FROM CONCEPT TO ACTION – UNIVERSAL HEALTH COVERAGE IN AFRICA

WHOAHF…….governments need to be deliberate in improving health financing policies, focusing on equitable access to health care and financial protection of the population especially the most vulnerable……

On June 27th-28th, 2017, Rwanda hosted the first ever WHO Africa Health forum with a theme, #Putting people first: The road to Universal Health Coverage in Africa. Not only as a participant, but also as a seasonal medical practitioner and an advocate of proper governance systems, the forum was of keen interest to me because it convened a broad representation of the African people from policy makers, health and finance ministries, African Union, private sector to CSOs and the media among many other sectors. Participants at the end of the forum, committed individually and collectively among other things to sustain strong political will and commitment, increase and sustain domestic and external mechanisms, ensuring value for money and increased accountability – I couldn’t resonate with this commitment more than I already do because it is coined with some of the core principles of good governance.

As various African countries contemplate on how to extend health care to more of their citizens while protecting them against the financial hardship associated with paying for the health care, nations ought to put proper governance structures in place, if the concept is to turn into a reality. When people have to pay a lot at the time they use health services, it poses a real, severe economic risk to their households which later affects the community and eventually the entire country in general. My argument is crystal clear – governments need to be deliberate in improving health financing policies, focusing on equitable access to health care and financial protection of the population especially the most vulnerable.

In a bid to achieve universal health coverage, the population needs:

  • Well trained health workers both at community and referral health facilities. For this to be possible, health workers must be compensated with a fairly good remuneration (I know this is relative), or brain drain will take effect. African countries have labored to ensure that their health care workers get the best education only to lose them to the highest bidder once they graduate. Nevertheless, governments need to combat this so that we have skilled people on the frontline of the efforts to prevent and treat different diseases. Well-trained and highly motivated health workers are the bedrock of a strong and functioning healthcare system. Staffing challenges can be exacerbated especially in emergency situations. A quick but also sad example is the Ebola virus outbreak in Sierra Leone and Liberia that exposed weaknesses in both countries’ health systems and knowledge gaps among the health workers. In total, the epidemic caused over 296 reported infections among frontline health staff, and 221 reported health worker deaths in Sierra Leone alone.

 

  • State of the art health care facilities – products, drugs and hospitals. If citizens need to travel either from one town to another or one country to another, worst one continent to another in search for better treatment, then we still have a long way to go. How many people can afford that without organizing fundraising campaigns? Does that mean the vulnerable are already condemned to early untimely death? They are given no chance to redeem themselves another minute or month, even a year with their loved ones. On top of that patients holding community insurance cards or lowest medical scheme need to also access treatment at the state of the art facilities.

 

  • Investment in Africa’s health systems is key to inclusive and sustainable growth. The health care sector is made up of many different industries – from pharmaceuticals and devices to health insurers and hospitals – and each has different dynamics. Healthcare investing requires a multifaceted approach to understand the underlying drivers. Investors can profit from investments in both the overall sector and/or its industries. This requires the private sector to make their contribution and support the efforts of government to achieve universal health coverage. However, the investors need to be attracted in to the sector through favorable incentives, subsidies and tax exemptions.

 

  • Political hygiene across Africa. Many African countries need to clean up their governments and uproot all the corruption and the offenders. Health care funds have been swindled by African senior leaders yet people in impoverished areas are left to die from treatable diseases. Corruption seems to be holding back development because governments are often caught up in a series of scandals – when will they get time to concentrate on adopting the right policies or making plan to put up state of the art or even standard health facilities. As we wait for government to do their part, also citizens can meet in the middle – if people refuse to allow corruption into their lives, there will be no opportunity for the corrupt to carry out their illegal deeds – so individuals most definitely can make a difference by breaking the chain of corruption.

 

  • Be aware about public health. Health sector players need to create public awareness about the anatomy (body organisms and parts), their physiology (how the body functions) and pathophysiology (when the body is sick). Instead of having facilities underutilized because citizens are not well informed, it would be better for people to know about their bodies and how they functions and also be able tis kef detect some symptoms so they can seek medical attention before their disease advances gravely.

 

  • Evidence based policies. To address the health needs of the population, proposed health policies should be grounded in methodologically sound analysis of the existing evidence. Too often, policy decisions are made without full consideration of the available research evidence or the results of policy modeling to understand likely economic and health outcomes. Therefore, health ministries need to adopt policies that reflect the best research evidence that improves the sustainability of the system and the well-being of all people.

I know that there is no one-size-fits-all approach to achieving universal health coverage; strategies need to depend on local circumstance and national dialogue but as this is considered, governments need to put people first.

Caution: The health sector is one area that can’t be avoided because it can haunt an entire community if not well catered for!

WHAT IS THE LIMIT ON THE FREEDOM OF EXPRESSION?

…….Tolerance seems to be one of the most essential rules in life, if the world is to realize sustainable peace………

This week, Rwanda’s national broadcaster RBA was honored to host President Paul Kagame in an interview that got people talking especially on social media – from applauds to exchanges in what was more like a difference in opinion or one exercising their freedom of expression and others playing custodians of freedom of expression.  As someone who is passionate about peace building, from my studies and still studying more, I have realized that tolerance seems to be one of the most essential rules in life, if the world is to realize sustainable peace. One Journalist Edmund Kagire posted a tweet questioning why a less known face from the French department at RBA beat the pecking order to land the opportunity of interviewing the President.

 

His tweet got replies of both support and accusations; some pointed to him as a misogynist while others attacked his liver cancer recovery (unfortunately or fortunately the post on twitter was immediately deleted – but it was about #bringbackourliver) but I got one from Facebook.

 

Some replies to Kagire’s tweet could really show some people were venting anger yet someone was just exercising their freedom of expression.  One thing I have come to learn is that it’s easier to be tolerant and appreciative of opinions different from yours only and only if you’re able to see them objectively. Some one that thinks different from you doesn’t necessarily label him ignorant or dense. We are all the products of our own individual upbringing and experiences so it is completely natural that we will all have differences in opinions on a wide range of issues. Imagine how the world would be so dull if we were all the same and believed the same – It’s the diversity amongst people that makes it such a fascinating place. So we ought to learn to respect diversity and some people not pretending to know the yardstick for what is true or what needs to be said.

President Paul Kagame in his 2016 New Year address said “It is everyone’s right to ask for explanations when you are not satisfied. So rather than shutting Kagire down or any other person trying to seek more light on a pertinent  issue, just give clarifications  if you have any or throw in your measured, studied and thoughtful argument. I know that it can be difficult to tolerate other people’s opinions, especially about sensitive subjects you have strong feelings about; you just have to learn to approach them in a calm fashion.

 

 

 

 

 

SHOULD ELECTIONS POINT TO VIOLENCE?

“………Why should an act of democracy be the same that takes people’s lives or one that dents the country’s history and its development?………”

Recently, a team of Ugandans visited one of the organizations I work with and after debriefing them about the vision  and mission  of the institution, they couldn’t help but ask about the election mood in the country.  The question was prompted by a mention of one of the pillars of the organization – governance and rights. They had though in Rwanda no local organization intervenes in governance and human rights  related issues.  With just less than 2 months to go to the polls, our visitors were surprised that there are no billboards advertising the presidential candidates or even that the city is not polluted with the loud campaigns or even flyers and brochures showing the flashy manifestos of the aspirants. They had just witnessed the primaries of the ruling party that were held in a peaceful and non-chaotic manner, contrary to what had happened in Kenya this April, a process that was marred by either kidnaps, injuries, accusations of seeking sympathy votes or even malpractices, causing fear that Kenya’s history of election violence may repeat itself, according to observers. Another friend from UK lured me into a conversation on elections and his fear was that back in the UK, the election turnout would be low (according to recent reports, he might have been right – only 68.7 %.) Well I am not here to compare the affairs of the nations, every country has its own challenges but I was taken into a moment of asking a question that I think we all need to ponder about: Do elections mean violence? Why should an act of democracy be the same that takes people’s lives or one that dents the country’s history and its development?

Some people have gotten so greedy for power that they don’t want to let go while others are so slobbering to be in command that they don’t mind the lives they have to leave on the way to their self-acclaimed glory. Oh my God!!!! Don’t these people know that they can do a lot out of the office? Most heroes didn’t have to first be presidents or cabinet ministers nor did they hold parliamentary seats to cause change in their communities – they just used what they had. All it needs is a remarkable drive and commitment to create a better world through community service.

Anyway my intention of writing this article wasn’t to tell you about how to effect change without necessarily being in the government but to ponder on how our nations can keep the election processes peaceful for the sake of the people they claim they want to serve. People everywhere deserve and rightly expect a pleasant and safe environment in which they can live and work. We all want good quality public services, with rising standards in our schools and in our health care institutions. We want local communities where everyone can participate in society, and effective care is available to those who need it. You can argue if you wish but it’s only that selfless leader who will work tooth and nail to ensure that the people live in a peaceful setting, they can even step down if the safety of the people is guaranteed. Therefore, as different people head to the polls this year, let me use this platform in my authority as a human rights activist to urge all to exercise their right to cast their vote and not allow to be intimidated in to voting any candidate that they don’t favor.  Also to our aspirants, we are here to hold you accountable for your decisions, walk away peacefully if you lose and serve the people if you win.

Elections don’t have to point to violence but to a pacific transition of power.

 

 

HOW SOLID IS THE AFRICAN UNITY? – AFRICA DAY

“…..Some counties tend to think in the confines of their small, fragmented and parceled-out little states forgetting they have no impact but if colonial boarders are opened, the impact will not only be for a single state but for the entire continent……”.

Every 25th May, the African day is celebrated within the African continent to mark the formation of the Organization of African Unity (OAU) on 25 May 1963 and the African Union (AU) in 2002, as well as celebrate the continent’s progress. 2017 of course wasn’t any different, African leaders were seen hosting events and ceremonies to mark the significant day. This year’s celebration was under the theme ‘Harnessing the demographic dividend through investments in youth”. The theme was derived from the fact that the continent today has one of the largest populations of people aged 35 and younger, and while that can be an asset, it can also be a challenge. Over the years, I used to ask myself why we celebrate the Africa day; I realized that we do so because of the richness and diversity of the continent and its people, and it’s also one of the ways to promote unity and solidarity among the African states. After realizing this, I started pondering on how solid the African unity is?

So far, only 13 countries have loosened or scrapped Visa requirements for African travelers in a move towards the lofty goal of turning Africa into a continent with seamless boarders, modeled after other regional blocs like the European Union, but what about the other 41 countries? This means that some African travelers are denied entry into many African countries. Let me just point out Ethiopia, a country that hosts the African Union headquarters requires almost all African states but 3 to pay for a visa between US$28-US$50. To what extent is this promoting the free movement of people and goods on the continent? I also tried to apply for a Visa to another African country (I choose not to disclose) to attend an International conference only to be denied. I wasn’t disappointed because I was not going to attend the conference but simply because I realized we still have a long way to go as far as reaching the African solidarity. Some counties tend to think in the confines of their small, fragmented and parceled-out little states forgetting they have no impact but if colonial boarders are opened, the impact will not only be for a single state but for the entire continent.

The notion “African solutions to African problems” became very popular in 2014, but it seems to just have been an interesting catchy phrase.  I think the founding fathers of the OAU: Ghana’s Kwame Nkrumah, Ethiopia’s Haile Selassie and Tanzania’s Julius Nyerere envisioned a united Africa free of war but African countries are fighting amongst themselves either politically, economically or even cold wars. Back to the popular phrase “African solutions to African problems” that is yet to yield much for the citizens of the continent. If we are to look at insecurities and conflicts in some countries like Burundi and South Sudan, many lives have been claimed and scores displaced. What has the continent done? To what extent has the AU gone to pacify these areas? How are the young people affected in the conflict areas? These are the questions and many more others that someone keeps asking. What solutions have been adopted for these African problems? Like xenophobic attacks that are still make headlines on the continent – often surfacing at the beginning of every financial year because post-apartheid South Africans are looking for job opportunities in order to put food on their table. This is not only a symptom of the deep leadership deficit but an indicator of limited or no African unity and solidarity.

Africa is a large and beautiful continent blessed with ample natural resources but surprisingly young Africans are always risking their lives on a desperate journey to cross the Mediterranean, only to live as illegal immigrants in Europe. We have lost thousands of young people to the sea, who are fleeing the poor state of the living conditions in their respective countries. What is the missing link? Unless African leaders start thinking about a more forward-looking, people-centered developmental agenda aimed to transform African communities, they might just continue singing the African unity and solidarity without realizing it.

 

 

AFRICAN UNION GENOCIDE PREVENTION EFFORTS – LONG OVERDUE

“Last year, a despairing 14 year old boy committed suicide in a Darfur camp, a situation that was worth the world’s effort to reflect on the appalling situation that was biting hard on the war-torn region”

The Peace and Security Council of the African Union, on April 11, 2017 convened for the 678th time, to receive a briefing on the prevention of hate crimes and the ideology of genocide in Africa, from which various resolutions were adopted. From its communique, the meeting stressed the importance of the need to deepen democracy, participatory governance and a culture of peace, a strategy I believe if implemented, gives a strong glimmer of hope for sustainable development on the continent. The emphasis is in line with aspiration 4 of Agenda 2063 that aspires for a peaceful and secure Africa. This aspiration stipulates that mechanisms for peaceful prevention and resolution of conflicts should be functional at all levels and all that guns should be silent by 2020

However, gun shots are still heard flying around in South Sudan, claiming thousands and leaving over one million people displaced by the violence. The South Sudan conflict was declared genocide by the UK in April, 2017, as the conflict is perpetrated along tribal lines. Also, a UN report in March stressed that South Sudan was experiencing ethnic cleansing by mostly government forces and their allies and that the country was teetering on the edge of genocide.

This could be more or less the same way Genocide  started in Rwanda. They were rumors of the killings, then journalists flooded the country from different parts of the world to report on the killings in some small country in East Africa and they later fled for their lives while the innocent lives were killed mercilessly as the world watched claiming their hands were tied. While the World repeats continuously that genocide should not happen ever again, , there have been reports of targeted killings in   South Sudan, driving  the youngest nation in the world towards i the edge of genocide and the world is looking on again in the name of non-interference in sovereign state matters.

However, with the 678th PSC declaration, Africa ought to shift from rhetoric to action, strengthen measures for prevention and reading early signs to avoid Genocide.  This declaration is long overdue, and will be meaningful, only if it doesn’t stay on paper, a declaration we refer to only in continental meetings, or an indicator of the achievements of the African Union towards genocide prevention, without practical strategies to implement it.

It’s very common for some warning signs of genocide to escape much notice but if there is more analysis, the signs will present themselves in all forms. Last year a despairing 14 year old boy committed suicide in a Darfur camp, a situation that was worth the world’s effort to reflect on the appalling situation that was biting hard on the war torn region. Imagine a young boy hanging himself with a rope in his family’s home, tired of the dire circumstance his family was living in. Although many people looked at it as extreme, especially being done by a child, with limited and blurred knowledge on death or even hanging himself for dead, but it’s the best in his own mind that could show a despairing sign of saying enough is enough.

So my point is, we welcome the 678th PSC declaration but it should not just be another statement without supporting action. Africa needs to walk the talk!  After the genocide of Tutsi in Rwanda, Africa committed to walk away from the old Non-interference principle and not to remain indifferent in the face of a tragedy on the continent.  We cannot remain silent while the people in our neighboring countries perish as we look on.

I pledge to keep my voice alive and loud to silence the guns on the continent. I will start with what I can do for now.

Photo is from http://www.voanews.comA man collecting bodies to bury in a mass grave approaches a burned hut containing charred corpses, on the outskirts of Yei, a center of the country’s renewed civil war, southern South Sudan, Nov. 15, 2016:

 

COMMITMENT TO THE FIGHT AGAINST GENOCIDE

I am back with another piece on genocide, not only because we as Rwandans are in the 3 month commemoration period of the genocide against Tutsi but because being at the helm of an organization that is hinged on the history of our country, gives me a drive to steer conversations about peace, good governance and genocide prevention. In this piece, I am drawing focus on three elements that can contribute to a sustainable fight against a replay of genocide anywhere in the world.

  • The respect for the dignity of each and every human being by combating all forms of discrimination, racism and exclusion can prevent genocide.
  • In our education systems and in schools, history should be emphasized as a way to avoid the mistakes of the past.
  • Empower critical thinking among the young and encourage active citizenry so as avoid blind following

Genocides are often carried out in a manner where one group of the society wants to exterminate another group. This in many cases is perceived as the struggle against political, economic and social marginalization and discrimination of ethnic, racial, religious or political inclinations. Although it is difficult to anticipate the critical moment at which genocide will begin or the scope that the massacre will take, it’s imperative to examine and interpret the warning signs and respond to them adequately. If one group is continuously discriminated against, they will start by resenting the system, then start forming opposition groups, then resort to organizing illegal or unknown meetings with others who are tired of a dire situation, from there, they develop a determination to end it once at for all, no matter the extent to which they have to go to. Considering that all human beings are equal before the law and are entitled to equal protection of the law against any discrimination and against any incitement to discrimination, any nation should treat all citizens equal in a bid to avoid a potential genocide.

Secondly, education is an important medium of acquiring skills and knowledge. A common saying notes that our education begins at home, but thereafter, as we grow we go to schools, colleges and other educational institutions. School education lays the foundation stone for the child’s future. As years go by after the genocide against Tutsis happened in Rwanda, a new generation that has no idea about the brutality of genocide is born. The best way to keep them informed and committed to Never Again is if they know the history of their country.  The more the young generation knows about their past and how it darkened and silenced the country, the more they will renew their commitment and intensify their efforts against genocide. Education can play a great role in a given society as a means of conflict prevention.

The aspect of critical thinking is both an education element and a trained skill. If the young ones acquire this skill, they will involve in active citizenry and thus know when they are manipulated or lied to. In this case, critical thinking constitutes the ability to integrate and evaluate information, that is looking at a conflict and see the similarities between it and previous conflicts, related or unrelated. The individual can then resolve the conflict using resolutions that have worked or adopt strategies that can prevent a potential fatal conflict or violence. A critical thinker can’t be just lured to hold a machete for the sake of ethnic clinging, they would questions the approach, they would weigh in to the impacts, and they will ask if there is no other way to resolve rather than opting to blood shedding.

I can’t say that these are the best mechanisms to preventing genocide, but these complemented with other approaches can promise a genocide free world.

Special dedication of this blog goes to the the millions of innocent children, women, and men who have suffered and died from the genocide against the Tutsi. It’s a reiteration that we shall do everything in our capacity not to let the genocide happen again in Rwanda but also to collaborate with other key stakeholders globally to prevent any genocide anywhere in the world.

commitment to “NEVER AGAIN” has proven that it has failed

Over the years, the international community’s commitment to “NEVER AGAIN” has proven that it has failed, as it happens “AGAIN and AGAIN.” The promise the United Nations made was broken, as again and again, genocides and other forms of worst pogroms in human history have befell the world. If I could list all the genocides that have occurred starting from the one in 1915 in Armenia that recorded 1.5 million deaths, the holocaust that lasted 3 years from 1942 t0 1945, claimed 6,000,000 Jews, Cambodia from 1975-1979, over 2,000,000 lives were killed, Rwanda in 1994, registering over 1,000,000 deaths; and ongoing killings  in Darfur-Sudan from 2001 to present where UN puts it to over 300,000 deaths have been recorded and not forgetting what is going on in Syria at the moment . These cases are not definitive as there are many others that are still debated upon if they should be termed as genocides or just civil wars that don’t need medaling. All the genocides have one shared characteristic, a human common tendency of considering only “one group” as human, and “de-humanizing” the other, which sparks off the need for ethnic cleaning.

For the next 100 days from 7th April, Rwandans in Rwanda and around the world will commemorate the genocide that was perpetrated against Tutsis 23 years ago and honor the courage of those who risked their lives for others. Although it’s a time to remember the pain and horrendous killings, it’s mostly a time to remember, unite and build. There has been a growing concern on how the fight against genocide can be sustained. And since the human being cannot determine how there forgetting curve can hold their memories, it would be appalling if the genocide was erased from our memories and future generations found themselves at the center of the brutal killings all over again.  Although most of us will be long gone and won’t have to endure that pain again, we can at least secure a better tomorrow for our children and those to come after them.

Genocide, like armed conflict of a certain dimension, does not erupt from one day to the next, but a result of a combination of factors: a lack of dialogue, a failure to respect Peoples fundamental rights and an absence of shared values among many others. It is difficult to anticipate the critical moment at which genocide will begin or the scope that the massacre will take, but at least we can relay concrete strategies that will kill genocides even before they manifest. We grow up and live in particular cultures, with particular lineages, but we are one, not us against them.

The genocide against the Tutsi in Rwanda was sparked by poor politics which incited ethnic differences; but in the spirit of unity and reconciliation, the current  government of Rwanda and other stakeholders have worked tirelessly towards building a national identity and  foster a Rwandan community that is based on respect, trust and unity.

Although the international community has continued to fail world citizens, watching in silence as genocides claim millions and millions of lives for example the Syria of today:-, there is something we can do on our own to never again have to witness or record any genocide in Rwanda. There is a common but powerful statement, united we stand but divided we fall.