In August 2016 the President publicly suspended about a dozen health workers at Mpumudde Health Centre III in Wakiso after locals accused them of absenteeism and poor service delivery.
The directive was widely covered and celebrated as an example of bold and decisive leadership. But two related and important matters were lost in the dust raised by the foot-stomping: a comment by a local leader, and why it took a visit from the President to “uncover the rot” at the facility.
We shall return to both. Before then we need to see the on-going strike by doctors, as well as teachers, prosecutors and university lecturers before them, on a bigger canvas, alongside attempts to improve the Ugandan public service.
The first significant attempt in contemporary times was the Structural Adjustment Programme, which saw the number of civil servants slashed from 320,000 in 1992 to 160,000 in 1995. This was quantitative.
The second, in the 2000s, was qualitative, designed to improve the coordination and execution of government programmes. Both have provided disappointing outcomes.
As this column has previously argued, the SAP and its social dislocations ploughed the fields of disillusionment and left an entire generation of career civil servants down-at-heel, inspiring children willing to lie, murder and steal in order not to end up like their parents. Weak and incompetent leadership did the rest, sowing the seeds by way of example, and irrigating them with a deluge of impunity.
The emergence of political competition in the 2000s turned what should have been a mere law-and-order issue into an existential one in which the ruling elite, feeling vulnerable, shored up its defences by, inter alia, accumulating financial resources and dispersing patronage. It turned corruption from a merely criminal enterprise into a quasi-legitimate strategy for political resource mobilisation.
It also turned the public service into both a source and destination of patronage, with reward and recruitment often based on loyalty, not competence.
And when the available jobs filled up we created new institutions, even if they were duplicating the work of existing ministries, and filled them with supporters. It was also hoped that, as nimble bodies filled with well-paid and highly motivated cadres, and with bigger budgets and more political support, they would deliver results faster. Unfortunately loyalty is rarely synonymous with competence.
Furthermore, it has had the unintended consequence of triggering demands for higher pay all around. This hasn’t been helped by inconsistent application of policy: one day there is a ban on pay hikes until badly needed investments in infrastructure are completed, the next day permanent secretaries and judges get a salary increment. This encourages other groups to test the government’s resolve.
So, why, despite having a Health ministry, political appointees at the district, local government officials, parish-level spy networks and a health monitoring unit in State House, did it take a visit from the President to cause action at Mpumudde Health Centre? It is because having a dozen institutions doing the same job does not necessarily get the job done faster or better. If anything, it creates a crowd effect, where each institution expects the other to do it.
But why were the health workers not at their stations in the first place? On the day the doctors were suspended, Charles Bwanika, the Wakiso district chairman, said: “Before you punish your workers, you must first make sure they have the tools to do the job.”
An inquiry found that the Mpumudde health workers, apart from being poorly paid and lacking essential supplies, did not have houses near the hospital.
They were late or absent because they were either moonlighting to make ends meet, or commuting from across the city. Two months after the dramatic suspensions they were quietly returned to their jobs – and one imagines, to their pattern of doing just enough not to get into trouble again, but pursuing other incomes elsewhere to make ends meet.
Rising household incomes, especially on the back of a growing economy and stable inflation, are the ideal outcome. For that to happen, you need a competent and effective public service with the right people in the right jobs.
So why do we pay drivers in some departments more than doctors? It is because while we hire doctors for their healing skills, we hire those drivers not for their driving skills but for their ability to mobilise voters and political support generally.
It is cheaper and more effective to pay a few mobilisers very well than pay many professionals slightly better if they won’t necessarily offer better services and win votes at the next election. This kind of patronage isn’t the way our society fails; it is the way it works.
Mr Kalinaki is a journalist and a poor man’s freedom fighter.