It is a product of poor incentives rather than lack of professional competence
The usual response of the international development community to
public sector incompetence in poor countries is obvious – and makes
sense. First they advise that we should put in place institutions of
accountability like parliamentary oversight committees, a free press, an
ombudsman etc. The second is to give financial aid to pay salaries of
public officials, furnish government offices with modern technology
gadgets – computers and cars etc. The third is technical assistance in
form of skilled foreigners to perform tasks.
These interventions have been employed across our continent for over
50 years with little to show for all the money and effort. Yet they
continue to enjoy broad support among the international development
agencies and African intellectuals, “civil society” activists,
politicians and journalists. I have grown increasingly suspicious of
these solutions to the point of exhaustion. Today I can hardly read a
book or an article in a newspaper or even listen to a politician or
academic speak. They just parrot the same talking points without
reference to our reality.
In 1998, my friend gave a car dealer he trusted Shs5 million to
import for him a car from Dubai. The guy took the money and disappeared –
apparently, he had gone broke. My friend reported to police. He then
spent the next four months visiting the Central Police Station (CPS)
headquarters in Kampala almost daily. Nothing came of these efforts. One
morning I linked him to a Criminal Investigations Department (CID)
officer to assist locate the car dealer. He gave some “facilitation” to
the CID officers and within two hours they called us back to CPS and we
found the man there – arrested. With a threat of throwing him in jail,
his family refunded my friend’s money and the CID officers took a small
percentage of it.
I learnt that CID has capacity to locate a criminal within a few
hours. Whenever a crime happens, the ability of CID to investigate it
depends on the persons involved. For example, if a very rich man is
involved in a serious crime, CID officers will investigate the matter
and produce a report akin to what you would expect of the New York
Police Department (NYPD) or even better. However, they might not hand it
to the state. Instead they might take it to the rich man and say: you
can buy your way out of this case or we can take it to the Director of
Public Prosecutions (DPP).
Of course the rich man will pay a couple of millions of shillings and
the CID will submit a watered down report for the DPP who will take it
to court and lose the case. Cases involving small poor people in
villages are poorly investigated because there is no incentive for
police officers to do a good job. When there is political pressure –
like in the case of John Katuramu etc. – the police will be careful
because the president and his top men are watching. Besides this is the
time to prove oneself and secure a promotion or get fired. The problem
is therefore not one of capacity but incentives. Pouring money into the
police to “build capacity” is wrong when incentives are poorly arranged.
This insight is the key to understanding the growing threat of
epidemics like Ebola and their likelihood to precipitate economic – or
even state – collapse in West Africa. As I write this article, the
international community has been seized by a “save the Africans” fever.
The US and UK governments, the EU and the UN, NGOs like Doctors Without
Borders etc. are falling over themselves to save Liberia, Sierra Leone
and Guinea. Even with the massive foreign help (witness the billions of
dollars and the armies of doctors, nurses, administrators, etc. who are
flocking to these countries), the virus seems to spread and spread.
Yet just look at Uganda’s healthcare system: with all the good things
it has done, it is still a shame. According to the World Bank, our
hospitals and clinics diagnose diseases correctly only 30% of the time.
Drugs are often diverted from public hospitals where they are free to be
sold in private clinics owned by people working in the hospital.
Patients go to public hospitals where doctors recommend drugs available
at their private clinics – well because they took the drugs out of the
I once visited Mulago and witnessed a lady giving birth on the floor
as the blood of another (who had given birth on the same floor) was
flowing freely to her ears. Mothers of newly born babies by caesarean
section were locked in a room that used to be a store. It had no
ventilation; no lighting except by kerosene candles and the women were
packed there like sardines. Across the hall, other mothers who had given
birth by the natural process were being housed on the balcony with no
windows or mosquito nets. I wondered what Uganda’s free press, civil
society, parliament, elected president, etc. do to help.
Yet this same dysfunctional healthcare system has consistently
contained Ebola each time it has reared its ugly head in our country.
What do our public and clinical health officials, our politicians and
administrators see in Ebola that makes them pull out all their skills
and public spiritedness but which is absent when it comes to routine
healthcare problems of malaria, whooping cough etc.? What incentives
motivate high levels of public spiritedness and professional competence
in response to Ebola in Uganda that we can transfer to routine health
To resolve the problems of service delivery, public debate in Uganda
(and Africa) needs to shift from democracy to incentives. What
incentives will make public officials serve the ordinary citizen
diligently? A genuinely democratic system while desirable (and we should
always strive for it) does not necessarily produce a government that
serves its people. It is possible that excellent public service in
Sweden and Norway is a product of the conscience of the elite than of
democracy. I’ve read and witnessed the depredations of the public sector
in India – a genuine democracy with a free press, free and fair regular
elections, regular changes of government and a vibrant civic life. Its
public sector, in performing basic functions like healthcare, education
and provision of clean water to its poor citizens who constitute the
majority, is worse than Uganda’s. India taught me that a democratic
process can produce undemocratic outcomes. What are required are
incentives that make public officials serve the ordinary citizen.