Black Tax

Decades ago, I did not go to Alliance. I did however attend the University of Nairobi’s law school where I met those very few who went to Alliance, sharing in the rarified air of their intellectual presence. Mosocho was my classmate and together with about 160 others, we were one of the pioneers of the government’s new increased student loan system. The system gave us direct cash amounting to about Kshs 7,000 per academic year as well as about Kes 42,000 indirectly which was remitted to the University instead to pay for our tuition. To be honest, I blew my “boom” as it was fondly referred to on the good life. The very soft life of a university student who needed clothes to look good and money to party. Mosocho, I later came to discover in my second year of university, was an orphan and was the eldest of six siblings. He used his boom to pay their fees throughout our time at campus.

Mosocho was my first unknowing encounter with the concept of “Black tax”. The term originated in South Africa and is defined by Investopedia as the financial burden borne by Black people who have achieved a level of success and who provide support to less financially secure family members. The monetary transfers are made by middle class and wealthy black people to relatives who are struggling to make ends meet. Investopedia further explains that the term not only defines the movement of funds, but more importantly includes the toll that it takes on the financially able family member who may be unable to build wealth in the same way as their White peers who don’t share the same financial obligations.

Historical racial injustices aside, Black tax is actually a continent wide phenomenon. Due to the high unemployment rates and economic disparities for most Africans, we endure Black tax under almost daily circumstances. From paying school fees for siblings, cousins and village mates to paying for hospital bills, rent, funeral expenses and daily subsistence for relatives, friends and former colleagues. Unless you live in an African Mars equivalent, you have to have paid Black tax in some shape or form in the last month.

Consequently, this is one of the leading determinants of the slow growth of African middle class wealth as there are multiple, unbudgeted financial pressures on largely static incomes. While it is virtually impossible to quantify the amounts paid locally, a more visible manifestation of Black tax is apparent in the form of diaspora remittances. In sub-Saharan Africa, the top five recipients of remittances in 2021 were Nigeria at US$ 19.2 billion, Ghana at $4.5 billion, Kenya at $3.7 billion, Senegal at $2.7 billion and Zimbabwe at $2.0 billion.

The more illuminating numbers are the ones that show just how impactful those dollar inflows are to the local economies. According to the World Bank press release, the top three sub Saharan countries where the value of remittance inflows as a share of GDP is significant are the Gambia at 27%, Lesotho at 23% and Comoros Islands at 19%. The senders of those remittances may or may not have achieved the middle class dream of owning their homes and living debt free. But they do partake (whether willingly or unwillingly) in the African spirit of Ubuntu which recognizes that the individual exists in a microcosm that is actually part of a larger community thus cannot survive without helping others.

Unfortunately it is this very concept of Ubuntu or its Swahili equivalent “utu” that leads to the insidious social fallout of Black tax. Diasporans have numerous nightmarish stories of money sent to close relatives to buy plots or construct homes which are only bought or built in the lofty corridors of the sender’s mind. Frequently the recipient diverts the funds to other personal uses. One frailty of the human condition is to confuse charitable largess with entitled, guaranteed income and consequently view the socially respected “rich” relative as a perpetual ATM. The subsequent family fallout is usually as spectacular as watching migrating wildebeest cross the Mara river. It never ends well for some.

The government’s push to Kenyans to seek more jobs abroad is an indirect way to ensure that this key source of attractive foreign exchange grows thereby diversifying our reliance on agricultural exports for global currency. Meanwhile, Mosocho became a very successful lawyer and is currently a senior partner at a leading law firm. Black tax does get its just rewards!

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Medical tourism on steroids

“Huduma zote za utafsiri kwa wagonjwa wa kimataifa ni za kusaidia. Hupaswi kulipa kwa sababu ya huduma yoyote ya mtafsiri.”

The same sentence that informed Swahili readers on the availability of free translator services was replicated in Russian, French, Portuguese plus five other Asian language scripts and was posted high on the wall at the International Patients Lounge of a Delhi hospital.Adjacent to it was amuch bigger notice board that provided details of over a hundred guest houses and hotels whose price ranged from US $ 15 to US$ 300 a night. Between Russians, Afghans, Kazakhstani nationals, Kenyans, Ugandans, Ethiopians,Tanzanians, Nigerians and Zambians, the lounge is a veritable mini United Nations of arriving international patients seated in rows of seats not too different from a railway station waiting area.
The Indians have nailed medical tourism down pat. It’s not anoh-by-the-way you can pop into a hospital when you get to an Indian city. The “international” hospitals have a dedicated wing for international patients that organizes their visa invitation letters, airport pickup, hotel reservations, money exchange, translator services and provide a dedicated hospital staffer to walk the visitor through each and every part of their check-up and fast track the international patient past the hundreds of local Indian patients. This particular hospital that is the subject matter of today’s column even has a local office in Nairobi with regular visiting specialists. Dr. KR is an ear, nose and throat specialist who has specialized in robotics. “I’ve been to Kenya many times and have even trained some of your doctors on robotic surgery,” she says desultorily. When asked what tools she uses, she doesn’t miss a beat, “No tools. Kenya doesn’t have the tools so I teach the theory only. We have the best robotics here at this Delhi hospital.”

When you see the rates charged by the specialists, you understand why middle-class Africans are coming to India in droves. A whole body check-up which includes visits with a cardiologist, gynaecologists (for ladies), mammograms, ultrasounds, ECG tests etc costs $180 or Kshs 18,540. If you wish to see a specialist outside of the program, the specialist charges INR 1,000 or Kshs 1,600. What the Indians have successfully done is to leverage on their existing medical capacity due to their large volume of local needs, relatively low pricing and best in class medical technology to tweak it into a service export.

If we can’t beat them, let’s join them. Our local private medical industry has been anecdotally known to throw all manner of spoilers to the entry of the large Indian hospital groups. I don’t blame them; no business wants a bigger, more advanced and cheaper competitor at their doorstep chomping at their heels.

It may be a useful exercise to redesign our national policy on provision of medical services. With multitudes of Kenyans leaving the country, (to the extent that the Government now requires a Kenyan to provide the Indian High Commission with a letter from a doctor validating the need to go to India for medical services as part of the visa application documentation) we might consider creating an Export Processing Zone of sorts for medical services. We provide an area where the Indian hospitals can come and build facilities and provide their low-cost services to allow for Africans from other countries to come and enjoy the same. With our “no visa policy” for Africans, the benefits will be monumental for the hotel, taxi and ancillary services that come with foreign visitors. In order for this to be acceptable to local private medical providers, we could pass a rule that Kenyan citizens are not allowed to use the medical services except for surgical procedures of a specialized nature.

Of course there is the chance of controversy that other Africans are enjoying the benefits of world class medical services that local Kenyans are not. But the benefits can be spread by permitting local medical students as well as practicing doctors to undertake residencies and training programs at the medical EPZs to ensure that the technical knowledge is disseminated locally. I’m not a medic and will not attempt to know the solution to this, but judging from the African Union general assembly that I found at that Delhi hospital, there’s potential for Kenya to take its place as a regional medical center, while uplifting the local medical training and expertise that has caused its citizens, including senior government officials, to seek medical attention outside its borders.
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Twitter: @carolmusyoka