By Andrew M. Mwenda
It is a product of poor incentives rather than lack of professional competence
The usual response of the international development community to public sector incompetence in poor countries is obvious – and makes sense. First they advise that we should put in place institutions of accountability like parliamentary oversight committees, a free press, an ombudsman etc. The second is to give financial aid to pay salaries of public officials, furnish government offices with modern technology gadgets – computers and cars etc. The third is technical assistance in form of skilled foreigners to perform tasks.
These interventions have been employed across our continent for over 50 years with little to show for all the money and effort. Yet they continue to enjoy broad support among the international development agencies and African intellectuals, “civil society” activists, politicians and journalists. I have grown increasingly suspicious of these solutions to the point of exhaustion. Today I can hardly read a book or an article in a newspaper or even listen to a politician or academic speak. They just parrot the same talking points without reference to our reality.
In 1998, my friend gave a car dealer he trusted Shs5 million to import for him a car from Dubai. The guy took the money and disappeared – apparently, he had gone broke. My friend reported to police. He then spent the next four months visiting the Central Police Station (CPS) headquarters in Kampala almost daily. Nothing came of these efforts. One morning I linked him to a Criminal Investigations Department (CID) officer to assist locate the car dealer. He gave some “facilitation” to the CID officers and within two hours they called us back to CPS and we found the man there – arrested. With a threat of throwing him in jail, his family refunded my friend’s money and the CID officers took a small percentage of it.
I learnt that CID has capacity to locate a criminal within a few hours. Whenever a crime happens, the ability of CID to investigate it depends on the persons involved. For example, if a very rich man is involved in a serious crime, CID officers will investigate the matter and produce a report akin to what you would expect of the New York Police Department (NYPD) or even better. However, they might not hand it to the state. Instead they might take it to the rich man and say: you can buy your way out of this case or we can take it to the Director of Public Prosecutions (DPP).
Of course the rich man will pay a couple of millions of shillings and the CID will submit a watered down report for the DPP who will take it to court and lose the case. Cases involving small poor people in villages are poorly investigated because there is no incentive for police officers to do a good job. When there is political pressure – like in the case of John Katuramu etc. – the police will be careful because the president and his top men are watching. Besides this is the time to prove oneself and secure a promotion or get fired. The problem is therefore not one of capacity but incentives. Pouring money into the police to “build capacity” is wrong when incentives are poorly arranged.
This insight is the key to understanding the growing threat of epidemics like Ebola and their likelihood to precipitate economic – or even state – collapse in West Africa. As I write this article, the international community has been seized by a “save the Africans” fever. The US and UK governments, the EU and the UN, NGOs like Doctors Without Borders etc. are falling over themselves to save Liberia, Sierra Leone and Guinea. Even with the massive foreign help (witness the billions of dollars and the armies of doctors, nurses, administrators, etc. who are flocking to these countries), the virus seems to spread and spread.
Yet just look at Uganda’s healthcare system: with all the good things it has done, it is still a shame. According to the World Bank, our hospitals and clinics diagnose diseases correctly only 30% of the time. Drugs are often diverted from public hospitals where they are free to be sold in private clinics owned by people working in the hospital. Patients go to public hospitals where doctors recommend drugs available at their private clinics – well because they took the drugs out of the government hospital.
I once visited Mulago and witnessed a lady giving birth on the floor as the blood of another (who had given birth on the same floor) was flowing freely to her ears. Mothers of newly born babies by caesarean section were locked in a room that used to be a store. It had no ventilation; no lighting except by kerosene candles and the women were packed there like sardines. Across the hall, other mothers who had given birth by the natural process were being housed on the balcony with no windows or mosquito nets. I wondered what Uganda’s free press, civil society, parliament, elected president, etc. do to help.
Yet this same dysfunctional healthcare system has consistently contained Ebola each time it has reared its ugly head in our country. What do our public and clinical health officials, our politicians and administrators see in Ebola that makes them pull out all their skills and public spiritedness but which is absent when it comes to routine healthcare problems of malaria, whooping cough etc.? What incentives motivate high levels of public spiritedness and professional competence in response to Ebola in Uganda that we can transfer to routine health problems?
To resolve the problems of service delivery, public debate in Uganda (and Africa) needs to shift from democracy to incentives. What incentives will make public officials serve the ordinary citizen diligently? A genuinely democratic system while desirable (and we should always strive for it) does not necessarily produce a government that serves its people. It is possible that excellent public service in Sweden and Norway is a product of the conscience of the elite than of democracy. I’ve read and witnessed the depredations of the public sector in India – a genuine democracy with a free press, free and fair regular elections, regular changes of government and a vibrant civic life. Its public sector, in performing basic functions like healthcare, education and provision of clean water to its poor citizens who constitute the majority, is worse than Uganda’s. India taught me that a democratic process can produce undemocratic outcomes. What are required are incentives that make public officials serve the ordinary citizen.