The deaths of one’s relatives, friends, peers and famous people tend to focus one’s mind on that inescapable fate. One hears comments like “death is on the rampage,” “there are too many deaths these days,” and “we must live as though today is our last.” It is understandable, of course, for death is an enemy that strikes every day, often unannounced, with a 100 percent likelihood of happening to anyone who was born.
With about 662 Ugandans dying every day, and with a life expectancy at birth of about 69 years, which is below the global average of 73.5 years, we have more room for improvement. However, there is good news that should encourage us to continue the fight against death. Yes, death shall win in the end, but we have the capacity to postpone that final event for most people.
Uganda has done remarkably well in the fight against death, reflected by the decline of the crude death rate. This is a measure of the number of deaths per one thousand people over a specified period, usually one year. The crude death rate was 24.21 in 1952, then 18.14 in 1962, then 18.07 in 1972, then 20.61 in 1982, then 17.18 in 1992, then 13.42 in 2002, then 7.82 in 2012, and 5.04 in 2022. Notwithstanding an uptick of the death rate in 2024, when the figure was 5.93 per 1,000 people, there has been a downward trend in the last four years. The rate had fallen to 4.84 in 2023. It is hoped that we shall see a return to that downward trend this year.
This is not due to accidental good luck, or fervent prayers without action. It reflects state, private sector, public and personal efforts to improve the socio-economic standards of the citizens. Whereas health services are a critical component of this successful effort, they are inadequate without an integrated, holistic approach to the struggle for better living for all. Politics matters. Peace and justice matter. Gender equality matters. Culture matters. Education matters. True freedom and security matter. All-weather roads matter. Clean water and electricity matter. Access to finance and good jobs matters.
However, access to high quality preventive and curative health care for all is a non-negotiable key component of the fight against disease, disability and death. This is an area where Uganda’s ruling class appears to be stone-deaf to the cries of the citizens, and blind to the paradox of claiming progress while they undermine health services with their actions.
Listening to speeches at some of the recent funeral and memorial services of prominent citizens left me with a sense of despair. People, including some political opposition figures, praised President Yoweri Museveni for giving the deceased money to pay for very expensive health care abroad. Some spoke with a sense of entitlement to public money, evidently oblivious to the presence of citizens who could not access effective health services at underfunded public hospitals in their neighbourhoods.
It was equally depressing to hear mourners applauding the president’s generosity to rich politicians that once, supposedly, represented impoverished Ugandans. It was another reminder that despite their loud speeches critical of the president, some opposition figures are part of a special tight-knit family headed by the president.
This is the point that was eloquently made earlier by Beti Kamya, the Inspector General of Government, when she visited the Uganda National Medical Stores (NMS) on Friday June 2, 2023. Encouraging the staff to report acts of corruption, Beti, who was flanked by Moses Kamabare, the General Manager of NMS, said: “For us seated here on this side – me here with Mr. Kamabare – none of us is going to die at Mulago Hospital because there is no medicine. I am telling you the truth.”
“If there is no medicine, he will call the president, the president will put him on a plane, and take him to America,” Beti continued, pointing at Kamabare. “He is not, and I am not a victim of corruption. You must know who the victim is and start fighting as a victim. You who will die in Mulago Hospital because you don’t have the option of going to Nairobi.”
Beti spoke a truth that incensed many Ugandans. They vilified her as insensitive and arrogant, yet she was sounding a necessary clarion call to Ugandans to wake up to the reality of their predicament. Beti made another important point, perhaps unintended. She and a select few, mostly politicians and others with access to the president, did not need to worry about the suboptimal state of healthcare services in Uganda. They belonged to a parasitic class that considered Nairobi, India, Turkey, and America to be their local healthcare centres. A phone call to the president was akin to a person in Mparo hailing a bodaboda for a ride to some sorry excuse for a health facility in Rukiga District.
Two years after Beti’s truthful speech, we still hear speeches affirming her point. Shameless people extol the kindness of the president for spending public money on a select few, even as we read and hear stories of preventable deaths and disability of Ugandan citizens. Forty years after they captured power, the historical leaders of the National Resistance Movement (NRM) have failed to develop a universal health care system that would meet the needs of the high and mighty, and those of the least of God’s children. They watch as Ugandans are impoverished by very expensive health care costs.
They have, instead, spent billions of dollars on themselves and their favoured citizens to received medical treatment abroad, at times provided by Ugandan émigré doctors. Their solution to that wastage has been to invest more public money in a so-called "ultramodern" hospital at Lubowa, Kampala, that was expected to cost $250 million eight years ago. We learned earlier this year that eight years after the groundbreaking by the president, the hospital is only 61 percent complete. The building alone has already cost over $200 million. By the time the building is completed and equipped, the final cost of the hospital may well be twice the original estimate.
Not that this hospital will be of any use to most Ugandans. It will be an exclusive address for the political, military, and business elite, and their hangers on. The unequal access to good health care will be transferred from Chennai and Istanbul to Lubowa. The parasitic elite will enjoy luxurious care and die in comfort closer to home. Most of The Wretched of the Earth will continue to endure substandard healthcare while singing, ululating, dancing, and voting for their political “leaders.” The funeral speeches will now inform the mourners that the deceased died in the comfort of Lubowa, President Museveni’s greatest contribution to the country’s health services. Pity.
©Muniini K. Mulera