Address gaps in service delivery in pursuit of transformation

Monday August 12 2019


By Emilly Comfort Maractho

My cousin had her own boda boda man, that eventually became a family boda boda man. While at home recently, I asked my cousin to call that boda boda rider for me, and she said, “he died.”
I was surprised, and asked what happened. She told me that he had typhoid fever that was treated as malaria and by the time it was realised he had typhoid, it was too late. He died. One nice young man lost his life because of wrong diagnosis. A preventable death.
For the most part, we have come to accept that service delivery is a challenge in Uganda. The service delivery challenge represents one of the difficulties in the way of socio-economic transformation. And, for most people, the gaps in service delivery, particularly in health and education are easily explained by corruption of leaders at the national or local governance levels. There is anecdotal evidence to that effect. Most of us still remember Solomon Serwanja’s documentary, ‘Stealing from the sick’.
One could in fact do a whole series on stealing from the poor in various sectors. While reports like Serwanjja’s can be disputed on the basis of methodology as some people wish to, the perception that endemic corruption among public officials is very high exists and it is common place. It is in various reports too.
Vision 2040, the blue print document I will keep referring to from time to time, notes that ‘corruption remains one of Uganda’s major challenges and increases the cost of doing business and negatively affects service delivery’ (p.6). At the time, Uganda ranked 127 out of 178 in Transparency International’s Corruption Perception Index report, 2010. This ranking has not exactly improved, considering that in 2017, Uganda ranked 151 out of 180 and in 2018 ranked 149 out of 180, but maintaining a score of 26 out of 100 in both years.
However, focusing on corruption implies that gaps in service delivery will be fixed by establishing tight accountability mechanisms, creating institutions to fight it or declaring war on corruption. While some gaps can be explained by differences made in investment in service delivery and what is actually delivered, others are compounded by a structural problem.
I recently spend some time with my sister in Nebbi Hospital. I had not been inside the hospital in several years. I heard of its renovation and the resultant transformation. From the outside, it looks very good. I went to the hospital every day for five days and got to appreciate it.
I then decided to deal with a tooth pain that had troubled me for several weeks. I was surprised by how clean, equipped and organised the dental unit was. For purposes of transparency, one of the dentists is my brother, although that has nothing to do with the structural improvement or my views of it.
In five minutes, my tooth was examined and extracted. What would have cost me good money in Kampala, cost me nothing except buying the antibiotics I needed.
What I discovered though, was that the hospital is structured to work with only one dentist and assistants. Although there are two dentists, only one can be paid as a doctor. Apparently, because district hospitals are supposed to have only one dentist.
Nebbi Hospital, most medical professionals who have worked there agree, has incredible capacity to efficiently serve the population since its renovation, to the extent that there is no need to plan for another hospital in its priorities in the near future.
Yet, its human resource needs remain challenging because there is supposed to be a government structure, agreed on long ago. Despite changes in the technical capacity of the hospital to deliver as a result of incredible donor funded investment, little is done to motivate and retain the few doctors, while also ensuring that its optimal capacity to provide service is enhanced with staffing.
Retaining doctors in the hospital has been a huge challenge for the district leadership for years. Reviewing the government structure or policy to make exceptions in some cases in order to improve service delivery can surely be pursued and make a huge difference. What I know is that the health sector is often a beneficiary of several financial injections and investments. Nebbi hospital is not an isolated case.
Much of this investment will mean little if innovative ways of handling changes in our service delivery mechanisms are not harnessed on a case by case basis.
Unwillingness to review policies that have become redundant is not helpful. Corruption may be a problem for service delivery, but failure to address structural loopholes will compound them. Innovatively addressing critical gaps in service delivery should be a priority in our quest for socio-economic transformation.

Dr Maractho is the head and senior lecturer, Department of Journalism and Media
studies at UCU.