Pede Hollist - SO THE PATH DOES NOT DIE

I purchased this book when it was released drawn to it but its catch title but also the surnale of the author. After a number of false starts, unrelated to the book, I have now managed to complete it. In a nutshell, I must say that the story was rivetting and did not disappoint. Pede Hollist adds to other Sierra Leonean authors whose books I have had the pleasure to read such as Ishmael Beah and Aminatta Forna. Sierra Leone is often seen through the eyes of its brutal Civil War but try as I might, have never quite understood the dynamics thereof. In the prologue, Pede Hollist says "When Atala the Supreme wants to test a people, He does not send a stranger. He sends a Kinsman". Perhaps this is his way of summarising the travails of Sierra Leone. This book is intense and weaves through different themes without suffocating the reader. It speaks to different kinds of loss including the loss of dreams, of loved ones, of a country, of ideals...without passing judgement one way or the other. Sierra Leone or Serra Lyoa in Portuguese owes its name to the 15th-century Portuguese explorer Pedro de Sintra, the first European to sight and map Freetown harbour. The Portuguese name, Serra Lyoa refers to the “Lion Mountains” or range of hills that surrounds the harbour. Its capital Freetown is so named because the land was "purchased" from local Themne chiefs in the late 18th century as a new home for resettled freed slaves from Britain and North America, and of 'recaptives' taken off seized slave ships on the Atlantic after Britain passed the 1807 Abolition of the Slave Trade Act. Pede Hollist makes us see Sierra Leone through Finaba's journey - and her travails - from a village in Salone to Freetown then to the USA and back. The book has an "Americanah" ting to it. Its characters, irrespective of their nationalities, are defined in one way or other by the Atlantic Ocean. Be it the African Americans like Aman, Islanders like Cammy and Scraps or Africans like Bayo, Edna, Kizzy and Finaba. They all are somewhat tied to the motherland but with different pulls to the African path. (I must digress to say that during the 2021 Olympics, my sister remarked that we should root from all people from the African Diaspora, their countries notwithstanding because they were sons and daughters of Africa - whether or not they acknowledged it.) I was drawn to Cammy's story which helped me process something rather personal. We meet Dr Cameron Dexter Priddy (Cammy) at a party midway through the book. Cammy struggles with the loss of his brother whom everyone concluded had tied quite unexpectedly. Cammy's grief is deep because he had always known that Donovan was "ill" but yet could not process it. Many years on - as a Doctor - he grieves for Donovan and cries from the depth of his soul wondering whether he could have stayed Donovan's death had he told of his illness. Often the call of "Home" is strong. The paths back home can be long winded but they must ultimately lead us home. Yet home is different things for different people. Finaba explains that home is the place where one feels comfortable whether they live in a mansion with climate control or in a windowless hut sitting on the equator. Home can also be different places at different times. Like in Chimamanda Ngozi Adichie's "Americanah" it is sometimes difficult to explain to people why one might leave the presumed "comforts" of America to return to the travails of Africa. This is the challenge that Finaba had in trying to explain to her fiancé Cammy why she needed to return to Salone when all her life she had wanted to escape from it. According to Cammy, "the concept of home is a but a memory, a canvas of good times stitched together to cope with present realities." Yet according to Finaba it is a calling preordained for her that she must fulfil so that the "path does not die". The way I see it, some paths get to a cul de sac and die but other path's go on and on. Pede sneaks a happy ending upon us...I like happy endings.

FIGHTING THE COVID-19 PANDEMIC IN KENYA – PUTTING ACCOUNTABILITY & TRANSPARENCY AT THE FOREFRONT

The Government of Kenya – like many other countries - faces an unprecedented crisis for which it has instituted certain measures to respond, in order to secure its population.  Since 29th January 2020, when the WHO declared the 2019-nCoV outbreak a public health emergency of international concern, countries started rolling out evolving strategies to curb the pandemic’s ravaging consequences in a fluid and fast paced environment.  Governments have ramped up public spending – through domestic funding, grants, loans and in-kind donations from the global & local community – to contain the pandemic, address macro-economic shocks and mitigate socio-economic implications. As per the President's 9th COVID-19 speech on 23rd May 2020, Kenya had pumped approximately USD 502.1million into the economy to soften the effects of the Coronavirus pandemic on the economy.

As with other pandemics, an increase of corruption risks and practices is often likely, contributing to illicit financial flows[i] not only in countries that have weak financial management & oversight institutions and capacity[ii].  Given the need to respond rapidly, ideal mechanisms are wrongly assumed to stifle the Governments’ ability to respond.  In New York, United States of America – in the context of a global shortage of ventilators - an executive order was issued to allow the State Government to pay USD 69.1 m for the delivery of ventilators prior to the goods being received and without the requisite due diligence on the “supplier”[iii].  Ideally, the state would have issued an RFP, performed due diligence on the selected supplier and waited to receive the ventilators before making payment. Whereas the state eventually terminated the contract after the supplier failed to deliver, it is unclear whether any state funds were lost.

Post the Ebola Crisis of 2014, Transparency International stated inter-alia that weak public financial management systems coupled with high levels of corruption in the [recipient] countries created many avenues for the abuse of power, bribery and unethical actions that limited the ability of funding to be used effectively to stem the outbreak. Given that so much money flooded into the region in a short period of time, accountability for those funds needed to shoot to the top of any list of priorities[iv]. However, for most practitioners, governance issues took a back seat until it was too late. 

Closer to home, a brief  to the National Assembly in response to a letter ref no NA/DCS/HEALTH/2020/023 of 24^th April 2020 regarding updates on COVID-19 funds threatened to derail the fight against the pandemic with Transparency International and the general public asking the Government to account on utilization of COVID funds[v].  At the said date, the MoH indicated that it had negotiated KES 8,077,320,434 (approx 80m USD) towards various health related interventions from the GoK and other donors such as the WB, Global Fund & Gavi plus in-kind contributions from Jack Ma Foundation & others. As the government struggled to make up for plummeting revenues by reprogramming activities and seeking assistance from development partners and the local community, it was not lost to the population that the funding received included in part utilization of KES 4m for tea & snacks, KES 70m on communication & airtime and KES 42m on leasing of ambulances which was considered wasteful and insensitive to the crisis.[vi]  The allocation for tea & snacks was reminiscent of the  oft quoted Hutton v West Cork Railway Co (1883) case at the UK Court of Appeal [vii] in which Lord Justice Bowen pragmatically concluded that “Although the law does not say that there are to be no cakes and ale, but there are to be no cakes and ale except such as are required for the benefit of the company.” In response to accountability concerns, the said report was later retracted without providing further information to reassure the populace that funds & contributions were being spent for purposes intended leading pundits to point to a looming scandal around the COVID funds.

This pandemic is particularly challenging with stay at home orders, lockdowns and inability for Government staff to perform what would be routine due diligence procedures.  However, the GoK can overcome the structural challenges posed to not only fight the pandemic but also institute safeguards that minimize misuse, misappropriation and ensure value for money.  Traditionally, the audit of any institution’s finances would normally take place when an activity for which funds have been provided has been completed and financial statements are submitted for auditing purpose.  However, due to public sensitivity and a sudden surge in the inflow of funds/in kind contributions, it would not be unusual for Supreme Audit Institutions to carry out ex-ante procedures & audits as and when such funds/in kind contributions are being disbursed. Generally, this is to ensure that public funds allocated – irrespective of the source - are fully and solely directed to the cause at hand and where there are anomalies, that these are promptly dealt with.

The Institute of Certified Public Accountants of Kenya has opined that corruption and theft of public funds not only drains public resources but also harms the government’s ability to provide adequate healthcare (including fighting the pandemic) and erodes public trust. The institute suggests practical ways[viii] where beyond simply a medical response, the Government may define acceptable financial management standards if it is to succeed in addressing what is the Government’s largest challenge since independence.

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[i] https://voices.transparency.org/covid-19-perfect-storm-for-the-corrupt-c42eb9dfc234?gi=7a502e223745

 

[ii] https://blogs.worldbank.org/voices/can-corruption-risks-be-mitigated-without-hindering-governments-covid-19-response#comment-210346

 

[iii] https://www.independent.co.uk/news/world/americas/new-york-coronavirus-ventilators-yaron-oren-pines-trump-tweet-cuomo-a9492531.html

 

[iv] https://www.transparency.org/en/press/transparency-international-calls-for-comprehensive-audit-of-ebola-funds-in#

 

[v] https://www.msn.com/en-xl/news/other/come-clean-on-sh13-billion-covid-19-funds-ti-tells-state/ar-BB13tzf7

 

[vi] https://www.standardmedia.co.ke/article/2001369631/how-sh1-billion-coronavirus-fund-was-spent

 

[vii] https://www.irishtimes.com/news/crime-and-law/cork-rail-case-clever-and-progressive-1.527442

 

[viii] https://www.icpak.com/inthenews/lets-be-alert-to-prevent-theft-of-covid-19-funds/

 

OPPORTUNITIES FOR KENYA & FIGHTING THE COVID-19 PANDEMIC

The Government of Kenya faces an unpresented crisis for which it instituted certain measures to respond, in order to secure its population. When the WHO declared the 2019-nCoV outbreak a public health emergency of international concern on 29th January 2020, countries started rolling out evolving strategies to curb the pandemic's ravaging consequences in a fluid and fast paced environment.    

Although the exact magnitude of the spread and impact of the virus in Africa is unclear, it is noteworthy that the WHO had warned that up to 190,000 people in Africa could die of COVID-19 related illnesses in by July 2020.  Other models by Western Epidemiologists had predicted even larger numbers resultant from the pandemic.  However, Africa’s weakness was perhaps its greatest strength with African Governments – cognizant of the threat posed by weak health systems – responding early, to avoid an apocalypse. Convened by the relatively young African CDC, an emergency meeting of African Health Ministers endorsed an Africa Joint Continental Strategy for COVID-19[i] leading to early political engagement and preparedness which demonstrated an ability to address future public health challenges. The other unintended impact is the increased focus of hygiene - with focus on fumigation and washing of hands - is  likely to impact other germ related illnesses.

From a clinical lens, health issues have taken center stage and forced the conversation around weak health systems and poor investment in health into the limelight. This should see more funding into the Health Sector in line with the 2001 Abuja Declaration[ii] where the African Union countries pledged to set a target of allocating at least 15% of their annual budgets to improve the health sector. UNECA indicates that COVID-19 has led to unanticipated increases in Health spending of up to USD 10.6 bn in Africa. If this is sustained year on year, then Africa will have the potential to meet the needed health financing gap.

 

Various press articles reported that Pasteur Institute in Dakar, Senegal[iii] and KEMRI in Nairobi, Kenya[iv] (in partnership with international research organizations) had started working to authenticate test kits that would produce test results for COVID-19 in 10 – 15 minutes.  The acumen in these innovations can be attributed to the fact that – with enough investment - technological know-how can be promulgated regionally for the benefit of the Continent.  Building on the COVID-19 momentum provided the opportunity to address outstanding human resource for health challenges with countries like Kenya recently advertising for 5000 additional health positions and expanding hospital capacity.  Public private partnerships have been enhanced to resolve what is otherwise a public health problem with bodies such as the the Kenya Health Federation - representing the Kenya Private Sector Alliance - rising to the occasion to influence public policy and bridge the gap left by the public sector.  Medical personnel of Kenyan origin from across the globe have rallied together through virtual platforms to exchange solutions on case management which is cheaper than alternative modalities for capacity building.

On the enabling front, COVID-19 has created a hub for innovation at the local level with citizens adapting local solutions to local problems in the absence of external support. The interruption of global supply chains has provided impetus for the revival & adaptation of garment factories in Kenya to manufacture & supply personnel protective equipment for health workers and masks for the general public in the face of the pandemic. Indirectly the revival of such factories has boosted the agricultural sub-sector for cotton farming and will increase household spending in health (and other social sectors) as people retain jobs despite the lock down.  It also became evident that the alcohol/ethanol industry could produce large volumes of hand sanitizers that are always in demand in hospital settings but have heretofore been imported. Travel restrictions occasioned by the pandemic have revived the debate around an over reliance on South Africa & India for treatment of many health conditions & importation of basic health requirements which have been poor policy choices.


Not to waste this crisis, African states must – through the African Union, African CDC and African Development Bank - continue to approach Health System Strengthening from a multisectoral & continental lens.  Investing in continental, regional & local institutions will increase the level of preparedness to address future pandemics.   In so doing, Africa can overcome its structural challenges to not only fight the pandemic but also inform long term policy positions that will enable it recover from an adverse post-COVID-19 impact. Beyond simply a medical response, Africa at large and Kenya more specifically, must look to the plethora of expertise at its disposal to define acceptable policy solutions to address what is the continent’s largest challenge since Independence

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[i] https://africacdc.org/download/africa-joint-continental-strategy-for-covid-19-outbreak/

 

[ii] https://www.who.int/healthsystems/publications/abuja_declaration/en/

 

[iii] https://edition.cnn.com/2020/03/12/africa/senegal-uk-coronavirus-rapid-test-kit/index.html

 

[iv] https://www.standardmedia.co.ke/health/article/2001367222/kemri-starts-manufacturing-covid-19-rapid-test-kits

 

SOCIAL DISTANCING DURING THE COVID-19 PANDEMIC IN KENYA

Following the 11 March 2020 WHO declaration of 2019-nCoV as a pandemic, Kenya’s Cabinet Secretary for Health (Health CS) declared COVID-19 a notifiable disease vide Gazette Notice No. 2787 of 2020 and subsequently, declared it a formidable epidemic vide Legal Notice No. 37 of 2020 in exercise of powers conferred under the Public Health Act.  Without vaccines or medicines available, most of the solutions at the disposal of the Health CS were neither clinical nor pharmaceutical.  One such solution is “Social Distancing” which, for many Kenyans was dead on arrival as it is premised on a social construct that is alien to the average Kenyan.

When “Social Distancing” was first touted as the panacea for COVID-19, the question Kenyans raised was how people who lived in “Pipeline” were expected to “social distance”.  The middle & upper class furloughed their maids and markets were closed as news of a pandemic struck fear into people’s hearts.  The poor complained that they, who only “saw airplanes on Viusasa”, bore the brunt of a disease imported via Kenya’s national airport from abroad.  It is the poor working class who faced the wrath of the police as they enforced curfew restrictions and asked why they wore no masks. It is they - without safety nets or medical insurance - who could not sell their wares at they had always done.  Faced with bigger challenges like where their next meal would come from, families in crowded settlements considered, “Social Distancing” an alien & elitist concept.  How does one “social distance” in the myriad of informal or densely populated settlements that are an integral part of Kenya’s skylines?  It is therefore unsurprising that on any given day “jobless corner”, in Nairobi’s CBD near the iconic Hilton Hotel, was said to be as full as usual and where “Social Distancing” was not observed in any way, manner or form.

To add insult to injury and pointing to a disjointed strategy, the early morning surprise eviction – in the midst of a lockdown - of over 5,000 families in one of the settlements in Nairobi, despite a court order, led residents to question how a government would have proceeded with an eviction, had it been serious about containing a pandemic. The national opprobrium was based on the fact that it would be quasi impossible for those rendered homeless to seek alternative shelter due to curfew hours, lockdown between geographical boundaries and lack of affordable housing stock.

The issues in the Brazilian Favelas, the Kenyan Slums, the Egyptian City of the Dead and South African Black Townships are similar.   Most of the people who stand, squat, sleep or hang around these areas pay rent to slumlords and try their best to eke a living despite the extremely unfair situation that they find themselves in. Perhaps what is an unfortunate situation is also their biggest advantage, that their bodies are immune to what is otherwise a ravaging disease.


The human being is resilient and those who are forced to live in these settlements make the best of their situation.  A few even thrive but this does not reduce the tragedy of that existence.  That one is forced to raise their children in such deplorable conditions - either by choice, circumstance or design - is a mockery of the vote that they carry in a democratic society and a waste of the tax they pay either directly or indirectly. These challenges are best explained by the summary in "A House for Mr Biswas" by VS Naipaul which ponders about the dishonor of one having to live and die as one had been born, unnecessary and unaccommodated.

The question the Health CS has not answered is how one “Social Distances” when there is no space.

FIGHTING THE COVID-19 PANDEMIC IN KENYA – AN OPINION

CONTEXT

The Government of Kenya faces an unprecedented crisis for which it has instituted certain non pharmaceutical measures to respond, in order to secure its population. Since 29th January 2020, when the WHO Director-General Dr Tedros Adhanom Ghebreyesus declared the 2019-nCoV outbreak a public health emergency of international concern, countries started rolling out evolving strategies to curb the pandemic’s ravaging consequences in a fluid and fast paced environment.  Even the most advanced economies are learning as the pandemic evolves. The Institute of Business Forecasting and Planning predicts that although total accumulated cases in the USA currently stand at 1,208,904 with total accumulated deaths at 69,458, by July these figures would rise to a total accumulated caseload of 1,830,796 and total accumulated deaths of 94,194[i]. Upon the WHO declaration, on 11 March 2020, of 2019-nCoV as a pandemic, Kenya’s Cabinet Secretary for Health (Health CS) declared COVID-19 a notifiable disease vide Gazette Notice No. 2787 of 2020 and subsequently, declared it a formidable epidemic vide Legal Notice No. 37 of 2020 in exercise of powers conferred by Public Health Act.
OPPORTUNITIES

On the one hand, Health issues have taken center stage in Kenya and forced the conversation on weak health systems and poor investment in health - despite Health System Strengthening programs -  into the limelight. COVID-19 should leave Kenya with more medical staff hired plus expansion of hospital capacity as counties scramble to prepare for the pandemic.  The Kenya Health Federation[ii] - which is the health sector board representing of the Kenya Private Sector Alliance (KEPSA) has risen to the occasion to influence public policy and bridge the gap left by the public sector. Medical personnel of Kenyan origin from across the globe have rallied together through virtual platforms to exchange solutions on case management. COVID-19 should also create a hub for innovation at the local level with citizens seeking local solutions for local problems in the absence of external support. The interruption of global supply chains has provided impetus for the revival of two cotton/garment factories to manufacture & supply PPE & clothes in line with the Government’s Big 4 agenda that promotes industrialization as one of its pillars[iii].  Of note is that revival of such factories quickly boosts the agricultural sub-sector for cotton farming. It has also become evident that the alcohol/ethanol industry can produce large volumes of hand sanitizers that are always in demand in hospital situations.  Following an initial impasse, the Kenya Revenue Authority has allowed the previously defunct Mumias Sugar Company to manufacture ethanol under bonded arrangement.  An over reliance on South Africa & India for treatment of many health conditions (and donors for solutions) & importation of used apparel have always been seen as poor policy choices as these can be provided for locally with a positive impact on the economy. Lastly, Kenya has continued to export vegetables and flowers to its major markets throughout the pandemic to earn much needed foreign exchange and keep jobs in the agricultural sector despite the lockdown.
STRATEGY
Challenges are apparent with the GoK facing an increasingly restless population that is either unable or unwilling to comply with the various legislative orders put in place, due principally to economic considerations.  Critics have pointed to the GoK’s lack of foresight in its handling of the pandemic and a severance of the social contract between the Government and its citizens[iv].  Kenya’s saving grace is that COVID-19 has heretofore spared it the worst of the pandemic which would have been disastrous for a country with a fragile health system. However, having studied the COVID-19 pattern in harder hit countries, a second and third wave seems likely, if not probable. Of note is that, countries such as Nigeria & Germany reported an increase of COVID-19 cases the day their Governments relaxed measures.  The GoK lacks a coherent strategy expected to clearly stipulate emergency preparedness, risk assessment, epidemic management, monitoring & case management, making it reactive rather than proactive. Many of these principles can be gleaned from the Ebola & HIV crises of years gone by and extend beyond the ambit of the Ministry of Health at the National Level.
STIGMATISATION
It was obvious that the stigmatization of patients of COVID-19 would be the country’s Achille’s heel. The hurried internment, in the deep of the night of a 59-year-old man in Western Kenya who allegedly succumbed to COVID-19 – without the dignity of a prayer or a coffin - was touted as “barbaric” by most Kenyans[v].  That none of the family members subsequently tested positive for COVID-19 after an 18-day mandatory quarantine exacerbated the level of distrust, with many questioning whether indeed the deceased had succumbed to the dreaded disease. Interestingly, the county health officials were seen to have gone against the already laid out Ministry of Health procedures for burial during this period. The Senate Committee belatedly instructed the Ministry of Health to roll out robust programs for county health teams on guidelines & protocols for handling of a person who had died of COVID and address the associated stigma with coming into contact or having a family member die from COVID. The International Committee of the Red Cross addresses this challenge to ensure that those who have passed away during COVID-19 are properly handed in a dignified manner[vi]
COMMERCIALISATION
The quarantine procedure in Kenya has been grossly mismanaged and is regarded as callous and fraudulent. Those affected have complained of excessive hostel payments, secrecy around test results and lack of psychosocial support during the quarantine period. The unsanitary conditions in quarantine facilities render those facilities as vectors for the coronavirus and/or other pathogens[vii].  Whereas the WHO has advised that the “backbone” of the response is “isolation, testing and tracing”, the GoK now finds itself in a catch 22 situation where sections of the population refuse to present themselves for voluntary testing for fear of being isolated and their loved ones quarantined.  A frustrated governor from a coastal county complained about the lack of utilization of voluntary testing services put in place despite assurances. The Health CS further decried the abnormally low frequentation of hospital services for routine services including for immunization & maternal and child health. Most disturbing are expectant women unable to access maternity services or losing lives during labor for fear of “breaking curfew rules”.  Stable cancer, heart, hypertension and diabetes patients caught on one side of the boundary have been unable to access specialized services at referral hospitals. Following allegations of commercialization of the quarantine effort, on 6^th May 2020, the Health CS recapitulated and indicated that the GoK would henceforth meet the costs for the testing and of mandatory quarantine as required under the Public Health Act.
MILITARIZATION
The UN office for Human Rights has voiced concerns on police brutality during lockdowns and singled out Kenya as one of the offending countries.[viii] Militarization of the pandemic response has led to resistance as victims allege various acts of criminalization.  It is noteworthy that more people have succumbed to police brutality during this period, as the police enforce curfew restrictions, than those who have died from COVID-19. The brutality of the Kenyan police includes but is not limited to forced quarantine for breaking curfew, open harassment for not wearing face masks and bludgeoning dissenting citizens to death[ix]. This further aggravates the distrust within a populace already on edge with social media awash with videos of people escaping from quarantine facilities or bribing their way out of them.
GOVERNANCE
A presentation to parliament by the Permanent Secretary for Health (“Health PS”) on COVID funds threatened to derail the fight against the pandemic. While the government struggles to make up for plummeting revenues by seeking assistance from donors, it was not lost to the population that the funding received included in part, utilization of KES 4m for tea & snacks, KES 70m on communication & airtime and KES 42m on leasing of ambulances which was considered wasteful and insensitive to the crisis.[x] This led to allegations that the GoK was padding up infection numbers to attract funds from donors concerned about global health security.  In response to accountability concerns, the Health PS, on 5^th May 2020 retracted the report without providing further assurances that funds were being spent for purposes intended leading pundits to point to a looming scandal around the COVID funds.
ECONOMIC IMPACT
Economic considerations have impacted how the population has reacted to the raft of measures set out by the GoK to contain the pandemic. Whereas many rich countries have provided unemployment benefits and allied packages to those whose incomes have been affected, this is unthinkable for low-income countries with neither the fiscal space nor the contingency funds to face any crisis given reliance on the daily collection of revenue. In this crisis, the GoK was caught flat footed as many tax paying businesses were closed. Without appropriate safety nets, the general populace is unable to adhere to “stay at home” orders as they must fend for their families[xi]. In addition, newspapers are replete with tenant/landlord disputes as tenants agitate for a three-month moratorium on rent payments during the COVID-19 period.  Many organizations have ignored the Government’s request to have employees work from home since no voluntary rescue measures are available and some organizations have issued redundancy notices which further threatens source of livelihoods. In the education sector, the e-learning proposals[xii] have also raised questions around access & equity with rural and poor students disadvantaged as a result of a previous aborted government strategy to provide laptops to all learners.
LABOUR ISSUES
Due to a global shortage not limited to Kenya[xiii], the GoK has been unable to deliver on critical promises such as provision of Personal Protective Equipment & recruitment of adequate health personnel. The WHO highlights that an estimated 89 million medical masks, 76 million examination gloves & 1.6m googles are required for the COVID-19 response each month.[xiv].  The global shortage notwithstanding, it is unclear how the donations from the Jack Ma foundation were distributed since County Hospitals still complain of a lack of PPE with health workers refusing to attend to patients. But the solution is not "more PPE" but a rational use of PPE for COVID-19 as per the WHO interim guidance for the use of PPE[xv]. This – lack of protective equipment - adds to a simmering situation where the number of health personnel per 100,000 people is significantly below the WHO requirements due in part to a desire to contain the wage bill and the lack of a Health Service Commission.  To address the staff shortage, on 3^rd April 2020, the GoK advertised up to 5,000 vacancies for various health care workers for hospitals around the country. As at the time of writing this article, none of these workers had yet to arrive at the county facilities where they are most needed. It will be a gigantic challenge to ensure that they are recruited, trained and prepared to face the COVID-19 pandemic should the pandemic evolve.Whereas essential workers on the front lines of this crisis are deserving of premium/hazard pay and protections that keep them safe, the Government of Kenya is faced with a disillusioned workforce where the unions & societies representing medical personnel have recently issued a 14-day notice to strike citing unfavorable working conditions[xvi].   A PR gimmick by the GoK to send flowers to UK medical personnel on 30^th April 2020 was not without its critics within the medical sector given local challenges. To address this imminent threat, the GoK on 6^th May 2020 announced a KES 3bn “COVID allowance” to recompense all health workers.
FRAGILITY
The pandemic comes at a bad time for the GoK which is yet to address the pending structural issues arising from the devolution of health[xvii] under the 2010 constitution. Whereas, other countries have also faced similar challenges, Kenya’s Health System has less than 200 critical care beds for a population of 47 million people[xviii].  A recent death – unrelated to COVID – at the largest hospital in East and Central Africa, Kenyatta National Hospital with a bed capacity of 2000 and 36 critical care beds brought to the fore the challenges faced by doctors in triaging access to critical care[xix]. The claim by the Health CS that Kenya had a 1000 critical care bed capacity was challenged by the Kenya Health Federation who also demonstrated that some counties had none. It goes without saying that there is more to critical care capacity than beds.
PRIORITIZATION
Whereas the most topical issue is COVID-19, Kenyans are faced with other significant challenges such as a locust invasion that threatens crops, damage to road infrastructure, flash floods that lead to displacements, mud slides that threaten livelihoods, cholera which has never been contained and the threat of a looming famine of “biblical proportions”. The government recently announced that it had nil maize strategic reserves should the coronavirus extend beyond a three-month period.[xx]  According to initial estimates, floods and mudslides have killed nearly 200 people and displaced more than 100,000 [xxi] whearas only 30 have succumbed to the pandemic.  The early morning eviction of over 5,000 families in one of the settlements in Nairobi, [xxii] despite a court order, lead residents to claim that the coronavirus was a hoax as the government would not have proceeded with an eviction in the middle of a pandemic. The national opprobrium was based on the fact that it would be quasi impossible to seek alternative shelter due to curfew hours and lockdown between geographical boundaries. (Kenyans last line of action is to relocate to rural homes when faced with a crisis in the city). Faced with floods, mudslides, evictions and the Holy Month of Ramadhan, social distancing which itself is an alien & elitist concept for families in crowded settlements takes a back seat. How does one social distance in the myriad of informal or densely populated settlements that are an integral part of Kenya’s skylines? Although washing hands is a solution for the pandemic, how are citizens expected to comply when running water is unavailable most days of the week? On 8th May 2020, the Nairobi City Water & Sewerage Company issued a notice stating inter-alia that it had shut down water treatment at Sasumua Dam treatment works which supplies 11.6% of Water to the Nairobi City County population. This was occasioned by a massive landslide in the Aberdare ranges[xxiii].
CONCLUSION
However, all is not lost and the GoK can overcome its structural challenges to not only fight the pandemic but also undertake long term policy positions that will enable it recover from an adverse post-COVID-19 impact. To succeed, Kenya in particular and Africa more broadly, should not waste this crisis, but must endeavour to approach this pandemic from a multisectoral lens. Using the Africa Union & Africa CDC, Kenya must push for African states to overcome barriers to regional production and reduce reliance on foreign solutions given that, in a global scenario, Kenya (and other LICs) will always be at the bottom of the pecking order. It is not lost to Africans that although Cote D'Ivoire, is the world's 7th largest producer of natural rubber, latex gloves are imported as the capacity to transform natural rubber into finished or semi-finished products has never been developed.  By understanding the psycho-sociological determinants of human behavior and making an effort to demilitarize, decommercialize and destigmatize the response to COVID-19, Kenya will come out stronger. Beyond simply a medical response, the GoK must look to the plethora of professionals at its disposal - both at home and abroad - to define acceptable policy solutions to address what is Kenya’s largest challenge since independence in 1963.

Other Contributions 
Dr Akwabi Wameyo , MBChB, MMed
Ms Amunga Wameyo, BComm, MBA, CPA(K)
Mr Hillary Wameyo, BSc, MBA, CPA(K)
Ms Olivia Wameyo, LLB, LLM
Mr Ted Malumbe, BA, MSc
Mrs Joyce Wameyo

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[i] https://demand-planning.com/2020/05/05/update-covid-19-usa-new-york-rolling-forecasts/?utm_source=Business+Forecasting%2C+Demand+Planning+and+S%26OP+News+and+Events+from+the+IBF&utm_campaign=11f3fc105d-BLOG_EMAIL_CAMPAIGN&utm_medium=email&utm_term=0_06ebba403d-11f3fc105d-43642238

[ii] http://khf.co.ke/

[iii] https://www.businessdailyafrica.com/datahub/The-silver-lining-in-Covid-19-pandemic/3815418-5528766-mnn2od/index.html

[iv] A Social Contract, in political philosophy is an actual or hypothetical compact, between the ruled and their rulers, defining the rights and duties of each.  In an ideal situation, the ruled have a fundamental belief that the ruler acts in the best interests of the collective. 

[v] https://www.nation.co.ke/counties/siaya/Orengo-sues-over-Siaya-Covid-19-burial/1183322-5523110-kk6r1k/index.html

[vi] https://www.icrc.org/en/document/covid-19-authorities-must-urgently-plan-ahead-ensure-dead-bodies-are-properly-handled

[vii] https://www.voanews.com/science-health/coronavirus-outbreak/rights-groups-deplore-conditions-kenya-covid-quarantine

[viii] https://www.reuters.com/article/us-health-coronavirus-un-rights-idUSKCN2291X9

[ix] https://www.aljazeera.com/news/2020/04/fury-kenya-police-brutality-coronavirus-curfew-200402125719150.html

[x] https://www.standardmedia.co.ke/article/2001369631/how-sh1-billion-coronavirus-fund-was-spent

[xi] https://www.nation.co.ke/news/Kenyans-snub-Kagwe-stay-at-home-orders-coronavirus-/1056-5501980-101yfupz/index.html

[xii] http://www.rfi.fr/en/africa/20200417-covid-19-widens-kenya-s-digital-gap-as-students-without-internet-access-penalised-coronavirus-rural

[xiii] https://www.adb.org/sites/default/files/publication/579121/ppe-covid-19-supply-chains-bottlenecks-policy.pdf

[xiv] https://www.who.int/news-room/detail/03-03-2020-shortage-of-personal-protective-equipment-endangering-health-workers-worldwide

[xv] https://apps.who.int/iris/bitstream/handle/10665/331498/WHO-2019-nCoV-IPCPPE_use-2020.2-eng.pdf

[xvi] https://www.africa-press.com/kenya/community/health-workers-extend-strike-notice-to-monday

[xvii]https://www.researchgate.net/publication/321050763_DEVOLUTION_OF_HEALTHCARE_IN_KENYA_ASSESSING_COUNTY_HEALTH_SYSTEM_READINESS_IN_KENYA_A_REVIEW_OF_SELECTED_HEALTH_INPUTS

[xviii] https://www.nation.co.ke/news/Medics-warn-of-a-health-crisis-over-limited-ICU-beds/1056-5509438-30cjy3z/index.html

[xix] https://www.nation.co.ke/news/The-painful-death-of-Ken-Walibora/1056-5533854-hwum1xz/index.html

[xx] https://www.pd.co.ke/news/national/maize-reserve-stores-empty-says-strategic-food-reserve-29992/

[xxi] https://www.nation.co.ke/news/Declare-floods-national-disaster--leaders-say/1056-5543726-o18nfn/index.html

[xxii] https://www.the-star.co.ke/counties/nairobi/2020-05-06-kariobangi-north-residents-still-in-the-cold-leaders-condemn-evictions/

[xxiii] https://www.standardmedia.co.ke/ureport/article/2001370613/the-following-areas-in-nairobi-will-experience-water-shortage