The health sector in Uganda has recently been under the spotlight again. It seems it is never out of the public eye for long. Sometimes it is for the right reasons, like the spirited fight against HIV/AIDS over the last three decades.
Other times it is for unflattering reasons like the theft of millions of dollars in aid to the health sector or the expiry of life-saving drugs in medical stores.
The most recent horror story has been the break-down of the radiotherapy machine for the treatment of cancer. It is not the only medical facility to break down but it has attracted the most attention.
Those who followed the recent presidential campaigns in Uganda remember the shocking pictures of a dilapidated Abim Hospital – derelict buildings and equipment, and demoralised, under-strength staff but who soldiered on nevertheless.
That raised concern but not as much as the cancer treatment machine. So what is the reason for the difference in attention?
The exposure of Abim’s condition could be dismissed as part of politicking. And then of course it is so far away from the capital. There are no prying eyes and talkative people to tell the rot.
It is among distant rural folk for whom deprivation is normal. If there are no medicines they will resort to age-old herbal remedies. If they die of malaria or other preventable diseases, well, they die.
If they live, they thank God and the government for little mercies and elect its leaders at the next election.
Cancer is a different disease. It is scaring because in many cases it is terminal. The breakdown of equipment is at the country’s famed Cancer Institute and cannot escape notice. Most of the patients are not the Abim type, resigned to their fate, but some of the country’s elite or their relatives.
There is also a historical reason. Uganda is a pioneer in cancer treatment in Africa. Although it has been overtaken by others in the region, still, there is a real sense of hurt national pride.
Also, it is not election time and pointing out broken down equipment cannot be blamed on vote-hunting rivals out to tarnish the image of the government.
These examples may be from Uganda, but the experience could be from any part of Africa. And the reasons are similar.
You may remember one of the first acts of Tanzania’s President John Magufuli after he assumed office. He paid an unannounced visit to a hospital in Dar es Salaam where he found conditions deplorable.
Patients were lying on the floor. Doctors were absent.
Equipment was in a sorry state. He ordered funds that had been meant for national independence celebrations (which he had cancelled) to be used to buy hospital beds and other equipment.
In Rwanda, President Paul Kagame has painted a vivid picture of ruined classroom infrastructure in some rural schools. He has said on a number of occasions that blackboards on which teachers write are so uneven, they appear to have potholes.
The breakdown of a radio-therapy cancer treatment machine or ‘potholes’ on a classroom blackboard reveal weaknesses in the way people regard public property.
Non- maintenance of public infrastructure and equipment is often not a result of a shortage of funds alone. It is more of a mindset problem. Public property belongs to none.
Even public servants who are its paid custodians do not treat it as their business but rather as something to be milked for personal gain. The irony is that everyone expects to benefit from it, including stealing money meant to keep it in a working condition.
Consequently public spirited civil servants, politicians or ordinary citizens are largely a non-existent species.
Where such spirit sometimes shows, it is often part of a political plot to discredit the existing system and not necessarily to improve services.
And so we rarely see a spirited defence of the common good or of public property except where individual or group interests are threatened. A lot of energy is spent on such things as agitating for political space, the right to demonstrate that may result in the destruction of public property, and so on,
These are of course very good things to fight for. But sometimes the conviction of the people agitating for greater freedom looks suspect. It appears like they are putting on a mere spectacle, usually for an external audience, perhaps to solicit support. They do not seem to be driven by a sense of public spiritedness.
Still, how great it would be if the same passion and boldness went into campaigning to demand that public property is well-maintained and that citizens get the public services they deserve.
We may get all the equipment we want, but if the public spirit to keep it in good use is lacking, it will routinely break down. Hospitals and schools will continue to be dilapidated.
Roads and other infrastructure will become unusable a few months after they have been built. Patients will continue to die in hospitals and children come out of schools barely able to read or write.
There is no alternative. We must develop a public spirit.