most social services are bifurcated: alongside free, state-run clinics and hospitals available to all free of charge, there are for-profit hospitals and clinics that charge payment for care, upfront or through medical aid schemes. At the time of the crowdfunding campaign’s launch, earnest questions circulated on social media about what would have happened had a person of less clout been in her predicament, and about what happens to the majority who aren’t able to access private health care in the first place.
There is a common underlying assumption to these questions, which reveals what South Africans think about health care: that private health care is better. It is thought that, even when a person cannot afford treatment in a private hospital, in an ideal world the opportunity to do so would be available to them—in other words, that universal access to private health care is a position to strive toward. An obvious reason for why South Africans think this way is made apparent by looking at the state of public hospitals.
Most are mismanaged, their resources misappropriated for corrupt ends, with stories regularly surfacing about horrific malpractice. One ghastly story in recent history was when 143 people died from starvation and neglect in state-run psychiatric facilities. This scandal was only called “Life Esidimeni” because that was the name of the original private hospital from which the patients were transferred back to the state’s care. The consensus was that this should not have happened.
There is a common underlying assumption to these questions, which reveals what South Africans think about health care: that private health care is better
Yet, one could ask, why are things privatized? This seems like an absurd question, especially considering that the extent of privatization in South Africa makes it feel like an inevitable feature of social life. If you operate from a certain class position in South Africa, it’s likely that every amenity you use is privatized, including supposedly “public” spaces like parks and outdoor recreational facilities (“right of admission reserved”).
If you belong to another class position, you are often excluded from access (perhaps not explicitly), unless it is to enter for work. This system of differentiated access rightly evokes images of apartheid South Africa, where race determined where one could move and what one could access. And, much like apartheid, it comes with its own naturalization, making it seem like a fact of how things are rather than the consequence of deliberate political and economic design.
But contrary to some trendy but puzzling revisionism taking hold, apartheid itself was driven by the need to facilitate accumulation for white capital by super-exploiting the black masses. The defining feature of capitalism is that it expropriates and dispossesses, which means that the things we all depend on to survive and flourish—whether it’s land or raw materials—became controlled by a select few. Thus, the fundamental basis of capitalism is privatization, the appropriation of common resources for their transformation into commodities to be sold back to us. And, in order to access these commodities, we face the imperative to earn a living by working for those who control their production.
The important thing to recognise about capitalism is that it organises the entirety of life around the market—whether it is where we buy life’s necessities or avail ourselves for jobs that will give us incomes to afford those necessities. The coercion of the market is hardly registered over the course of life, firstly because it is impersonal (no one stands over you and physically forces you to work), and secondly because we are told we have the free choice of choosing to work or not, as well as of what work we’d like to do (just work hard to make it happen!).
But rather than being a free and just condition, life under capitalism is a precarious and oppressive one. Without the assurance that one will retain their job forever, with the fear that the security one has achieved for themselves might yet disappear, people feel compelled to work harder for better—to one day be promoted to manager, to one day own their own business entirely. Why? Paradoxically, to become less dependent on the market! The problem with capitalism is that this freedom is still promised through the market.
The important thing to recognise about capitalism is that it organises the entirety of life around the market—whether it is where we buy life’s necessities or avail ourselves for jobs that will give us incomes to afford those necessities
This is the tragedy of Dr. Sindi’s story—what happens when the market fails you? Returning to the point that there was nothing obliging her to use private health care—in a very strict sense, this is true. But what would have been the alternative? By this point, it should be clear that it is not just the unique incompetence of governments which constrains their successful provision of public goods, but also that they have to compete with an outsized private sector that monopolizes most of the available resources.
The premise of postwar social democracy in the West, when the state was at its most interventionist, was not simply to dole out welfare to the needy, but to restrict the power of the market through collective provision of our most social needs—health care, transportation, schooling, and housing. Underwriting such an arrangement is the norm that our lives are lived interdependently, not as isolated, self-interested atoms.
The crowdfunding campaign kick-started to assist Dr. Sindi and her family with medical expenses testifies to our intuitive capacity for solidarity. But that so many assisted is the right response to a fundamentally wrong state of affairs. That is, it was an instance of trying to solve a public, systemic problem (the lack of free, quality health care) through a private interaction (donating money), obscuring that it is not simply Dr. Sindi’s individual circumstances that were unfortunate, but the society which made her circumstances possible. Like most forms of charity, it represented what Oscar Wilde called a remedy that’s “part of the disease.”
Tragedy is borne from the human need to live life well, and to do right by those we care about—whether it’s our relatives, friends, or colleagues. Capitalism makes tragedy an ever-present threat looming over life. It pits not only ourselves but various aspects of our lives and beliefs against each other because it subjects humans and our needs and values to the overpowering competitive logic of the market. The problem is that the consumerist ideology of capitalism, which sells the good life as an endless pursuit of commodities—a bigger house, a better car, better clothes—results in a tragic state of being, for at no point is capitalism capable of answering the question what is it all for. As the debut album for the 80s English pop band It’s Immaterial goes, “Life’s hard and then you die.”
The crowdfunding campaign kick-started to assist Dr. Sindi and her family with medical expenses testifies to our intuitive capacity for solidarity. But that so many assisted is the right response to a fundamentally wrong state of affairs
Of course, if one were to suddenly become conscious of all this, that doesn’t guarantee that they’d desire an alternative. Capitalism isn’t just an economic system but a form of life, and one that’s made humans more individualistic and less discerning of the common good. Even for the group most exploited by capitalism—the working class—resistance isn’t a given, as this requires a coordinated effort that involves personal risk and hardship. But today’s economic crisis, though it affects the working class most acutely, has started to squeeze the middle class too, as capitalism is now unable to deliver the social mobility and high rates of consumption that it once promised. Many are in a similar position to Dr. Sindi’s: overindebted, underinsured, and a missing paycheck away from personal catastrophe.
As the South African left reconstitutes itself in the wake of COVID-19, universal health care must be one of its leading demands. The proposed National Health Insurance Bill, which will transition South Africa’s health care system to a single-payer model, is a step in the right direction. But to challenge the for-profit health system and hold the state accountable will require a big fight, and the weakness of trade unions, plus the general disarray of working-class forces, means it is a fight it can’t wage alone.
A reorganised left must present universal health care not just as a tool to assist those with inadequate health coverage, but also as a basic condition for realizing our freedom. This must become the new common sense. If what makes humans free is that we have the distinct capacity to set and pursue our own ends, then what permanently threatens that capacity are the limitations of our bodies—their abilities are finite, they are bound to get sick, and eventually, they die. A free society should guarantee their care, for without it, freedom is impossible. Anyone who lives in constant worry of what would happen to them if they got sick, of whether they will be able to afford care or time off work, lives in a state of unfreedom. Any model of society that makes this worry inevitable is itself diseased.
Kenya Chooses Its Next Chief Justice
The search for Kenya’s next Chief Justice that commenced Monday will seek to replace Justice David Maraga, who retired early this year, has captured the attention of the nation.
Since Monday, the 12th of April 2021, interviews to replace retired Chief Justice David Maraga for the post of the most important jurist in Kenya and the president of the Supreme Court have been underway.
The Judiciary is one of the three State organs established under Chapter 10, Article 159 of the Constitution of Kenya. It establishes the Judiciary as an independent custodian of justice in Kenya. Its primary role is to exercise judicial authority given to it, by the people of Kenya.
The institution is mandated to deliver justice in line with the Constitution and other laws. It is expected to resolve disputes in a just manner with a view to protecting the rights and liberties of all, thereby facilitating the attainment of the ideal rule of law.
The man or woman who will take up this mantle will lead the Judiciary at a time when its independence and leadership will be paramount for the nation. He or she will be selected by the Judicial Service Commission in a competitive process.
KWAMCHETSI MAKOKHA profiles the ten candidates shortlisted by the JSC.
IMF and SAPs 2.0: The Four Horsemen of the Apocalypse are Riding into Town
Stabilisation, liberalisation, deregulation, and privatisation: what do these four pillars of structural adjustment augur for Kenya’s beleaguered public health sector?
The International Monetary Fund’s announcement on the 2nd of April 2020 that it had approved a US$ 2.3 billion loan for Kenya prompted David Ndii to spell it out to young #KOT (Kenyans on Twitter) that “the loan Kenya has taken is called a structural adjustment loan (SAPs). It comes with austerity (tax raises, spending cuts, downsizing) to keep Kenya creditworthy so that we can continue borrowing and servicing debt”, adding that the “IMF is not here for fun. Ask older people.” With this last quip, Ndii was referring to the economic hardship visited on Kenyans under the structural adjustment programmes of the 80s and 90s.
Well, I’m old enough to remember; except that I was not in the country. I had left home, left the country, leaving behind parents who were still working, still putting my siblings through school. Parents with permanent and pensionable jobs, who were still paying the mortgage on their modest “maisonette” in a middle class Nairobi neighbourhood.
In those pre-Internet, pre-WhatsApp days, much use was made of the post office and I have kept the piles of aerogramme letters that used to bring me news of home. In those letters my parents said nothing of the deteriorating economic situation, unwilling to burden me with worries about which I could do nothing, keeping body and soul together being just about all I could manage in that foreign land where I had gone to further my education.
My brother Tony’s letters should have warned me that all was not well back home but he wrote so hilariously about the status conferred on those men who could afford second-hand underwear from America, complete with stars and stripes, that the sub-text went right over my head. I came back home for the first time after five years — having left college and found a first job — to find parents that had visibly aged beyond their years and a home that was palpably less well-off financially than when I had left. I’m a Kicomi girl and something in me rebelled against second-hand clothes, second-hand things. It seemed that in my absence Kenya had regressed to the time before independence, the years of hope and optimism wiped away by the neoliberal designs of the Bretton Woods twins. I remember wanting to flee; I wanted to go back to not knowing, to finding my family exactly as I had left it — seemingly thriving, happy, hopeful.
Now, after eight years of irresponsible government borrowing, it appears that I am to experience the effects of a Structural Adjustment Programme first-hand, and I wonder how things could possibly be worse than they already are.
When speaking to Nancy* a couple of weeks back about the COVID-19 situation at the Nyahururu County Referral Hospital in Laikipia County, she brought up the issue of pregnant women having to share beds in the maternity ward yet — quite apart from the fact that this arrangement is unacceptable whichever way you look at it — patients admitted to the ward are not routinely tested for COVID-19.
Nancy told me that candidates for emergency caesarean sections or surgery for ectopic and intra-abdominal pregnancies must wait their turn at the door to the operating theatre. Construction of a new maternity wing, complete with its own operating theatre, has ground to a halt because, rumour has it, the contractor has not been paid. The 120-bed facility should have been completed in mid-2020 to ease congestion at the Nyahururu hospital whose catchment area for referrals includes large swathes of both Nyandarua and Laikipia counties because of its geographical location.
According to Nancy, vital medicine used to prevent excessive bleeding in newly delivered mothers has not been available at her hospital since January; patients have to buy the medication themselves. This issue was also raised on Twitter by Dr Mercy Korir who, referring to the Nanyuki Teaching and Referral Hospital — the only other major hospital in Laikipia County — said that lack of emergency medication in the maternity ward was putting the lives of mothers at risk. Judging by the responses to that tweet, this dire situation is not peculiar to the Nanyuki hospital; how much worse is it going to get under the imminent SAP?
Kenya was among the first countries to sign on for a SAP in 1980 when commodity prices went through the floor and the 1973 oil crisis hit, bringing to a painful halt a post-independence decade of sustained growth and prosperity. The country was to remain under one form of structural adjustment or another from then on until 1996.
Damaris Parsitau, who has written about the impact of Structural Adjustment Programmes on women’s health in Kenya, already reported in her 2008 study that, “at Nakuru District Hospital in Kenya, for example, expectant mothers are required to buy gloves, surgical blades, disinfectants and syringes in preparation for childbirth”. It would appear that not much has changed since then.
The constitution of the World Health Organisation states that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition” and that “governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures.”
The WHO should have added gender as a discrimination criteria. Parsitau notes that “compared to men, women in Kenya have less access to medical care, are more likely to be malnourished, poor, and illiterate, and even work longer and harder. The situation exacerbates women’s reproductive role, which increases their vulnerability to morbidity and mortality.”
With economic decline in the 80s, and the implementation of structural adjustment measures that resulted in cutbacks in funding and the introduction of cost sharing in a sector where from independence the government had borne the cost of providing free healthcare, the effects were inevitably felt most by the poor, the majority of who — in Kenya as in the rest of the world — are women.
A more recent review of studies carried out on the effect of SAPs on child and maternal health published in 2017 finds that “in their current form, structural adjustment programmes are incongruous with achieving SDGs [Sustainable Development Goals] 3.1 and 3.2, which stipulate reductions in neonatal, under-5, and maternal mortality rates. It is telling that even the IMF’s Independent Evaluation Office, in assessing the performance of structural adjustment loans, noted that ‘outcomes such as maternal and infant mortality rates have generally not improved.’”
The review also says that “adjustment programmes commonly promote decentralisation of health systems [which] may produce a more fractious and unequal implementation of services — including those for child and maternal health — nationally. Furthermore, lack of co-ordination in decentralised systems can hinder efforts to combat major disease outbreaks”. Well, we are in the throes of a devastating global pandemic which has brought this observation into sharp relief. According to the Ministry of Health, as of the 6th of April, 325,592 people had been vaccinated against COVID-19. Of those, 33 per cent were in Nairobi County, which accounts for just 9.2 per cent of the country’s total population of 47,564,296 people.
The Constitution of Kenya 2010 provides the legal framework for a rights-based approach to health and is the basis for the rollout of Universal Health Coverage (UHC) that was announced by President Uhuru Kenyatta on 12 December 2018 — with the customary fanfare — as part of the “Big Four Agenda” to be fulfilled before his departure in 2022.
However, a KEMRI-Wellcome Trust policy brief states that UHC is still some distance to achieving 100 per cent population coverage and recommends that “the Kenyan government should increase public financing of the health sector. Specifically, the level of public funding for healthcare in Kenya should double, if the threshold (5% of GDP) … is to be reached” and that “Kenya should reorient its health financing strategy away from a focus on contributory, voluntary health insurance, and instead recognize that increased tax funding is critical.”
These recommendations, it would seem to me, run counter to the conditionalities habitually imposed by the IMF and it is therefore not clear how the government will deliver UHC nation-wide by next year if this latest SAP is accompanied by budgetary cutbacks in the healthcare sector.
With the coronavirus graft scandal and the disappearance of medical supplies donated by Jack Ma still fresh on their minds, Kenyans are not inclined to believe that the IMF billions will indeed go to “support[ing] the next phase of the authorities’ COVID-19 response and their plan to reduce debt vulnerabilities while safeguarding resources to protect vulnerable groups”, as the IMF has claimed.
#KOT have — with outrage, with humour, vociferously — rejected this latest loan, tweeting the IMF in their hundreds and inundating the organisation’s Facebook page with demands that the IMF rescind its decision. An online petition had garnered more than 200,000 signatures within days of the IMF’s announcement. Whether the IMF will review its decision is moot. The prevailing economic climate is such that we are damned if we do take the loan, and damned if we don’t.
Structural adjustment supposedly “encourages countries to become economically self-sufficient by creating an environment that is friendly to innovation, investment and growth”, but the recidivist nature of the programmes suggests that either the Kenyan government is a recalcitrant pupil or SAPs simply don’t work. I would say it is both.
But the Kenyan government has not just been a recalcitrant pupil; it has also been a consistently profligate one. While SAPs do indeed provide for “safeguarding resources to protect vulnerable groups”, political choices are made that sacrifice the welfare of the ordinary Kenyan at the altar of grandiose infrastructure projects, based on the fiction peddled by international financial institutions that infrastructure-led growth can generate enough income to service debt. And when resources are not being wasted on “legacy” projects, they are embezzled on a scale that literally boggles the mind. We can no longer speak of runaway corruption; a new lexicon is required to describe this phenomenon which pervades every facet of our lives and which has rendered the years of sacrifice our parents endured meaningless and put us in debt bondage for many more generations to come. David Ndii long warned us that this moment was coming. It is here.
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