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

War Mongering during elections is unconstitutional.

WAR MONGERING

In 1996, Dr. Kawanga Semogerere of DP teamed up with Hon. Cecilia Ogwal of UPC to give Museveni a ran for his money. I was a high school student watching Museveni lie through his teeth. I was also an avid admirer of Ms. Ogwal, not so much of Semogerere, because he played a significant role in legitimizing the fraud that the Museveni regime has become and the decline of DP.

I was a regular at my HSC debating club during the 1994 Constitutional debate that resulted in Uganda's 1995 Constitution. That Constitution lacked in many ways, but it was a document that designed a clear democratic path for Uganda.

I could say some democracy because many of the critical levers that may have cemented Uganda's democracy were also made vulnerable to manipulation by Museveni's regime agenda.

The 1995 Constitution also gave Ugandans hope through term and age limits and a civil language that encouraged civil society organizations and opposition political parties to fetter. These are critical platforms that mediate between citizens and the state.

That Constitution also assured Ugandans that civic engagement was a right and not criminal – that citizens could protect the state from intruders and pronounce themselves over Uganda's territorial integrity using state machinery.

Left in its 1995 form, that Constitution could have delivered Ugandans to unimaginable triumph on several fronts, such as a peaceful transfer of power from one President to another or from one political party to another. This feat is vital because there has never been such an experience in Uganda's entire existence.

Suppose the Constitution was so clear on avenues through which Ugandans could legally participate in democratic governance and see that their will to be governed is respected. Why do we always get into this war-mongering mode at every election since 1996?

In philosophy and African wisdom or even in moral discourses, one does not get a valid result from a fake process. You cannot be pregnant by eating a mango. This concept feeds into the logic of mathematics and all sciences. Machiavelli failed society as a desperado by claiming that the end justifies the means. In lawful and organized philosophical or scientific society, only the means matter.

In 1996, when Dr. Semogerere picked Mrs. Ogwal as his running mate, Semo was demonized as Dr. Obote's empathizer. Musevenists went to Luwero and displayed skulls by the roadside, attributing that to wars of Obote. Spooky stories of ghosts of Obote and the northern hate-mongering filled the airwaves. The threat of going back to the bush was the highlight of that campaign.

Many Baganda shunned Semogerere and treated him as an Obote ally, a traitor, and an anti-progress that the NRM had brought. You may understand why the north is cold about a Muganda Bobi Wine.

In 1999 when Col Besigye jumped off the NRM bandwagon to challenge Museveni, the regime did not take it lightly. It blackmailed, threatened, and went ballistic on all fronts, accusing Col Besigye of planning wars, being an enemy of the state, and so forth. A similar pattern came on in 2006, 2011, 2016, and so forth. From 2006 to this date, there has never been a Presidential candidate not charged with treason.

Hon. Robert Kyagulanyi Ssentamu and Lt. Gen Henry Tumukunde have treason charges looming on their heads in this campaign.

In sum, it is a pity that the 1995 Constitution, even when fraudulently amended several times, did not remove Ugandan's rights to unseat an incumbent as treasonable. Some of the provisions within 1995 constitution, as amended dubiously, still recommend the preservation of human rights and rights to civil liberties, right to participation in civic discourses. Above all, it upholds that elections every five years.

If contesting against the incumbent constitute a threat to national security/war, or leads the state to kidnap, shoot at, detain without trial, torture, or murder citizens who are practicing their constitutional obligations, then what is the worth of a constitution disorder?

END

 

 

IEC should afford integrity and fairness to 2021 Elections

 SAVINGS ELECTIONS

 The gory scenes of Police vandalizing Hon. Robert Kyagulanyi's vehicle on his nomination day and battering his adherents conjured up frighteningly with the rather comical scene where the same police violently violated the FDC President, Hon. Patrick Amuriat. These events may serve the dictatorial regime, but it deprives the 2021 Elections of its much-needed integrity, decency, and fairness.

We should not tolerate violent elections or unfettered state violence against the opposition.

Images of scenes where journalists are battered to a coma while on duty tells a tale of tyranny and leaves quite impactful trauma in the mind of those who experience or witness it.

Those who care to read into and internalize this regime's militant engagement with the public rightfully have a very low expectation of 2021 Elections. As a social critique, the only plausible claim to any NRM ideology is militarism and its raw violence.  The conduct of the 2021 elections embodies this militarization in as much as the militarized agricultural programs or COVID-19 lockdown measures. And, the violence just increases at every subsequent election without an end in sight.

Comrades Kyagulanyi and Amuriat must take heed of these trends. I know they are doing their very best to remain level headed, calm and peaceful, however, even Chinua Achebe advises that any handshake which goes beyond the elbow, turns into something else. Solving sociopolitical problems using rampant and unjustifiable use of excessive state violence only helps to radicalize our youths and subdue our population. Thus, undermining the democratic processes.

The COVID-19 lockdown revealed a snippet of how meticulous militarism can go on a civilian population. The violence effectively immobilizes and disengages the opposition from interfacing with the voters and then generates voters' apathy towards the electoral process and its outcomes.

For democracy to occur, its tenets must be alive, and freedoms must be afforded to all.  How possible could Candidates Kabuleta traverse over 145 districts in 60 days when the only Candidate Museveni with rights to fly choppers and use the media unfettered?

The Byabakama's electoral commission has played its part in undermining the integrity of the elections covertly and overtly by their policy of non-action against police brutality on opposition candidates. Without equal access to the electronic media, this digital or so-called smart election is itself a big fat farce.

 The IEC must establish a clear rule to enable all Candidates equal and unencumbered access to the media. In Uganda, the NRM has consolidated its control over the media/press and press freedoms. The media is over-infiltrated, censored, surveilled, and most governed by the regime's cadres and operatives to the detriment of freedom of expression. As such, intellectual debates over the media have been curtailed and intellectualism has declined profoundly. 

 As it looks, Presidential Candidates, Hon. Robert Kyagulanyi and Hon. Patrick Amuriat will not be tolerated on the media waves to reach their audiences. I can predict that the regime may tolerate Hon. Mao and Gen. Muntu more for their benign presence on election tracks. Already Kyagulanyi is not even allowed to visit a district other than his own home in Magere or campaign venues.

 Further, the conduct of the militarized NRM police is a sobering indicator that there will not be any fairness in the 2021 elections. The so-called Independent Electoral Commission serves a mere functionality of legitimating an already flawed process if they cannot protect candidates and subdue the police. You could see how the Commissioners were so self-absolved and least bothered that Hon. Amuriat walked bare feet to his nomination at Kyambogo. That insensitivity ought to be called out. 

 The main conclusion is that the integrity and fairness of 2021 elections are on the line. The IEC should guarantee access to the media, control the police, and ensure free access to district facilities. 

End.

 

Raiding Opposition offices reveals the limit of Democracy in Uganda

 DICTATORSHIP

We woke up on Wednesday to the news that a combined force of the Ugandan army and police had raided the offices of Presidential hopeful and the charismatic youthful legislator from Kyadondo East, Hon Robert Ssentamu Kyagulanyi, aka Bobi Wine.

Both the army and police have not explained their motive or whether there is a formal investigation. The armed forces detained more than 100 supporters of the NUP party. But the marauding forces took literally every document, computers, and whatever they could land on to stifle the nascent party from organizing itself to challenge the dictatorship in the forthcoming elections. The police confiscated nomination, promotional items, and apparently some money intended to pay for NUP flagbearers in the just-concluded parliamentary nominations.

The raid on the NUP head office is not the first of its kind and will not be the last. The Forum for Democratic Change Party, Uganda’s largest opposition party has suffered its own episodes. The same combination of army and police have raided party headquarters at Najjanankumbi multiple times and at critical times, to carry away computers and sensitive party documents before, during, and after elections.

The problem is that Ugandans take these violent state assaults as a mere episode, thereby ripping it of the context in which such acts should be assessed and understood.

The limits of democracy in NRM’s Uganda has been apparent and yet we fail to read it correctly. John Stuart Mills once expressed his fears of how monstrous democracy can be. Mills was concerned with the tyranny of the majority over the minority and argued that such tyranny could generate and impose on the population certain moral rules and culture that the people may not necessarily want. Lenin was more cynical about democracy and many prominent scholars have asked whether democracy even exists.

In Uganda, where the military dictatorship is preoccupied with violence, what passes for democracy is what Lenin prescribed as the opportunity to spread propaganda to the backward strata. The origin of liberal democracy is exactly what democracy is now reinforcing in Uganda. Democracy arose as resentment to the monarchical monopoly over power. Democracy aimed at ensuring that ordinary people made decisions on how they wished to be ruled and served. This gave prominence to equality in society, recognized individual will and rights, which must be exercised freely among free men (and later women).

The conditions that constituted a “free man” has eluded Africans and particularly, Ugandans, making our democracy stale.

The freeman in Africa was demolished by events leading to and including colonialism. The violent way that states in Africa were formed must be examined formally elsewhere. However, both the colonial state and hegemony were entrenched through absolute violence. 

Franz Fanon ably linked the colonial psychological violence to pervasive psychiatric problems for the colonized. Elsewhere you read about physical violence, seclusion, deprivation, and so forth. These forms of violence have a transgenerational impact that must be properly studied and understood. It seems that chronic repression deforms society in as much as a chronic monopoly of power deforms its bearers.

The Ugandan state has maintained this finesse of colonial violence and the Museveni regime not only usurped that violent state apparatus, they even sharpened it.

In such a suppressive condition, the free will of man is also squashed. There remain men without liberty and freedom, but only dependent men whose "free will" becomes their token for subsistence. That free will becomes the preserve of violence. Under such a condition, liberation is reduced to a personal endeavor to supplicate the regime’s middle class, for whatever they can spare.

There is no democracy without free will. This pervasive state violence means Ugandans will not be able to change their government through the ballot in the next thirty years. Those who try to challenge the tyrants will be violently raided, even killed.

END.

Uganda Elites' fear-mongering discourses against Kyagulanyi erodes our democratic rights

FEARMONGERING

The Uganda elites have been most unfair to Hon. Kyagulanyi since he emerged as a firebrand opposition leader. They have treated Kyagulanyi condescendingly without letting up. Kyagulanyi, however, has continuously manifested himself in the total opposite of those who frame him as an elusive object of fear. The groups most vicious in their onslaught are even embedded within the enterprise opposition.

In politics, we understand the role of paid propaganda as part of the discourse production to sustain the status quo. A discourse is usually evidence-driven views, both textual and discursive that prevails in society as part of the dominant idea. These are transmitted either consciously or unconsciously to the masses to shape perspectives and decision-making in favour of those who produce it – those in power.

In the Ugandan context, “innuendo and rumours” have “replaced evidence-based” in as much as violence and impunity have replaced due process in laws. The rumours and innuendos gain legitimacy through certain individuals with power. Their sources of power could be patriarchy, crooked professionalism and experience, wealth and marital polyandrous status drawn from having regime ties and privileges.

Over time, the core arguments levelled against People Power Movement have varied and some, strange; yet unchallenged.

That Kyagulanyi’s group draws mainly from low life rascals, the “unwashed” of slums and are to be feared – as if Kyagulanyi produces slum dwellers.

Another group claimed that Kyagulanyi is violent, unpredictable and capable of derailing the rented elite conveniences under the repression – these hate to hear sentiments such as freedom or liberation.

Other groups argue that opposing Museveni’s tyranny and draconian laws equate to triggering a war – these pessimists do not realize that Hon. Kyagulanyi does not command an army or speak the language of violence.

Then there are the “Obama birthers” equivalent among desktop academics - these claim that Hon. Kyagulanyi is not academically sophisticated or experienced to lead Uganda - such groups fail to produce desktop evidence showing that high-level academics have delivered transformational corruption-free leadership anywhere in African since independence.

The non-Baganda groups argue that the People Power Movement, and now the National Unity Platform Party is a Ganda-centric ethnic consciousness whose central leadership is exclusive and hostile to non-Baganda – this group sits by and does nothing to probe up their own ethnic consciousness against misrule.

However, the most prominent of the siasa discourse emanates from the sensational propagandist, Mr Andrew Mwenda – that people power is a group of radical intolerant extremists capable of lynching anyone with whom they are disagreeable – this line disregards the main source of violence as Mr. Museveni, whose regime “crushes” any forms of organized opposition.

Of course, all of these claims are contrived and lack both substance and good intentions. Time has decomposed some of them with the failing the reputation of their proponents such as Mwenda.

Absolutely, it is not my place to speak for PPM or Mr. Kyagulanyi. However, as a righteous citizen of Uganda, it is important for me to redirect the masses away from the petty politics of fear and defending rented convenience.

I know that Mr. Museveni and group came to power with a one-way ticket and will do anything to retire in power.  Thus, exposing Uganda’s elite pretensions in this repressive environment can alleviate the fear levels.

Uganda is one of the many African countries where unconscionable elderly statemen are in charge of a very young population. These fellows are far more concerned with the hereafter than us who should concern ourselves about our future.

In generating and sustaining fear-mongering propaganda against Hon. Kyagulanyi, we collectively violated our own civic rights as citizens of Uganda with contempt and narrow the democratic space.

In sum, we are consciously digging our graves wider and deeper beneath the Museveni’s decades-long entrenched dictatorship by embracing fearmongering discourses.

END.

Of Gulu City's Illicit trades, Part 2

ILLICIT TRADES

In the first part about Gulu dames, I decried the Gulu elites’ bashing of prostitution as a viable economy. I recognized that prostitution is a blight in our societal conscience. I took exception of child prostitution and attempted to explain with many difficulties, the genesis of child prostitution as the total

breakdown of our social safety nets. Most of these maladies of society are exacerbated in the

post-conflict Acholi. 

I also paled off any pretense that Acholi that we know now, is as conservative, morally, as the Acholi we knew before the war. In this section, I guide my readers to what we should do. I start by enumerating the inevitability of societal evolution.

Far from Gulu, the other worlds have evolved spectacularly within the liberalised economic doctrine.

They have developed liberal markets where every item that money can buy, are sold. With such a

market, many of our vulnerable persons become commodities. Children become commodities,

not just for sex, but for labour, organs, research, trafficking, objects of luscious fetish, and so on.

A researcher, Kevin Bales concluded that these humans – without a proper and firm foundation

in a protective society, become disposable human beings. The children are used and recycled and

sometimes disposed of in mass graves.

An old report by the International Organization of Migration (IOM) revealed that children and

young women from East Africa, including Uganda, are being enticed by a mere plate of cooked

food and trafficked into the global line of human sex trafficking. These are serious concerns that

we should not turn into our past time gossip subjects. 

Clarity

I am not saying that prostitution is good. I am saying that it is despicable. Prostitution is a sign of

societal failures to provide equal opportunity for all. I am reiterating that prostitution is our

reality of a failed society. I am saying that by spending time lambasting the people who earn a

living as prostitutes, maybe someone should begin to understand them beyond their trade or that

identity – to look at them as daughters, parents, and citizens of value in a perverted society. 

Had it not been for COVID-19, and had it not been for the hunger associated with the quarantine

to force these women to place our leaders at “pussy point” as Bosmic Otim said, very few people

could have known that prostitution is marketable in Gulu. We now know that the demand for

prostitutes is high. We also know now that the most profitable consumers are Gulu local leaders.

A condition must exist for an event to emerge.

I am saying that these women lacked, and still lack opportunities for alternative income-

generating activities. , I am certain that we could do more for them as a society.– We could

initiate public policies that will provide a safety net for the children, make a demand for

prostitution unsavory and retrain these women into productive citizens.

Lastly, the colorful language we employ in describing prostitution is simply uncouth, violent,

dismissive, and barbaric. These people are earning a living and partaking in a sensitive sector of

the pleasure economy. They should be legalized, and their trade legitimized as work, licensed,

and therefore taxed. The taxes could be levied from designated operation chambers – brothels,

bars, stages, or hotels. 

As such, the women will no longer be called prostitutes, but dignified Sex Workers with rights

and respect like all traders and workers. This group, however, becomes of the essence for public

health, thus the necessity for licensure. Society must also be careful to discern the prostitutes

from the prostituted and sex workers. This can help in identifying the Pimps, Johns, and Madams

early on. Prostitutes do it voluntarily, independently, and are perverse. The prostituted are forced,

exploited, and often mistreated – children and disempowered rural women. The sex workers

have more rights and recognition in society because of their legal status. They could even have a

Union. It is hard to find a city in the world that has settled the issue of sex-workers, prostitution and prostituted decisively. One thing we must safeguard, however, is our people from

exploitation, human trafficking, and cruel treatment. The Bishops are allowed to disagree with

me!

End.

Evaluate the role of Political Parties in Uganda's democracy

PARTY POLITICS

I read Norbert Mao’s piece titled “Political Parties are key in democracy” in the Daily Monitor of Aug 2, 2020, that reminds us of the relevance of political parties in a pluralist democracy. Mao observes that political parties galvanizing the socio-political spheres in a polity through enforcing a set of core beliefs.

In adjoining this discussion, I emphatically assess that political parties in Uganda have been in abeyance for too long and have collectively lost their shine. Mao presides over the oldest political party in the country – the Democratic Party. His sobering recollection could, therefore, affirm that his own party’s values have faded and hard to recognise. As a seasoned lawyer and politician, Mao has a commanding knowledge and experience in party politics where he is held hostage to a turbulent party environment.  One challenge is that reinventing parties that are subsumed in a chronically repressive environment and yet strives to partake in a sham democracy willingly becomes a major contradiction.

Youths reading Mao’s article becomes doubtful if political parties in Uganda actually adhere to any core values or perform those roles, functions or responsibilities as Mao articulated. When I read the article, I struggled to delineate between Mao’s ideals and parties’ realities in the Ugandan political context.

The youthful Ugandans are acquainted with the abnormalities of parties and not their core values. Uganda has 29 registered political parties. Some are sold like pancakes to the highest bidders. Most are briefcase elements for pomp and defections. Those established and barely functioning parties are themselves war zones - places for quarrels, fights, and protracted tribal wars; or even where to rebrand for meal cards politics. Parties in opposition are known as the nexus of both physical and mental poverty.  There are parties in Uganda that have built reputations as the political uterus in which potential NRM cadres are conceived.

Ugandan Political Parties are treacherous and have become a reservoir of the politics of violent confrontations. The NRM regime has pulled out the gut material from all political parties and organizations rendering them clientele agencies. When Hon. Robert Kyagulanyi bought NUP, some people lamented that the People Power sophistication had ended. This is how people have strayed away from Parties.

Under Museveni, Parties are like bars - enclaves for political hotheads to cool off. Talk about flattening the political pressure curve! Party leaders are mostly listening post for the ruling regime, making it hard to trust any of them.

Mao needed to move beyond validating political parties and reinventing their relevance for future generations. Parties in Uganda have outgrown their usefulness. It is time for movements that are not legally bound to the repressive laws of the regime to take center stage. Parties have left spaces for robust social movements and various non-traditional formations to emerge. Ugandans should take those spaces to liberate the nation from impunity. Parties no longer command such ideological thrust and have alienated the majority of Ugandans from the democratic process. Parties are no longer repositories of trust and preferred engines for social transformation because they have not shown maturity or brought the desired change when all they do is fight for flagbearer position.

In the Ugandan context, no Political Party can survive in a political environment when it has no independent source of well managed and steady revenue. Paid party membership must have significantly declined over the decades.  Parties cannot contribute meaningfully to democracy when they are resource-constrained and operated on a non-democratic non-value basis. Thus, the sad realization about Uganda’s political parties is that they are prone to imperialism and elite class collaborations with foreign donors and exploiters.

End.