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How State decisions ‘distribute’ deaths

Tuesday August 13 2019


A patient who has not been attended to by Kisumu County Hospital medics rests with her newborn, on February 2, 2019. The hospital does not have adequate resources. PHOTO | TONNY OMONDI | NATION MEDIA GROUP 

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Whenever there is a social issue that needs State intervention, the government’s reaction reminds me of addiction. Addiction is not getting hooked on some drug, but the pattern of outsourcing or delegating emotional – and in this case governance – processes onto something else that backfires.


The death of Joyce Laboso, Bob Collymore and Ken Okoth to cancer is an opportunity for Kenyans to see this addiction manifest. Suddenly, there is a call to declare cancer, Kenya’s third killer according to the death registry, a national disaster. How honourable!

Decision making in public health is a complex technical and political process but in Kenya, politics outweighs the public good. Studies, which have been echoed by various healthcare workers’ unions, show that a strengthened health system is resilient enough to cushion the public from death in the occurrence of expected challenges.

The World Health Organisation lays out seven pillars for a good health system but for argument’s sake, let us define it this way: It’s one that can respond to a crisis, such as an outbreak, but still be able to discharge other core duties like delivering babies; it can learn from the crisis and when need be, change its countenance; it is humane, such that it would do all that is in its power, exhaust all options to save your life at both good and bad times.

A weak health system crumbles in the face of outbreaks. Ask West Africans how Ebola took more than 11,000 people in just a few days. Having such a resilient system, realistically, would be where the government begins. Even in the richest country, this takes a while because it is not just about money; it is a process.


It is consulting technical people who have spent half their lifetimes studying how various parts of a health system should work, it is allocating money thoughtfully to projects that would not only yield social results but also prevent damage, say investing in preventing cancer just as you would on treating it; it is placing citizens, no matter how entitled they are, at the core of every decision; it is training and protecting the healthcare workers so that they give their all to keep this system stable.


This yields “resilience dividend” where your people are safe in good or bad times.

This is where exhibit number one of outsourcing responsibility comes in.

Instead of the government strengthening this system, it has declared it a national disaster, a cue for forming a ‘technical working group’ whose report we will never see. It is a cue for allocating billions of shillings to a kitty which, in a few months, my editor and I will be racking our heads on what name we should give it to separate its disappearance from the other corruption scandals.

Instead of saying, “Kenyans, we have failed to make the health system diagnose and treat on time and we will correct it”, an addict Kenyan government says “this problem persists because we have not declared it a disaster, colossal amounts of money have not been allocated to it, and so do not place this on me”.

Just like an addict who has already been given what they need, attention on cancer has been here, only that it was the poor dying. Funds were allocated but the government paid for diagnostic tools in hospitals that did not have running water, and the cash that was left went to a few people’s pockets.

What is most heartbreaking about this outsourcing is that it shows us how political and economic decisions distribute sickness and death. In Kenya, death is not random or natural. It comes to the poor sooner than to the rich, sooner to the people in the countryside than those in the city.


The other two top killers – malaria and pneumonia – are poor people’s diseases because when arrested on time, an antibiotic and antimalarial drug would eliminate them off your system. Did you see how fast Rarieda MP Otiende Amollo was treated when he collapsed due to cerebral malaria? Yet, 21,584 died of pneumonia in 2018, according to the Ministry of Health and another 17,553 of malaria.

These inequalities are a consequence of decisions by power holders on the distribution of ‘social costs’; they decide who should suffer the disease costs of large-scale mismanagement of health resources in the country.

During the 2017 strike, I met Emmanuel, a single father whose son was sick of meningitis and hospitalised at Mbagathi Hospital. The boy died, and in the following months the old man visited the playground in Mathare, often weeping in the dark as he watched the boys that played with his son. He was heartbroken, his spirit and soul crushed.

Somehow, Emmanuel’s pain did not push the Ministry of Health to act.

Ms Okeyo is a health reporter at Nation Media Group. Email: [email protected]