Thread by @wmnjoya

This article is so stereotypically neoliberal, I wish the author had even tried, at least, to pretend it wasn't. @dailynation @KNH_hospital
nation.co.ke/oped/blogs/dot…

The first paragraph I agree with..Kenya is infected with policy hysteria, with the belief that we have good policy and bad implementation. But that's where my agreement with Kane Owino ends.

Policy IS its implementation. Kenya has BAD policy. That's why it's (not) implemented.

I'll take a detour here about what that statement means, which an economist may not understand.

When people say we don't implement our otherwise good policies, what they are saying is that Government is good and we are bad. We the people should fix ourselves, not the government.

The point is that the public is always to blame for the government's inefficiency. And that is Owino's premise throughout the article. The problem is us citizens. Starting from the second paragraph: "I have come to worry that many Kenyans do not understand what good policy is."

Like I said, separation between policy and implementation is nonsense. Policy is its implementation. A good policy is an implementable one. Policy which does not take into account the realities of the people, or policy WE don't understand, is NOT good policy in the first place.

We have PUBLIC PARTICIPATION in the constitution for the simple reason that bureaucracies like states can't see the whole picture. James Scott's "Seeing like the state" insists that states have tunnel vision, so they need citizen input to formulate good policy. KNH fails on that.

Now back to Owino's "it's always wananchi's fault for being stupid" article.
First, he suggests that KNH has no responsibility for poor health outcomes. The problem is "the underfunded county level hospitals."

Again. This is familiar. It's an attack on devolution.

It's the people in the counties who don't know what good healthcare policy is. And we wananchi are performing a "public gnashing of teeth" out of our "love for histrionics as replacement for public reasoning."

This is madharau for the public, the users of the same healthcare.

And let me remind Kenyans that you cannot have good policies or institutions made by people who dharau you. It's impossible. Because if healthcare is supposed to serve us, then what we think and want matters.

KNH is part of a whole national health system. That's why it is called a "referral" hospital. So separating it from counties is disingenuous.

2. If the fault is county healthcare, then fix county healthcare! instead of inviting pirate sector to cope with "failures" of counties.

So the other premise Owino relies on that KNH (aka Nairobi) is different from the counties and should make its own decisions, including pricing.

This is such un-national and elitist thinking. Kenyans need to resist this isolation of Muthamaki's seat from the rest of Kenya.

Let me go to the Milton Friedman line of the article.

CHOICE.

Owino says that we can improve health outcomes through competition, and that's why we need a private hospital at KNH. He also talks of increasing "choice" for Kenyans seeking medical care.

He also says that KNH private costs would moderate the costs in other private hospitals.

Where do I start?

The ideas that private sector necessarily offers better outcomes is nothing but an assumption. Service provision depends on many things besides institutional ownership.

Competition is misleading. Pirate sector competes in profit making, not offering better services. When KNH enters the private sector boxing ring, it will not be competing on better healthcare for Kenyans but on customer service, massages, PR and advertising, interior design, etc.

KNH will mistreat the medical workers like private hospitals do, and, which is the point of privatization, it wont allow collective bargaining with unions. So KNH will join pirates in demeaning working conditions, then Kenyans will think shaming workers will improve healthcare.

The last point on competition.

Competition is among equals. Government is public, so it is not an equal to pirates. To enter competition with pirates is reducing the public to the level of pirates. So it's a coup through economics.

So a hospital owned privately will be owned by someone other than the GoK or people of Kenya. That is why this privatization project is simply robbery and THEFT.

The other question we must ask is "choice for whom?" Owino says it's "for all patients in Kenya irrespective of their income level."

That's a lie.

The people who come to KNH come out of no choice. If they barely afford the public side of KNH, they wont afford the private.

Choice is for the people who already afford the Nairobis, Aga Khans, and MP Shahs. KNH wameshikwa na tamaa na wateja wa hospitali za binafsi, and they want that money. They should resign from KNH, join those hospitals, and we get people who are not ashamed to serve the public.

So many issues with Owino's article, but let me with quotes that show his madharau for us.

"The opponents of the proposal are fixated..."

"Only people obsessed with morbidity would be making the ignorant and unsavoury statements.."

"ideological puritans"

Oh, I cannot end this thread without highlighting Owino's hatred for unions, especially unions of public sector workers, which is clearly a shot at @kmpdu.

He says that "The most aggressive opponents of the hybrid system that the board of KNH is determined to try are the public sector unions."

KMPDU is not alone on this one, and isolating them is a divide and rule tactic. We are other Kenyans who support the union.

I refer to my earlier tweet about using fallacies and assumpions to religiously claim that private sector is necessarily more efficient by virtue of being private alone. Owino says that "public sector unions [want] to avoid any comparisons of productivity among workers."

Can I just say that "productivity" is such an enslaving, dehumanizing concept that should not be used on any type of worker. It is rooted in slavery, when Africans were whipped and maimed based on their daily record of cotton picking or sugar cane cutting. bostonreview.net/race/caitlin-c…

It is unlikely that there is any evidence that pirate sector workers are more productive. If the evidence is the profit margins, they are simply a sign that the workers are mistreated more and paid less. I even shudder thinking about what this article is suggesting.

And this was the issue all along, right from when the World Bank plotted in 2015 to treat public medical workers badly so that they could run to private hospitals ad be paid just as badly, if not worse. Remember Rotich's confession

As Rev William Barber said, pirate sector has invaded public social services because they have realized that the money government pays for those services is more than pirate sector can ever, ever make from private business. So they use economists as propaganda tools to hide this.

The attack on our doctors is an attempt to reduce them to sweat shop workers who will do anything to make money for private hospitals. And much as we want to sing about the pay of doctors, remember that these are the people we want to care and not treat us like money bags.

Our healthcare will get worse if ideologies like Owino's are allowed to take root. Healthcare is not a business. We patients are not customers buying dresses or eating restaurants. We need workers who care about us, and not about productivity.

Say NO to the privatization of KNH.

This is my lecture about what privatization is doing to the workers in healthcare and education, and what it means for our humanity. It's an hour plus.

SAY NO TO PRIVATIZATION OF KNH.

End.

m.soundcloud.com/wmnjoya/profes…