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Who is sacrificing for Uganda?

By Andrew M. Mwenda

Sometime in the middle of April, I spent three days with my colleague at office, Melina Platas, ‘working’ at Mulago Hospital.

We saw patients lying on rotten mattresses, on broken beds (for the lucky ones) while many were on the floor in overcrowded wards and in the corridors with no medical attention at all.

The walls were murky, the floors dirty, the toilets smelly ‘ threatening to unleash cholera on patients, nurses, doctors, visitors and relatives tending to the sick. The glass windows were broken, giving mosquitoes a free reign in the wards.

In the maternity ward, we counted 58 expecting mothers sleeping on the floor in the corridor because the ward was full.  Another 37 mothers were lying on the balcony outside with their newly born babies because there was no space in the wards and corridors.

We visited a small 10 Sq meters room without any ventilation that was designed to be a store. There we found 26 mothers who had given birth by caesarean ‘ with their newly born ‘ packed like sardines. The room was dark, stuffy and congested. A medical student told us that in the maternity ward the previous week, three women had delivered babies from the same mattress on the floor ‘ and the blood of one was oozing into the ears of another.

We talked to overworked nurses, doctors and medical students. The hospital capacity is overstretched beyond limit. Built to accommodate 900 beds, it now has 3500 ‘beds’ ‘ largely mattresses and mats on the floor. It has only 850 nurses and less than 200 doctors. ‘If it was not for us,’ a young medical student said, ‘this hospital would close.’ ‘The biggest risk here is the possible collapse of the building,’ an old consultant said, ‘It was structurally designed to host only 900 patients and now it has a population almost four times its capacity.’

Mulago is Uganda’s leading hospital ‘ up to 1970, it was the best teaching hospital in Africa. Patients and specialists came from far and wide to receive the most specialised medical treatment and training. This year, the government allocated the residence of the president, State House, Shs 88 billion. Mulago and its 3,500 ‘beds’ got Shs 40 billion ‘ meaning that every bed has Shs 11m per year. In 1970/71 Financial Year, government allocated State House Shs 1.5 million. Mulago got Shs 14.7 million, almost ten times more than the residence of the president.

In 1970, the value of the Uganda shilling was linked to the IMF’s Special Drawing Rights (SDR) at Shs 3 per SDR i.e. Shs 2.7 to 1$. Therefore the budget for Mulago was US$ 5.9m (US$ 118m in 2006 prices) or Shs 259 billion today for 900 beds i.e. Shs 278m per bed in today’s currency. State House got Shs 24 billion in today’s value i.e. 20% of what it will spend this year. Apparently, the president at the time, the late Milton Obote, was not sacrificing a lot.

At the beginning of April, I had gone with Platas to Rwanda and we visited their equivalent of Mulago ‘ King Faisal Hospital in Kigali. With 150 beds, it has 51 doctors and 208 nurses in a country that had only one surgeon in 1994. It has a budget of US$ 25m (Shs 52 billion) i.e. Shs 345m per bed per year. There is a sense of purpose; the place is clean, the patients have rights pinned on every wall. The pharmacy is fully stocked and patients are served milk, eggs, sausages etc according to a menu written by a nutritionist. In the casualty unit, there is a hotline to call if a patient is not attended to within 15 minutes of arrival.

‘If a patient in casualty calls that hotline,’ the Ugandan expatriate doctor told us, ‘the head of this hospital, a former state minister for health, will be on the phone with the doctor on duty. Sometimes it can be the minister,’ and toning down his voice, he added: ‘It can even reach the president and he can call asking why a patient has been ignored. And the patient will be an ordinary peasant from some remote village in Cyangugu.’ While King Faisal is not a typical hospital in Rwanda, it shows the overall attempt of government there to improve healthcare for the citizen.

We once visited a small hospital around Kigali at Kibagabaga and there is cleanliness and a sense of purpose. The resources, both human and material, are not like those of King Faisal, but they are commendable given the country’s level of income. The government has established a national health insurance scheme, Mutuelle de Sante which makes it possible for every Rwandan to access health care. Any poor illiterate Rwandan peasant that needs it will be evacuated to India for a kidney transplant at public expense while a Ugandan with the same problem will simply die ‘ unless he has connections to State House or appeals to good people in newspaper ads.

The Rwandan comparison always animates a lot of passions among a small but loud section of the elite in Uganda. I use Rwanda to show that it is not lack of resources that explains the tragedy at Mulago ‘ itself small compared to other hospitals around this country. The money allocated to the health sector alone in Uganda this financial year by government and donors (Shs 1.3 trillion) is 90% of the total national budget of Rwanda (Shs 1.5 trillion). Why does Rwanda with a string budget outperform Uganda in the provision of such critical services to citizens?

The problem is lack of political accountability of our government to our people. But how can this be possible given the amount of ‘democratic space’ in our country compared to Rwanda?

It is here that the Ugandan elite have betrayed the people in an anti-democratic bargain; in exchange for ‘freedom’ we evade taxes, violate traffic rules, build in road reserves and shout on radio. We have allowed the regime to loot public resources and destroy public goods and services. The costs of this bargain are incurred by 90% of our population who, excluded and voiceless, have become subjects/clients rather than citizens; a subject I will return to next week.

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