THE LAST WORD: By Andrew M. Mwenda
Why nations that are different exhibit similar health service dysfunctions
I have been rereading Melle Leenstra’s 2012 book, `Beyond the Façade; the instrumentalisation of the Zambian health sector’. It offers an interesting insight into the challenges that central African nation faces in its attempts to provide quality healthcare to its citizens. It reads like a story of the healthcare system in Uganda or any other poor country. Let us cite the book at some length.
“In the ward of a provincial hospital, some patients lie on mattresses on the ground. Many have delayed their coming having first tried the services of witchdoctors or first saved enough money to be able to afford medical care. Other ill people prefer not to come at all, considering hospital places to die rather than places to get better. In the corridors, family members flock in attendance, bringing extra food and caring for the needy. The walls bear posters teaching the ABC of sexual health beside handwritten posters professing the values of public service.
“Nurses enviously eye the doctor’s new Pajero and complain that their allowances have not been paid yet. Some patients are vexed by nurses’ rudeness and complain that drugs are out of stock. The doctor has not shown up today; maybe she has gone to moonlight at a private clinic or is attending a workshop, earning something extra as money is never sufficient. From time to time, the nurses are mobilised by the union to demand higher salaries and extra allowances from government.
“Meanwhile the laboratory technician checks blood samples and compiles horrific statistics, relieved that this month he has received their proper reagents. In the evenings, he studies, perhaps his correspondence course will bring him the qualifications to move on to a better life in South Africa or beyond. In a distant rural health centre, one can see a health worker, overworked, underfunded and yet still showing up to work, immunising children and supervising deliveries, while a cleaner is screening patients and giving them drugs.
“The limited resources government provides are inventively stretched as far as possible. Further away, a radio transmits the voice of an opposition candidate. She curses the government for incompetence and corruption and promises better education and affordable healthcare.”
I have read similar accounts of healthcare challenges in Ghana, Senegal, Tanzania, Kenya, Benin and Malawi among others in Africa. I have also read academic papers and books on the healthcare systems of India, Nepal, Pakistan, Bangladesh, Sri Lanka, Afghanistan, El Salvador, Nicaragua, Peru, Vietnam, Cambodia, Laos, etc. and the story reads almost the same as Uganda and these other African countries.