What Is It With Uganda’s Health Sector?

Morris Komakech


The state of health care services in Uganda has literally collapsed. At least, from the experiences of Ugandans who are confronted by its failures. The bad state of the healthcare is only symptomatic, something that the public has consensus over. Painfully, nobody seems able to do anything about it.

There is a pattern to this state engineered collapse of public institutions. To understand this pattern, one needs to study the state’s ability to balance public and private sector performance. The sole purpose of the liberalisation of the economy is to enhance the exploitation of the many by a few. The “few’, may be corporations, or individuals who comprise market players. Corporations are the key institutions of a developed capitalism. Corporations become the new governors, per se, in a Uganda-type liberalism where government has gone to sleep.

The market-based economy is a tricky one to follow because of the complex market dynamics. It requires that government concede its’ control of the market, thereby retreating from providing direct social services to its people. This would allow private entities, and players such as international corporations to take over these roles. Your water, power, health insurance and healthcare, roads, etc to be provided by a private agent.

Governments are then restrained by series of forced rules, to deregulate, implement structural adjustments (retrenchment to reduce government workers) and institute tax regimes that favor these corporations. In other words, government becomes a passive player to an extent.  This classical liberalism does not work in most of the African continent where the World Bank and IMF imposed it. Our people’s consumer mannerisms are still too remote to act as a conscious consumer in a free market would. There might just be a handful of conscious consumers in the free-market.

The World Bank’s recent poverty assessment report for Uganda for 2006 – 2013, illuminates such gloom of free-market economy. Nearly 80% of Ugandans are still poor to afford quality private healthcare services. Even the country is unable to attract high-impact investors because of the nature of our markets. As such, Uganda’s tax-base is not expanding as anticipated. Uganda is now drowning in debts, with Shs 6,400 Trillions due in interests to foreign debts payable in 2016/17 financial year. This is interest, not even the principal.

Has the liberalisation of economy helped us, Ugandans? What else should Uganda do differently to benefit from this entrenched imperialism?

The answer to these questions calls for a debate by experts and academics. What is clear is that liberalisation of the economy, with absolute lack of regulation does not, and did not benefit Uganda and most of these African countries. Even the countries which we consider to be the mother of capitalism, have developed social safety mechanisms to safeguard their citizens. Most of these countries operate under welfare regimes where healthcare, pensions, employment, education etc., are safeguarded from the vagaries of free-markets a matter of citizenship rights. In Uganda, we left all to the vagaries of the liberal markets.

The open market has allowed for proliferation of lumpen businesses in cahoot with state agents to utterly rob Ugandans. Often, the competition is not fair or just. Some businesses, in which state players have interests, tend to benefit disproportionately than others. These benefits are varied, from taxation waivers, tax evasion, kickbacks, low interest rate loans, state bailouts, bribe seeking, and irregular contracting, money laundering, to repatriation of profits and illegal offshore bankings .

On its part, the government has continued to withdraw from offering quality public service in the pretext of non-interference in the private sector.

It appears then that the decay in the healthcare services is a method of state control over the citizens. The health Ministry in 2016/17 fiscal year received Shs 1.853Trillions in comparison to Security of Shs 1.588 Trillion and Agriculture, the backbone of the economy that got a paltry shs 824 Billions. How do we explain that security and agriculture are highly functional and healthcare is not?