Health For All But Not women and Homosexuals

 

By Prima Kwagala-Ugandan human rights lawyer and CEO Women’s Probono Initiative.

In the wake of the dismantling of USAID and relentless attacks on multilateralism, the US government dangled a deal many African governments could not resist – billions to finance the health system in exchange for unquestionable submission to growing human anti-rights rhetoric, as perpetrated by the US government under President Donald Trump, and unfettered access to health data.  The men who have led the African continent through decades of growing poverty, inequality and human rights abuses shook hands with the leader of the world’s super power and declared that the kind of support, given in a context where African leaders do not have to go through checks from a nosy civil society, is just what the continent needs to rewrite its health story.

This health story is one riddled with anecdotes of women giving birth on hospital floors with none of the strained and exhausted health workers available to attend to them. Stories of the rich people in government, the children and grand children of the men who shook hands with Trump, flying to Europe or America to treat their ailments because they know the extent of the rot they sowed and oversaw in their national health systems, are well known and retold with resignation over dinner.

Kenya and Uganda were the first countries to sign the Memorandum of Understanding, with the US saying it will support Uganda’s health sector with US $ 2.3 billion and the Kenya health sector with US$ 1.6 billion over the next five years. Under the Memorandum, the Uganda government, in order to receive this support must increase its health spending by US$ 5OO million in the next five years. While Kenya must increase its health spending by US$ 850 million in the same period.

Both the governments of Kenya and Uganda have deep citizen distrust in common. The 40-year-old rule of President Yoweri Museveni of Uganda, who came to power following a coup, recently saw unbridled violence meted upon opposition members in the lead to the elections that took place in January. This violence closely mirrored the violence seen in Kenya during the Gen z protests, where the young people led protests to demand accountability and express their discontent with punitive taxes that targeted essential products. The Kenya government, like their Uganda counterparts, reacted with force – spraying the young people with bullets and tear gas.

It is now these same governments that have overseen dysfunction being entrusted to rebuild the health system through a model that bypasses traditional civil society checks. The anti-rights sentiments in the US have emboldened African governments to commit human rights violations in their own countries, and the rewards for these human rights violations have started trickling in. Where there used to be strong condemnations and sanctions, the US, under Trump, now gives sweeping memoranda of understanding that hands resources directly to authoritarian regimes.

Besides the moral and human rights dilemma of entering into memoranda without holding governments to account for authoritarianism and abuse of human dignity, these memoranda also contain questionable clauses that further call to question their intention and ability to deliver better health. The fact that it entrusts governments that have failed to meet past commitments such as that under the Abuja Declaration, where African governments committed to dedicate at least 15 percent of their budgets to health, with substantially raising their funding budgets until they no longer depend on US funding, within a period of five years, is an indication of just how blind the memoranda are to reality.

Promises of building a more sustainable health system and increased domestic financing ring hollow considering the political contexts in which these memoranda are signed. The emphasis on faith based health organizations is a reinforcement of the anti-rights commitment to lock out essential health services, especially for women, sexual and gender minorities. Therefore, while the memorandum purports to seek to strengthen national and global health for all, these health benefits are being withheld from women and people perceived to be homosexual in perpetration of harmful religious beliefs.

In addition, the memorandum decidedly gives minimal attention to maternal and child health and extorts unconscionable commitments from African states to share their health and biological resources in violation of past commitments such as those under the Pandemic Treaty.

Already, holes have been punched into these health memorandum, with the Kenya High Court, to its credit, suspending implementation of the Kenya-US memorandum pending decisions on the question of patient data and sensitive information. Yet, the courts in Africa have an erratic human rights decisions records, occasionally making sound and progressive human rights decisions while still living room to take the opportunity to make decisions that reinforce human rights abusive status quo. We now watch and wait to see if Kenya’s courts will choose human rights over questionable and extortive health bargains.

At the end of the day, lives are on the line as African countries are being expected to transform overnight and look out for the health of the people without the systems in place to enable this transformation and check accountability. Civil society on the continent is dying a slow death and dissent is heavily punished. One thing is for sure, in the next couple of months, malls and apartments will arise mysteriously. No one will have the courage to question whether there is a link between these malls and the disbursement of health money under the memoranda because the price of dissent grows costlier every day.