Government prioritises vehicles for VIPs over health services

Government vehicles rot away in the parking yard at the Ministry of Public Service in Kampala. The Attorney General says most government entities do not have a specific policy or guidelines on motor-vehicle management to eliminate theft, losses, wastage and misuse. PHOTO / AFP

What you need to know:

  • Data shows that whereas government has an appetite to purchase vehicles for its most paid civil servants and politicians, it’s less keen to buy ambulances and equip emergency rooms at government hospitals, write Rita Kemigisa & Emmanuel Mutaizibwa.

Mr Danstan Kasango and his father, Mr Willy Tigalya, bow their heads to escape the rays from the scorching sun as the colours from the sky bow in reference to their grief.

It is two months since they buried 29-year-old Angel Nakasango who died outside Kampala Hospital in an ambulance as the family frantically searched for money to pay for her treatment.
She had earlier on been turned away at two private hospitals. 

“They [Kampala Hospital] then asked us to pay Shs2m deposit before working on her; during that process, my sister was still in the ambulance on oxygen until it got finished. They asked us to pay Shs40,000 consultancy fee which, we paid but after paying, they tried to remove her from the ambulance after about 30 minutes, but she had passed on,” Mr Kasango told Daily Monitor newspaper in June shortly after his sister’s passing.

As they tend to Nakasango’s cemetery in Isiri Village, Buwenge Sub-county in Jinja, Mr Kasango and his father believe Nakasango would not have died if health services in the country were not in an ailing state. 

“Why should you put money into buying cars? It is useless, the government should take care of all of us equally. When I go for a medical checkup, everything should be there, why should we invest in MPs who get more money,” Mr Tigalya wonders.

The predicament of Nakasango bears resonance with thousands of financially-handicapped families that are struggling to pay bills in Uganda’s ailing health sector that was further exposed by the second wave of the Covid-19 pandemic.

Many patients died before the rescue could reach them.  Those who survived have been blighted by long-term side-effects of the disease, which include trauma, depression and mental illness.
Other families remain indebted to private hospitals and shylocks, and others are on the verge of bankruptcy. 

The national response towards combating the deadly pandemic received plaudits in its early days when the pandemic struck in March 2020.  But at the country’s hour of reckoning, it lurched from one crisis to another. 
So, were there any lessons learnt from this experience?

“We did not get here by mistake, we got here almost by design. We have mismanaged so much, we have mismanaged so many things that when the pandemic required us to manage that one thing, there was no chance we were going to manage it properly, we had a long history of mismanagement,” argues Dr Olive Kobusingye, a surgeon, and epidemiologist.

A research into the state of emergency medical services in Uganda undertaken in 2018 by Dr Kobusingye as the lead investigator and a team of doctors foreshadowed a crisis that could cripple the health sector in the event of a global pandemic outbreak.

“We have a long history of misplaced priorities. Some of the best paid employees are MPs; they should manage their own transport. I am a surgeon, shouldn’t the country be concerned about what cars surgeons drive? But is anybody buying surgeons cars, no,” Dr Kobusingye says.
Only last month, the government spent nearly Shs106b shillings to buy lawmakers brand new vehicles. 

The cost elicited criticism from the public who felt that for a poor country facing a health crisis of such monumental proportions, it should have prioritised the health of its citizens.

“Our proposal during this financial year was that nobody should buy a car, no transport equipment should be bought except for security and health. These ministers who are claiming they want new cars, furniture etc, these are things we should have postponed,” says Mr Julius Mukunda, the executive director of Civil Society Budget Advocacy Group (CSBAG).

“This is when we say, have we learnt anything from the first phase? Is the timing right to buy vehicles? These are expenditures you can postpone for now,” says Dr Madina Gulooba, an economist at Economic Policy Research Centre.  

“We should not buy cars for MPs; this country needs ambulances in national referral hospitals. We need ICU ambulances, why don’t we invest in facilities that will benefit the public instead of those benefiting a few individuals who are highly paid and can meet these costs?” opines Mr Ibrahim Ssemujju Nganda, the Kiira Municipality MP.

But beyond the vote towards MPs, the government continues to spend large sums of money to purchase a fleet of vehicles, fuel and oil lubricants and pay for its maintenance.

According to this year’s financial budget, government doled out Shs714b towards purchasing vehicles for public servants and politicians in the country.  The cost consists of the following; fuel, lubricants and oils (Shs257.4b), vehicle maintenance (Shs110.6b) and transport equipment (Shs346.5b).

Of this, Parliament received a vote of Shs127b, the Defence ministry got a vote of Shs161b and Uganda police Shs62b.
 The Office of the President received Shs20b while the Health ministry was allocated at least Shs10.9b and State House Shs21b.

According to records of the Auditor General’s report for the 2020/2021 financial year, government spent nearly Shs118b to purchase vehicles in the last three financial years.

This sum excluded costs on fuel, lubricants and maintenance of the fleet. 
The report further revealed that about 130 government vehicles procured at a cost of Shs33.9b had engine capacities higher than what was recommended.

The Attorney General said of the 61 sampled government entities, 49 (80.3 per cent) did not have a specific policy or guidelines on motor-vehicle management to eliminate theft, losses, wastage and misuse.

Ambulances deployed to evacuate confirmed cases to Entebbe Grade B Hospital on April 1, 2020. Whereas the government has an appetite to purchase vehicles for civil servants, it’s less keen to buy ambulances. Photo | File

In 2016, MP Ssemujju tabled a motion to revise the vehicle policy in the country.
“I was in the Parliament of Seychelles and the Speaker and Clerk to Parliament bypassed me driving a [Toyota] Raum, a vehicle of about Shs20m. In Uganda here, it’s a convoy. My motion was that we go to a zero fleet, like it was at one time in Rwanda; provide soft loans maybe with no interests but make sure everyone buys his own vehicle, pays for their own driver, fuel and their own maintenance,” says the Kiira Municipality MP.

In 2020, Seychelles GDP per capita was $11,639 while Uganda’s GDP per capita by 2020 stood at a paltry $ 912. 
Mr Ssemujju later presented the motion to the Public Service minister, Mr Muruuli Mukasa. 

“The minister told me they did not know the number of vehicles that the government had bought and that they needed to do a head count. He said they need to do more consultations. Government needs to have vehicles like other companies, like pickups to take people to the field, not those which show status,” Mr Ssemujju, who plans to retable the motion in the 11th Parliament, adds.

Experts weigh in
“By doing that, we are taking resources that should be going into real needs and we put them in the wrong places. MPs are not essential workers, they can be locked up for three months in a pandemic and the country will run; if they need to be on zoom once in a while so be it. We have real essential workers and we do not know how they get to work, we don’t know where they sleep, what they eat,” argues Dr Kobusingye.

She says ‘Ugandans need to put their foot down and say no, we need to manage our affairs better than this.’
Politicians and civil servants usually prefer to drive posh four-wheel vehicles for a short span of time and have them replaced with brand-new cars. 

As a result, an abandoned fleet of vehicles lies in ruin across parking yards of government ministries, departments and agencies.

Whereas government has an appetite to purchase vehicles for its most paid civil servants and politicians, it’s less keen to buy ambulances and equip emergency rooms at government hospitals.

Among the major findings of the research on the country’s emergency services, Uganda did not have a national policy on emergency medical services.

For instance, ambulances, which are acutely short in supply, lacked the most basic equipment and medicines both to monitor, and to treat emergency conditions.

It was discovered that advanced life support equipment within ambulances such as vital signs monitor, electrocardiogram machines, defibrillator and intubation were missing.

So, where did we go wrong? 
 Dr John Baptist Nambohe, the commissioner for Emergency Services in the Health ministry, admits that the pandemic caught them unaware.

“When Covid-19 broke out, we did not think that there would be so much need for ambulances.  We intensified planning. We had only 20 type B ambulances (equipped with life support services) prepared for the covid-19 response across the country out of 178. When Covid-19 hit the country, we only had two type C ambulances in the country, but now we have 5 after we procured three others. For type B, they are now 116 and are in the process of procuring more,” he reveals.

He says they grappled with emergency care treatment because they had not trained enough professionals for highly infectious people.  “When community infections surged, that’s when we realised we needed more,” says Dr Nambohe. 

Many low-income countries, including Uganda, lack a streamlined emergency medical system. Consequently, an estimated 80 per  cent of deaths due to injuries occur before they get to a hospital.  
According to Dr Nambohe, the country needs about 400 ambulances to be fully-prepared for emergencies.

“We made a plan and realised we needed about 460 ambulances to have enough coverage for the entire country for the second wave. Thirty would be basic life support, 30 would be intensive care unit ambulances type c. We have started the procurement of these equipment. However, this was part of the five-year strategic plan and with Covid, it requires that we implement this in one or two years,” Dr Nambohe says.

Type B and C, Dr Nambohe explains, handle critically-ill patients and offer life support while type A are patient transport vehicles.

“If we are to run comfortably, we need Shs145b annually, if we are to fill all ambulance needs in the country. For the next three to four years, we need Shs500b to meet the full response,” he reveals.

When Covid-19 made a landfall in March 2020 and barreled across the country, well-wishers donated a number of items, including food and money worth Shs29.6b.

The Health ministry spent Shs23b out of the total donations to buy double-cabin pickup trucks.
But Dr Nambohe says cars are an integral part of the Covid-19 response.

“The double cabins we bought are very necessary if someone is reported to be sick, the surveillance team should go there. These cars were for the response, not for mere travelling. The district surveillance officers will tell you how they suffered in the first and second wave,” he says.

Patients feel the pinch
Patients in the country bear most of the cost for an ambulance and the median cost for the shortest run costs about Shs50,000 and for the longest run, costs Shs400, 000. 
The research reveals that for patients in need of emergency care, the ambulances were not different from any other vehicle providing transportation. 

Dr Nambohe says new rules and regulations on ambulances are in the offing.
With a third wave looming, the country continues to borrow heavily and loans could surpass the 50 per cent threshold of debt to GDP ratio. 

However, as the country inches towards the fiscal cliff, there are fears that most of the expenditure is geared towards the non-productive sectors of the economy such as the wasteful expenditure on vehicles and sustaining a bloated government structure.
“Expenditure is a very touchy issue, Borrowing is okay and I cannot condone it if it’s spent in the right way. If we had learnt from our mistakes then we could say let’s borrow correctly and for the right reasons. We saw the IMF/World bank sent in more money, I sometimes also doubt their expenditure plans. Where is the first expenditure for the first loans we got for the same purpose before more money is released?” says Dr Gulooba.

So, what should govt prioritise?
 According to Dr Madina Gulooba, an economist at Economic Policy Research Centre.
investments in ICT, health and education sectors could lift the economy out of gloom.
“Those sectors are apparent and even they are good for continuity of employment. The issue is how you train people to continue using them. Those to me are the three critical ones,” says Dr Gulooba.

Dr Olive Kobusingye, a surgeon, says healthcare is the most critical sector that needs an overhaul. “We do not have the right numbers but also the right types of health workers in the right places. Those we do have, some of them are poorly trained, they are poorly paid, we have no incentives to do a good job. We need to look at the health infrastructure,” she says.
She also says health insurance is required to provide a safety net for those with modest incomes. 

“As long as we have a vulnerable population that does not have access to life saving care, then our health services will be good enough for chronic conditions or for those who have enough money and we have few people who have enough money, we have seen it in the pandemic,” says Dr Kobusingye
 The second wave of Covid-19 appears to have hit the economy severely and dimmed prospects for a quick recovery.

According to the August Bank of Uganda monetary policy statement, the economic outlook is uncertain and will grow at a range of between 3.5 per cent and 4 per cent in Financial Year (FY) 2021/22.

Economic experts postulate that fiscal discipline, austerity measures and spending on priority sectors will offer relief to millions of Ugandans whose lives have been upended by the pandemic.