Kenya’s mixed election history
Sometimes it is said, with some validity, that the only peaceful, non-violent, free, fair, credible, verifiable, and acceptable elections took place during the “sunset” years of British colonialism in Kenya (1957-1963).
During these six years we elected our African representatives to the now multi-racial Legislative Council (LEGCO). It is during this period that decolonization talks took place in Kenya and later at Lancaster House, London.
In 1961 Jomo Kenyatta was released from his detention at Maralal in the Samburu County. He soon joined his fellow Africans in the LEGCO, participated in the independence talks at Lancaster, London, as the leader of Kenya African National Union (KANU).
His party KANU won the 1963 Elections, forming the internal self- government (Madaraka) from 01 June 1963. He became our first Prime minister on 12 December 1963 and the first President of our Republic on 12 December 1964.
Although it was widely accepted that the colonial government and the British settlers would have loved a government of Kenya African Democratic Union (KADU) and the liberal British settlers, KANU was the more popular party.
Rigging an election against KANU was out of the question. Gone were the days the colonial government would select their colonial chiefs from the outcomes of rigged queue voting (if for some reason they thought this voting was necessary).
The post-colonial times are peppered with stories of the rigging of elections, particularly during the few years the Kenya People’s Union (KPU) existed before it was banned and its leaders detained in 1969.
The by-election in Kandara (1966) in which independence hero Bildad Kaggia ran on a KPU ticket was rigged by making sure that ballot boxes were thrown out into coffee farms as government land rovers ferried cast votes to the district headquarters for the Loyal and law-abiding peasants in Kandara who showed up with the ballot boxes they found in their coffee farms were routinely arrested and detained!
Later in local government elections that took place, all the KPU candidates were disqualified because it was said they were unable to fill their nomination forms correctly! What saved the country from widespread violence was the strength of the provincial administration and the machinery of violence that the KANU government was able to mobilize.
The chilling call “Fanyeni fujo muone/Cause trouble at your own risk was often repeated, driving the point home that Jomo Kenyatta’s KANU would not be defied. That is not to say there was no resistance against the subversion of the right to vote.
When Kenya became a de facto one-party state in 1969, the KANU party and its government used many tricks to disqualify its members from running for elections. Members were either expelled from the party under dubious party disciplinary proceedings, or simply denied nominations to run for elections.
In cases where elections took place and so-called KANU “dissidents” were elected, a Judiciary, enslaved by KANU party and its government was able to nullify such victories. Others who were found guilty of election offences were barred from running for office for five years.
It was in 1988 when KANU dropped all pretense of holding free, fair, and credible elections. The Mlolongo/Queue Voting (where candidates would be elected based on the length of the queues of supporters lining up for them) took place and rigging took place in broad daylight.
In Othaya Constituency where former President Kibaki was a candidate, KANU party and its government tried to rig him out of his victory displayed by a long queue, far longer than his opponent’s.
It was during this election that Kibaki famously told the Presiding Officer that he could not rig that election because “it takes intelligence to rig elections.” Clearly, if the Presiding Officer had tried to declare Kibaki’s opponent the victor he may not have left Othaya alive!
The post second liberation elections of 1992 and 1997 elections were won by KANU because of the violence in the Rift Valley, a divided opposition, a subdued Electoral Commission of Kenya and its twin institution, the Judiciary.
Although in 1997 the KANU party and government allowed for opposition representation in the Electoral Commission, the changes didn’t curb electoral fraud.
The 2002 Presidential election was won by NARC (National Rainbow Coalition) because the barons (mabaroni/mababe vita) of the five communities that control over 70% of the vote (Kalenjin, Kikuyu, Luhya, Kamba, and Luo) voted for President Kibaki. It is safe to assume both Kibaki and Uhuru being Kikuyus shared the Kikuyu vote.
The violence that took place after the 2007 Presidential election is well documented. The loss of property and lives are well documented. The raping of women is well documented. One only needs to read both the Kriegler and Waki Commission Reports for the details.
This time round the Judiciary was rejected as a possible institution to hear the Presidential election petition by the losing political party. Again the Electoral Commission of Kenya was rightly accused of not conducting free, fair, peaceful, and credible elections.
It is clear to me that the 2013 Presidential elections did not result in violence because Raila Odinga stated that he accepted the decision of the Supreme Court although he did not agree with it.
In 2017 the Supreme Court nullified the Presidential election. The subsequent presidential election was boycotted by NASA Coalition and the resultant presidential petition filed by citizens was dismissed by the Supreme court.
The Supreme Court had shown that it could rule against either of the political factions, Jubilee and NASA. The “we shall revisit” warning by Jubilee to the Judiciary is still being felt.
It is possible that the two Supreme Court decisions birthed the dictatorship of the government and opposition (the Handshake and its child named BBI) and the continued political instability in the country.
Potential Electoral War in 2022
The potential for conflict, strife, instability, and violence in 2022 cannot be ruled out. The dynasty/hustler narrative is fraught with danger. Demystified it simply means that a possible war between haves and have-nots that the intra-elite conflict instigates.
The author of the hustler narrative, Deputy President Ruto identifies four dynastic families (Kenyatta, Odinga, Mudavadi, and Moi) as the cause of all societal problems in Kenya. He refuses to acknowledge he is the political orphan of the Moi dynasty.
He refutes the scientific wisdom of the OXFAM report that states that 8,300 billionaires and multimillionaires own assets equals to what the rest of the population of 48 million own.
Now that is the comprador bourgeoisie that can be characterized as the dynasty/monarchy. And without a doubt, the Deputy President along with other black, white, and brown dynasties are part of that class.
He is not calling for a class war between Kenya’s working people and the middle classes against the comprador bourgeoisie, the dynasties/monarchs/walalahai/Mabwenyenye who are multi-racial and multi-ethnic and who rule this country with their foreign masters.
The Deputy President is not calling for that class war, but a war against competing dynasties who are grouped in BBI, NASA, and the One Kenya Alliance.
He is inviting Kenyan youth to join in that war with a promise of a budget of 30 billion Kenya shillings to set them up in the so-called wheelbarrow economics!
If we go back to 2008 and ask ourselves who sowed the seeds for the post-election violence (PEV) we know it was the ethnic barons representing their cartels and the comprador class in their struggles to capture political power.
Unable to reach a consensus on how to protect their collective interests they used their evil genius in the politics of division to declare war on the people of Kenya. We still face this danger, more so because no alternative political leadership exists to warn Kenyans of the dangers they face if they are duped to participate in this intra-elite war. Already, we can clearly hear the war drums being beaten.
What the Kenyan youth must do
The 2019 national census told us that 75% of our over 48 million population comprises youth aged under 35. It is the youth who have borne the brunt of the denial of their material interests: education, water, land, national resources, housing, work, sanitation, health, food, and security. Without these public goods available to the youth we cannot talk of their human dignity.
Of course, the youth are not homogenous, but the majority are not the offspring of the 8,300 billionaires and millionaires. We are talking here about the daughters and sons of working-class and middle-class Kenyans. It is this youth that the elite have been able to divide on the bases of ethnicity, religion, region, race, generation, gender, clan, class (where the elites have successfully convinced these youth that their problems are caused by their parents who in reality subsidize the failings of the government and the ruling elite), and sports.
It is also this youth, particularly those who come from the working classes that are used as cannon fodder for the intra-elite battles through bloody handouts that do not result in any of their material interests being realized.
It is on the basis of the history that I lay out here, and the potential for war in 2022 that I call upon Kenya’s youth to do the following:
- Demand that IEBC immediately complies with the Constitutional decree to register every youth who is over 18 to vote in 2022 election;
- Support the parties that the youth are forming on the basis of their interests and ensure they come into power;
- Refuse to vote for the baronial elite parties that have shown in the last 58 years they cannot give the youth of the working classes human dignity;
- Absolutely refuse to be divided along the bases I have stated and stay focused on their material interests, particularly the right to work which is the basis of their humanity dignity;
- Refuse to be recruited in ethnic and other criminal militias to be deployed to kill fellow youths in the country;
- Solidly support the implementation of the Constitution and join movements that call for Linda/Tekeleza Katiba/Protect and implement the 2010 Constitution;
- Vote out the elite and their factions of Kieleweke, Tinga Tinga, Tanga Tanga, One Kenya Alliance, Wipa Wipa, Fodi, Fodi, all Dynasties including those calling themselves Hustlers;
- Demystify and expose the cruelty and inhumanity of laughing at the working people, the real hustlers, by endangering their lives in a war among the elite;
- Promote peace among fellow Kenyans and save the Motherland from warmongers and ethnic barons who are the causes of war amongst Kenya;
- Join in struggles can seek alternative political narratives to those of theft, corruption, banditry economy, leadership by agents of foreign interests, politics of division, politics of foreign and national exploitation (Wavuna Jasho ya Wavuja Jasho), politics of incurring national debts against our collective national interests;
- Understand clearly how elections are rigged today; through the capture of institutions implicated (IEBC, the Armed Forces, the Treasury, cartels, the Judiciary among others), use of Public Relations agencies, and Artificial intelligence (for example algorithms) that we are now familiar with;
- Ensure that you focus on the MCA seats so that challenges can come from the grassroots; and
- Defend the Motherland and its people.
A time for transformation
If we go back to the elections of 1963 and 2002 it is clear that there are elections that cannot be rigged. In both elections the voice of the majority was clear. That voice could not be reversed. It could not be revoked.
The powers that be, the colonial government and the Moi-KANU dictatorship respectively knew what would be the consequences of rigging those elections.
The voice of the majority in 2022 must be the voice of the Kenyan youth. Giving this country a political chance to implement different economic, social, cultural, spiritual, and cultural narratives that subvert the status quo is the result of our poverty.
It is true that our elections are about money, big money. What Kenyans should remember is that the first people’s representatives in the 1950s were financially supported by the people themselves.
There is absolutely no reason why this cannot happen again and our people see the need to invest in alternative politics that will be anchored on their collective humanity.
My dear Kenyan youth, all I can think of under these suggestions I have made to you is a clarion call to action, to transformation, to fundamental change in this country, to the protection of the Motherland by all means necessary, including death! I believe this is the reality that has to be said.
We must think of freedom and emancipation from forces that enslave and divide us. We can start this patriotic dialogue by putting in place a political leadership that cares about your humanity, a leadership that you participate in directly and not as proxies.
This article was first published by Africa Uncensored, an independent media house set up by Kenya’s finest investigative journalists.
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BBI: Political Tool or State-Building Opportunity?
The Building Bridges Initiative has only opened up the more important discussion of Kenyans coming to terms with their social realities. It cannot be expected to be the silver bullet that will solve the country’s problems.
When the history of Uhuru Kenyatta’s second term at the helm of Kenya’s political leadership is written, it shall cast him in Machiavellian light as a wily fox—a scheming and unscrupulous prince. This history, shall perhaps, at the same time, be magnanimous and laudatory of Raila’s repeated efforts, over the long duration of his career, to demonstrate pragmatism and build bridges on more than three occasions. Indeed, these two politicians, perhaps, shall be looked upon by such an objective history quite kindly for being able, somewhat, to douse the intense fire and latent political violence before and after the 2017 elections. It is undeniable that the private talks, the subsequent highly public political and symbolic “handshake,” and the BBI consultation process was “created by people in the executive to stabilize the state.” However, as contemporary political commentators observed, this initiative has quite a few pitfalls, blindsides, and shortcomings, and this, history shall not forgive. As the constitutional lawyer, and political commentator, Kamotho Waiganjo noted, the BBI shall not “fundamentally solve our problems.” Moreover, the country’s fundamental problems do not lie in the law, but elsewhere.
When put in historical perspective, this political initiative, and the debate around it, only opens the more important discussion of Kenyans coming to terms with their social realities. As Waiganjo stated, citizens must have “an honest national conversation about what ails” Kenya— what takes away our ethos? Why do we celebrate unethical conduct by public servants and officials? Why do we elect people we know are thugs? Why is it that we are corrupt in every sector of our society? According to Waiganjo, that is the substantive conversation that Kenyans ought to have in every sector of society, be it private or public. As such, the BBI cannot be expected to be the be-all and end-all silver bullet that will solve all the country’s various problems (and especially not the two twin tyrannies of ethnic expectation and institutionalized corruption that feed off each other, and are inextricably connected).
As already noted above, while the initiative staved off violence and bloodshed, it largely remains an elite initiative as opposed to being people-led and driven as the protracted constitution-writing process of the 2000s was and, therefore, cannot be as radical, and revolutionary. And, if anything was revolutionary, it was the 2010 constitution, which was the result of a people-driven process. When the account of this process is written, it shall record that this process was, indeed, anything other than “a reform document,” and that, while the report may contain some strains of what could pass as reform, “it is inherently inconsistent with itself.”
As Wanjiru Gikonyo noted, the initiative failed the litmus test of elite accountability and answerability. In Gikonyo’s own words, the two political leaders, and the elite in general, ducked being accountable and answerable regarding the precipitous 2017 events by hiding behind BBI. Neither does the report mention the rampant economic or financial crimes perpetrated against the people of Kenya, and nor does it comprehensively address issues of economic marginalization. As such, the report did not only “fail spectacularly to be accountable to the people,” but it, for the most part, descended into “political theatre”. In the end, it is Kenyans who were had by the political class. “We have been snookered,” as Gikonyo put it. And, given the benefit of hindsight, honest and objective wananchi looking back would say, “No, we needed to get out of this charade. We were snookered. The report cherry-picked this or that carrot for women; another carrot for devolution; that carrot for youth; and put together all these various carrots in an unfathomable framework.”
In observing that BBI was akin to trying to fix fundamental and systemic governance weaknesses and failure using a Band-Aid approach, Gikonyo could not have been more apt: “It is a whitewash process, but this whitewash process is also trying to take us forward by taking us backwards. It is taking us forward from the chaos we have now, taking us back to the coalition government, because . . . without a vision, and failing to have a progressive mind-set, they [pro- BBI politicians] are saying things were a bit better when we had a coalition government. Let us put some . . . Band-Aid on our governance system and go back there.”
“BBI was akin to trying to fix fundamental and systemic governance weaknesses and failure using a Band-Aid approach.”
Lastly, it is also worth observing that, while widespread grassroots “consensus” was sought, the process was not necessarily greeted with enthusiasm. A survey conducted by Tifa, a polling firm, at the beginning of 2021 revealed that only a paltry 29 per cent of registered voters said they would vote for the BBI proposal or referendum to amend the 2010 constitution. Conversely, 32 per cent of Kenyans said that they would vote “No” to oppose constitutional changes suggested by the BBI. Another computer-aided telephone survey conducted at the end of January 2021 by Radio Africa Group revealed that the BBI referendum appeared to be on shaky ground. This poll found that 43 per cent of wananchi did not support the process compared to 21 per cent who were pro-the process. However, there was, according to this poll, “a potentially high swing vote as 25 percent say that they ‘do not know much about BBI,’ while 11 percent ‘don’t care either way.’” Furthermore, 40 per cent said they would not vote although 60 per cent said that they would. Without a doubt, the BBI process, like the electoral process historically, is quite divisive, which in Kenya, can only forebode trouble of a terrible kind.
The irony of the BBI process is that, while it was intended to stabilize the state, to build bridges between perceived rival ethnic groups, and to cohere the nation by healing past divisions, it appears to have succeeded in re-sowing seeds of old tribal hatreds across the country. As in the past, Kenya perches on delicate tenterhooks thanks to the “building bridges initiative.”
Obstacles on the way to Canaan: can Kenyans afford the democracy they crave?
This also is a key question. Indeed, it has enjoyed a lengthy history in Kenya, particularly regarding the issue of federalism or majimbo. A criticism raised against such schemes from the 1940s through the early 1960s was that federalism was too expensive for Kenya. The right-wing European politicians (e.g., the Federal Independence Party) who advocated devolution of powers to settler-controlled provincial or district councils sought an exclusionary political, economic, and social order that would keep political control and land in the White Highlands in the hands of the European minority while maintaining racially segregated schools and hospitals. Critics pointed out that such a system of government would be very expensive. For these federalists, exclusion had to be maintained no matter what the cost, especially in the case of schools.
Without a doubt, the BBI process, like the electoral process historically, is quite divisive, which in Kenya can only forebode trouble of a terrible kind.
KADU’s proposed majimbo scheme that emerged in 1961-62 also drew criticism as to potential cost from colonial officials and members of the public in addition to the leaders of KANU. This criticism focused on the creation of regional governments and duplication of functions. Peter Habenga Okondo, one of the architects of KADU’s federal proposals and a principal spokesperson for federalism, answered such criticisms bluntly. He wrote in November 1961, “If we want to preserve individual liberty what is the cost?” No cost was too high, he asserted, if Kenyans wanted to maintain a system of separation of powers and functions and “maintain the democratic process of government” that he claimed Kenyans longed for (East African Standard, 23 November 1961). The argument that no cost is too high to pay for civil liberties and representative government has since that time been reiterated during the debates surrounding the adoption of the 2010 constitution and by some of those supporting the constitutional changes called for in the BBI reports.
Yet these supporting arguments leave unmentioned issues that in the past have proved controversial and difficult to surmount. Two economic issues that raised concerns of cost during the transition to independence have yet to be confronted and put to rest. These are the issues of land ownership and labour mobility under a devolved system of government. At about the same time Okondo was advocating for regional governments with control over land and the government work force in their areas, civil servants at the British Colonial Office expressed concern that if regional assemblies were given the right to allocate land to owners and tenants, this would go against British proposals for a free market in land. The officials feared that KADU’s proposed system was “a reversion to the old tribal concepts from which we have been trying to get away in the new policy of regarding land as an economic asset” open to purchase or lease by any Kenyan. Jobs might be reserved only for individuals born in the devolved unit of government (British National Archives: CO 822/2242).
These concerns were allegedly laid to rest after the demise of KADU and the scrapping of majimbo, but the ethnic clashes of the 1990s and the 2007 post-election violence indicated that such was not the case. Do the BBI constitutional amendments promote a constitutional and legal environment that finally “solves” these issues? This is a key question yet to be definitively answered.
Not All Gloom and Doom: A Rebuttal to Mehari’s “Elections? What Elections? Abiy Is Counting on A Military Victory”
The plethora of political, judicial, economic and military reforms for the betterment of the People of Ethiopia and beyond that were introduced by PM Abiy since he came to power are still in place with an ever-increasing vitality and returns, to which the people of Ethiopia and other persons of common sense could attest to.
On 02 August 2021 your esteemed outlet The Elephant published an Op-Ed by Mehari Taddele Maru entitled “Elections? What elections? Abiy is Counting on a Military Victory”. In this regard, we would like to point out the fact that the piece was deliberately misleading, obviously biased and entirely fictitious. The distorted allegations against the leadership of Prime Minister Abiy Ahmed – that it has “failed to deliver on all three counts” i.e., political democratization, further economic liberalization, and what the author conveniently termed a ‘post-ethnic’ Ethiopian politics is not only misleading but also utterly misinformed. The plethora of political, judicial, economic and military reforms for the betterment of the People of Ethiopia and beyond that were introduced by PM Abiy since he came to power are still in place with an ever-increasing vitality and returns, to which the people of Ethiopia and other persons of common sense could attest to.
The author’s fallacious and twisted characterisation of Ethiopian politics as “bitterly polarised along ethnic lines”, against all odds, is a stale argument. First and foremost, conjuring up fictitious, non-existent “ethnic split” within the Ethiopian National Defense Forces (ENDF) could only serve the propagandist agenda of the Tigrayan Peoples’ Liberation Front (TPLF), let alone being a solid argument based on facts on the ground. Brazen declaration of Ethiopia as having “two armies” – the ENDF and Tigrayan Defense Forces (TDF) is not only utterly preposterous but a flat out attempt against the sovereignty and territorial integrity of the Federal Democratic Republic of Ethiopia. Equating a terrorist organization such as the TPLF with the
Government of Ethiopia, in the same token ENDF with TPLF, by itself constitutes the disinformation campaigns of the latter. As such, it is emblematic of complicity with the hypocritical junta that is hellbent on wreaking havoc not only in Ethiopia but also the entire of Horn of African region. On the other hand, interpreting the fight of the people of Ethiopia, in whom the sovereign power of the government lies, against a clique that threatens the national security, peace and calm of not only Ethiopia but also its neighbours, as a war against the people of Tigray is a morally flawed statement. The Government of Ethiopia, has made it time and again abundantly clear that the war being fought is against the terrorist cell that is TPLF, not the People of Tigray. The government firmly believes that the People of Tigray must be liberated from the tyranny of this insatiable cabal that on a daily basis rains brimstone on the People of Tigray and threatens peace of the country in their name. Hence, the Tigrayan people have been the perennial victims of the TPLF clique’s unorthodox, evil rule that deprived them of descent living, development and prosperity. Mutatis mutandis, Ethiopia only has one army and that is the Ethiopian National Defense Forces.
Speaking of economic liberalization, it is of grave importance to pay due emphasis to the myriad initiatives instituted by the leadership of PM Abiy under the rubric of A Homegrown Economic Reform Agenda: A Pathway to Prosperity and Ease of Doing Business since 2018. These pioneering tools of economic reform geared towards a prosperous Ethiopia, contrary to the author’s misreading, not only stimulated Foreign Direct Investment (FDI) but also heartened robust Kenyan companies such as Safaricom to venture into the untapped telecom industry of the Ethiopian economy.
On the political democratization front, discrediting the recently conducted historic General Elections in Ethiopia as lacking in participations and competitiveness in itself amounts to discrediting the collective will of the Ethiopian People. Deeming a historic election, the People of Ethiopia conducted in a peaceful, fair and democratic manner, while effecting a new political dispensation, as discriminatory as the author boldly claims, while accusing the Prime Minister of devising “ways to effectively exclude the real contenders with any chance of defeating the incumbent”, could more or less described as a total disregard for the will of the Ethiopian people. Technically speaking, putting a genuine critique of what really transpired during the 6th General Elections aside, the author is engaged in astroturfing in favor of the TPLF junta and character assassinations ad hominem against the Prime Minister. Professional journalism at least requires that the consent of the governed be logically analyzed and criticized based on distinct merits and that scapegoating of all sorts be put aside.
There is also no mention of the unconditional unilateral declaration of ceasefire by the Federal Government on 28 June 2021 aimed at enabling humanitarian assistance that is being hampered by the TPLF’s sabotage and continued harassment. The use of child soldiers by the TPLF is also nowhere to be found in the article. It is however surprising to witness the author’s meditative misinterpretation of the unilateral ceasefire as not only a scenario of capitulation- in the authors words, “defeat and withdrawal of the Ethiopian army from Tigray” but also of “Ethiopia…losing its army.” The withdrawal of the ENDF troops was not recognized by the author as a welcome gesture geared towards ensuring the wellbeing of our people in the Tigray Region, who are being held captive by the TPLF junta. It rather portrays the Government as an entity that capitalizes on what the author carelessly claims “legitimacy hanging on military victory.” To the contrary, the Government strongly believes that its legitimacy emanates from the collective will of the People and that there are not victories to be won in the efforts to save our People in Tigray from the mouth of a wolf pack in sheep’s clothing that is the TPLF.
Losing Our Minds: Brain Drain of Africa’s Psychiatrists Is Costing the Continent
Many of the continent’s most highly trained mental health professionals migrate outside Africa. The result, sadly, makes global inequalities in access to mental health, worse.
The brain drain of medical professionals from African countries to rich countries in Europe, North America, and the Middle East has been particularly pronounced since the 1980s. As Bibilola Oladeji and Oye Gureje have noted, as of 2011, there were more than 17,000 African physicians practicing in the US alone, over two-thirds of whom had been trained in African medical schools. Of this group, two-thirds were trained either in Nigeria or South Africa, the two countries with the most extensive medical training systems on the continent. Psychiatrists have also made up a significant piece of the larger medical migration, drawn by higher salaries, better facilities, opportunities for professional development, and prospects for long-term stability to seek jobs outside of the continent.
The brain drain has become a commonplace terminology to describe the emigration of highly skilled labor from developing countries to highly industrialized states in the post-colonial world. The concept has been particularly valuable for understanding persistent underdevelopment in sub-Saharan African countries as related not so much to deficiencies in African expertise as its redirection primarily for the benefit of wealthy countries. Similar to the “brawn drain” of the Atlantic slave trade or the natural resource depletion that characterized European colonialism in much of the continent, brain drain has had long-lasting impacts on African countries’ internal development and position in the global economy.
The impact of the brain drain on mental health care in Africa can be seen through the example of Nigeria, one of the few sub-Saharan African countries with university hospitals providing accredited medical training in psychiatry. Nigeria’s first trained psychiatrist of indigenous background was Thomas Adeoye Lambo, who studied at Birmingham and the Maudsley Hospital in the UK before returning to Nigeria to practice at the newly founded Aro Mental Hospital in 1954. Lambo and his acolyte, Tolani Asuni, developed much of the infrastructure of Nigerian psychiatry in the 1960s and 1970s, and several Nigerian universities began producing psychiatrists by the 1980s. The purpose of developing such programs was to produce a qualified mental health workforce for the country. Students from other countries in West Africa also trained in psychiatry at Nigerian institutions. Nigeria’s mental health care workforce grew slowly but surely from only three psychiatrists in 1955, to 25 by 1975, and 100 by 2001. But the brain drain has had a major impact on Nigerian psychiatry. Today, there are roughly 250 psychiatrists in Nigeria to serve a population of approximately 190 million. At the same time, a study from 2010 found that there were 384 Nigerian psychiatrists practicing in the US, UK, Australia, and New Zealand, a number 50% higher than the estimated total practicing in Nigeria.
The effects of this psychiatric brain drain have been significant. Beyond the worsening of the psychiatrist-to-population ratio, this phenomenon has the potential of severely weakening ongoing reproduction of this limited resource as more freshly qualified psychiatrists and senior residents are being enticed/encouraged to relocate on the guise of training opportunities abroad, from which they never return. In addition to psychiatrists, mental health nurses are also leaving the continent in droves, with packages designed to make emigration easy and more likely to be permanent. The rate of migration far outstrips the rate of production, leaving a huge deficit in human resources, one of the major pillars of a health system, according to the World Health Organization.
Several reasons have been proffered for the exodus of medical doctors from Africa to the economically developed world. Oberoi and Lin classified these reasons into endogenous and exogenous factors. Endogenous factors include poor working conditions, poor remuneration, and lack of job satisfaction and job security with little or no opportunities for career development. Exogenous factors include social pressures from relatives, preponderances of civil unrest, and armed conflicts with attendant high levels of insecurity. Ironically, the factors that push mental health care workers to relocate abroad are the same ones that likely contribute to rates of psychological distress in their communities of origin that, in turn, require more and better mental health care.
Since the late 2000s, the “global mental health” movement has sought to ameliorate this “treatment gap” in mental health services in developing countries, including Nigeria and others in sub-Saharan Africa. In most cases, reducing the treatment gap relies heavily on training lower-qualified workers to perform the duties of highly-skilled practitioners, a set of practices known as “task shifting.” Task shifting in international public health has existed for a long time, and has been employed extensively in the field of HIV/AIDS diagnosis and treatment in many environments. But it’s use in psychiatric care is somewhat more controversial. Most notably, global mental health has been critiqued as potentially socially and culturally insensitive, importing knowledge and practices from western industrialized countries that might not adequately reflect local cultural beliefs or social determinants of health, while simultaneously marginalizing indigenous health systems.
Task shifting has also been proposed as a strategy for alleviating the effects of the brain drain on the health care sector. In a review of policies to address brain drain in sub-Saharan African countries, Edward Zimbudzi has identified some areas of possible intervention. These include ethical recruitment, brain drain tax or compensation for source countries, increasing investment in training more professionals, improving remuneration of health workers and working conditions in general, importing more staff, ensuring political stability, and encouraging remittances. However, the review concluded “that there is considerable consensus on task shifting as the most appropriate and sustainable policy option for reducing the impact of health professional brain drain from Africa.” While some studies have concluded that task shifting has effectively filled the treatment gap, others have indicated that it is by no means a comparable substitute for professional mental health care due to lack of proper supervision and training of lower level workers, among other factors.
But we would like to offer a different critique of the task-shifting discourse: it’s tendency to normalize the brain drain of health care professionals. Global mental health has always emphasized practicality over ideology: anything that can be done to fill the “treatment gap” is presumably better than not doing it. The origins of the medical brain drain are not really global mental health’s concern, but its consequences are a large part of the foundation of the movement’s argument for “scaling up” the health care workforce to address the “treatment gap,” which is effectively the primary justification for the movement’s existence. However, in making the case for immediate action, the discourse on task-shifting in global mental health replicates the long history of ignoring the long-term exploitation of African resources in order to focus on short-term, externally funded, non-state interventions to provide what Africa supposedly “lacks.”
Promoting task shifting to lower cadre health care workers as the best way to scale up mental health services in low- and middle-income countries indirectly suggests that these countries cannot hope for better, even as billions of dollars are lost by African countries from investment in training highly qualified health workers who go on to treat patients in wealthy countries. Meanwhile wealthy countries acquiesce to helping train up less-qualified caregivers to fill the “treatment gap” created in part by this brain drain. It also implies that African countries can get by on less than wealthy countries. Indeed, severe mental illness continues to be neglected under the “task shifting” model that does little to increase specialist capacity to handle such cases. While this rather popular principle in global mental health appears practical, it inadvertently panders to the notion that some lives are more important than others, and calls to question the relative value placed on the health and lives of citizens of the developing countries of Africa compared to the developed world. It reinforces and normalizes global inequalities.
Mitigating the psychiatric brain drain must ultimately be about much more than filling “treatment gaps.” It must also be about addressing the geopolitical and macroeconomic conditions that have produced the gap in the first place. Developing equitable and sustainable mental health services for all Africans is a political, economic, moral, and ethical issue of contemporary urgency and historical significance.
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