By Andrew M. Mwenda
Since someone posted pictures showing newly born babies in Kawempe hospital lying on chairs and patients on floors, the Ugandan elite have gone wild with self righteous indignation. On all social media, everyone is condemning government and the ministry of health for incompetence, corruption and insensitivity. The skies are about to fall onto the ground.
Yet these pictures reflect not the lack of political will and corruption but poverty in Uganda. Indeed gross corruption and incompetence are a consequence, not a cause, of Uganda’s unrealistic desire to do everything for its citizens on a string budget.
While it is true that at a micro level there is a possibility that such a situation as we saw in Kawempe can be avoided, at a macro level the problems of the Ugandan healthcare system are a reflection of low revenues than of lack of political and bureaucratic will to do better for our citizens.
So first a caveat: the human being in me was saddened and enraged to see those pictures. For a moment I felt like lurching out at President Yoweri Museveni and his government for incompetence, corruption and insensitivity. This was especially so given that the president has concluded an expensive countrywide campaign tour which he deceptively dubbed “wealth creation.”
Yet the analyst in me refuses to be driven by these emotions. I want to analyze, not moralize. In any case, my critics were sending me these pictures asking how it is that I have been posting photographs of hospitals and municipal roads being refurbished and rehabilitated when such a mess is going on. So here is my one cent worth of response.
There is an indignation manufacturing machine in our intellectual life; many elites use every opportunity of failure in the public sector to demonize the state: a bad act by police here, a poorly provisioned clinic there; a poor road here, a horrible school there. In our obsession with our failures, we miss many great things happening in our country from which we can draw inspiration to address the bad ones.
This country needs journalists, pundits and political leaders who are courageous to swim against the tide of popular rhetoric; who can fight the self righteous indignation-manufacturing-machine that has become a hallmark of our intellectual life. I am glad that I am that journalist and I hope I can inspire others.
Even with the best of intentions, Uganda cannot avoid situations like those that we see in Kawempe. Our government spends $11 dollars per person per year on health; that is about Shs 40,000. And this is for both recurrent costs (buying medicines, paying medical workers etc) and for the development budget (building hospitals, equipping then etc).
Think about it: even if we discounted the people who go to private hospitals and those who don’t fall sick, these resources are incapable of providing the quantity and quality of healthcare we demand. It does not take a rocket scientist to see that the state in Uganda, I suspect under both democratic pressure and popular expectations, has assigned itself a role it can not afford.
Across Africa, the state is overdeveloped in functions but grossly underdeveloped in capacity, so its reach goes far beyond its grasp. This is the cause of the corruption and incompetence we see. The aim of any state should be to preserve bureaucracy; in Africa, the bureaucracy gets expanded rapidly relative to the resources available to run the services demanded. This leads to its degeneration into a pool of neo patrimonial plunder.
All the rich countries whose healthcare systems we admire and want to ape began to provide them at a much higher level of development and income. In the UK, the National Health Services (NHS) was established in 1946 when that country was manufacturing planes and nuclear weapons and when per capita spending was above $5,000 per person (in Uganda it is $190). In USA, Medicare and Medicaid were introduced in 1965 when that country was placing satellites in space and planing to send a man to the moon.
The problem of African elites is to ignore the resources available to the state and therefore imagine it their governments can do so much. Uganda government is doing great things in health and the outcomes tell the story: life expectancy at birth has grown from 49 years to 63 years in the last 9 years, maternal mortality from 550 death per 100,000 mothers to 280; vaccination for DPT and measles is almost 100%, malaria prevalence has fallen from 42% in 2009 to about 12% today, deliver in the health facility is 60%, availability of six most important drugs is close to 95%; antenatal visits are now above 90% of pregnant women visiting a hospital at least once in the pregnancy etc
So there is massive improvement in the delivery of healthcare and I think this is because of increasing revenues at the hands of the state. This is not to say Ugandans should not criticize things like what we saw at Kawempe. Rather it is to say that in spite of such bad things, things that we shall continue to see for decades to come, there is a lot of progress our country is registering.