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THE LAST WORD: Missing insights in our healthcare

Museveni visits Mulago. Health is an example of a sector where most say conditions are declining yet outcomes have improved

I am also conscious of the fact that public health facilities perform better than private ones in Uganda. There is no private hospital better than Mulago in Uganda – the highest concentration of medical expertise in our country. When it reopens in January next year after its renovation and refurbishment, it will be the most well-equipped and well-staffed hospital in East Africa – and among the top ten in Africa. I have been there and inspected the works several times to speak with authority.

Yet it is not always good for public facilities – be they education or health – to be the best in, especially, a poor country. This would attract the rich to opt out of private services to public ones and thereby compete with poor citizens for the same facilities. The taxpayer is better served when rich people pay taxes and also pick their own and their families’ medical and education bills. This allows the rich to actually subsidise the poor.

When I listen to and read the writings of many Ugandan elites, I am only reminded of the gap between expectations and reality. Uganda spends about $20 (Shs73,000) per person per year on health. Even if we discount those who go to private health facilities (the rich few) and those who do not fall sick, this money is too small for our development needs (building, renovating and equipping health centers) and recurrent expenditures (paying medical staff and buying drugs). Ugandans speak as if their country has the resources of Belgium, Norway or the USA.

We are fixated with the excuse of corruption. Nowhere is propaganda more effective (and dangerous) than when it uses (and abuses) actual facts. Of course there is corruption. But it does not explain the fundamental causes of poor health delivery in our country. Its contribution is negligible. The real issue is low levels of public revenues to finance the very many competing demands on a poor government. While it is very important to improve efficiency and minimise corruption and abuse, its contribution to overall healthcare outcomes is negligible.

This lesson came vividly to me following Rwanda, the most efficient government in use of public resources in Africa. At a very low level of income ($800 in per capita income and about $250 in per capita spending), Rwanda is governed like a rich country. Indeed, the World Economic Forum index of efficiency in the utilisation of public finances places Rwanda 5th in the world behind the richest nations such as United Arab Emirates, Singapore, USA and Qatar – all of which have 50 times its per capita income.

Yet when I look at healthcare outcomes of Uganda and Rwanda (such as life expectancy, child, infant and maternal mortality, malaria prevalence, rate of vaccination for things like measles, polio, DPT3 etc. – the things that really matter in health) the differences are negligible. (Uganda is number 100 in the index i.e. very inefficient in the use of public resources). This is quite discouraging for all the efforts Rwanda puts in fighting graft and serving the public good.

The lesson here is simple but fundamental: efficiency gives you very little return. The real challenge is sustaining rapid economic and, therefore, revenue growth. As long as a country is poor, even the highest levels of honest government and the public spirit cannot change the fundamentals of poor outcomes. This is not to say honest and efficient government is not desirable. Rather it is to demonstrate the limits of efficiency i.e. that at best you become a well-managed poor country but a poor country nonetheless.

*****

amwenda@independent.co.ug

 

 

11 comments

  1. Excellent piece of article. All Ugandans of all grades need, as you rightly put it, is TOTAL MINDSET CHANGE and WORLD OUTLOOK of things rather than dwell on self-seated personal hatred because one cannot reap positive results with negative thoughts.

    • IT is laughable that you find this article excellent( you are of course entitled to your opinion) and advocate TOTAL MINDSET CHANGE and WORLD OUTLOOK and yet your HERO , once VILLAIN is the strongest advocate of CORRUPTION and thinks it is miniscule in the scheme of things.

      ONE of the biggest issues we have as a MINDSET issue is to think that corruption is a SMALL and NATURAL issue and has no bearing, as M9 would want us to believe, on the overall outcome of development.

      IF you are a fan of FORMULA 1, you would know that races are sometimes determined by a margin of 1 thousandths ; and that the team and the driver look to see where they have lost the 1/1000ths and where they can gain 2/1000ths. That is the WORLD OUTLOOK you are talking about BUT do not seem to have a clue. World currencies, stock markets and shares, production levels do not fall or rise in the 100s of percentages , sometimes not even 10s or units of thereof, but in fractions.

      That is why some of S**pid leaders advocate an explosion of our population claiming that it is a good thing and not realising that it wipes out all the positives that we gain by way of economic growth, ditto corruption even if we claim it accounts for “only” 1% or whatever figure we may wish to apportion to it

      AND yet here you are talking of mind set changes and world out look.

  2. You know Andrew Mwenda we used to hate you with passion for your guts when at Makerere University in Lumumba Hall between 1991- 1995 ,as a then student reporter of the Daily Monitor, for the openness and blatant attack on government and other establishments. However, over time your analysis has become great that you are so balanced and I love your analysis everyday.
    This is very mature analysis calls for applaud. Thanks for this explanation.

  3. ” This realisation came in large part because I became deeply conscious of my own weaknesses. Once this happened, I felt liberated from self-righteous anger and what it leads to – the delusion that I am perfect and everyone else is incompetent and corrupt.”

    ON this I may wish to digress , because I think you still have a very high level of self righteousness and always present your opinions as fact and consider all those with a differing opinion (sometimes rooted in concrete facts) as ignorant.

    YOU are very much a TRUMP and a M7.

    • You are “dividing” Mwenda between a “Trump” and a “Museveni?” I think you’re are being “conservative” in your judgement. Mwenda Trump Museveni Putin. Those are not “four” different personalities, no. That is Mwenda himself. The man might appear to be Small in stature but is very Big on ego.

  4. “We are fixated with the excuse of corruption. Nowhere is propaganda more effective (and dangerous) than when it uses (and abuses) actual facts. Of course there is corruption. But it does not explain the fundamental causes of poor health delivery in our country. Its contribution is negligible. The real issue is low levels of public revenues to finance the very many competing demands on a poor government. While it is very important to improve efficiency and minimise corruption and abuse, its contribution to overall healthcare outcomes is negligible.

    This lesson came vividly to me following Rwanda, the most efficient government in use of public resources in Africa. At a very low level of income ($800 in per capita income and about $250 in per capita spending), Rwanda is governed like a rich country. Indeed, the World Economic Forum index of efficiency in the utilisation of public finances places Rwanda 5th in the world behind the richest nations such as United Arab Emirates, Singapore, USA and Qatar – all of which have 50 times its per capita income.”

    M9 seems to suggest that the contribution of corruption is negligible; and yet you say in the same breath that the reason why services are poor is because of a “small purse” , made smaller by the same corruption.

    Likewise you seem to suggest using the example of RWANDA that the effort it puts in reducing or eliminating corruption has a diminishing return effect.You also say that despite the seemingly small purse, not to mention most of our health care is foreign financed. Any right thinking person would stop and think, if Uganda is doing well with a “small purse” , how much so would it do if all these funds were stolen. Likewise one would ask, if RWANDA despite or in spite of putting a lid on corruption is not doing so well. how much worse would they be if they had rampant corruption.

    BUT M9 who wants to argue from a PRO CORRUPTION angle will always put a spin on his narrative.

  5. “how much so would it do if all these funds were stolen”
    meant ……….. if all these funds were not stolen………”

  6. Mr Andrew Mujuni M9, I would like to seek clarification from you sir. When u say ” Then I reached the road to Damascus “; what exactly do u mean, is it arguing from pro-wanainch (opposition) to pro-govt (NRM) point of view? I ask this because m9’s own original views – in his earlier editions of “The Independent” magazine – were spiced by the words “you buy the truth we pay the price”. Many of us preferred to spend our hard-earned little coins to buy that vibrant copy of then weekly magazine to missing a meal! But, alias, we were very wrong as the man himself has now pleaded guilty writing all those “researched facts ” from a point of ignorance!

    • “Mr Andrew Mujuni M9, I would like to seek clarification from you sir. When u say ” Then I reached the road to Damascus “”

      M9 and indeed some people think that a change is always for the better.

      The fact that he changed his thought process does not mean he changed onto the right thought process. M9 says that he was ignorant , and now he has “changed” , but as far as a I am concerned, he changed and became even MORE ignorant.The GANDA say “nobusilu bukula”!!!!!!

      Give him another 5/10 years and he will be telling you what he was writing in 2019 was s**t, this time I do not know whether he will have seen the road to where (Damascus).

  7. 1.I really love babies.
    2.When it comes to pleasing men, a woman can do anything in Africa for example; the only way of booking space in a man’s heart is by producing babies thats how we mark our territory unfortunately at times we get losses in the processing of booking a place in a man ‘s heart hence unwanted pregnancies.
    3. What are the main causes of premature births and how do we address them?Poor feeding and STDS can at times cause premature birth.
    4.There is alot of pressure from men to have unprotected sex and naturally women are submissive in nature they are told by their sengas that sex is the best thing on earth and they should be generous with it.
    5.The biggest distributors of HIV these days are young girls and ladies.

  8. True@Mwenda.it is also interesting to note the our health outcomes are similar to those of Rwanda yet the Rwanda government is known to be so efficient.

    I do believe that this also applies to our personal lives where the elite focus on becoming highly educated ignoring the emphasis on embarking on a deliberate basic trading opportunities to enrich the economic outcomes of them selves and their families.

    Some one has a PHD or a masters in business administration but cannot be deliberate to run a supermarket with Capital of 20 Million

    We need to remember that what is important is to ensure that our countries are rich first , then we can focus more on other moral related endeavors .

    What is happening now is that we are focusing on what is not our priority

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