The politics of US$ 150m spent by government on evacuating top officials for medical treatment abroad
On Monday, April 23, Daily Monitor
reported that the government of Uganda spends US$150 million per year
(Approx. Shs 375 billion) on medical treatment of its top officials
abroad. When I was still young and intelligent, I would have been angry
and denounced Uganda’s ruling elites as heartless. I would have widened
the argument to claim that such abuses are symptomatic of a broader
elite crisis in Africa; and that it is lack of democratic accountability
that perpetuates such abuses. Today, I have grown old and stupid; I
carry a sobering awareness that such actions are actually predictable
human behaviour.
The students asked enthusiastically how
such ordinary citizens get such extraordinary medical attention. The
doctors answered that it is because every Rwandan has medical insurance.
How does the hospital select those to go for specialised medical
attention abroad? Doctors answered that there is a medical board that
does so. But how do they protect its independence so that it makes
recommendations on the basis of medical need as opposed to political
influence? What if a powerful army general or politician wanted to get
his wife with a minor problem unto the list as opposed to a poor
peasant; can the board resist? The doctors answered that such abuses
don’t happen in Rwanda because such powerful individuals would be held
to account. By who, students asked. The answer was unanimous: by the
president. This is a blessing and a challenge; a subject I will return
to another time.
To revert to Uganda’s US$ 150 million
expenditure on the powerful, I suspect, it is what happens in
democracies like Kenya, Zambia, Ghana, Malawi and Senegal. It is also
what happens in the United States, United Kingdom, France and other
democracies. We saw the speed and ease with which the US government
released US$ 750 billion in 2008 to bail out Wall Street banks (a record
four days) whereas the country had spent decades debating whether 40
million of its poor citizens can get medical insurance and had failed to
do so. The benefits from the mistakes by these banks had gone to
individuals as bonuses, dividends and capital-gains while the costs of
the bailouts were incurred by the taxpayer. That is how human society
works most of the time. Elites in positions of power and influence serve
their own interests first, the rest later.
I see this inversion of things with
charities: often, their administrative and fundraising costs take nearly
70 percent of their revenues; the beneficiaries of their work, 30
percent. It is also what happens with aid projects. Many “pro-poor”
programs across the world – in rich and poor countries, in democracies
and dictatorships – benefit the elites who work in them than the poor
who are supposed to benefit from them. Indeed, it is better for one to
be an employee of an aid project (or a charity) than a beneficiary of
its work. It is also the reason I prefer free markets to state welfare.
Rwanda therefore is an exceptional case.
Norway, Sweden, Canada and other rich countries do provide their poor
citizens with world class medical care. But I suspect that may be
largely because these countries are very rich. Every elite has the best
medical care they need; so they can afford to be generous to their poor
citizens. I suspect that if Canada or Norway had a similar level of
income and its distribution as Rwanda, elite behaviour would be closer
to what we are seeing in Uganda. In our poor countries, the rich compete
with the poor for the same resources. Since the distribution of power
favours the rich, elites in control of public resources serve their
interests first.
President Yoweri Museveni was the
leading critique of such elite behaviour when he was not yet president.
Now, it is the government he presides over that has indulged in the
worst excesses of elite privilege. I have watched over the years
politicians denounce him for such abuses. Immediately he has won them
over, they are the first to get themselves and their families such
international medical evacuations and State House scholarships. Often
those complaining do so because they don’t have access to such benefits.
The fact that most of the elites in Uganda do not provide medical
insurance for their workers (including domestic house-helps) or even
adjust their salaries to inflation tells a lot about what they would do
if they had state power.
Last year, police unleashed
unprecedented brutality against opposition leader, Dr. Kizza Besigye. In
one of the most macabre episodes in Uganda’s history, we were treated
to a gruesome television torture-show featuring Besigye and starring one
police officer Gilbert Arinaitwe. The heroes of that day were the
bodyguards of Besigye who tenaciously held unto defending him, risking
everything to protect their leader. So they suffered almost as much
beatings and pepper spray as Besigye.
There was a lot of concern about
Besigye’s health in the press. A few days later, I saw him being flown
to Nairobi for specialised medical treatment. I did not hear anyone talk
about the fate of those bodyguards and their medical needs. When I
raised this issue, I was told I hate Besigye. And each time I have
raised issues with expenditure at State House, I am told I hate
Museveni. In politics, as in history, the names and dates change but the
arguments and events remain the same.
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