Thursday, September 12, 2013

Uganda’s Democratic challenges and possible solutions

Uganda’s Democratic challenges and possible solutions

Uganda still faces a number of democratic challenges ranging from institutional management and administration to democratic management of elections among many others. However, democracy promotion is a collective effort which does not only take politicians’ willingness and mandate but also the general population. As one may clearly note, Uganda’s electoral democracy is more or the same bought by rich class seeking to occupy certain political positions. This has led to continued oppression of the poor for the rest of the five years they give their voting right to self-minded and egocentric politicians. It has become a culture that citizens will only seem to be relevant to Uganda’s governance systems when it comes to electoral period. Therefore, if the challenges are to be realized and solved, it will take the wholehearted willingness of the general public more so the voting population of Uganda.

In Uganda like it was with the governability of western European nations; her governance is being hampered by a set of related which revolve around the general the general emphasis on bureaucratic rule, the lack of civic responsibility and the breakdown of consensus (Michel J. Crozier, Samuel P. Huntington and Joji Watanuki, 1975). Governance and management of state affairs has of recent times become like a one man’s show in that even simple land problems in Ugandan villages are directly brought to the executive to be solved. This has time by time eaten up the institutional fabric in that certain state and local government institutions become weaker day by day. This has also hampered the rate of service delivery in the country.  Important also to note is that the moral fabric among civil servants is nearly to death due to rampant corruption in the system. It would have been more relevant and reasonable if all systems and institutions of government are respected and given chance to be innovative and pro-active in implementation of certain policies and strengthening service delivery. There is no doubt that in case of a political catastrophe like a military coup in Uganda, all government intuitions may cease working unless another stable government is in place. To political scientists, this is a very dangerous time bomb because in causes diverse negative effects to citizens in cases of political crisis.

In Uganda’s electoral system and process, universal adult suffrage with a secret ballot is in place for presidential, parliamentary and local government elections. Judicial complaint mechanisms are also provided for in cases of electoral petitions. Please note that; following the referendum decision of 2005, the Movement System has been replaced by the multiparty political system. Since then therefore, the opposition parties can operate legally, although they are still struggling to effectively organize themselves in terms of programs, operational structures (particularly in the remote areas), funding and qualified personnel (Bertelsmann Stiftung, BTI 2012: 9). This has given NRM (the ruling political party) to remain stronger basically in Uganda’s rural areas. However also, the fact that on some instances the opposition has been suppressed and placed in a disadvantaged position by the ruling party cannot be disputed. On some instances opposition political parties ‘rallies have been stopped by Police and party leaders brutally handled. On many occasions for example the lead opposition political party leader (former) Kiiza Besigye has been put under house arrest by Police on no clear legally stipulated grounds (Simon Masaba, New Vision Oct 09, 2012).  Therefore, one can argue that the only solution to the current political democracy challenge could be; creation of room for a free political participation without involvement of state coercion to oppress the opposition. More so, it is important to give chance to opposition to maximize their available political opportunities to avoid a blame game at the end of the day.  On most occasions, the opposition has disputed presidential and or parliamentary election results based on such grounds as limited equal political platform.

Talking of institutional independence in Uganda, as already noted above it is one of the biggest democratic crises in the country. As one may have noted, there is less or no institutional independence mostly among the three most important pillars of government (Judiciary, Executive and Legislature) due to two major reasons; one is excessive constitutional powers of the executive (president) and the other is dominance of one political party in parliament. Expounding more on this, it is important to note that most of the influential positions ranging from cabinet, heads of corporations, Police, Service Commissions, Judges including the Chief Justice, Heads of the  electoral commission and Bank of Uganda are appointed by the president.  Whereas the parliament has the duty and mandate to approve presidential appointees, manipulation is unavoidable due to the fact that majority of members of the appointments committee of parliament subscribe to the ruling party hence rubber stamps to the President’s decisions.
“....Democratic institutions exercise their functions in principle and generally political decisions are made within the constitutional framework by the appropriate authorities. However, inefficiencies exist due to frictions between institutions at different levels. One of the challenges the multiparty political system still faces is the extent to which the NRM and the state are still interwoven. The NRM has a two-thirds parliamentary majority and for more than two decades Ugandan governments and administrations have been dominated and formed by the party. This has led to an overall situation where the lines and limits between the different actors have a tendency to be blurred. The mandates of democratic institutions like, for example, the inspectorate of government, the directorate of public prosecutions and committees of parliament such as the public accounts committee partially overlap....” (Bertelsmann Stiftung, BTI 2012:14)
Talking of independence, there is great executive influence on the two other arms of government as already noted above due to the mere fact that some of the members (in most cases majority of them) in such arms of government are cadres of the ruling party hence must implement party decisions. In most African states, this has been one of the long lasting problems and it has in one way or the other jeopardized institutional democracy and endangered service delivery. Therefore, the only solution to the long lasting problem is liberalizing appointments of officers who are considered to be most influential and nonpartisan like those in the Electoral commission such that their appointments are participatory. Here I mean; there should be consultations with other political parties, media, general population and civil society when appointing such officers. This is to ensure that they are officers of high integrity and highly respected by the society they are leading. 

Uganda may need to learn from Europe where Western Europe is known to have suffered a tragic period of social and political regression when the effervescent world born out of World War I could not face its tensions, especially those of the depression, and when its needs for order were met by recourse to the fascist and Nanzi regression (Michel J. Crozier, Samuel P. Huntington and Joji Watanuki, 1975: 49). Uganda through all the political regimes has faces such kinds of regressions politically, socially and economically as stipulated above.  As noted for example during Amin’s regime after the expulsion of Asians from Uganda, Uganda is said to have experienced an economic regression by 20 years backwards. Alongside that is the military dictatorship and repression of government institutions among others. The same trend continued even after Amin’s regime and the situation started recovering after the National Resistance Army by Museveni took over in 1986 up to today. However, the political environment in Uganda today is a clear manifestation of what Uganda is likely to go through after the Current Government which one can’t predict to be good. Therefore, if Uganda is to be a progressive country in terms of social, political and institutional democracy, there has to be measure put in place to ensure a peaceful political transition of power. As noted above, since independence Uganda has had eight presidents but none of them has ever handed over power peacefully hence the reason for 1970s and 80s regressions. Therefore, if the current government is to ensure that there is no such kind of situation as in the 70s, it has to ensure that a peaceful way of handing over power is established. However, this can only be done when leaders come to learn that Uganda belongs to Ugandans not certain individuals hence anything done should be for the good and benefit of all Ugandans. This is an aspect most leaders in Uganda have always forgotten. After acknowledging that, independent intuitions will be established to handle a peaceful transition in Uganda.

Like in US in 1960 where party identification dropped sharply, and the proportion of the public which considers itself Independent in politics correspondingly increased hence the decay of party system (Ibid: 85), there is a growing decline in the role of political parties in Uganda. Due to domination of the NRM party, most political parties have been rendered toothless and do not do much in shaping policies of government because they are a minority group. Due to this, the presumed political participation which is said to increase polarization within society according to Michel, Huntington and Joji has lost meaning. The existence of political parties has only been seen as an avenue for opposing each and every government policy good or bad. This has also created some form of bias in citizens in that they no longer give much credit to existence of political parties. Hence, any seek for political power by an individual; he or she has to use the NRM ticket to get there. Therefore, there is an urgent need to effective political and civil society participation in shaping of public policies but also internal reorganization of political parties in order for them to earn credibility in the entire public.

In conclusion therefore, as clearly noted above, there is still a long way to go for Uganda to achieve effective democracy. However, achieving democracy does not only take the so called “revolutionary leaders” but also collective participation of able bodied citizens in the country. As I conclude, I will try to suggest five most important aspects that may need to be put under consideration for Uganda to be considered a democratic state. They are; intensification and support of political leadership institutions, boosting of political parties, effective social and economic developmental planning, recognition and acceptance of innovation in areas of work and lastly and most importantly institutional creation for cooperative promotion of democracy.  As one may have realized, many of the democratic challenges we have in Uganda emanate from the above five aspects. Hence if one has to solve the problem, then he/s must acknowledge the cause.
Institutions of political leadership should not be neglected mainly in execution of their constitutional mandate. Such form of support may range from creation of room for innovation, technical and financial support. There are democratic disputes in Uganda due to neglect of opposition groups and looking at them as political enemies to governments in power. This has created political problems and on most occasions has led to abuse of human rights when the police is handling opposition in a brutal way. Supporting them would mean involvement in policy making agenda and financial support as suggested by the United Nations Convention against Corruption.
Poor and self-centered social, political and economic development planning is one of the biggest democratic challenges we have not only in Uganda but in the entire Africa. Leaders in political power only give the first priority to short tern strategies that would help keep them in political powers other than looking at long term developmental aspects. Therefore, if some aspects of democratic constraints are to be solved, there has to be some kind of strategic developmental planning. Plans that last for centuries not just decades are the most relevant for Uganda. More so, as already stipulated innovation among politicians from all political parties, civil and public servants to not only shape policies but also direct their implementation is a key to democratic development in Uganda. Running of government affairs like a machine has in one way or the other led to reluctance and less innovation among government employees leading to moon-lightening hence less value for money.
Last but not the least, it is important to note that democracy stands on the foundation of institutions. Hence noting; absence of relevant independent institutions is one of the biggest blows to democracy. If Uganda has to realize her democratic potentials, it should not only strengthen existing institutions as noted above but also create other relevant institutions like independent appointing bodies among others. Such institutions should be given constitutional mandated to exercise their duties without political interference or influence. This is could be done in an effort to increase respect for credibility of institutions of the state. Most citizens have lost respect to most of the existing institutions basically because they are looked at as creations of the existing g0overnments to help them stay in power. This is one of the historical events not only in the existing government but also in the past governments. Collectivity in policy making is the way forward for Uganda’s democracy.
Julius Byaruhanga

Friday, June 28, 2013

Service Delivery; a Victim of Poor Policy-Making and Implementation

What is the way forward? 

After analysis of certain social policies, i have tried to ask my self these questions; What would be the best policy approach in instances where over decades there are "policy overlaps" in major policies with in developing countries? Is it justifiable to take a "put all on paper and implement non or less" approach or "put less on paper and implement it all" approach to accomplish certain policy areas in developing states as you create a pace to work on others? My personal analysis is that what is important is "Strategic Planning" not "Persuasive planning" where the "book cover" will look white when "papers" inside are black. Keeping in mind that policy implementation does not take a "revolutional" but an "evolutional" approach.

Many scholars have argued on the planning approaches and ways to realize development and improvement in SD but my personal point of view is taking an approach of Quality other that Quantity where few long lasting developmental projects are implemented other than many short lasting projects. This argument puts much emphasis on SD essential infrastructures which will act as a ladder to realizing individual and communal objectives or needs. This will come about only when development actors learn how to speak in one tone and sing from the same hymn book. Self-minded approach of policy makers and unnecessary opposition of developmental policies without clear solutions accompanying such opposition by certain political actors can be one of the biggest saboteur to development and consequently SD.

So then what is important of us? Plan and sleep or plan, evaluate and act? Long lasting goals, where policy makers and political actors will not only make policies primarily as a strategy to keep them active in power (as many political scientists have argued) but rather to set long lasting developmental infrastructure  as previously stated is the best approach! However, this will take a nationalistic and patriotic heart where actors are looking beyond self. I would argue that "Donor eye catching" and "electorate persuading" policies are no-longer reliable to realise development and hence SD that we need. So then, questions to be answered are; What do developing states want? When do they want them? How can they get what they want? And, How long will it take them to get what they want? That way, we shall learn how to jump a river when we are already along its banks.

In some of my previous posts and articles I have always tried to argue that any improvement in SD should take a bottom top approach. However, it all starts at the heart of policy makers. Even when a common man knows what he wants, he does not know how to get it, if they know how to get it they don't know how to get to where they are expected to get it but still if they are able to do all the above, they don't have the capacity and authority to act. Hence I must categorically argue that 85% of the blame must go back to policy makers and more so political actors.

Food for thought

"If a village kid at home asked a mother how bread comes on table, is it justifiable for the mother to say; we get money from the wallet, go to the shop, buy bread, butter it and put it on table? OR us and other fellow village farmers go to the wild bushes, clear them with pangers and hoes, sow wheat grains under tough conditions, look after gardens, harvest the wheat when it is ripe and dry, grind it, take to the market, bakers buy it and use other ingredients to make bread, shop-keepers buy bread from them in whole sale, and we go back to buy bread from the shop-keepers when we have money from the savings we made when we sold wheat flour or grains".

Hence no policy what so ever to my understanding should just be an overlap to impress readers and listeners but rather a reality of what should be done whether simple or tough such that reality is met when it comes to implementation.

In one of my next publications on the same; i will try to point out the approaches necessary to achieve the best such that my readers will be able to get a clear picture of what I am aiming at pointing out.

Saturday, June 22, 2013

Comparative Analysis of Uganda’s 1999 and 2009 Health Policies

University of osnabrueck
Social Sciences  Faculty
MA. Democratic Governance and Civil society

Comparative Analysis of Uganda’s 1999 and 2009 Health Policies
By
Julius Byaruhanga
17th June 2013
Objective
Evaluation of the progress and challenges with in Uganda‘s Health sector from 1999 to date & forge a way forward 
Summary
Policy(s) Background
  1. Uganda’s Health Staus 1999 and 2009
Policy(s) Aims and Objectives 
  1. The National Health Policy 1999 and 2009 Political issue/aims
  2. Policy sector; 1999 and 2009Matters and objectives
Implementation
  1. Actors (implementers and supporters of the Policy)
  2. Strategies, beneficiaries
  3. Health Situation analysis; Critics and possible solutions/measures
  4. Other current health challenges and possible solutions
Conclusions

1999 Uganda‘s health Status
  1. Projected population of 20.4 million (Statistical Abstract 1997), that is 50.9% females and 49.1% males,
  2. Annual population growth rate of 2.5% (1991 Census) & annual GNP per capita of US$300 and
  3. Approximately 46% of the people living in absolute poverty
75% of the life years lost due to premature death were due to ten preventable diseases i.e.
  1. Perinatal and maternal conditions (20.4%),
  2. Malaria (15.4%),
  3. Acute lower respiratory tract infections (10.5%),
  4. AIDS (9.1%) and
  5. Diarrhoea (8.4%)
  6. Others included; tuberculosis, malnutrition (with 38% of under-5s stunted, 25% underweight for age and 5% wasted), trauma/accidents and measles.
2009 Uganda‘s health Status
  1. Population of 30.7 million with an annual growth rate of 3.2% & population density of about 120 persons per km2
  2. Life expectancy increased from 45 years in 2003 to 52 years in 2008; HIV prevalence has stabilised; polio and guinea worm had nearly been eradicated
  3. Between 1995 and 2005, U5MR declined from 156 in 1995 to 137 deaths per 1,000 live births; and MMR reduced from 527 to 435 per 100,000 live births.
4.      Underweight prevalence reduced from 23% to 16%
These health indicators are still poor.
  1. Malaria, HIV and AIDS and tuberculosis remain the leading causes of morbidity and mortality.
  2. 70% of overall child mortality is due to malaria, Acute Respiratory Infections, diarrhoea and malnutrition.
Overall Objective and mission
Health Sector Objective
The overall objective of health sector policy is to reduce mortality, morbidity and fertility, and the disparities therein. Ensuring access to the Minimum Health Care Package
1999 Mission
Attainment of a good standard of health by all people in Uganda, in order to promote a healthy and productive life
2009 Mission
A healthy and productive population that contributes to economic growth and national development

The National Health Policy 1999 and 2009 Political issue/aims (specific objectives)
  1. Organisation and management of the national health system
  2. The minimum health care package (1999 & 2009)
  3. Monitoring and evaluation
  4. Legalislation and regulation
  5. Health resources
      1. Human Resource Management and Development
      2. Medicines and health supplies
      3. Health Infrastructure
      4. Health financing
  6. Partnerships in health
      1. Public Private Partnership in Health (PPPH)
      2. Intersectoral and interministerial partnership
      3. Health development partners
      4. Partnership with the community

Components of the minimum health care package
“Policy overlap”
1. Control of Communicable Disease
  1. Malaria 
  2. STI/HIV/AIDS
  3. Tuberculosis
2. Integrated Management of Childhood Illness
3. Sexual and Reproductive Health and Rights
  1. Essential Ante-natal and Obstetric Care
  2. Family Planning
  3. Adolescent reproductive health
  4. Violence against Women
4. Other Public Health Interventions
  1. Immunisation:
  2. Environmental Health
  3. Health Education and Promotion:
  4. School Health:
  5. Epidemics and Disaster Prevention, Preparedness and Response:
  6. Improving Nutrition:
  7. Interventions against diseases targeted for eradication
Actors (implementers and supporters of the Policies)
„Well structured?“
  1. Health related central line ministries,
Minister of Health
ü  State Minister for Health (General Duties)
ü  State Minister for Health (Primary Care)
  1. The Health Service Commission,
  2. The Local Governments,
  3. Donors,
  4. Private Practitioners,
  5. NGOs and
  6. Traditional Practitioners within the decentralized system
  7. Semi-autonomous bodies;
    1. Uganda National Health Research Organization
    2. Uganda Blood Transfusion Service
    3. National Drug Authority and
    4. National Medical Stores

Strategies & beneficiaries
Some of the Strategies
  1. Provide additional resources  
  2. Subsidise designated public health and essential clinical  services
  3. Provide national guidelines  
  4. Restructure the organisation and management of the National Health Care System
  5. Implement the organisation and management reform of the Ministry of Health
  6. Strengthen district health services management
  7. Decentralise operational responsibilities for integrated health promotion, disease prevention
  8. Clarify the relationship between the key stakeholders
  9. Divest clearly defined central MoH functions, as appropriate, to the autonomous and semi-autonomous bodies
  10. Review and strengthen the existing national drug policy;
  11. Review and update the national food and nutrition policy

Beneficiaries  
General Population with much emphasis on;
  1. Pregnant and non-pregnant mothers
  2. Children
  3. HIV/AIDS Patients
  4. Rural population

Health Situation Analysis

Policy area
Situational Analysis
Critic(s)
Posible solution
Health service delivery
Provided by the public and private sector with each sector covering about 50% of the standard units of outputs
High burden on the Pupulation
Establishment of more Public Hospitals & equiping the existing
The public health delivery system
Autonomous Village health teams (VHTs), HCs II, III and IV and district general hospitals) and regional (RRH) and national referral hospitals (NRH),
Less Accountability
Poorly equiped
Limited personnel
Personnel recruitment
Equiping RRH and NRH to maximum
Acc. Checks and balances
The private sector
_not for profit organisations (PNFPs), private health practitioners (PHPs) and the traditional and complementary medicine practitioners (TCMPs).
_not properly integrated with the public sector
 _PNFPs have not been properly harnessed to support health promotion at community level
_Encourange PPP
_Government support to private hospitals
_Encourage Private Hospitals establishment at community levels
The Private notforprofit subsector (PNFP)
PHPs provide mainly primary level services and have a large urban presence.
_Receive no support from government
_Standerd not checked
_Need to be standerdised
_Need for Gov‘t support
Traditional and Complimentary Medicine Practitioners
Approximately 60% of Uganda’s population seek care from TCMPs
Many traditional healers remain unaffiliated to gov’t or private HCs
_Check Standerds and affliate them with support from Gov‘t
Supervision, monitoring and evaluation
Area Teams, technical programs, District Health Teams and HSDs supervise service delivery at government and PNFP facilities at different levels, except the national and regional referral hospitals
_Supervision and monitoring visits are irregular and poorly documented; 
_lack of human resource newly created districts 
_Lack of supervisory skills at district and HSD levels;  
_Lack of transport and inadequate budgets
_More empasis on funding the activity
_Trainning of more supervisors
_on-job training

Other current health challenges and possible solutions
Challenges
Possible solutions
Maternal Motarity rate still high
_Adquet funding and trainning of more Midwives  for at least 3 midwives per Health centre mainly at local levels
Childhood mortality is generally higher among children of less educated mothers
_Mass training of rural mothers 
Delay of woman seeking care cited in 112 maternal deaths
_Compulsory natinental care for pregnant mothers
Uganda has the world’s 2nd highest accident rate, with over 20,000 road accidents a year and 2,334 fatalities in 2008
_Strengthening of traffic laws and effective implementation
Human resource shortage in hospitals remains a major challenge to service delivery
_Increase remuneration of medical personnel and sponsorships to students interested in medical field
Many of the hospitals especially private health practitioner hospitals do not satisfy the criteria of a hospital but are nonetheless registered as hospitals
_Strict laws on registration of hospitals based  even on number of Doctors and other health workers a hospital has before it registered
Very few if not no ambulances in rural government health centres
-Provision of at least 10 Ambulances per Health centeres at a Hospital Level and at least 4 each sub-county for Local Health centres





Conclusion
  1. Why is the policy important? “Clear reasons for their development”
  2. What are the requirements? “Specific actions defined”
  3. Who needs to know, execute and own the policy? “Clearly communicated?”
  4. Where do the standards apply? “Multiple areas?”
  5. How will the standards be applied to business? “Awareness (language)”
Meeting such standards will automatically mean less or no priority overlaps in 1999 and 2009 Uganda‘s health policies