The Independent Uganda: You get the Truth we Pay the Price
Of course it is unfair to exclude the poor and many people would be justified to be angry with this.
Why should our government have such a good hospital that does not serve its most vulnerable citizens? However, righteous anger is rarely a source of good policy. The only way in which the poor can get access to such high quality and expensive services is through a national medical insurance scheme. Knowing Uganda, such a scheme can easily lead to tears, as initial weaknesses would turn it into an opportunity for political grand standing.
It is never obvious to us that any new such nation-wide scheme will go through a process of learning. This would inevitably involve a lot of mistakes such as fraud, nepotism, incompetence etc. The strategy is always to play the long game, accepting short-term weaknesses and mistakes as the price for one’s long-term goal. But with politicians in power making short-term political-survival calculations while facing intense public scrutiny and excessive mistrust in public institutions, no government can afford to host such grave mistakes that are an inevitable part of learning and experimentation.
In such circumstances, the solution is a painful one: concession the hospital to an outside company, preferably owned by Europeans such as the British or Germans. This will protect it from political interference. Under such circumstances, if government wants its poor citizens to access these highly specialised services, it should pay for them in cash. Short of this, government would send its poor citizens to the hospital and delay to pay. The hospital would run out of money to repair and maintain equipment, buy drugs and pay staff. That is how many public institutions in Uganda have failed to function.
The debate on health in poor countries is a toxic combination of high emotions and little knowledge, dominated by elites. Elites are the most articulate sections of our society. They dominate the mass media and all other spaces for public expression. They thus exploit this to push public policy in health towards those areas of spending that address their interests instead of the interests of the most indigent citizens.
Poor countries lack resources to pay for medical costs for all their citizens. They also lack the institutional capacity to use the little resources they have efficiently and effectively – Rwanda being a rare exception. The reasonable solution is to focus meager health resources on those areas where they can have the highest impact for the most people. For example, most deaths in poor countries are among children before the age of five years. Therefore, the challenge poor countries face is not highly complicated health problems such as organ transplants, cancer, complicated surgery, heart disease etc. but communicable diseases such as diarrhea, cough, TB, and malaria.
The most effective way to handle these illnesses is not investment in curative (or clinical) medicine – hospitals, doctors and nurses. It is in public health programs such as immunisation, vaccination, vector control, better hygiene, access to clean water, good nutrition and improved sanitation. Many of these interventions are not even part of health spending. Yet they would save many lives by reducing infant and child mortality and thereby increase life expectancy. But who will listen to this enlightened gospel? It’s so unpopular.
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amwenda@independent.co.ug
This is good progress however,since most spealists will be based in mulago won’t the issue of congestion still persist?is there provision for paitents to be airlifted to mulago from the rural areas?
Mr Mwenda, you are out of your depth in this area. You should be writing as a reporter rather than a commentator.
Phrases such as “this will be one of the most advanced hospitals on our continent” are bunkum. You have no knowledge of women’s health and have not worked or studied in any of Africa’s other Women’s’ hospitals. Thus you cannot make any meaningful comparison.
So the biggest risk to Mulago is “our democracy”!! Apparently, according to you, the national leadership is excessively sensitive to public opinion and is thus rendered unable to make the hard decisions necessary for competent management. Well, you know these people better than me so I grant you may well be right. I just wonder why this sensitivity to public opinion has never prevented them from seeking medical care abroad even for minor illness and routine childbirth. At public expense.
Your last paragraph on the question of priorities in health care in poor countries (preventive over curative) is old news. It was being taught in Africa’s medical schools before you were born. Your attempt to pass it off as news exposes your lack of knowledge in the area, as does such empty claims as “..the debate on health in poor countries is a toxic combination of high emotion and little knowledge..” It is nothing of the sort, it is a very pragmatic field whose recurrent theme is “how do we function with limited resources”.
The Mulago that the British passed on to the new government in 1962 was not just a building; it was a group of very highly skilled workers. Leading them were senior specialists whose salaries were the highest in the government service. Today’s government, which you assure us is unduly sensitive to public opinion, gives its highest-paid officers salaries that are ten to twenty times more than those of Mulago’s top specialists. One government agency in Kampala actually pays its drives the same salary as Mulago pays its mid-career doctors!
Mr Mwenda, if you had gone to Mulago as a reporter you would have asked the director “how much are you going to pay the top specialists who will run this place?”. Then you would have gone and done some research on how much those doctors would earn in Rwanda, Kenya or South Africa. And written a very different article.
Mwenda is deluded. He is also making a case for the rich thieves as the only qualified Ugandans to use the hospital previously built for the masses.
“In such circumstances, the solution is a painful one: concession the hospital to an outside company, preferably owned by Europeans such as the British or Germans. This will protect it from political interference. Under such circumstances”
What happened to the slogan; “African problems – African solutions” In this particular instance? And you talk of a Mulago vision- Which vision does it fall (vision 2018, vision 2020 or vision 40?) Were you talking about an “imagination” for that matter- another ruse?
-I must admit being confused by the idea that only Europeans would be able to undertake the duty of concession…would it not be better to open it up to Ugandans,EastAfricans, Africans, then Europeans or Asians if no African operator appeared satisfactory? Whilst I am all in favour of welcoming foreign investors and expertise to Africa, surely this contradicts the Old Man usual mantra of Africans taking ownership of their continent unless I misunderstood the article.
-Being out of my depths here, I understand why you reason the way you do, trying to protect an investment from the government and prevent it from going into decay. Something that I know happens in Britain, and maybe in other places is that within the NHS hospitals, there is private provision. So,maybe Mulago could offer faster treatment, and dedicated wings to those paying a higher fee, or whose insurance would qualify them , and still offer the free service to the wider public…
-If the facility is marketed as effectively as North African countries or South Africa have marketed their own facilities, added to the fact that Uganda is pitching itself as a desirable tourist destination and has assets in this regard, it could really be successful. And raise the money necessary for its upkeep
-Uganda Tourism board could therefore playa part in promoting it locally, regionally as part of a package for a holiday with a partnership with some resorts for recovery in an idyllic location
Still, this is a cause for celebration and so is the arrival of the cancer machine which means Uganda keeps the money which would otherwise be going to foreign countries for cancer treatment, and the government is not accused of failing its citizens. The truth is, while African elites maybe accused of having some unreasonable expectations, and better ability to skew policies towards their own interests, which can sometimes seem aloof, they are also the backbone with the highest purchasing power in the citizenry. They also have the biggest power politically for disruption if their demands are not met. Therefore, there has to be an accommodation of their very well articulated demands, whilst not losing sight of the need to support and offer policies and facilities aimed at tackling in this instance the health issues of the bigger part of the population, often the least able to have a voice.
Is Uganda going to attract sick tourists? Is that a realistic niche? Or are we trying to work upon a convoluted idea?
Other countries do…many people travel to Europe from African countries, use their medical insurance which covers them for health check ups and they do as part of a holiday most of the time…why could Uganda not snatch away some of these “health tourists” as part of its desire to make the most money out of Mulago, and fund the free service for those who cannot afford to pay. If the medical staff is trained to World class standards, then there is no reason to not compete with the rest of the World and use tourism as a comparative advantage…some go and give birth in Europe…let’s make it cool to travel within Africa to give birth too…this maternal wing can also feed into the wider economy by boosting sales of products related to maternity…there is no point in having top of the range facilities and to restrict one’s ambitions as to what can be achieved with them
With the discovery of technology, medicine has become easy to practice so doctors should not scare us into believing that medicine is complex e.g a scan can tell that a lady is 5 seconds pregnant.
We need to check our eating habits, i like the way the rich eat they are picky while selecting food to eat but the likes of Rajab will want to eat Potatoes,cassava,yams,beans,maize,groundnuts at once how do they expect digestion to happen?
I don’t like potatoes, yams, cassava, beans and maize, no. I like matooke, rice, irish, g.nuts, fish, chicken meat (fatty and fresh) just that you know. And I don’t suffer any dietary complications- if so you wondered.
Andrew, giving credit where it is due (such as in the medical staff training effort you mention and in the rather grandiose plans the hospital management told you) is okay. I also think the point you make on depoliticising this particular hospital’s services is fine. However, I note you seem to have been carried away by the apparent ‘magnificence’ and probably also by the sums of money involved in revamping the facility. But these units and systems will have to be correctly operated and maintained. Work ethics at the hospital not only for medical staff but for everyone else – including security guards, receptionists, mortuary attendants, cleaners etc. will have to improve. Is that one of the reasons you call on the ‘gentle’ British and the ‘no nonsense’ Germans to handle the management? Well, let me tell you: I worked in Ug. for a long, long time for at least one of these and have consulted in RSA for the other. I tell you, ‘not everything that glitters is gold’ – but that is not a tale for here.
Let me however ask questions whose answers may in part explain the decadence of the old facility (and therefore caution us about a possible fate of the new one): How much Ugandan engineering content was involved in not just the civil works but the electro-mechanical systems design as well? is our engineering fraternity in the country geared to service these facilities – and is the hospital administration prepared to pay appropriately for their services? Finally as an industrial-mechanical engineer previously in charge of industrial safety at two of the above ‘European’ local factories, let me point out one glaring ‘misnomer’ in that gas factory photograph: the blue piping needs to be properly secured, lest a risk of gas leak (let me hope it is simply air – from the colour coding) exists with potential harm to people and certainly with excessive compressor energy running costs.
Cheers,
Dr. Eng. Kant Ateenyi
A thousand apologies Andrew and your readers. The factory photograph mentioned is not in this column but in one of the dailies. I normally have limited time to scan all Ugandan papers for stories of interest – and in this case, had just read a related story elsewhere before opening Andrew’s column.
Let me hope this clears confusion caused by my submission above.
Dr. Eng. Kant Ateenyi
Cape Town.
Was Robert Kabushenga fired???
@ Kant Ateenyi:As an Engineer you should explain why you like cutting corners and cheating your clients the safety of the gas pipe at Mulago depends on integrity of the contractor of course some will do shoddy work deliberately so that they are always contacted for servicing,maintenance and repairs (Let me show you how crafty Engineers are)when you call an IT expert to repair your gadgets,they will instead replace some components in your computer with old parts,a mechanics will also do the same,a civil engineer will alter the structural design and will not admit that he has failed to follow the structural design,
Sister Winnie,
Not again!! (I mean the protracted conversations we had some time back). Surely, it cannot be that all engineers ‘cut corners’. Besides, every engineering job has a cost and price attached to it. Some customers/clients simply cannot afford the price of certain products/services – and yet want some working solution. They pay less and get what they ‘pay for’!!
As to the integrity part, any reasonable engineer will be open and inform the client of implications of the latter’s choice. For the case in question however, this is not simply a matter of integrity. It is one of design checkpoints. Any product design MUST have safety of people (especially users) and of other assets at the forefront of the designer’s mind. In this case, securing that curved pipe adds insignificant cost and cannot change the price. But it reduces risk and helps cut running energy costs (the latter by the way do not go to the engineer: they go to the power supply company!).
Okay – you cite examples of practitioners who you say do not follow what the designer intended. I think sister, there is a mix-up here. Most of the people you cite are NOT Engineers in the strict and legal sense of the word. In a different forum on ‘decolonising Africa’s engineering education’, I address this common confusion quite comprehensively. Let me hope there will be time for you to get differences between different engineering practitioners much clearer.
Cheers – and stay well.
Kant Ateenyi
@ Kant:Why do you think that i dont understand what i say?It seems you studied engineering during Obote’s time when there were few engineering programmes.Aren’t there software,computer and Mechanical Engineers?Dont mechanics mess up peoples” cars?Dont software engineers exchange components in peoples gadgets with old stuff ? actually a computer engineer will confuse you by claiming that he needs to open up a gadget yet his aim is to steal;haven’t you seen buildings that have collapsed in Ug under the supervision of registered Engineers? When you say engineers provide services that are worth someone’s income does it mean that they are trained to perform poor quality work for those who can not afford good services and high work for those who can afford good services?
So the issue of safety of the gas unit in Mulago should not bother you coz technicians/engineers are trained to do a good job.
Hahahaha!!! That is all from me on this one.
Stay well sister.
@ Kant:Engineers also steal cement meant for construction.