For Kenyans it is 'not yet Uhuru' in the health sector

Two recent events in Kenya stick out like a sore thumb, the recent spat between the Kenya government and USAID on the modalities of importing HIV antiretrovirals and the implicit taxation issue.

The Devex report of April 21st by Sarah Jerving talks of the Kenyan government being in a stalemate with USAID over a large batch of antiretroviral treatment and other donated health supplies that have been stuck at the Port of Mombasa since mid-January.

Before the dust settled, there was another related stalemate relating to ARVs again, this time a report on 29th April indicated that Kenya Medical Supplies Agency (Kemsa) believed to have released toxic antiretroviral drugs to Kenyans.

During the exchange, I could not help noting the recurring word, donated/donors and the paternalistic trend of these donors being global North based who have continued with the beneficent paternalism that started within the colonial era.

The ever potent saying that “beggars have no choices” became a reality for us.

A quick journey down the memory lane would reveal to you that even though we nominally attained independence some 60 plus years ago, the development assistance for health architect has remained lopsided.

This has been heavily dependent on the former colonial masters, effectively maintaining the asymmetrical power imbalance that gives the former colonizers a huge sway in the health sector and a lever to exert their interest in the other critical sectors including economic.

Indeed, the COVID-19 has in the recent past exposed these enduring fault lines of the colonial legacy and its attendant post-colonial frameworks in the health system.

The pandemic which has literally upended the fragile health system in Africa has by no means introduced new dynamics in this all too familiar scenario of perpetual dependence on former colonial masters for critical services like health but has rather made it acute ways that make them difficult to deny or ignore.

The pandemic has provided the moment to reclaim the soul of public health from the historical capture by the predatory imperialist capitalist powers and recenter in its rightful place as a public good that is owned and defined by the people it is meant to benefit.    

The Lancet of May 2020 in its editorial noted that at the advent of the COVID-19 pandemic, the wealthy nations quickly closed their borders and retreated inwards, many of them unable to cope with the sheer burden of the pandemic in their own countries.

The folly of Africans having invested its hope on the benevolence of rich colonial masters who continue to anchor a lopsided health architect came to haunt us. These inward-looking tendencies have continued, morphing into what has now become known as “Vaccine Nationalism” which has seen the rich countries hogging the global of vaccine stocks with countries such as the UK and Canada committing vaccine suppliers for quantities enough to vaccinate their citizens more than five (5) times, leaving the poorer countries scrambling for whatever little remains.

It has been noted by many that historically, pandemics have forced humans to break with the past and imagine their world anew.

This is one is no different, and perhaps it is time to robustly interrogate the colonial premised health architect which from the outset never made much effort to hide its true intention in the design and motivation of its self-seeking, self-preserving motivation in the health system design.

The economic premise of public health as conceived by the designers of the colonial enterprise is perhaps the most enduring facets of colonialism, and while territorial colonialism may have ended some 60 years or so in most African countries, the colonisation of medicine, economics, and of politics, remains alive.

 In the colonial era, Health activities took on an exalted role given its visible and seemingly uncontroversial way to address the needs of the continent’s people.

It was evidently a soft entry point for the entrenchment of the economic interest, that strategy remains alive to date!

Tlaleng Mofokeng, a radical health activist and a South African medical doctor who was recently appointed the first African woman as United Nations Special Rapporteur on the right to health points out that indeed ‘Medicine has always been used as a political tool and needs to be examined through the lens of the broader socio-economic realities in which it is deployed’.

With absent public service infrastructure right from the critical determinants of health like water and sanitation and public health system, these tax-paying citizens are treated like they have no right to be in the cities, the exact same way the colonial legal architect conveniently crafted vagrancy laws to keep the poor out of the cities.

Arguably the ‘marginalized majority’, these citizens are disenfranchised from the democratic pursuit of their health right through deliberate fragmentation and disempowerment by deep-seated racial, ethnic, and financial inequities that fuel structural determinants of health.

These kinds of power imbalances were designed by the colonialist and persist in the neo-colonial power asymmetry.

Clearly, our so-called leaders have assumed the role of the colonizers in the local scene and have entrenched themselves to benefit from inequitable power structures through their private sectors cronies who benefit from the dysfunctional public health system.

I would say health is one of the efficient levers of the state capture which the ruling class have ensured remain least funded and least politicised and hence remaining a leading impoverishing and disenfranchising factor.

Predatory capitalism, the greatest motivation of the colonial and neocolonial enterprise continues to run roughshod in global health.

Just like the colonial motivation to use health as an economic tool, the corporates have never relented in propagating narratives to portray the public health sector as inefficient and private corporate involvement as the panacea.

The health sector with an estimated global value of $8.5 Trillion as of 2018 (projected to reach $10 Trillion in 2022) is a minefield of vested interest involving the corporate sector. It is thus a fiercely contested space of varied interest jostling for control of the vast resources, ethics notwithstanding.

It is no wonder that in US, according to data from OpenSecrets.org (2016), Corporates dealing in pharmaceuticals and medical commodities spent $246 Billion in lobbying, invariably this lobbying would entail influencing their country to influence global health policies.  

In terms of knowledge, raw materials for research are extracted from Africa but the resulting academic wealth (authorship, recognition, awards, and funding) flows disproportionately to institutions in the colonial powers of old, this phenomenon is perhaps better understood by looking at the funding landscape for health-related research and development.

While Africa hosts 15 per cent of the world’s population and carries 25 per cent of the global disease burden, it accounts for only one per cent of the global investments in research and development (R&D) and two per cent) of the world research output (PATH, 2020).

Clearly, the dearth in R & D investment by African governments then opens it to ‘strings-attached’ externally funded knowledge and information generation that then sets the health agenda in line with the funder's interest.

In conclusion, there is no doubt that global health continues to operate in deeply politicized ways with the colonial legacy trends continuing largely albeit in subtle politically correct ways.

We always tout our lack of resources when it comes to health financing, yet we have money for everything else and if we don’t, we take loans?

This capacity gap card is indeed the hook through which the colonial benefactors continue to exert control on our health but has been revealed as a hollow escapist gimmick that has been used to depoliticise health. Failure to invest in its people health by Kenya and other African countries is a political choice.

The writer is the Health and Rights Manager at the Open Society Foundation (OSIEA). The views are personal.