Prime
If our hospitals are good, why are ministers’ kids not attending them?
Author: Daniel K Kalinaki. PHOTO/FILE.
What you need to know:
- Hardware is relatively easy to install, but service delivery requires the software of consumables, trained and motivated staff, as well as a focus on outcomes and impacts.
Sometime in 2008, Kakaire Ayub Kirunda, a young reporter at this publication, started reporting on the state of the country’s health centres. His reporting, which was published in a series called ‘Our Sick Hospitals’, revealed serious and systemic gaps in staffing, the supply of drugs, infrastructure, and equipment.
Health centres at the bottom of the chain were worst affected. Unable to find drugs or doctors, patients flocked to bigger hospitals, which ended up overcrowded and overwhelmed.
Shocked, embarrassed or perhaps even inspired by the series, the government around the same time applied for a $130 million loan from the World Bank to fix the health sector, which was approved in May 2010. The next year the African Development Bank approved another loan of $88.8 million earmarked for repairing Mulago Hospital.
Yet just over a decade later, the Ministry of Health finds itself at the centre of a public campaign seeking to expose gaps in the health sector. The campaign shows us the significant changes that have occurred, in just a few years, in how and where such wars are fought, and how the casualties are measured.
Start with the where. The theatre of the current campaign is not in ink-stained newspaper pages or in air-conditioned TV and radio studios, but in the dark and humid alleys of social media. Such warfare might have some titular form of leadership – in this case Jimmy Spire Ssentongo whose side gigs as a cartoonist and agent provocateur almost seem like social experiments for his scholarship as a professor of ethics and identity studies.
In reality, this guerrilla warfare is somewhere between a free-for-all brawl and self-organising cells of decentralised terror. That it sometimes flows back into mainstream media platforms is the exception that proves the rule. The great debates of the day, in which citizens demand for accountability from those in power will not be channelled through Letters to the Editor but through direct, unprovoked and unmediated hand-to-hand combat in digital spaces, occasionally spilling over into physical town squares.
Consider, also, the how. In the 2008 example cited above, the Ministry of Health had no compulsion to engage with the newspaper over the series. They could have reached out to ensure their side of the story was captured and it is even possible that they simply kept quiet and used the series to buttress their loan applications. But the luxury of silence has been eviscerated by the real-time drama of the attention heat sink that is social media.
This is the problem now facing public officials who abuse taxpayers money by weaponising advertising to reward silence and punish criticism. The information asymmetry provided by social media and the decentralised access to information by millions of users have dulled this weapon. There are not enough influencers in the world to paper over cracks in public service. It is far cheaper and more sustainable to fix the underlying problem.
Which brings us to the casualties. Officials from the ministry have done well to counter pictures of rundown health facilities with those that have been rehabilitated or fitted with new equipment.
There is logic in providing facts to fill in information gaps, and in showing forward movement. But it appears that the things that matter most are not just those that need to be seen to be believed, but those that have to be experienced to be appreciated.
Public officials instinctively respond to public criticism of their work by showing off physical infrastructure that has been built, or equipment that has been installed. But citizens have now learnt to see beyond this; they are more willing to share their own experience of those spaces, not just marvel at the new paint.
This is the new way of measuring casualties. It is not enough for the education ministry to tot up how many students are enrolled in public schools; they have to show and prove learning outcomes.
Similarly, the Health ministry can show off the fanciest equipment and hospital buildings, but the true measure of progress is in health outcomes.
The reason for this is simple. Hardware is relatively easy to install, but service delivery requires the software of consumables, trained and motivated staff, as well as a focus on outcomes and impacts.
Citizens will only believe the quality of public services if they see government officials using them. Local hospitals, schools, public transport etc., will only be deemed fit enough for citizens when they are good enough for ministers and their families.
Mr Kalinaki is a journalist and poor man’s freedom fighter.
[email protected]; @Kalinaki
