Primer on Methodology

 

Can democracy grow “organically” in this era of neoliberalism?

HOMEGROWN DEMOCRACY

I read Dr. Moses Khisa’s article in the DM of April 17/21 entitled; “The Problem of Promoting Democracy” and extracted three interesting premises which I thought are worth a rebuttal.

The first premise was that the reductionist act of casting a vote and enthusiastically supporting one’s candidate while unaware of the socio-political context in which such an exercise was designed, simply aid in afflicting the mind of an overzealous nation with utter delusion. The second premise was that democracy cannot be an import. It must be grown from inside, organically, through protracted citizens’ activism and struggles. The third premise, and perhaps a classical observation was that a viable democracy depends on a viable state.

I found Dr. Khisa’s piece evocative. There are more versatile political scientists who could, perhaps, rebut this piece. On my part, I am compelled to respond to the three premises as follows.

Premise 1 – on derision and delusional anticipation of change through the reductionist act of casting one’s ballot as democracy, I do agree with the author. Indeed, democracy is not merely validated by an event of voting or running crazy after a sloganeering candidate of choice. This observation has been the convergence point for many of us who, for the longest time, dissuaded the legitimate section of Uganda’s opposition from validating sham elections disguised as “democracy” where the habitual candidate and incumbent organize it behind closed doors.

The opposition must not wait for the next elections to begin organizing and engaging the fascist regime in a meaningful dialogue. We have learned that most last-minute deals have degenerated into transactional politics – the dominant means of survival among the “Abazukulu” politicians.

With the many draconian laws that curtail human liberties and freedoms to organize, the Ugandan version of democracy has become an illiberal ritual of validation. Indeed, participating in this kind of democracy makes prominent politicians compete with invalid votes because the incumbent already holds the leash to the “valid” outcome.

Premise 2 – On growing democracy organically from within, I disagree with the author. In the era of neoliberalism, foreign interests such as multinational corporations have amassed for themselves so much power, influence, and privileged situatedness with sacrosanct legal rights. In an authoritarian environment like Uganda, multinational and transnational corporations have enough dirty money to write the course of “democracy”, to shape public policies without input from the people.

In the Ugandan scene, I hear a cacophony that the small Indian businesspeople pay more taxes than all Ugandans combined. In another, that MTN - a multi-national corporation is a top taxpayer in the country. Ironically, a 2019 Economic Policy Research Centre (EPRC) study found that domestic investors in Uganda pay more taxes than multinationals.

The cumulative impact of this propaganda is to undermine citizens’ capacities to nurture democracy through legitimate civil activism and holding the authorities accountable. The space for exercising civil rights is already violently curtailed because the state, itself under captivity from the armed junta, considers citizens as unworthy elements in shaping the nation’s destiny. The state survives on taxes. If the taxpayers are foreign investors or multinational or transnational corporations, that shifts the allegiance of the state to the ones who pay taxes. Neoliberalism itself is anti-statist for its exploitative agenda. It, however, expects a strong state intervention when the marginalized masses threaten its exploitative nature.

Further, democracy as an idea, ideal, or practice is inherently alien to and highly contested in the continent. The nations that might grow their in-house democracy, are nations that chose democracy as a compromise over annihilation from anti-imperialist wars. Democracy is not “native” to any of them.

Premise 3 – On democracy as dependent on a stable and a neutral, thus a viable state, I agree and reiterate that the relationship must be mutually reinforcing.  

End.

 

 

Why power discussion is central to health equity.

 

HEALTH EQUITY AND POLICY

Reading Amb. Rudi Veestraeaten and Prof. Rhoda Wanyenza’s article in the Daily Monitor of April 7, 2021, about health equity as the theme for this year’s World Health Day was refreshing.

The article applauded Uganda’s strides towards affording Ugandans a certain level of health services, mostly that reduced maternal-child mortality and so forth. The article also identified key areas where efforts have lagged mostly due to government underfunding of the health sector. It further identified emerging health challenges such as early teen pregnancies, a barrier to accessing health information, and specific sexual and reproductive health services reaching the poor.

My rejoinder is that the two dignitaries could have been clearer by not mixing the pursuit of health with healthcare. And this is the "problematic" prevailing in health equity debates, especially when a non-committal term such as "disparity" is used to ascribe inequities. Critics have identified the persistence of positivist science as central to this aberration such that we must be deliberate to discern health from healthcare in every conversation.

Health inequity consideration arises from social and economic conditions, most of which are unfair but also avoidable. Health care pertains to downstream curative approaches which are narrow in scope. Health is the general wellbeing, and it depends on social, economic, and environmental determinants (Social Determinants of Health), whose resource distribution is moderated through public policies. How these resources are produced and distributed across the population defines inequities in health. For example, the closure of schools and workplaces during the pandemic and subsequent failure for parents to feed or pay fees for their daughters to return to school contributed to a national teen pregnancy crisis.

For health equity to materialize, society should question imbalances in the distribution of power and privileges in a way that paves way for equity public policy - itself a social determinant of health. Rudolf Virchow demonstrated this correlation during the 1847-8 Typhus epidemic in upper Silesia. Rudolf developed the term “social medicine” to reflect the need for social, economic, and cultural factors that he deemed central in the typhus etiology and identified the lack of participatory voices (alienation from politics and democracy) as contradicting local efforts to contain the outbreak.

Virchow’s experience translates in the Uganda scene by the increasing socio-political disempowerment of Ugandans through the rampantly fraudulent and violent socio-political processes. The chronic and pervasive corruption and violence against the people disempower citizens from holding their state managers accountable for inequities in their health experiences. When people feel that they have no voice in how their society should be managed, their input in the public policy processes diminishes to their own detriment.

Today, very few Ugandans can seek accountability for failures of government to deliver services relevant to health. Take, for instance, we all know the importance of education and early childhood development, accessible healthcare services, employment and working conditions, infrastructure and built environment, etc., have on the health of every community. These services are often delivered within a community, requiring community input in ensuring that they are made accessible and culturally relevant. Without the political clout and community voice, the government has felt no obligation to elevate these services to an acceptable level rather than divert service delivery to the private sector. Social services are constantly on the decline among the poor majority indicating a loophole in the policy processes, but also a strong favor for the market orientation.

Most revealing is the new concept of equity in this aegis of neoliberalism. The government is steering Uganda into the money nexus, and yet many Ugandans are not prepared. In effect, commodification has augmenting exclusion in understanding the dynamics of the money economy and its distribution, thus, equity now means the ability to pay from out-of-pocket to gain access. 

Moreover, monetary income is the most important element in the market economy. In the Ugandan context though, the market orientation is exclusive of the majority with soaring unemployment across the population affecting the social and family context. That experience further strains social relations as everyone depends on the other. This is made worse because liberalism thrives on individualism which is literally tearing families apart.

Lastly, health equity has been redefined and Ugandans should see it for that. The true meaning of health equity is that individuals, and not the government, should cater to their needs using out-of-pocket resources, which is driving families to catastrophes. The idea that healthcare is the solution to poor health is untrue. We must escalate investment in a socio-politically empowered community and in their public health systems. The 2008 WHO Commission on Social Determinants of Health stated it succinctly that what makes people unhealthy or healthy are found in the communities and not in healthcare facilities.

END