Chapter 2: Using Theory As A Guide... Chapter 2: Using Theory As A Guide To Design And Draft Evidence-Based Transformatory Legislation Chapter 4: Reforming Drug... Chapter 4: Reforming Drug Registration Practices In the East African Community

   Chapter 3: An East African Community Health Commission

Michael Kempster

(Editors' note:  As emphasized in this resource book's first chapter – and as remains true of all the other chapters – Kempster's report and bill comprise drafts.  Those drafts identify issues which the relevant EAC workshop team members will undoubtedly wish to consider – and perhaps revise – in light of their more intimate knowledge of East African realities.   The chapter raises question which include:

1. Who should appoint commission members, using what criteria and procedures, to ensure appropriate coordination and development of the relationships between EAC member states' and regional health care institutions?
2. Does the existing bill provide adequate criteria likely to ensure transparent, accountable and participatory decision-making procedures for enabling the proposed Commission – essentially a new law-making institution for conducting research and drafting effective regional health legislation to help mobilize regional human, financial and physical resources – to overcome the EAC health care problems?  
3. Hopefully, the workshop team will identify and answer any other questions they consider important.]

On 27 December, 2007, Kenya's presidency hung in the balance in a disputed election between the incumbent, Mwai Kibaki, of Kikuyu ethnicity, and a challenger, Raila Odinga, of Luo ethnicity.⁷⁸  Accusations of gross irregularity in Kibaki's declared victory quickly led to serious and widespread civil unrest.  By 8 February, more than a thousand people had died.⁷⁹  Interethnic strife forced at least 600,000 people throughout the country from their homes.⁸⁰  'Horrible' living conditions, diet, water and sanitation prevailed amongst the refugees.⁸¹

Of these people, roughly 90,000 had HIV;⁸² they entered a zone characterized by the sort of civil strife in which sexual and other sorts of violence are, alas, prevalent, and likely to spread the disease.  Roughly 5,600 had tuberculosis⁸³ and lived in often close quarters ideal for transmission of the disease.  Between 200,000 and 400,000 had malaria;⁸⁴ mosquitoes bit these people at least thrice daily, and went on to bite inhabitants, infected or not, of other regions. 

Much Ugandan commerce passes through the affected region on its way to Mombasa, Kenya's major port.  Civil unrest disrupted Mombasa's commerce as well, diverting significant volumes of trade to Dar Es Salaam, Tanzania, which typically handles half Mombasa's trade volume.⁸⁵ HIV spreads readily along trucking routes (China,⁸⁶ India⁸⁷ and Africa⁸⁸); trade diversion to Dar Es Salaam  exposed citizens of Tanzania to infectious agents from Kenya, which they had not encountered before, and against which they had never developed immunity.

Prior to the 2007 EAC Health Summit Meeting, the East African Legislative Assembly (EALA) and Secretariat, as presently constituted, had neither identified or prioritized health issues, conducted or utilized research on health issues, or responded to health issues  with legislative solutions at the community level. Instead, duplicating efforts without taking advantage of economies of scale, the separate member states efforts to resolve their health problems did not effectively address community-wide health needs.  The First East African Health and Scientific Conference of 2007 recognized this unmet need.  It explicitly called for the establishment of community-wide institutions and a community legislative health agenda.⁸⁹ Since that time, two more regional health conferences have taken place.⁹⁰  Member states' Ministries of Health, apparently have only begun to work together to coordinate their health programs on a community-wide basis.

This research report aims to provide evidence to justify the proposed East African Health Commission Act. That Act's detailed provisions will establish an East African Community Health Commission to conduct or sponsor research, set priorities, and propose legislation addressing specified health issues both to the EALA and, as seems appropriate, to the legislatures of the EAC member states.

A. The larger context   

The founding document of the EAC, the EAC Treaty of 1999, specifically alludes to the manifest economic, political and health concerns which the member nations of the East African Community share in common. The EAC leaders realized that, in today's rapidly evolving technological era, they must work more effectively together to identify and coordinate their human, physical, and financial resources to resolve the health problems that shortened their citizens' life expectancy. 

The epidemiology of infectious disease does not respect political borders.  The brief introductory paragraph's description of a single event and its potential consequences demonstrates that the causative agents of infectious diseases confined to rural areas or urban areas may abruptly and unpredictably mix and spread.  Such agents, introduced in a single country, or a region within a country, do not respect national boundaries.  Local or even national, rather than region-wide solutions to the problems of infectious disease, will likely fail.  In some cases, only a regional solution may suffice.  Yet the EAC member states' Health Ministries have not yet successfully worked together to coordinate their efforts on a regional level.  Moreover, while the member states' Ministries of Health have identified health issues, they have not done so on a more than national level.  A community-level institution, capable of conducting research to identify health problems, and proposing legislative solutions, could mobilize their community resources to address new constellations of health problems, whether arising from a sudden mass movement of refugees, or from unanticipated epidemics.  Absent such an institution, the EAC can neither identify nor deal in a timely fashion with health problems likely to lead to human suffering and economic losses – disasters that EAC health institutions, working together, might prevent or mitigate.

[Editors' Note: In Kempster's original Research Report, the remainder of this Introductory Part I incorporates additional relevant information, here provided in the first Chapter of this Resource Book.]

B. Methodology

This report uses institutionalist legislative theory's four-step, problem-solving methodology to structure the available evidence in the form of a research report to justify a proposed law to establish an EAC Health Commission.⁹¹
 
Step 1 (in this report's Part I) briefly describes the EAC member states' uncoordinated health programs as they superficially appear. It identifies the officials of the five member states' various health-related institutions as the primary role occupants, and their Ministries of Health as the main implementing agencies.  By definition,⁹² these social actors' historically shaped behaviors comprise the institutions that tend to perpetuate the uncoordinated national health policies and practices.  The proposed Health Commission bill focuses on using law to change both sets of role occupants' behaviors.  That change will maximize the use of the region's human, physical and financial resources to improve regional health care.
 
Step 2 (in this report's Part II) uses legislative theory's ROCCIPI categories⁹³ to formulate hypotheses as to the causes of the problematic behaviors of the responsible health officials as individuals, and the Ministries of Health as implementing agencies.  Those explanatory hypotheses serve to guide the search for the available relevant evidence to demonstrate that the hypotheses prove consistent with the facts.   (If, any one hypothesis does not so prove, the theory calls for revising that hypothesis until it does.)  

Once warranted  by  the evidence, these  explanatory  hypotheses lay the basis for Step 3 (in the report's Part III):  The design of the proposed bill's detailed provisions makes it likely that the proposed EAC Health Commission will facilitate drafting interrelated regional and member states' legislation. That legislation in turn will coordinate and improve affordable, effective health care for all East Africans.

Step 4 (included in the report's Part IV) specifies the bill's provisions for a transparent, accountable monitoring and evaluation mechanism.  Those provisions must empower and induce relevant stakeholders – especially the region's poor and vulnerable – to provide evidence as to whether the law, once enacted, will likely prove effectively implemented, and, once implemented, likely to advance East African public interest.

This Part briefly describes the narrow problem which the bill, described in this report, aims to help resolve.  That problem constitutes the way East African health care delivery to institutions, shaped by the region's colonial rulers, still primarily allocate the region's available health resources to serve the needs of its well-to-do populations, predominantly located in urban commercial centers.  Law can only help to resolve social problems by changing the behaviors that comprise them. This research report therefore identifies⁹⁴ and provides evidence as to the problematic behaviors of the relevant role occupants.⁹⁵  These mainly comprise the member states' health officials, and the Ministries of Health that supervise their efforts to implement existing law.  

A. The Social Problem:  The inadequacy of East Africa's inherited health institutions to resolve the region's health problems

The surface appearance of the problem constitutes the myriad unsolved, even undefined, health problems left unaddressed at the community level.  Existing institutions permit health issues transcending national boundaries⁹⁶  to remain unidentified or imprecisely defined.  The Introduction to Part I demonstrates the danger that an event that, originally seemingly isolated in a single nation, may have region-wide epidemiological consequences. 

As another example, consider the difficulties East Africans experience in accessing affordable, effective medicines. Routine, well-established drug regimens exist to treat, prevent, or cure three of the major infectious diseases in East Africa – HIV, tuberculosis and malaria.  The enormous economic, social and political burden these diseases impose on the EAC and, for that matter, on all African countries, in any strategy for development make their control a central consideration.  The EAC, with a population of about 125 million, and a GDP of around US$104 billion, forms a large and potentially lucrative market for pharmaceutical manufacture and sales.  Foreign firms, however, manufacture the bulk of EAC medications abroad.
In the event, EAC member states pay high global pharmaceutical prices at great expense, reducing the availability of affordable, effective medicines, and aggravating the net flow of capital out of the area.  Further, the capital investment, economic growth and employment opportunities that would attend a robust domestic capacity to manufacture medicines in the region remain, not a reality, but a vision.

Existing national laws authorize the member states' Ministries of Health to act only within their national borders.  The EAC Treaty of 1999 explicitly recognized the desirability of community-wide cooperation on health issues in general, and issues surrounding pharmaceutical quality control, registration, licensing, research and development of pharmaceuticals in particular.⁹⁷ It called upon the member states to cooperate, and 'undertake to act' on a variety of issues, offering no further specific mechanism or guidance.   To date, the East African Community, both at the community and member state levels, however, still encounters difficulties in drafting and implementing regional legislation to improve health care delivery.

B. History of the East African Community's Health Institutions

The inadequacy of EAC health care delivery institutions arises from inherent weaknesses attendant on the East African Community's history, and the structure of its institutions under its founding treaty.

Building on the British precedent of establishing a common market area in the colonial era,⁹⁸ Kenya, Uganda and Tanzania first founded the East African Community (EAC) in 1968.  An attempt to establish a common post-colonial currency failed when Tanzania nationalized its banks in 1966.  Idi Amin's ascension to power in Uganda in 1971, and the ensuing regional and civil war, broke up the common structures of the then-extant EAC, which ended in 1977.⁹⁹  In 1999, Kenya, Uganda and Tanzania reconstituted the EAC by treaty.  Rwanda and Burundi joined as member states in 2007.

The East African Community Treaty of 1999 established the East African Legislative Assembly, inaugurated in 2001.¹⁰⁰ The national legislatures of its member states elect the EALA's members, with the addition of one minister from each member state and the secretary general and Counsel to the community.¹⁰¹  The treaty clearly aimed to constitute the EALA as a representative body not just of the member states' governments, but of their peoples:

The National Assembly of each Partner State shall elect, not from among its members, nine members of the Assembly, who shall represent as much as it is feasible, the various political parties represented in the National Assembly, shades of opinion, gender and other special interest groups in that Partner State, in accordance with such procedure as the National Assembly of each Partner State may determine.¹⁰²

However, not a body of the EAC, but 'the institution of the Partner State that determines questions of the election of members of the National Assembly responsible for the election in question'¹⁰³ has authority over all questions as to membership.  The EALA cannot pass a bill unless it is approved not only by the EALA, but also by the presidents of the Partner States.¹⁰⁴

The founding EAC treaty thus severely circumscribes the EALA's power, and freedom of action.  The EALA depends entirely on legislators who act as creatures of their respective national assemblies, and its actions remain hostage to unilateral veto by a president of but one of the member states.  It does not seem surprising, therefore, that critics have described the EALA as a 'paper tiger'.¹⁰⁵  A Ugandan commenter contributed this jaundiced view of the EALA:

Commentators often charge the EAC with 'elitism', working at a distance remote from the common person.  Kenya's relatively larger economy,¹⁰⁷ whose primacy in the region dates to colonialist times and imperatives,¹⁰⁸ often forms the context of such charges.

The EAC treaty, however, explicitly grants the EALA the power to establish 'any committee or committees for such purposes as it deems necessary,'¹⁰⁹ and affirms the right of persons to attend and take part in the Assembly at the invitation of the Speaker.¹¹⁰   In 2007, the EAC called the 1st East African Health and Scientific Conference in Uganda.¹¹¹  The EAC plans to reconvene the conference annually.¹¹²  The agenda items included a draft protocol for the establishment of the East African Health Professions Authority, and the East African Food and Drugs Authority, as community-wide organizations.  The goals of the conference included movement towards community-wide integration in health, as has started to accomplish in trade:

Ambassador Juma Mwapachu, the EAC Secretary-General, addressed the building of community-wide institutions:

The EAC posted on its website the position of principal EAC health officer, vacant for quite some time.¹¹⁵ The job description placed it within the Secretariat of the EAC, reporting to 'the Director Productive and Social Sector.'¹¹⁶  The description mentioned neither the 'East African Health Research Council' of Mwapachu's remarks, nor the 'East Africa Health Professions Authority' of the Conference program, nor the Sector Committee on Health.  The EAC Web site mentioned the attempt to recruit a Health Coordinator as early as 2004.¹¹⁷ A search of the Web for information about the 'Productive and Social Sector' of the EAC, or its Director, yielded nothing save for the reference just cited, and for a 'social sector' in very general terms, rather than, as the job posting implied, a specific governmental entity.  The EAC Web page mentions a 'Health Sectoral Committee' and a 'Sectoral Council' of Ministers of Health, but offers no information on them.¹¹⁸  A Web search yields no further information.¹¹⁹

Chapter Five of the EAC treaty creates a Council, made up of the 'Ministers responsible for regional cooperation of each Partner State and such other Ministers of the Partner States as each Partner State may determine.'¹²⁰  The treaty gives the Council the power to make policy,¹²¹ monitor and review implementation of Community programs,¹²² initiate and submit bills to the EALA¹²³ and regulations, directives and the like.¹²⁴

The EAC treaty assigns implementation, and the monitoring of implementation, to a Co-ordination Committee made up of the Partner States' permanent secretaries for regional cooperation.¹²⁵ The Co-ordination Committee has the mandate to receive and consider reports of the Sectoral Committees, and to coordinate their activities.¹²⁶

Under the treaty, the Council, on recommendation of the Co-ordination Committee, creates Sectoral Committees, presumably including the Health Sectoral Committee referred to above.  Their mandate includes:

Summarizing the above, under the EAC Treaty, the Council proposes legislation to the EALA, as well as regulations and directives, presumably on recommendation of the Sectoral Committees, acting through the Co-ordination Committee. The treaty variously assigns responsibility for implementing, monitoring, and evaluating legislation to the Council, the Coordinating Committee, and the Sectoral Committees. 

Explicitly recognizing a need for a community-level response to health problems, the EAC convened the 2007 Health and Scientific Conference and called for the establishment of community-wide organizations to address the issues. The establishment of a Health Legislation Commission, as proposed in this report, would mirror positions held publicly from the Secretary General of the EAC on down, and facilitate the specification of goals and institutions to deal with the health issues delineated in the Conference.  As envisioned in this research report, the Health Commission would share functions that the EAC treaty assigns, though not exclusively,¹²⁸ to existing bodies.  As outlined below in this report's suggested bill, the Commission's design would require it – more effectively than have existing bodies – to conduct research, obtain data, define problems relating to health, and propose legislation to change the behaviors causing these problems.

By its own admission, the health needs of the EAC remain unmet.  Apparently, the responsible EAC institutions have not succeeded in identifying regional health issues, designing and implementing appropriate health laws, and monitoring and evaluating their social impact.  The EAC member states' Ministries of Health, by law required to view their missions nationally rather than on a community-wide basis, cannot fulfill this need.  Using legislative theory's ROCCIPI categories,¹²⁹ this Part suggests several explanatory hypotheses as to why each of these social actors seems unable to carry out their responsibilities. It also indicates the kinds of evidence required to warrant those explanations.  Once warranted, the workshop participants will have opportunity to assess whether the proposed bill's detailed provisions logically seem likely to alter or eliminate the causes of the problematic behaviors, as identified by those hypotheses, thus to induce new drafting behaviors – i.e., new drafting institutions. Those new drafting behaviors aim to produce a legislative program that will effectively change dysfunctional inherited institutions and provide improved health care for all East Africans.

A.Responsible Officials

1. The EALA

Rule:  Essentially, the EALA remained limited by structural constraints on their membership and access to funding.¹³⁰   All heads of member states must assent before the EALA can enact a bill related to any issue, thus granting every member state president¹³¹ power to veto any EALA law, including any related to health.¹³²   Article 118 of the EAC Treaty discusses health issues solely in the context of possible actions which member states might take in concert.   The article does not mention, or prescribe actions, which the EALA, or indeed any community institution, might take related to health.¹³³

Opportunity:The EALA may establish committees for any purpose deemed necessary.¹³⁴

Capacity: The EALA itself has no capacity to research health issues. No easily available evidence indicates appointment of an EALA committee responsible for taking action on health issues, or any ongoing interaction between the EALA and the Sector Committee on Health. 
Communication:  No easily available data indicates that either EALA or an EALA committee communicates regularly with relevant member state officials about health problems.

Interest:  With the exception of two ex officio members, member state national assemblies elect their EALA legislators. EALA legislators thus elected may feel beholden to their countries' legislators and their interests, rather than considering the needs either of the community as a whole, or other Member States.¹³⁵

Process: EALA legislators do not actively solicit information, and have no specific responsibility for health matters.¹³⁶  The 2007 EAC Health and Scientific Conference called for legislation addressing health problems.¹³⁷ The EAC treaty, however, requires only that the EALA communicate with the National Assemblies of the Partner States,¹³⁸  heads of government and the secretariat.  No statutory or constitutional provision exists requiring that the EALA communicate with other stakeholders or the citizenry of the EAC, save through publication of enacted legislation in 'the Gazette.'¹³⁹ No mechanism exists through which citizens can petition, or even be heard, though the EAC Treaty specifically allows for the possibility.

Ideology:  The EALA as a whole seems to find trade issues more compelling than health issues.

2. The EAC Secretariat

No easily available evidence seems to explain the EAC Secretariat's apparent inactivity relating to health issues.

3. The EAC Health Sectoral Committee, Coordinating Committee and Council

No evidence about these bodies, other than the enabling clauses in the EAC treaty and the occasional references cited, seems easily available.  Absent firmer evidence on which to ground recommendations, any solution -- including the one proposed by this report -- must remain tentative.

4. The Member States' Ministries of Health

Rule:  The member state Health Ministries operate under charters issued under their separate existing national legislation.  These tend to restrict their efforts to consider formulation and implementation of consideration of possible regional health laws.

Opportunity: The Ministries seem limited by national considerations, apparently still significantly influenced by the concerns of the urban, wealthy, vocal population.  These apparently tend to crowd out the concerns of the poor majority, especially those living in rural areas.

Capacity:  The member state Ministries have limited research capacity, and little means of coordinating and exploring the regional implications of their findings, far less for designing potentially effective regional health legislation. Even on the national level their research resources appear limited. Regional logistical support – roads, infrastructure, electricity, Internet computers – all remain in short supply.

Communication:  To date, the EAC leaders have supported few channels – other than the recently established annual regional health conferences – to encourage member state Health Ministries' efforts to design and implement improved regional health legislation. 

Interest:  The Ministries' interests in health-related priorities primarily seem to reflect those of their member state governments.  And, alas, as too often happens the world around, the needs of the urban, wealthy, vocal populations tend to crowd out those of the impoverished majority of the region's inhabitants, whether they inhabit urban or rural areas.

Process:  As yet, little evidence seems available as to a community-level process of ongoing inter-EAC Health Ministries' cooperation to facilitate the conduct of research, drafting and implementation of effective regional health-related legislation.¹⁴⁰

 (WE WOULD MUCH APPRECIATE RECEIVING RELEVANT DOCUMENTS AS TO THE PROGRESS MADE ON THESE ISSUES AT THE THREE REGIONAL CONFERENCES OF EAC HEALTH MINISTRIES, ESPECIALLY THE MOST RECENT CONFERENCE IN KIGALI.) 

Ideology:  EAC member state health ministries, responsible for dealing with their parent governments' health problems, do not appear predisposed to see them in a larger, community-wide context.  That tends to make discovery of regional solutions for some of them more difficult, if not impossible.

5. The Ministries of Trade and Industry

Again, paralleling the Ministries of Health discussion above, potential economies of scale in providing training, scientific research, and manufacture of medical equipment and effective, affordable medicines underscore the importance of exploring community-wide solutions.  Nevertheless, the prevailing ideology seems focused on advancing national rather than community interests (as illustrated by the neglect of possibilities of expanding pharmaceutical manufacturing for a larger regional market, providing more integrated production processes in regional plants, more and better paying jobs for regional inhabitants, etc.).¹⁴¹

6. The Universities

Rule:  Member states' governments fund the universities and subsidize tuitions.   No member state rules seem to require those universities to work together to develop training materials and courses to equip regional medical professionals with the skills and attitudes required to manage rural health facilities as well as to fulfill essential rural health needs.  Few if any member state governments have introduced incentives or imposed restrictions to discourage medical and engineering graduates, on leaving school, from leaving for greener pastures in urban centers or even abandoning the African continent altogether.  

Opportunity:  The region's medical faculties regularly encounter the full spectrum of health problems.  University faculty members and staff do know about modern, up-to-date scientific advances likely to expand the limits on what works, what does not.  Nevertheless, their countries face continued difficulties in maximizing the region's inhabitants' benefits from those advances unless the EAC universities' faculties and staffs cooperate to improve their countries' scientific and professional human capacity to make better use of their region's physical and financial resources.

Capacity:The East African governments do not fund their medical faculties lavishly, nor do graduates who remain in their countries earn lavish salaries.  Even if no university graduates emigrated in search of better remuneration in seemingly safer environments, the number of well-trained physicians, nurses, pharmaceutical technicians, and other health professionals would likely remain insufficient.  

Communication:Member state governments make insufficient efforts to inform potential medical professionals about the critically important potential value of conducting research and training to ensure greater use of their countries' human, physical and financial resources to improve their countries' poor majorities' health services, and ultimately their regional capacity to manufacture medicines to improve their inhabitants' health and life expectancy.

Interest:The universities' health faculties would like to maintain and, if possible, increase their funding, and increase the size of the student body.  Higher salary and better working conditions, however, predispose too many medical professional members to consider emigration, instead of working to improve health conditions in their own countries.

Process:University decision-making processes do not sufficiently focus on whether and how to equip faculty and students – not only in medical and scientific professions, but also those in social science and law programs – to conduct research on the use of evidence-based law to resolve health problems.

Ideology:University faculty appear not to have devoted sufficient attention to engaging and persuading students of the importance – rather than seeking high paying jobs serving the urban, powerful and wealthy few – of creating new institutions to improve all East Africans' health care and life expectancy – especially the largely voiceless poor majority.

7. Non-governmental Organizations (NGOs)

Rule:  Many NGOs have internal rules, which restrict their donations, and retain control over the resources and gifts they do donate.¹⁴² Member states' laws may limit their efforts to coordinate programs to improve training, foster better use of equipment, and, in general, Community health professionals' contribution to improving health services available throughout the region.¹⁴³

Opportunity:  Large amounts of monetary and substantive aid enter Africa on a steady basis.  Some of it goes to waste, due to poor logistics, poor prioritization of needs, or corruption.  NGOs, too, might benefit from economies of scale if they could work with EAC-level organizations to improve their allocation of resources.

Capacity:  Highly visible groups like the Bill and Melinda Gates and the Clinton foundations, the United Nations groups like UNESCO, and others have made financial resources available, but apparently without sufficiently engaging local health professionals in finding ways to use them to improve member states' – far less regional – use of their own resources.

Communication:  Member state governments make insufficient effort to facilitate efforts of civil society and NGO personnel to work together to improve their use of NGOs' personnel and financial resources.

Interest:  As their stated raison d'être, most NGOs aim to help people through wise, even participatory, deployment of resources. Their officials' personal interests, however, sometimes may override that declared objective.

Process: NGO personnel do not always operate with transparency, accountability or participation.   To the extent that their organization's rules do not require them to make their decisions in public, grounded on evidence obtained from the relevant stakeholders – especially the poor and vulnerable – their actions may undermine their proclaimed efforts to empower EAC member states inhabitants to achieve improved, sustainable health care.

Ideology:  NGOs' ideologies relating to health seem to vary widely, with varying degrees of insistence as to its primacy.

In sum, a review of the ROCCIPI agenda, as to the possible causes for relevant social actors' problematic behaviors, suggests a variety of explanatory hypotheses – educated guesses.   Some of these hypotheses have proven consistent with the available relevant facts.   Far more evidence seems required, however, to warrant the suggested explanations.   Members of the proposed workshop may offer some of the essential necessary additional facts.   Nevertheless, the difficulty of finding the necessary facts underscores the necessity of setting up an EAC Commission empowered to conduct the essential research as to the probable causes of the seemingly problematic behaviors of all the primary role occupants and implementing agencies listed.  On the basis of that evidence, the Commission drafters, presumably well-trained, will find it possible to draft a number of bills – a legislative program – to empower the EALA, together with the member states, to change the problematic behaviors of the many social actors discussed in this report's Part III.

To formulate and implement an appropriate legislative solution, Part IV incorporates two essential problem-solving steps – Step 3 which defines the proposed solution, and Step 4 which calls for monitoring the new law's implementation and social impact.   In this case, Step 3 involves designing the proposed bill to establish a Regional Health Commission, and Step 4 calls for incorporation in the bill of a provision for monitoring and evaluating.
 
Part IV first reviews the alternative legislative solutions, observing that, based on the available evidence, the proposed bill to establish an EAC Health Commission to conduct research and draft bills in the context of a legislative program seems most likely to improve regional health care.  It demonstrates that, logically, the bill's detailed provisions will likely prove cost-effective in overcoming the causes of the problematic behaviors at issue.  Finally, as required by problem-solving's Step 4, this Part describes the bill's provisions to establish a transparent, accountable and participatory monitoring and evaluation system to permit, after enactment, ongoing assessment and – if necessary, revision – of the Health Commission Law.

A. Possible alternative legislative solutions

Without creating another administrative agency, the EALA might set up an ad hoc Committee to conduct the necessary research and draft the needed health legislation. That might happen if, say, a member of the EALA, possibly of long service and well-regarded expertise, developed an interest bordering on a preoccupation in health issues, as occasionally happens in the American Congress.¹⁴⁴

Unfortunately, reliance on exceptional individuals, while fortuitous in the event, seems an unreliable route to institutional change.  The EALA, or a member or group of members of the EALA, as presently structured, seem unlikely to have the capacity to obtain data, conduct research, and analyze the findings so as to produce a bill grounded in facts and logic, or to monitor and evaluate a bill's implementation on an ongoing basis.¹⁴⁵

Alternatively, the EAC member states' Ministries of Health could take on the task of conducting research and drafting regional legislation.  The bill here proposed would not, of course, preclude that kind of action.  Indeed the proposed Commission should encourage the health ministries to initiate needed legislation.  Past experience, however, suggests that the national health ministries, concerned with their own countries' health problems, lack both the interest and capacity to pursue community level solutions.¹⁴⁶

As the EAC treaty seems to permit, the EAC Sectoral Committee on Health could take on many of the functions of the envisioned Commission.  (Need more research on structure, membership and history of action/inaction by the Sectoral Committee to determine why it has not done so; the 2007 Summit call for a Health Commission,¹⁴⁷ however, seems, a priori, to suggest that conclusion.)

As another alternative, the proposed Regional Health Commission might issue subordinate legislation, or administrative regulations, rather than propose legislation.  The regulations could take effect on issuance, as do rules promulgated by the Occupation, Safety and Health Agency (OSHA) in the United States.  Regulations alone, however, could not – as could a legislative commission – introduce legislation to change existing institutional structures, or create new institutions.  As well, a legislative commission could, should the facts and logic emerging from research suggest it, propose legislation of the intransitive sort, creating a subordinate department charged with making regulations.

The Sector Committee on Health could itself take on the role envisioned for a Commission in this report, or form a body to do so.  Given, however, the current inadequate response of the Sector Committee, as acknowledged by the EAC itself in calling for new institutions in 2007, such an allocation of responsibility would probably not result in a more productive, transparent body.     

The situation could continue as it presently exists.  As all acknowledge the necessity for action on the unsolved health problems of both the EAC and its member states, on local and regional levels, the status quo seems an unacceptable alternative.

B. The Proposed Regional Health Commission

This report supports the establishment of an EAC Health Commission with the power to conduct research and draft health legislation to maximize the potential use of member state and regional human, physical and financial resources to improve regional health care for all East Africans.

Under the proposed bill, the Commission draws its members from the Community's member states through a transparent process of appointment. The Commission serves primarily to represent, not competing interest groups, but rather the insights of knowledgeable professionals in the health care delivery systems. (Two advocacy NGOs representing the rural poor constitute an exception to that proposition.)  The Commissioners therefore consist of public health professionals with experience in-country.  A wide range of authorities and organizations nominate those members: The Ministers of Health and of Justice of the EAC Partner States, the Deans of their medical faculties, EAC nurses', pharmacists' and other professional organizations, and organizations that advocate for the rural poor.  Involvement by academics as well as government functionaries will broaden and deepen the Commission's agenda, further involve academics in policy, facilitate research and analysis, and make the Commission more independent of other entities.   The National Legislatures will retain confirmation power, maintaining their stake in the Commission without thereby limiting Commissioners' independence or freedom of action.  (See Schedule A to the draft bill.) 
Under the proposed bill, each year the Commission will hold two regular meetings.  They invite participation from every level of society and every stakeholder throughout the community, not only at those meetings (see draft bill, Article 9).  The Commissioners seek information from as broad a range of sources as possible, and, using this input, identify and prioritize health care problems (Draft Bill, Chapter Four).  The act requires public and regularly convened meetings;; that all who wish to speak may do so, that all stakeholders receive notice of the meetings and given time to attend, submit and respond; that the Commission's deliberations, in and out of the meetings, are made public (Draft Bill, passim).  The widest possible representation on the Commission, and the widest possible collection of data, will help the Commission prioritize, respond to urgent and long-ignored needs, and monitor and evaluate its prior actions and their implementation, with a view towards improving them.

The Commission will establish drafting teams to gather the available evidence, or to carry out original research, as the basis in facts, logically organized, for recommending legislative solutions – i.e., bills.   
 
The proposed Act requires that the drafting teams accompany their bills by research reports to provide the evidence, logically organized, to justify the bills' detailed provisions (Articles 13 and 14).  The Commission must make these reports available to the public, thus to enable interested parties to provide inputs to the design of legislative solutions based, not on power politics or trade-offs, but on the available facts and logic.  Publication of the reports will contribute to making the law-making process transparent, accountable, and participatory – an essential quality control:  The reports will  inform any who read them of the factual and logical bases that undergird the proposed legislation; any interested person can assess whether the proposed solution seems logically derived from relevant facts which correspond to reality.

Once the EALA or a member state enacts a bill proposed by the Commission, the accompanying research report will facilitate public participation in monitoring and evaluating whether it proves effectively implemented to help achieve the desired social impact.

The establishment of a Health Legislation Commission, as proposed in this report, would reflect the position, held publicly from the Secretary General of the EAC down, that the health problems of the EAC require a community-wide response. It will facilitate the definition, prioritization, and achievement of goals for improvement in health, and the institutions dealing with health issues, delineated in the 2007 Conference.  Note that the EAC treaty includes language specifically enabling the member states to act on health issues, including pharmaceutical issues.¹⁴⁸

The Commission will share functions that the EAC Treaty assigns, though not exclusively, to existing bodies.  The commission's design empowers it to prioritize problems in the health care delivery system,  conduct research, obtain data, define problems relating to health, and propose legislation – backed by facts and logic elucidated and recorded in a research report accompanying proposed legislation – to change the behaviors causing these problems, in a more effective manner than do existing bodies.

The Commission, under the proposed Act's detailed rules requiring published data and analysis, more than do existing law-making institutions, likely will act positively and with a view to fill the need for improved regional health care.  By virtue of its scheduled meetings (Chapter Three), carefully prescribed bill-designing methodology and detailed research reports (Articles 13 and 14), under the proposed bill the Commission has the capacity and opportunity to prepare legislative proposals more likely to ensure effective regional health care delivery systems.  Its well-defined processes facilitate the prioritizing of problems, the capturing of relevant evidence, and its use of problem solving methodologies in proposing, justifying and evaluating solutions – all critical to its mission.  The meetings specified in the Act will improve data collection, expand outreach to people not always represented or heard, and promote citizen and institutional involvement in health problem solving.

The proposed Act requires the Commission to communicate with stakeholders, citizens and others in timely fashion, and to solicit and accept communications from them.  Transparency, accountability and the greatest possible public participation can only contribute to achieving optimal use of available human and financial resources in providing adequate EAC health care delivery systems.

The Commission's underlying ideology – the improvement of health in the East African Community through action on a community-wide basis – can only prove congenial to stakeholders, and provide an incentive to cooperate with its agenda rather than dismiss or marginalize it. 
 
The bill's mechanism for periodic information gathering also includes monitoring and evaluation of the effect of enacted legislation. Ongoing improvement in legislation, by a continuously operating entity, makes significant results possible even with incremental steps, or with initial moves requiring later correction.

This report documents a need for action on health issues at the level of the East African Community, and not just at the level of its member states.  The East African Community has itself called for the establishment of institutions to provide this action.

The report documents institutional deficiencies at the level of the East African Legislative Assembly, and national Ministries of Health, as presently constituted, which limit those bodies' ability to respond to the need.

The suggested legislation would establish a Health Legislation Commission which, by design, would meet the identified need:

1. It will represent the member states and their health ministries;
2. It will be required to gather data throughout the EAC;
3. It will function in an open and public manner;
4. It will propose solutions to both the EALA and member states' legislatures and Ministries of Health for their consideration;
5. It will involve institutions such as universities and current health care givers;
6. It will propose legislation based on research findings reflecting realities on the ground;
7. It will monitor the effects of legislation if passed, evaluating its efficacy, and if necessary recommend changes, again after conducting research and obtaining wide input from all stakeholders and citizens.

A ROUGH DRAFT OF THE PROPOSED BILL:
 
[Editors' Note:  In view of the difficulties in obtaining the relevant essential evidence essential for establishing an effective EAC Commission, as noted above, this comprises at best a very rough draft of the kinds of detailed legislative provisions likely to prove necessary.   If the proposed EAC workshop takes place, the EAC legislative drafters, health professionals and others who participate will have an opportunity to provide the essential additional information (as indicated above)  On that basis, they can revise the draft research report, and the rough draft of the bill here outlined.]

1.Short title

This  Act may be cited as "The East African Legislative Health Commission Act."

2.Objectives

(1)  In this Act –

'bill' means draft legislation, draft subordinate legislation or a draft regulation; it does not include a rule for the internal administration or governance of the Commission.

'Commission' means the East Africa Community Health Research and Drafting Commission as established by this Act.

'to design a bill' includes devising the detailed substance of a bill's provisions.

'to draft a bill' means to write out the words of a proposed bill.

'EAC' means the East African Community.

'EALA' means the East African Legislative Assembly

'Partner State' means a partner state of the EAC.

(2)This Act has the following objectives:

1. to identify health problems in EAC and its Partner States.
2. to conduct research concerning these problems and the behaviors that constitute them, as the necessary grounding of evidence-based legislation likely to ameliorate them;
3. to prioritize bills for designing and drafting;
4. following that prioritization, to design and to draft bills addressing those identified and prioritized social problems;
5. to propose  evidence-based bills for further study and enactment or adoption and promulgation by EALA or by the relevant subordinate bodies of EAC;
6. so far as feasible, to utilize legislation, subordinate legislation and regulations to ameliorate health care delivery problems in the EAC in ways that maximize benefits and minimize costs;
7. towards that objective to utilize the collective economic, political and social power of EAC;
8. so far as feasible, within EAC, to ensure that EAC inhabitants wherever or however situated have equal access to health care delivery systems
9. in drafting a bill, to ensure the maximum feasible inputs to the drafting process from civil society advocates for the poor and disinherited, for ethnic minorities, for women, for children, and for others usually excluded from the corridors of power;
10. to provide the highest feasible level of training for EAC health care professionals  
11. in drafting a bill, to the maximum feasible extent, to ground the bill on facts and logic;
12. in its efforts to achieve the objectives of this Act, to base its actions and its recommendations on sound science;
13. to the maximum feasible extent, to foster the conditions in which the EAC Member Countries can develop a pharmaceutical industry to supply pharmaceuticals and other medical supplies to the EAC market.

3.Establishment of the Commission

This Act establishes the Commission as a constituent part of the Secretariat of the EAC.

4.Composition of the Commission; appointment of members

The Commission shall have the membership, with the qualifications, and enjoying the tenure, pursuant to Schedule A to this Act.

5.Foundational and subsequent meetings; appointment of Director General of the Commission

1. The Commission shall hold its foundational meeting and appoint its Director-General pursuant to Schedule A to this Act
2. At subsequent meetings of the Commission –

1. The Director-General shall serve as Chair, and have a casting vote.
2. If the post of Director-General becomes vacant, in conformity to the provisions of Schedule A, Article 5 (concerning the Acting Chair in the absence of a Director-General, and appointment of a new Director General) the Commission shall appoint a new Director General.

6.Quorum

Absent a provision to the contrary, at a meeting of the Commission, by a simple majority vote a quorum of not fewer than half the members may conduct business of the Commission.

7.Regular Meetings

1. The Commission shall meet twice a year on the call of the Chair.
2. A reasonable time before the scheduled date of a regular meeting, and in any event not later than two calendar weeks before a regular meeting, the Chair shall circulate an agenda for the meeting, together with supporting documents.
3. By written notice received by the Chair not less than three calendar weeks before a regular or special meeting, a member may require the Director-General to include in the agenda an item, and to circulate to members of the Commission necessary supporting documents, as the member may request.
4. The Chair shall conduct either a regular or a special meeting called pursuant to Article 8 in accordance with Roberts' Rules of Order.
5. The Director-General shall ensure that a member of the public may attend a regular or a special meeting of the Commission

8.Special meetings

1. The Commission shall meet in special meeting at the call of the Chair, or at the call of three members of the Council.
2. The Chair, or the parties who pursuant to sub-Article (1) call a special meeting, as the case may be, shall give not less than two weeks' written notice of the time and place of the meeting.
3. The Chair or the parties who pursuant to sub-Article (1) call a special meeting, as the case may be, shall accompany the call for the meeting, or in any event not less than one week before the special meeting, shall circulate an agenda for the meeting, together with supporting documents.
4. By written notice received by the Chair not less than three calendar weeks before a regular or special meeting, a member may require the Chair to include in the agenda an item, and to circulate to members of the Commission necessary supporting documents, as the member may request.

9.Publicizing matters of concern in EAC health care delivery systems

1. In this Act, 'to publicize' means informing the public by all feasible means.
2. When required by this Act to publicize a matter of concern, as a minimum, the Director-General shall –
   
   • inform institutions of the media such as newspapers, radio and television stations, and magazines, and relevant University departments, faculties or other university institutions within the EAC concerning the matter of concern;
   • post the matter on a web site easily accessible to a person with access to a computer and the Internet; and
   • conform with sub-Article 15(3) (concerning sending information to persons who have registered with the Commission); and,
   • if in the Director-General's or the Commission's opinion the circumstances so warrant, organize one or more public meetings on the matter of concern, in locations and at a time convenient for most stakeholders in the matter.
3. Publicizing the solicitation as widely as feasible, the Director-General shall solicit identifications of problems arising in health care delivery systems within the East African Community or within a particular Partner State.
4. The Director-General shall keep a record of reports of such problems whether they arise within the jurisdiction of the East African Community or within a particular Partner State, or whether a member of the public, a concerned non-governmental organization, an official of EAC or of a Partner State, or a member of the Commission report the problem to the Director-General.
5. The Director-General shall make a preliminary investigation of a problem in the health care delivery system within East Africa called to the attention of the Director-General's office, and describe that problem in not more than five hundred words.
6. The Director-General shall circulate that description of the problem among members of the Commission and others who the Director-General believes should learn about it.

10.Prioritizing health care delivery problems for legislative attention

1. Semi-annually, the Director-General shall compile a list of health care delivery problems within the East African Community, accompanied with a description of the problem as prepared by the Director-General pursuant to sub-Article 9(5)
2. Semi-annually, the Director-General shall make a preliminary prioritization of the health care delivery problems mentioned in the list compiled pursuant to sub-Article (1)
3. Semi-annually, prior to a regular meeting of the Commission, the Director-General shall forward to each member of the Commission the list of projects mentioned in sub-Article (1) and the preliminary prioritization mentioned in sub-paragraph (2)
4. Taking into account –
   
   • the relative medical urgency of the several health care delivery problems in the list provided pursuant to sub-paragraph (3);
   • the relative social urgency of those problems;
   • the resources available for completing the research necessary to produce a meaningful draft bill addressing each of those problems;
   • the drafting resources available;
   • the likely available legislative time before the Council or the EALA for consideration of the proposed legislation; and
   • the preliminary prioritization made pursuant to sub-Article (2),
   • the Commission shall compile a schedule indicating the priority for drafting bills addressing the problems mentioned in the list made pursuant to sub-Article (1).
5. The Commission shall accompany the schedule mentioned in sub-Article (4) with a memorandum justifying the prioritizations in that schedule.
6. In compiling the schedule mentioned in sub-article (4), the Commission shall indicate which, if any, of the proposed bills mentioned in that schedule addresses a matter of insufficient importance and simplicity to warrant excusing the drafter from the obligation imposed by Article 14 (requiring the drafter to accompany the bill with a research report formulated pursuant to Article 14).

11. Emergency health care delivery system problems

1. If two Ministers among the Ministers of Health or Ministers for EAC Council Affairs of the Partner States, or the Director-General, believe that a medical emergency requires immediate legislative or regulatory intervention in the health care delivery system of either the Community or of a Partner State, any two of those Ministers from two different Partner States may require the Director to convene, or the Director on the Director's own motion may convene, as soon as feasible, in a venue that the Director may select, an emergency meeting of the Commission.
2. Pending that meeting, the Director-General, and at that meeting, the Commission, may take whatever action within the Commission's powers seems appropriate to address the medical-legislative emergency mentioned in sub-paragraph (1) 

12.Drafting a bill for EAC

1. So far as feasible conforming to the prioritization determined pursuant to Article 10, and as the Director-General may require, a staff drafter shall design and draft a bill appropriate for ameliorating a social problem identified in the prioritization schedule mentioned in Article 10 (concerning the prioritizing of health care delivery problems for legislative attention)
2. Except as required by action taken pursuant to Article 10 (concerning emergency health care delivery system problems), the Director-General shall assign a drafter to design and draft a bill in the order of prioritization set forth in the list compiled pursuant to Article 9 (concerning the prioritizing of health care delivery problems for legislative attention)

13.  Designing a bill: criteria

1. In designing a bill, the drafter shall take into account only the objectives of this Act as set forth in Article 2 (stating the objectives of this Act).
2. In designing a bill, the drafter shall follow a problem-solving decision-making methodology, as prescribed in Article 14 (concerning research and the Research Report) with respect to the design of a Research Report.

14.    Research and the Research Report

1. A drafter assigned, pursuant to Article 12 (1) (requiring a drafter on the instructions of the Director-General to draft a designated bill) to draft a bill, shall undertake detailed research on the several aspects of the assigned bill, following the methodology prescribed by sub-Article (3). 
2. Except with respect of bills with low importance and low complexity as mentioned in sub-Article 10(5), the drafter shall accompany a bill with a Research Report, which demonstrates that the bill's detailed provision rest on facts, logically organized.
3. In designing a bill as mentioned in sub-Article (1), and, pursuant to sub-Article (2), in writing the Research Report, the drafter shall –
   
   • first, examine in detail the behaviors that constitute the social problem that the designated bill will address;
   • second, identify in detail the relevant constraints and resources that influence those problematic behaviors;
   • third, design a bill whose provisions address the factors, identified pursuant to sub-paragraph (ii), which likely influence the problematic behaviors at which the bill aims, and demonstrate that the prescriptions of the bill will likely provide the most economical available legislative solution for the social problem addressed; and
   • fourth, include in the bill provisions for monitoring and evaluating the law after its enactment and implementation.
4. The drafter shall write the Research Report mentioned in sub-Article (1)—
   
   • a.in a form that explicitly tracks the decision-making methodology prescribed  in sub-Article (3);
   • b.including evidence to support a claim that the addressees of the several prescriptions in the bill will conform their behaviors to those prescriptions;
   • c.in a manner that the drafter believes will win support of the draft bill by a  rationally skeptical voter. 
5. In the Research Report, the drafter shall make every effort accurately to predict the behaviors that the bill will induce in the relevant actors.

15.    Participation in a drafting project

1. When pursuant to Article 12 (concerning drafting bills for consideration by EAC) the Director-General assigns a health care delivery problem to a drafter, absent a prescription to the contrary, the Commission shall publicize that it has undertaken drafting a bill to address that problem.
2. A person desirous of receiving notice of progress in drafting the bill may submit his or her name and address to the Director-General, together with a specification of the bill of interest to that person.
3. Thereafter, whenever pursuant to sub-paragraph 9(2)(b) this Act requires the Director-General to publicize a draft of that proposed bill, in addition to other publicizing efforts, the Commission shall notify by ordinary mail or by e-mail a person who pursuant to sub-paragraph (2) has submitted a name and address to the Commission.
4. Until the closing date for comment mentioned in paragraph 15(2)(b),  person may at any time submit to the Director-General a suggestion for inclusion in, or exclusion from, a proposed bill.

16.    Publicizing the draft bill; comment.

1. Upon completion to the satisfaction of the Director-General of a preliminary draft bill that purports to ameliorate the designated health care delivery problem, together with the Research Report mentioned in Article 13, the Director-General shall publicize that preliminary draft bill and its accompanying research report in conformity to sub-Article 9(2) (prescribing steps required to publicize a matter).
2. In publicizing, pursuant to sub-Article (1), a preliminary draft bill and its accompanying Research Report, the Director-General shall include – 
   
   • a.the text of that preliminary draft, or advice where a stakeholder or other interested person may obtain a copy of that preliminary draft bill, and its accompanying research report, if any; and
   • b.an invitation to stakeholders and other interested persons to comment on that preliminary draft bill, together with a time limit for submission of comments.      

17. Promulgation of the bill

1. After the expiration of the time limit prescribed by sub-paragraph 16(2)(b), the responsible drafter shall revise the bill in light of the comments received.
2. In the bill revised pursuant to sub-Article (1), the Director-General shall either –
   
   • include the substance of a comment made after publicizing the preliminary draft bill pursuant to sub-Article 16(1)  and before the expiration of the time limit mentioned in sub-Article 16(2)(b), or
   • explain why the Director-General rejected such a comment.

18.Commission approval of a bill

1. Upon completing the revision of the bill pursuant to Article 17(1), the Director-General shall circulate to each member of the Commission the following:
   
   • a copy of the preliminary draft bill, as publicized pursuant to sub-Article 16(1);
   • the research report that pursuant to Article 14(2)(requiring that a Research Report accompany a preliminary draft bill) accompanied the preliminary draft bill;
   • the bill as revised pursuant to sub-Article 17(1), and
   • the statement of reasons, if any, made pursuant to sub-paragraph 17(2)(b)
2. If within thirty calendar days after circulating the bill pursuant to sub-Article 1, a member of the Commission does not request that the Director-General schedule the bill for further Commission discussion and vote, the Director-General shall forward the bill and its accompanying research report and other materials to the Secretary-General of EAC for appropriate EALA or EAC action.
3. If within thirty calendar days after sending the bill pursuant to sub-Article 1 a member of the Commission does request that the Commission schedule the bill for further Commission discussion and vote, the Director-General shall place the bill on the agenda for the next Commission meeting, and shall so notify the members of the Commission.
4. At the meeting mentioned in sub-Article (3), the Commission shall approve some or all of the revised bill, the research report, and the reasons for rejecting a comment, or reject some or all of these, or require changes in any of these.

19.    Miscellaneous powers and duties of the Commission

1. The Commission shall:
   
   • make, keep, store, preserve and make available to an interested party:
   • records of Commission proceedings; and
   • research reports generated or used  by the Commission;
   • publicize the times and locations of all Commission hearing
   • open all its meetings to the public
   • keep account of the funds of the Commission, and keep those funds in a secure account;
   • record the Commission's expenses;
   • annually, make public an annual account of the Commission's income, expenses, cash reserves and transactions;
   • make public rules, procedures and regulations made pursuant to Article 8.
2. Within budgetary limitations, the Commission may employ staff to help it carry out its functions.
3. The Commission shall train drafting staff in designing and justifying draft legislation in terms of facts and logic, and in conforming to the requirements of Article 14..
4. The Commission shall collect, store and preserve information concerning –
   
   • the specific types of public health programs implemented in the Partner States; 
   • the criteria Partner States explicitly employ in designing their public health programs., and in choosing between alternative possible designs for those programs;
   • the criteria Partner States employ in selecting persons in charge of implementing their public health programs;  
   • procedures for terminating a public health official's tenure;
   • the resources Partner States allocate for public health programs;
   • the cost of implementing and sustaining Partner States' public health programs;
   • the monitoring, evaluation and feedback mechanisms Partner States employ with respect to their public health programs, and their effectiveness;   
   • how frequently Partner States review their public health programs;
   • the major challenges facing the several public health programs of the Partner States; and
   • the data collection and storage system of the Partner States' public health systems, and their accessibility to the public.

20.    Dispute Settlement

1. A party aggrieved by an action purportedly taken in terms of this Act may petition the Secretary General of EAC for relief.
2. The Director General shall appoint a senior EAC civil servant as Master to hear the matter and to recommend an appropriate remedy, if any.
3. The Master shall expeditiously hear the parties in person and through counsel, record the proceedings and the evidence, write an opinion with recommendations for action, and submit the record and the Master's opinion in the matter to the Director-General.
4. The Director shall decide the matter in writing, stating reasons, on the record made before the Master.
5. A party aggrieved by the Director-General's decision may appeal on the record made before the Master to the EAC Court.

21. Funding

1. As part of the EAC Secretariat, in estimates for the Secretrariat, the Director-General shall include funding for the Commission.

22.    Making rules for governance of the Commission

1. Except for sub-Article 18(2) (concerning forwarding a bill to the Secretary-General of EAC) following the procedures for designing, drafting and promulgating a bill in terms of  Chapter Five, the Director-General may make a Rule for the better governance of the Commission, or to enlarge its capacity to accomplish the objectives of this Act.
2. If within thirty calendar days after circulating the Rule pursuant to the procedures prescribed in sub-Article 18(1), a member of the Commission does not request that the Director-General schedule the Rule for further Commission discussion and vote, the Director-General shall forthwith promulgate the Rule as a Rule for the governance of the Commission.
3. If within thirty calendar days after circulating the Rule pursuant to procedures prescribed in sub-Article 17(1) a member of the Commission does request that the Commission schedule the Rule for further Commission discussion and vote, the Director-General shall place the Rule on the agenda for the next Commission meeting, and shall so notify the members of the Commission.
4. At the meeting mentioned in sub-Article (3), the Commission shall approve some or all of the revised Rule, the research report, and the reasons for rejecting a comment, or reject some or all of these, or require changes in any of these.
5. After final approval by the Commission of the proposed Rule, the Director-General shall forthwith promulgate the Rule as a Rule for the governance of the Commission.

23.    Evaluation and Monitoring

1. At the regular meeting of the Commission that falls closest to the beginning of a new calendar year, the Commission shall elect three persons to serve as that year's Evaluation Committee.
2. The Evaluation Committee shall forthwith prepare a Report describing, commenting upon and evaluating the Commission's work during the relevant calendar year.
3. The Director-General shall assign one or more regular Commission staff to aid the Commission in its tasks.
4. Within sixty days after appointment pursuant to sub-Article (1), the Evaluation Committee shall forward its Report to the Director-General.
5. Immediately upon receipt of the Report pursuant to sub-Article (4), the Director-General shall send a copy to Commission members, to members of Commission staff, to the media, and to all persons who pursuant to Article 15 have registered with the Commission,
6. Not more than seven calendar days after the date specified pursuant to sub-paragraph (5)(a), the Director-General shall send a copy of the Report and of comments received pursuant to that sub-paragraph to the Secretary-General of EAC.
   
   • The Director shall accompany the Report sent pursuant to this sub-Article (5) with the address of the Evaluation Committee, and a statement that the Committee will accept a comment on the Report until a specified time and date, thirty calendar days next following the receipt of the Report, pursuant to sub-Article (4), by the Secretary-General.
7. The Secretary-General of EAC shall forthwith circulate the Report and accompanying comments, if any, to the members of EALA, to the Ministers of Health of the several EAC Partner States, and to the Presidents of the Partner States.

22.    Definitions

1. In this Act –
   'bill' has the meaning assigned to it in sub-Article 2(1)
   
   'Commission' has the meaning assigned to it in sub-Article 2(1)
   
   'to design a bill' has the meaning assigned to it in sub-Article 2(1) includes devising the detailed substance of a bill's provisions.
   
   'to draft a bill' has the meaning assigned to it in sub-Article 2(1) means to write out the words of a proposed bill.
   
   'EAC' has the meaning assigned to it in sub-Article 2(1) means the East African Community.
   
   'EALA' has the meaning assigned to it in sub-Article 2(1) means the East African Legislative Assembly
   
   'Partner State' has the meaning assigned to it in sub-Article 2(1) means a partner state of the EAC.
   
   'to publicize' has the meaning assigned to it in sub-Article 9(1)

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