I am writing from Kigali, a city that reminds us that it is possible for Africa to get it right when we focus on what matters.
Yet a reader of my journal of the sounds, sights, smells and thoughts on this visit encounters a montage of Rwanda and Uganda.
Instead of enjoying a momentary interlude in my obsession with the state of health services in my motherland, I find myself constantly thinking about the case of Bukeeri and Buwunga Health Centre IIIs in Masaka District.
We read in the Daily Monitor of last Thursday, that Bukeeri had run out of basic drugs for common diseases.
Patients were being referred to Buwunga Health Centre III, 12kms away. My people would call that measure “okuhungira enjura omu nkukuuru” (taking shelter from the rain under a cactus plant.) Buwunga Health Centre III itself was reported to be “grappling with water shortage and power challenges as the solar system they have cannot power the refrigerator to preserve blood for transfusion, as well as providing enough light.”
These stories are so routine across the entire country that they are probably received with a shrug by a population that has come to accept this as “the way things are.”
But things were not always this way.
Memories of a childhood spent at Mparo Health Centre in Kigezi flood back. My father was the senior medical assistant in charge of Mparo between 1954 and 1963.
One of the unforgettable treats was the highly predictable arrival of a “burensi” (ambulance), piloted by the ever-smiling Mr Rubambarama, loaded with drug and other supplies.
My father would invite my older brothers and I to lend a hand to Mr Rutembesa, the “ton boy”, to unload the burensi, restock the dispensary shelves and load boxes of expired drugs into the vehicle.
Rubambarama and Rutembesa were such regular visitors to the health center that we considered them part of our lives.
Years later, I learnt from my father that the same burensi would deliver an envelope containing his salary and that of other staff at the health centre. Not once did money go missing. Not once did staff go without pay beyond the expected day. Not once did the health centre have shortages of supplies.
There was a very large billboard at the main entrance of the Mparo Health Centre that read: Emibazi n’eyabusha. Okugigura n’obushema.” (Drugs are free. Buying them is foolishness.)
Why was this possible? I think the answer boils down to two things: Leadership and national priorities.
The colonial rulers, from the governor down to the sub-county chiefs, considered it their duty to serve the people. There was clarity of purpose and pride of progress.
Serving Her Majesty’s subjects was not some meaningless rhetoric but a serious commitment to making a difference in people’s lives. The governor’s comfort did not take precedence over the needs of his subjects. The members of the Legislative Council did not consider their survival and emoluments to be top on the national agenda.
This spirit continued in the early years of independence, until things fell apart following the military coup of 1971. However, the semiliterate military rulers were amateurs compared to their educated successors when it came to feeding off the national trough.
In 2015 the rulers seem to consider it their right to be served by their subjects. This is illustrated by the decision by parliament to burden the treasury with another 65 parliamentary constituencies.
This gross gerrymandering, designed to cater to the needs of the political class, will further deprive the people of Bukeeri and elsewhere who teeter at breaking point.
The current parliament of 384 members is already too big, too expensive, dysfunctional and unnecessary. The ease of mobility and telecommunications in 2015 compared to 1965 makes the work of a serious MP much easier than it was back then. Yet the same country had a small and relatively affordable parliament of 92 members.
I continue to believe that the number of MPs should not be determined by population size, but by geographic area represented. After all, besides attending weddings, funerals and fundraisers, an MP hardly serves individual concerns of his constituents.
However, if we stick to a population-based approach, a ratio of 1:200,000 would be more than sufficient. With a current population of 37 million, Uganda’s parliament ought to be reduced to 185 members.
Besides improved efficiency of representation, legislation and oversight, these being the real duties of an MP, the savings would go a long ways towards meeting the real needs of the citizens.
Instead we now have a situation where the expansion to 425 MPs will cost the poor even more, including the added demand for a larger chamber to accommodate them.
And that is not all. The MPs, distrustful of the public health services that their constituents endure, will demand even more allowances at the start of the next parliament, to enable them to travel abroad for better care. It is one area where there is unity across the party lines.
In the end, the solution to the plight of the people in Bukeeri, Bududa, Buikwe, Ber, Bushenyi, Bugangari and all over the land must come from a population that is determined to peacefully reclaim their rights.
Dr Mulera is based in Toronto, Canada. firstname.lastname@example.org