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Forget meaningful development if we do not fix healthcare system

The World Cancer Day shoved in our faces the reality of a broken health system. Previously considered a non-epidemic, cancer in recent years has proven to be a more ravaging risk than even AIDS and Malaria, erstwhile the tier one killers.

Against cancer, we are sitting ducks. We have limited facilities. We lack the equipment to deliver treatment. We have almost zero epidemiological data. There are few oncologists in the country. We have not dedicated the same kind of resources that we dedicated in the fight against AIDS and Malaria. To dampen everything, Cancer hardly has the same appeal, however twisted, that AIDS and Malaria have had, to previous donors. Simply, we are on our own here.

This is unacceptable, considering that for over half a century, we have been chorusing how disease is a major impediment to development. Disease ranked among top-most enemies that our Founding Fathers set out to confront, together with poverty and illiteracy. Why has the goal of tackling disease by ensuring that quality healthcare is accessible – physically and economically — to all Kenyans, eluded us this long?

Granted, we have made steps in increasing physical accessibility by reducing the long distances that some Kenyans have to cover to get to a health facility – but this is not all. A lot more still remains to be done. Stories are told of Kenyans losing their lives, not because they did not get to health facilities in time, but for lack of money for them to be admitted, no bed to place them on, drugs being out of stock or no health personnel to attend to them.

Never mind that a healthy population is a key ingredient towards delivering a prosperous nation as envisioned in our long term national development goals. If we are not going to fix the healthcare system, then we could as well forget about the Promised Land of sustained economic development in the next one and a half decades that we constantly dream of.

Kenya (and indeed, many countries in Africa and the rest of the developing world) has to rethink our approach towards delivering quality healthcare. Of what use is a government (national or county) that cannot effectively take care of its people’s most basic needs, such as healthcare, ability to earn a living and security? Access to quality healthcare for all is one of the avenues through which we could tackle inequality that still remains high in this country.

Statistics indicate that health-related expenses take up a significant portion of an average households’ expenditure. The more important problem is the vulnerability to poverty that sickness of a household head poses. When people are sick, they don’t work and do not earn a living for their families. Imagine the economic impact that would accompany a functional public healthcare system that ensures families do not spend that much on healthcare and do not worry about skipping work because they are sick and cannot afford medication. Basic economics indicates that when households are able to save money, they increase their purchasing power as well as ability to invest in business or other productive activities.

How then, do we fix Kenya’s public healthcare system? Some of our neighbouring countries have delivered much more impressive health outcomes, while we continue chest-thumping about being the regional economic powerhouse. Even with the facilities and equipment that we have, it is possible to generate much better outcomes than we already are. Is our strategy hamstringing efficiency of the healthcare system?

A haphazardly designed and executed decentralization has contributed to the chaos by splitting responsibility and accountability for health – that county governments are responsible for implementation but national government retain substantial policy power. Maybe we devolved health too soon, or devolved too much or we have to go through the teething problems to refine and reinvigorate it.

One of our weakest links is following through on all the excellent plans that have been formulated over time to transform the public health system. Legend has it that some of the brilliant development plans in this country have gained much more traction elsewhere in the world, while ours continue to gather dust in technocrats’ magnificent shelves and computer hard drives. If there is a leaf we were to borrow from the success stories such as Singapore, then it should be disciplined execution of plans. Apparently, it is usually said in these countries that: ‘Policy is implementation and implementation is policy’. Unfortunately, we have not made execution a core competence for our healthcare system.

It all boils down to leadership. In our circumstances it is not even clear where we should look for leadership. The constitution mandates county governments but they are still strong-armed by national government that nonetheless absolves itself from blame for the turmoil in the sector. Not that the counties themselves do not have a leadership crisis, anyway!

What Kenya needs is persons who will get things done to ensure systems function properly all the time. Then cases of health systems being paralysed by medics’ strikes will be a thing of the past. Kenyan families will no longer have to organize many fundraisers to take their kin to India for treatment because some equipment and procedures are not available locally.

Therefore, the challenge for the managers of the country’s healthcare system in whatever jurisdiction is to consider the strategy statements – the vision, mission, objectives, scope and competitive advantage — and work towards achieving them. How comes, for instance, that we still have acute shortages of certain specialist skills, and have one doctor for a huge population, way beyond acceptable levels. That some health facilities suffer shortages of drugs and other key consumables from time to time – are our priorities right?

Even as we rethink our strategy for the public healthcare system, we should also cascade it to the entire healthcare workforce of different cadres. This will ultimately transform the mindset of medics working in these facilities. Ask anyone who has been to a public health facility about their experiences and they will regale you with tales of terror at the hands of the nurses and other health workers. It gets worse in the maternity wards.

The public healthcare system will only be effective if it is treated as a service and a right, and not a work of charity – even if the service is for free. Our taxes run it, anyway!

At the end of the day, this country needs a healthy population to create wealth and livelihoods — and ultimately achieve its national development goals. The public health system serves the vast majority of the Kenyan population and fixing it would translate into huge economic benefits. It would be able to effectively play the role of not only treating but also preventing some diseases through education measures such as good nutrition and clean environment to avoid small but expensive ailments like diarrhea, malaria, typhoid and others that overload the health system.

After all, labour (and a healthy one at that) is a key factor of production. There is a case for a transformed, functional and equipped healthcare system.

This artice was first published in Business Daily onFebruary 25, 2016 and online at http://www.businessdailyafrica.com/Opinion-and-Analysis/Transform-the-health-sector-for-meaningful-development/-/539548/3090936/-/1x1o7x/-/index.html.

 

 

 
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Posted by on July 21, 2016 in Uncategorized

 

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How infrastructure can change lives of poor

In the eyes of my kinsmen, our hometown of Butere has joined the league of developed parts of the country.

For the first time since God created the Earth, there is a tarmac road linking up our hamlet to the rest of the world. Add this to the fact that the little hamlet is connected to the national electricity grid and most schools have cemented walls and floors. We are ‘developing’!

In the wisdom of my people, development is not having to endure slippery muddy roads during the rainy season. It is having lit up shopping centers where we can take our phones for charging and grind our maize into flour. It is granting our school-going children the luxury of not having to carry cow dung to school every morning for smearing the classroom floors and walls.

Roads, and infrastructural development in general, remain a big deal – and not just for my village. A promise of any of these is a seductive ruse by many an aspirant for political office. The parliamentary hopefuls are wont to promise to tarmac our main roads while the aspiring councilors (now MCAs) would regale us with their grand plans to murram the footpaths in the village.

For many people, smooth tarmacked roads and electricity, on their own, should be a potent charm against poverty. This is the basis that those who dismiss mega projects as not pro-poor base their arguments on, like Dr Patrick Mbataru did in the Sunday Nation (August 9, 2015) asserting that ‘Mega projects have little impact on the poor’.

Infrastructure is actually a foundation, a catalyst and a critical enabler of development. It is a facilitator of enterprise that eventually translates into wealth for the entrepreneurs and lift communities out of poverty.

Smooth roads should enable the poultry farmer in the hinterland to ferry their eggs much more efficiently to the market. It will make the investor, who every county is busy wooing through conferences and forums and trips abroad, to select a well-served area to set up a factory that will create jobs and a market.

Nonetheless, infrastructure is not a panacea for all or developmental shortcomings. Rather, it should be viewed as a basis, which if harnessed well and backed by favourable incentives and pro-enterprise measures, is bound to transform lives.

Fixing our infrastructure is in itself a step forward on our path towards the promised land of development. Perhaps, the only challenge we face in our rush to upgrade infrastructure is efficiency in the allocation of resource. We sometimes allocate too much to infrastructure that ends up eating into what we would have invested in the social infrastructure which deal with immediate needs of the poor.

Nonetheless, with more and more parts of the country ‘developing’, it is incumbent upon county governments to rise up to the challenge and fashion policies that will encourage enterprise in their respective areas of jurisdiction. Contrary to popular opinion, we do not have to court foreigners to come and invest in our villages and create jobs. We can also create jobs by encouraging local homegrown businesses to thrive while leveraging off the superior infrastructure that we are fortunate to have. Creating the right circumstances for enterprise to thrive is critical. It empowers citizens to build wealth, and of their own power, to reach out for their full aspirations, and development.

If anything, it is in the interest of the devolved governments that each county has a strong enterprise base. These governments have to generate revenue to supplement funds received from the central government.

Alongside putting up the brick and mortar of infrastructure and supporting enterprise to thrive, we need to increase our investments in social infrastructure and services– through targeted development programmes in education and health. At the end of the day, this is the true measure of development. It makes people’s lives easier and more meaningful. These are the tangible benefits to the ordinary citizen that will complete the picture of development in the minds of Kenyans.

Devolution creates an excellent opportunity to deliver this. Unfortunately, the charm of roads, infrastructure and cement has clouded politicians’ minds, as they are keen to ‘show’ development. This ends up playing into the mindsets of kawaida people, who are fixated with a constricted view of development.

Granted, huge strides have been made in operationalizing devolution, as it is imagined through the historic constitutional development. It is now upon the devolved units to re-imagine development from the stand-point and circumstances of the poor villager. It is not only what the villager perceives as development, but also importantly, how development, however conceived, actually changes the lot of their lives. This is through ease of access and affordability of their daily bread.

If the villager is happier, healthier, more educated, well-fed, is empowered and can easily access and meet their needs, then the addition of smooth roads, flowing water cemented classrooms, really brings development home.

This was first published in Daily Nation on August 26, 2015; and online at http://www.nation.co.ke/oped/Opinion/How-infrastructure-can-change-our-lives/-/440808/2846298/-/14hl6co/-/index.html 

 

 

 

 
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Posted by on July 21, 2016 in Uncategorized

 

#GES2015KE Post-mortem: I defend the Press

The media is oft an easy scapegoat. In the aftermath of the GES, hordes of ‘media analysts’, have gone ham on the Press over its handling of the just concluded GES 2015, yet another example of how media is easily made a scapegoat.

These analysts’ reading of media reportage is damning – coverage was not only dismal, it was focused on the wrong things. According to this reading, the Kenyan press focused on “minor distractions” at this very important conference – POTUS, his family and lifestyle, his toys, namely The Beast, Air Force One and Marine One. That the media glossed over big picture issues – entrepreneurship, investment and bilateral talks between Uhuru Kenyatta and Barack Obama. Analysts on social media and talking heads on television told anyone who cared to listen that the meaty media abandoned the boulders and went for the pebbles.

Of course this is not the first time that the media, which is scorned and praised in equal measure, has been designated a carry all flak taker. From politicians claiming that they were misquoted, and individuals caught in scandals accusing them of invading privacy, to government officials terming them unpatriotic and focusing on negativity that paint countries in bad light internationally, the media is always on the receiving end.

The reality though is that, like leaders, we get the media coverage that we deserve. The media, like art, is a mirror held up for society to gaze at itself. The media is also in business, and misreading its audience is costly. If media focused on matters that we, the audience, did not care about, they would be out of business. The Kenyan media is not only in business; and viewed as a sector, it is also doing very well. It is because the media outlets are giving us what we want as readers, listeners and viewers.

One of the basic lessons at journalism school is that the role of media is to inform, educate and entertain. On its coverage of the GES 2015, the media did very well on these three counts. Indeed, had the media focused on what our media analysts call the big picture issues, they would be drifting from their audience.

The average Kenyan media consumer does not think much about business news, which is where most of the coverage on the summit would have been. This is the reason why business news is given a small proportion of the news in dailies and bulletins. Such news is tucked deep past page three in print media, and after the main news in broadcast media.

But it is also the ‘news value’ of events that matters. This includes proximity of the news, its ‘unusualness’, timeliness, prominence and the emotions involved. Between the price of potatoes that has increased by 3% and a politician caught with his assistant’s wife in a compromising situation, the latter wins on news value any day.

President Obama is a media phenomenon, in Kenya and elsewhere. He makes news.  Kenya is not just anywhere, but the land of his father’s birth. He was visiting for the first time since he ascended to the position that makes him the most powerful man on the planet. The least anyone would expect is that he would hog the space and time in media long before he lands, and after he leaves. Any editor who misses this point is not worth the title.

My verdict is that the disappointment with the coverage has nothing to do with its focus or quality. Rather, most of these events were beamed live, in their wake, arousing furious banter on social media. By the time the events of the day appeared in in news bulletins and newspaper pages, they were already old news. We had already seen President Obama land, the famous ride in The Beast with his sister and everything else he did before the newspapers went to print.

The challenge for the Fourth Estate is not about its focus; rather, it is in adapting and keeping abreast of rapidly unfolding events, and to determine what is news within what times spans. We live in a world where social media and live coverage of events have made the work of a journalist a lot more complicated. It is incumbent upon the modern day journalist to report knowing that his audience already have full view of the happenings via social media and live broadcasts (depending on how big the issue is). In such a case, the journalist is obliged to give informative and fresh analysis to be relevant.

A business leader who attended the State banquet held in honour of President Obama recently made a statement that illustrates the point. He says that when everyone rose to take pictures and videos of Potus getting down to Lipala, he did not bother since he knew it would be on Twitter in a few seconds – and sure enough it was. How then, as a journalist covering this event, would you expect to present this to us as ‘news’?

Kenya has journalist that are at par with the best in the world. They might just lag in innovation.  It is not that Kenyan media did not see news value in the summit and the throngs of entrepreneurs from across the world in attendance. The issue is that that they gave us ‘news’ that was rather late to be news.

This article was first published in The Standard newspaper on August 4, 2015 and Standard Digital on http://www.standardmedia.co.ke/article/2000171514/in-defence-of-kenya-s-fourth-estate-after-obama-s-visit.

 
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Posted by on March 24, 2016 in Uncategorized

 

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Dear #Kenyans, #POTUS does not have answers to all our problems

Ladies and Gentlemen,

It is my turn to ‘Face the Nation’. Our popular and powerful cousin is coming to town and we are justifiably excited. This is our time to address, pontificate, analyse and discuss everything about #POTUS. I therefore take liberty to make my address to the Nation of Kenya.

President Barack Obama in the Oval Office Photo Credits: Whitehouse.gov

However, and which is also my reason for writing this note, I fear that we may be expecting too much from this homecoming of sorts, which journalists have billed ‘the first ever visit by a sitting US President to Kenya’.

It is no little wonder that in the last few days, we have had all manners of wish lists calling out for Obama’s attention. This ranges from the Kogelo chap asking for US-made shoes, to the Siaya Governor who wants a university, paediatric hospital and power plant. Add in the President, who is asking for help in fighting terrorism and enhancing trade between Kenya and the US. Then there are the opposition leaders who want to enlist his help in tackling graft and entrenching good governance. It is hard being Obama!

Fellow Kenyans,

Truth of the matter is that it is not #POTUS or any other outsider, with the solutions to these many problems that afflict us. Remember the maxim ‘African solutions to African problems’? That is what I am talking about.

Granted, Obama is the President of the world’s largest economy and Leader of the Free World, and even has family ties to the Great Land of Kenya. However, this is not ground enough to inundate him with our problems to the very minutiae.

I am convinced that if we were to look carefully within us, we would find solutions to these many problems that we think it requires #POTUS to solve. For instance, do we really need him to get us shoes for individuals, or even build a hospital in the county of his father’s birth? We will never become the globally competitive and prosperous nation with a high quality of life we envision by the year 2030, with this kind of mindset. It is time to decolonize our minds.

We have incredible examples of great work that is already being done by Kenyans for Kenyans. Take Nailab for instance, the startup incubator that is helping tech enterprises unlock their potential. All we need to be asking of ourselves and our leadership is how to scale these kinds of initiatives to increase impact.

Brothers and Sisters,

As the clock ticks towards the Global Entrepreneurship Summit, which is the main reason for #POTUS’ trip, let us make the most out of it; but not to expect freebies or magic from him or the entrepreneurs and other attendees who will be in town at the weekend. IN this regard, a huge shout out to the enterprising Kenyans who are taking advantage of the hype to sell merchandise and make money.

Go ye and conquer the world when it comes to town at the weekend!

 
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Posted by on July 22, 2015 in Uncategorized

 
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Open Letter to Africa: #ListenToSouthSudan

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Fellow Africans,

Under different circumstances, I would have relished such an opportunity to address the continent. However, the issue at hand is so disturbing that there is absolutely nothing enjoyable about making the statements that I am about to.

It is about South Sudan – the continent’s newest nation that we welcomed in 2011 with pomp and celebration.

Only a few years later, we’ve abandoned South Sudan at a time when they need us most. We have chosen to stand by and watch in silence as innocent people of South Sudan are butchered in a conflict that they are mere pawns.

Whatever happened to Ubuntu — the African humanness! The Ubuntu philosophy stresses humanity towards others, which is at the core of being African. As a people, we have abdicated this responsibility. Apart from the gallant social media citizens, we have remained silent to the cries of the people of South Sudan.

It is time we rose up and took action. In our own little ways, we have a contribution to make in addressing the suffering of the great people of South Sudan. Let us show the rest of the world that indeed ‘it is time for Africa’ — and that this is not just a line from a song. Which better opportunity is there to demonstrate that we can develop African solutions to African problems?

And when all is said and done, the buck stops with our leaders — nationally, regionally and continentally. This is the time for the AU, EAC, COMESA and other blocs to step to the plate. Surely, we can come together for a good cause that benefits us all; and not wait to rally together for selfish initiatives such as withdrawal from the ICC. A stable and peaceful South Sudan is in the interest of us all.

The world is watching keenly. Don’t we harp on and on about our sovereignity as a people? Why are we still waiting for others us to deal with issues in our neighbourhood? How many more people are waiting to die before we take action? Let us speak out, declare sanctions against the protagonists, convene peace talks, and do everything else in our power. The time is now.

In conclusion, I leave you with the wise words of Irish statesman and philosopher Edmund Burke, who famously noted that “All that is necessary for the triumph of evil is for good men to do nothing”. Let us listen to South Sudan, and do something.

Yours,

Proud Son of Africa

 

 
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Posted by on April 23, 2014 in Uncategorized

 

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Mr President, Here is my wishlist for your second year

President Uhuru Kenyatta

President Uhuru Kenyatta

Your Excellency,

How time flies! We are on to the second year of your tenancy at the house on the hill.

Much has been said about your first year in office — by yourself, your crew, critics, columnists, talking heads on telly, bloggers — really everyone with an opinion.

Heading into the second year, I wish to present my wish list for the next 365 years. Think of this as an agenda setting session that normally, our supervisors, in cahoots with the HR types, would subject all of us to at the beginning of the year. This is just me trying to act like your boss (read voter and citizen of Kenya).

For starters, I hope the energy that you have brought forth, together with the First Lady and the Deputy President, does not fizzle out. Let it increase manifold and run over . I am glad that the First Lady has hit the ground running literally — at the London Marathon 2014. Please pass my kind regards to the good lady.

While at it, we hope to see this energy in dealing with the things that matter to the rest of us. You have been praised for being in tune with the rest of us ordinary Kenyans (as many of your ilk are wont to call us). If only you matched this with tangible action. Just in case you are not sure what I am referring to, I will give you my wish list:

  • Please do something about the heavy taxation and make life more affordable for the rest of us. We do not have to wait for 2030 to deliver a high quality of life for us all. Do we?
  • Please assure safety and security for ourselves and our loved ones — let us go back to those days when houses of worship were safe havens and we did not have to endure sessions reminding us of security exits and what to do in case of an emergency like we did at my church last Sunday.
  • Also, while I acknowledge that it is not the job of the government to create jobs, please make it conducive for the private sector to spawn employment opportunities for our relatives — that way, the rest of us will have less dependents. Tax them less.
  • Mr President; it would help to do something about the many promises that you made to the People of Kenya. Of key importance are the laptops for Standard One pupils. Between me and you, this could just be your legacy.

In conclusion, I would suggest that this year you seriously walk the talk with regard to fighting graft. It pains as a taxpayer, to hear that your taxes are lining pockets of an unscrupulous civil servant. Please convince us that your administration is not just paying lip service to fighting this vice.

All the best, Mr President.

Citizen number 2******0

 
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Posted by on April 15, 2014 in Uncategorized

 

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Excuse me Mr Governor, Devolution was never meant to enrich yourselves

Kenya’s President Uhuru Kenyatta poses with governors and other government officials at State House, Nairobi. Source: Coastweek.com

Your Excellencies,

Let me begin by acknowledging your exquisite tastes as demonstrated in your days in office. From big cars and preference for putting up in hotels with fat entertainment perks to boot, you have outdone yourselves! If your dreams as outlined in the county budgets are anything to go by, then we are in for a lesson in the lifestyles of the rich and powerful.

I am informed that in living up to this billing, an audit report of your expenditure between July and September 2013, found that about half of you only lavished yourself in allowances, travel, with no thought of development of your respective counties, which in my humble opinion, would be a key pursuit. And you are not yet done with us – you still want more cash.

While I am disappointed, and deservedly so, it is hardly surprising based on the kind of demands you were making last year. I do not quite remember what became of your ill-conceiveddemand for a large fully furnished and staffed office in Nairobi ostensibly to ‘attract investors’. This is after winning the fight for public buildings in which to set up your bases in respective counties. Boy, don’t you love the fine things in life!

However, and which is the reason am penning this note, I wish to remind you a fact that you seem to be blinded to in your quest for the very best that your good office can get. All that you are enjoying is at my (and other taxpayers’) expense. For this reason, we demand that you keep your eye to the ball – which is development projects that benefit us. The key objective of devolutionis not to attend to your tastes, but to take development closer to the people.

Of course, popular opinion has it that you, the political elite, will continue having your way for as long as you have deep pockets that can buy our support and votes come the next election. However, do not be too sure. The Kenyan voter is evolving.

Kenyan voters queue to cast their vote during the March 2013 general elections. Source: Capitalfm.co.ke

In conclusion, I leave you with the sagely words of our former president Mwai Kibaki: “Some people got devolution wrongly. Let us quote the Constitution as it is. Remember that our ultimate objective is to serve the people of Kenya and to improve their economic and social welfare”.

A Happy and Prosperous 2014, Gentlemen. Hope you focus!

 
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Posted by on January 9, 2014 in Uncategorized

 

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