Why Oulanyah’s evacuation to Seattle was not a waste of taxpayers’ money
THE LAST WORD | ANDREW M. MWENDA | On April 8, former Speaker of Parliament, Jacob Oulanyah, was finally laid to rest. But all will remember a group of wannabe Ugandans demonstrating outside a Seattle Hospital against his medical evacuation. To some Ugandans, it was a waste of taxpayers’ money to try save his life.
And for many others, the highly specialized medical attention he was receiving should be available in Uganda – preferably provided by the state for free to every citizen who needs it. This article seeks to hammer this thinking on its head.
This problem is not found only in Uganda. Across our entire continent, and indeed most (if not all) the third world, there is the conviction that the state should provide a large basket of public goods and services (roads, dams, hospitals, schools, bridges, railways, airports, clean water, electricity, education, health, sanitation, agricultural extension services, security, justice, a clean environment, etc.) for free or cheaply to all citizens who need them. This conviction is held as an article of faith.
Our minds are not a tabula rasa. We approach every subject with many assumptions, prejudices, biases, attitudes, mindsets and beliefs. The belief in a nanny state is one example. In the advanced nations of the Western world, Japan, Singapore, South Korea, Israel, etc., there is a close link between the demand for a nanny state and the capacity of the state to perform this role.
Take the example of the USA. Last year (2021), federal, state and local government spending was US$11.5 trillion. Because federal government transfers to state and local governments totaled US$1.1 trillion, actual public spending was US$10.4 trillion. If we divide this by the USA population of 332m, we get public spending per person of US$31,325. This financial year, Uganda’s total public spending is Shs 37 trillion (US$10.4 billion); divided by 42m Ugandans, public spending per person is Shs 800,000 (or US$250).
There are many problems with the government of Uganda – incompetence, corruption, wastage, etc. But even with the best of intentions and with angels from heaven running our public affairs, there is a limit to how much this money can do.
Simply put, the government of Uganda doesn’t have the financial (leave alone the human) resources to provide a large basket of public goods and services to all her citizens – everywhere, all the time and for free or cheaply. Because the modern state is assigned such a responsibility as a normative value does not mean a poor government can afford it.
The fundamental source of failure of service delivery in Uganda today therefore is lack of financial and human resources to perform this role effectively. The kinds of corruption, incompetence and wastage we see are a product of this limitation.
How? The state is overdeveloped in functions but underdeveloped in capacity. It seeks to imitate the state in the rich nations by basing its legitimacy on delivering a large basket of public goods and services to all its citizens for free or cheaply. Thus, its reach goes far beyond its grasp – its ambitions and aspiration far outstrip its means.
One would expect educated Ugandans (and Africans) to appreciate this fact. This is because the vast majority of them come from poor families where their parents struggle to provide them basic necessities of life. So, they know very well how to live under a tight budget. They grow up in modest housing, have less meals a day and of poor quality, have few and cheap clothes, walk to school, etc.
Yet, they insist that the state should provide high quality education, healthcare, clean water, good roads, highly public sector wages, etc. like the USA government does for her citizens. Yet they never insisted to their parents to provide them the same quality of life business mogul Sudhir Ruparelia provides his children.
Yet, it is the less educated (or uneducated) Ugandans in the villages that I find with a realistic view of the state. Why? Because they have not been infected with the mindset that somehow the state should provide all her citizens a large basket of public goods and services for free or cheaply.
Therefore, they do not have exaggerated and unrealistic expectations. This mindset is acquired through formal education and access to information about the role of government in rich countries through mass media.
Hence, whatever little the state provides, even when the service is poor, they see it as benevolence. Our internalization of assumptions about the state drawn from the experience of rich nations has given us the wrong mindset that blinds us from seeing our reality as a poor country.
This brings me to the wannabe Ugandans who want the best medical services in Uganda. First, the state of Uganda cannot afford to provide even her richest citizens the highly specialized medical services that force many of them to be evacuated abroad.
One evidence is the inability of the market to provide them at a commercial rate. There simply isn’t large enough scale or purchasing power in Uganda to make it comedically viable for an investor to put his money in such a service. So, seeking medical help abroad for the rich and powerful is going to continue.
Second, I think the decision to evacuate Oulanyah was political. From the information I have, everyone knew (including Oulanyah himself) that his chances of survival were minimal. But given our politics, government (or President Yoweri Museveni for that matter) may have been conscious that if the speaker died in the country, the failure of evacuate him would have been weaponized by his opponents.
And given our ethnic politics, this claim would have taken a life of its own especially because many less-senior politicians from Western and central Uganda have been evacuated before. For political reasons it was necessary to demonstrate that government did not spare anything to save his life.
Managing politics (and human affairs generally) involves many calculations and accommodations. What may be technically efficient can be politically explosive. The state, like a family, is a social, not a technical, organism. Its functioning depends on myriad calculations that may be technically wasteful but socially and politically useful.
A man who earns a take home pay of Shs 1.5m, has a family of a wife and four children, has to pay rent, buy food, pay for transport etc. He may drink four beers worth Shs 20,000 every weekend while watching soccer. This expenditure of Shs 80,000 of his income every month may seem wastage.
But it is what allows him to socially interact with friends and indulge his passion thereby getting satisfaction in living. The state may also spend on things that technically seem wasteful but which are, politically, what allows it to placate the diverse and rowdy claims of its elites.