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Uganda’s failure to transform

Why in spite of registering good welfare outcomes we have made little progress at structural transformation

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

I have just been reading the National Population and Housing Census (NHPC) report for 2014. It shows Uganda has registered many welfare improvements, but also reveals that President Yoweri Museveni’s dream of transforming Uganda from an agrarian to an industrial society has not progressed. Let us look at welfare improvements first.

Between 2002 and 2014, Infant Mortality Rate has fallen from 87 to 53 deaths per 1,000 live births (39% improvement), Under Five Mortality from 156 to 80 deaths per 1,000 kids (a 48% improvement) and life expectancy at birth has increased from 50 to 63 years. Maternal Mortality has fallen from 550 deaths per 100,000 mothers giving birth in 2000 to 360 in 2014. Malaria prevalence has fallen from 42% to 19% between 2009 and 2015.

Comparatively, only Ethiopia and Rwanda do better than Uganda on most of these health scores in Sub-Saharan Africa. Yet we think Uganda’s health services have become worse. If this perception holds any water, why are health outcomes improving? One could say that failures in public health institutions have been compensated by private healthcare providers.

I would love to embrace this interpretation because it confirms a policy bias I have always articulated i.e. that government should leave healthcare provision to the private sector and restrict itself only to financing. But I have learnt to avoid letting my biases blind me to facts revealed by scientifically generated data. We have a qualitative study by the World Bank on medical competences in Uganda. What does it show?

On vital medical tests like diagnostic accuracy, adherence to clinical guidelines and management of maternal/neonatal complications, the differences between private and public sector providers are statistically insignificant. The private sector is marginally better in drug and equipment availability and much better in infrastructure availability.

If clinical health conditions are declining in Uganda (as we commonly believe) what explains improved health outcomes? Only increasing incomes, improved maternal education and improved nutrition would explain these gains. The alternative explanation would be that it is Jesus Christ, Allah or the spirits of our ancestors who are performing the trick.

The report findings indicate improving delivery of public goods and services on the one hand and increasing household incomes on the other. Regarding public services; in 2002, only 8% of Ugandans had access to electricity. In 2014 that had increased to 20%. Access to improved water sources has grown from 24.8% in 1991 to 60.9% in 2002 and to 71.2% in 2014. School attendance and literacy rates have all dramatically improved.

Regarding household income, while 77.4% lived on rammed earth floor in 2002, only 32.4% did in 2014. Houses whose walls are built of permanent materials have increased from 12% in 1991 to 26.1% in 2002 to 43.7% in 2014. Roofs made of permanent materials were 40% in 1991, 56% in 2002 and 70% in 2014. This shows economic growth has been widely shared.

While these welfare gains are commendable, evidence in the report shows that our country has only made baby steps on the core vision that Museveni has always articulated – structural transformation. This is especially disappointing for a president who has been in power for 30 years.

The 2002 NHPC showed that 78% of Ugandans depended on agriculture for a livelihood; 73% of whom as subsistence farmers. Only 2% of the population depended on industry and 8% on services for a livelihood. The report also showed 87.6% of Ugandans lived in rural areas, 12.4% in urban areas. These are characteristic features of a backward society.


  1. ”If Museveni is the reason Uganda is not industrialising, what explains the entire continent?” Mwenda cant you express your message in a non revealing and expressive way that you are punting for Museveni for all purposes and intentions. What has really happened to your objective journalism. If you have no problem with the perpetual mediocre leadership many have. We know how many roads Zenawi tarmacked in 15 years and what dam he left. We also know how many roads tarmacked by your despot in 30 years and the corrupted minute Karuma and Bujagali dams. We know the dilapidation of all Mulagos, lack of dialyses and cancer machines in a third of a decade leadership.

  2. The answer to this apparent conundrum is to be found in technology which is disruptive to economic or such predictive-based analysis by social sciences. Manufacturing itself is now done by robots. Even traditional professions such as medicine, law, teaching or journalism are gradually becoming robotized. Machines are replacing workers and process so that in future fewer and fewer people will be required in the professions. Think about it, one country, China, has been able to manufacture nearly all the worlds products. You hate to sound like a Luddite but the structure of future work or place is bound to be drastically different from what it has been thus far.

    • Exactly my worry Ocheto. At the rate of progress that we are witnessing, our children who are in Nursery might complete University 20 years later when all they learned is obsolete. The future looks grim. No wonder M7 is addicted to agriculture because he knows the human stomach is here for keeps; no matter what progress is realised in other fields. All the reason we should be united as one so we can continue to dominate the region in food production and export. My opinion is: Back to the yellow bus and away with political parties ( aka foreign assisted inflitrators). In just 5 years we would be the dominant nation in this region; beloved of all; including former enemies.

  3. 1.If i was the president,the cancer machine would be in the country in a week’s time (i) I would just travel with hot cash in my jet escorted with a cargo plane to carry the machine(ii) Regarding economic devt,i would use whatsup to monitor progress of development.(iii) Introduce use of petty cash to avoid inconvenience & bureaucracy.
    2.Who told the medics that we should use a proton beam machine only? aren’t there any alternatives?? There are good hospitals in France, Saudi Arabia,Israel & German y don’t the technical team visit these facilities if i Winnie can fly to London at times twice in a week how about facilitating technical staff to window shop??Remember Arafat was poisoned with Polonium,Khaled Mashal was injected with opiod overdose and they were all referred to either France or Jordon for treatment this means they have facilities that can treat diseases with chemical & cancerous cells.

  4. 3.Nations normally keep their cash in foreign reserves for purposes of intervention during volatility in the market why keep such huge cash in a foreign land yet they tax our money? Once in a while we should deplete our reserves. During Obote’s time in exile,that was the kind of money that was facilitating the Adholas in exile.
    4.I was looking at the GDP of Zambia its 29 Billion$ yet they have a population of 15million this means their standard of living is slightly better than the one of Ug coz the popn is manageable Ug’s GDP is 27Billion$ with a popn of 40 million Did you know that Nigeria’s GDP is 521 Billion $ S.Africa is 350 Billion$ & the standard of living in S.A is better than that of Nigeria?Much as Nigeria ‘s GDP is high the population is so big so services can’t be that good this simply means that the smaller the popn the better the services.

  5. 5.The vaule of a PhD of a scientist & that of arts based courses is different i used to think having a PhD & being a Professor was a big deal but waapi for those who studied Arts based programmes one can easily become a Prof basing on their publications in refereed journals & presenting papers now who cant do that?
    6.Dr.Nyanzi really ashamed women with her black nickers that was even torn i dont know why old guys prefer torn undergarments the office she undressed for even has no floor tiles,curtains nor AC i have always doubted the sense of judgement of FDC chaps like Dr.Stella

    • Winnie, the number of PhDs in Arts are as many as DRC military generals. Like you say, quantity always undermines quality and starts to question it. These Drs are far too many to be (all) true. There is a time Prof Mamdani was lamenting the quality of Makerere graduates; saying he feels embarrassed when he is equated with them just because they all (he and them) trained and quaified from same University. So he suggested they all (he included) return their certificates and rewrite exams under international supervision. Personally, I have known graduates who do not know that 0.25 is smaller than 0.5 or that 1/4 is smaller than 1/2. You begin to wonder where they passed when they were on their way to University; knowing Uganda sieves 3 times before you reach any tertiary.

      • You wrote: “There is a time Prof Mamdani was lamenting the quality of Makerere graduates; saying he feels embarrassed when he is equated with them just because they all (he and them) trained and quaified from same University.”

        Just a small point: I do know that Mamdani never studied at Makerere.

    • As for Dr Nyanzi stripping, it augurs badly for her fellow ladies who all along people say they get all they own (degrees included) by stripping for the awarders. Personally I know (not think) it is not true because I have known many girls who were enlightening us in complicated equations as per advice we received from teachers. Being of the old school, we were encouraged to know,recognise and respect those who understood faster than us so we could approach them politely and request to be enlightened. In that spirit we learnt more from schoolmates than from teachers. You will agree with me too that a woman without her man is 99% likely to enter (herself and others) into trouble… see Eve.
      No wonder muslims don’t trust a woman to move on her own without a male over 7 years old.

      • You wrote: “No wonder muslims don’t trust a woman to move on her own without a male over 7 years old.” this is not just reactionary; it is archaic.

  6. Andrew, under-five mortality rate and maternal mortality ratio are expressed as per 1,000 and 100,000 live births, respectively.

    • Thank you for the correction Dr but remember Andrew writes for professionals as well as lay-people and he attempts to strike a middle ground so all will understand; like the Holy Bible.

  7. James jones bantu

    It’s funny that Ugandans still see things through short lenses, country can not transform until people get knowledgeable, not buildings or roads, that is an illusion.

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