By Andrew M. Mwenda
President Yoweri Museveni has been telling us that his government has built 750 health centres in the country. However, The New Vision revealed last week that there are more than 100 ‘ghost’ hospitals. Most of them have been ‘receiving’ drugs and funds from the government. And of course they must have been ’employing’ nurses, medical assistants and doctors whom government should have been paying salaries.
The way this fraud was uncovered is revealing. A member of staff at the National Medical Stores (NMS) saw a name of a health unit allegedly located in his village. He knew there has never been one there. So NMS decided to deliver the drugs themselves. ‘When we reached the village,’ an NMS official told the state-run New Vision, ‘we could not see it.’
I was not surprised by these revelations. There have been many stories of ghost teachers and schools, ghost soldiers and battalions, ghost pensioners, ghost civil servants etc. When Security Minister Amama Mbabazi chaired a High Command committee to investigate ghost soldiers in the UPDF, it found that almost Shs 70 billion was being paid to none existent soldiers. And when the Ministry of Finance began to pay pensions directly to pensioners’ accounts (as opposed to sending it to line ministries) Shs 30 billion was saved last year.
This problem is not unique to Uganda. Across most of Sub-Sahara Africa, the state has deeply entrenched institutional dysfunctions. Some call this ‘state failure.’ In his study of the challenges to administrative modernism in India, Lant Pritchett argued that such outcomes show that the state is ‘flailing’ i.e. the head (centre of administration) has little control over its other body parts like its fingers, hands, toes, legs and arms.
I have grown to question such interpretations. These ghost hospitals were created as a result of the collusion between local district officials and their counterparts at the Ministry of Health headquarters. So the state in Uganda is not lacking capacity to monitor and control activities in its remote parts. Rather, state officials have designed creative ways in which to use the foreign aid funded state to their own advantage.
It will be extremely difficult to build systems aimed at serving the ordinary citizen because such an effort will threaten deeply entrenched political and bureaucratic interests that benefit from existing dysfunctions. Therefore, efforts to improve administrative efficiency will be up against those who are profiting from current dysfunctions.
Many analysts think that these failures are products of authoritarian rule because it lacks accountability. Yet the experience of democracy in Africa over the last 15 years has shown that it also fails to eliminate these practices and sometimes even tends to entrench them. It seems that the form of government has limited effect on the quality of institutions.
It is possible that through feats and starts, we will get there. Exposing these ills is the beginning point. Building a politically weighted majority against such practices should be the next step. But who will supply the demand for this accountability? The opposition in Uganda has been unable to capitalise on these weaknesses to build a political following. This could be because they are not fighting to change ‘the system’ but to take control of it so that they too can profit from its existing dysfunctions.
Last year, Museveni wrote to his Health Minister pointing out the inefficiencies in healthcare delivery in Uganda. His crocodile tears aside, the President made a better criticism of the failures of his government than the opposition leader Kizza Besigye has ever done. Secondly, these weaknesses should ideally inflict electoral costs on the ruling party. Why has the NRM made only token attempts to combat them?
Although most Ugandans lose, NRM leaders gain from these dysfunctions. So they have a vested interest in sustaining them. But why don’t voters punish NRM for these failures by voting its leaders out of office? It seems that in very low income countries like Uganda, poor voters find it more desirable to demand direct cash payments or other material inducements from candidates than for public service delivery. A person who lives on one meal a day would prefer to get a kilo of meat than a promise of healthcare. This structure of incentives favours a minister who has stolen half the road budget and can therefore give voters soap, sugar, meat and alcohol.
However, such utilitarian reasoning has limitations. For example, from 1962 to 1971, the first UPC administration under Milton Obote inherited a fairly effective but shallow colonial bureaucracy. The colonial state used to deliver public goods and services to a narrow geographical range. Health and education services were severely restricted to a few urban centres. Roads went to areas of mineral and agricultural potential that were of economic advantage to the colonial master rather than to centres of African settlement.
Yet, within eight years, Obote built many new schools and hospitals in rural areas and expanded existing ones. He took infrastructure ‘ railways, telephones, roads and power lines to the far reaches of Uganda. He established public enterprises that out-performed private companies. By 1970, the quality of public services and goods, and the institutional competences of the state in Uganda were among the best in the world.
This shows that incumbents in power are not always seeking to maximise that which is to their immediate monetary advantage. Obote inherited a bureaucracy from the colonial state with a deeply entrenched culture and ethics of public service. There was therefore a shared moral foundation to serve the citizen. The greed and graft of today partly reflect the collapse of this moral foundation in our politics.
The experience of the first Obote government shows that Uganda has traditions of a state that is effective and responsive to the needs of its people. Yes, the corruption and incompetence under Museveni reflect a common post independence Sub-Sahara African trend. It is also true that the observed dysfunctions are structurally obdurate. However, just as it takes human agency to build and sustain these dysfunctions, I believe that the same human agency can be used to eliminate them. Our history shows that a state that is responsive to the needs of its people is possible in Uganda.