The day after Robert Gabriel Mugabe, who led a heroic liberation struggle then wrecked the country with a vengeance in his last years, died in a Singapore hospital on September 6, 2019, a veteran Kenyan journalist invited me to a dinner.
Mugabe, the most educated African leader ever, and who was imprisoned for 10 years, led the revolutionary Zimbabwe African National Union (ZANU) to power in 1980, and its successor ZANU-PF until his fellow liberators forced him to resign with a gun to his head in November 2017.
In his early years, Mugabe oversaw one of the most dramatic post-liberation transformations anywhere, handing, among others, Zimbabwe one of the highest literacy rates on the continent in a very short period. But his rule got brutal quickly, with massacres of opponents in Matebeleland in the early 1980s, and shocking torture and repression of the Opposition. Then his incompetence and corruption ruined Zimbabwe, leaving what was once a southern African food basket, a sorry basket case.
However, the veteran scribe wanted to discuss something entirely different about Mugabe. Not whether he was hero or villain, but what he called “the meaning of his death”.
“We have little control of the timing of our deaths, but most times we have control over the place where we die,” he said. “What does it mean when an African (former)-leader of Mugabe’s stature dies in a foreign hospital after he was president for nearly 40 years?”
Mugabe ran down Zimbabwe’s health system. And so, like many other African leaders, including Uganda’s, for the years he was president, his favourite place of medical care was abroad (Singapore in his case).
What seems inexplicable is why decidedly greedy and selfish leaders, who enrich themselves and their relatives, and cling on to power for ages, can’t do what logically would be the most selfish thing – invest all the money in a single world-class hospital or clinic, just for themselves. It was the meaning of that, and not that our leaders are hopeless, that the veteran was talking about.
One part of the reason is that from pre-colonial to colonial times, for rulers and power structures in Africa, healthcare has never been about health. It is perhaps even more political than politics. For example, while we must applaud nationalist and anti-colonial African heroes, the main reason that this continent was never comprehensively overrun and settled by European conquerors as happened with South America, was because of disease. Malaria, especially, prevented Muslim and Christian missionaries, then the European colonisers, from taking over the African interior, confining their settlement to mostly coastal lands/nations.
Partly because they couldn’t get a chartered or regular flight back to London, Paris, or whichever European capital, the missionaries and colonialists invested in hospitals in ways few post-independence Africans – with more money and much better technology – have.
But that investment in health served a bigger political goal, helping make the point that the mzungu’s way was superior. That Western medicine was far better than that of the local witchdoctor, dancing around the sick in his feathers, chicken bones around his neck, throwing black stones around and ordering demons to exit the suffering. And with that, a shift of not just religious and political allegiance to the mzungu way, but submission to them.
However, African leaders could just have done the same; improved on healthcare and related services, and bought political support. Indeed a few did, including Uganda’s own Milton Obote in the first few years of independence.
However, with the foreign enemy, the coloniser, gone, politics too had to be reorganised. For many of our leaders, healthcare became patronage – something with which you rewarded your supporters and bought loyalty.
We have heard dozens of stories of a one-time VIP who’s fallen on hard times, and his family crying for the government to come to his rescue to raise Shs100 million for his treatment abroad.
The ruler of the day indeed coughs up the money (taxpayer’s money), and it’s a big story. A shift then happens in which dozens of vulnerable middle class families, reposition to pamper the president so when their day comes, they will get money for treatment of their loved ones abroad.
And not getting the presidential envelope for healthcare, becomes a cost which many Opposition families aren’t willing to pay.
For this to work, it is important to collapse the public healthcare system. This leaves only private care, which is expensive. And to get money to pay for it, you need to turn to State House for favours. Same result.
This could be why some of the best public healthcare in Africa is/was available in entrenched autocracies that feel secure (eg Morocco, Egypt) and don’t have to molly coddle the people, and mostly absent in fragile dictatorships and highly competitive democracies.
Mr Onyango-Obbo is curator of the “Wall of Great Africans” and publisher of explainer site Roguechiefs.com.