Reproductive health in Uganda 3 years on

mukono ambulance

MP Nambooze standing by the new district ambulance

Three years ago,I stumbled upon a story in the Daily Monitor Uganda’s daily about Cecilia a young woman who had die in labour because she and he husband didn’t have £66 to cover her care at the local hospital.

Cecilia’s story was shocking and it was hoped that something like that would never happen to another woman. We were wrong!

Yesterday, I stumbled upon another story of a young woman who lost her life needlessly. The story is told by her local MP Bakireke Nambooze and this is what she wrote on her Facebook page

MATERNAL DEATH OR MURDER? Death has occurred to Nakamya Florence (23years) wife of Mpanga Steven, together with her unborn baby. The Young Lady checked into Mukono Health at 5.00am yesterday with early signs of labour. At 10.00am labour had intensified but on checking her, the Midwife detected that the baby was very big and she couldn’t have a normal delivery, she suggested referral to Mulago or a bribe of 250,000/= to get the Mukono Doctor operate on her. Another Doctor who heard this one Christopher Bingi approached the attendants and convinced them that Nakamya Could be delivered normally if only they would shift her to his Private Clinic called Trinity at Nasuuti and pay him 100,000/=. They finally settled for 90,000/=.The Husband of Nakamya a Bodaboda cyclist found Doctor Bingi’s offer affordable. Nakamya was taken to Nasuuti were Dr. Bingi abandoned her with a cleaner. He came back at 6.30 in the evening to find Nakamya in great pain, minutes later Nakamya collapsed and died. Dr. Bingi fooled the relatives that Nakamya was still alive and drove her body to Mukono Church founded Hospital and took off. Ennaku z’omubbi ziba 40 zokka because at the same time I happened to be at the same place. I mobilised police immediately and we arrested Bingi. Nakamya’s body is in Mulago with the baby still in her Womb as the Police Surgeon is nowhere to be found.I couldn’t sleep the whole night as I kept thinking about Nakamya and the many women dying in Uganda while bringing life in this World. I feel so annoyed with the entire staff of Mukono Health Centre IV. Basawo (doctors) you have betrayed me for I strive very hard to see that my Health Centre doesn’t run out of supplies, We have a community Ambulance to handle referrals…… why were you asking for 250,000/= in the first place, how could you refer a Woman with obstructed labour to a private clinic… could this happen…….I HATE YOU UGANDA.

According to the MP the midwife at the midwife at Florence’s local health centre asked Florence and her husband for a bribe of £62.06 a fee she said said was required to bring in a specialist.  The doctor who offered to transfer Florence to his private clinic asked for £22.50 and although Florence’s husband agreed to pay this fee, his wife was not given the specialist care that would have saved her life and she died.

As the MP quite rightly says, Florence died unnecessarily, the district has an ambulance and she could have been transferred to the specialist hospital which is roughly 17KM away.


I share the MP’s frustration in this. Florence’s life like Cecilia’s could have been saved

Goal Number 5
 of the  the Millennium Development Goals is all about Reproductive health/maternal health  and as we edge towards 2015, discussions are under way as to what will replace these goals.

The question that preoccupies me today as what have we achieved when women like Cecilia and Florence are still dying because they do not have £22 or £66. Is this the price we place on a woman’s life?


I am so angered by this, I could go, but I would rather hear your views

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Uganda: The long arms of international institutions


Over the last few days I have been watching a conversation on Twitter between some of the Ugandans I follow.

The conversation appeared to be a protest about something the electric supplier @UmemeLtd  in Uganda had or had not done to annoy a prominent Ugandan lawyer @dfkm1970 .

UMEME LTD has monopoly over the supply of electricity in Uganda and has sought to impose a system that would see folk all users transferred onto pre-paid meters whether they like it or not. To achieve its ends UMEME Ltd resorted to intimidation and threats to disconnect customers who did not sign up for the switch.

It is this that got David F.K Mpanga angry. As a lawyer he investigated his rights and those of  the electricity supplier and this culminated into the exposure of UMEME’s unethical practices in this post.

The use of prepaid meters is not new nor unique to Uganda/UMEME indeed here in the UK it is seen as away of helping those on a low income manage their finances.

However, this is contested  as some experts argue that consumers that  pay for their domestic  fuel using this method pay a lot more than those who pay monthly. Moreover that this sort of consumer is the one that can least afford to pay  for fuel using a prepaid meter.

But the  issues raised in David’s post got me thinking about  the actions  and or decisions of  International Institutions such as the World Bank, World Trade Organisation etc

These institutions have over the years  advocated limited government intervention as well as market liberalization through opening up trade barriers to international markets and the privatisation of publicly owned institutions  in the global South  in exchange for various forms of aid, grants and loans.

However the selling off of government businesses has not necessarily reduce poverty levels nor bring about effective service delivery for citizens that had been envisaged  as demonstrated by David and his experience at the hands of UMEME.

UMEME came out of what was known as the Uganda Electrical Board (UEB) and was privatised along with other previously controlled government utility companies. During the privatisation frenzy, Uganda also became an “aid darling” with donors throwing money at Museveni’s new government.

The extent to which that aid has benefitted the man on the ground is debatable as the disparity between the rich and the poor in Uganda is huge.

What we learn from David’s post is that instead of helping the poor  the International Finance Corporation a subsidiary of the World Bank and the  Commonwealth Development Corporation have partnered with a global company with unethical practices that disadvantage the poor.

It is evident that these international institutions do not serve the interests of the common man a situation that is compounded by the fact the  government is the gate keeper between the domestic economy and the international system.

With the government in control of economic growth and playing gatekeeper,  the man on the street has to have his wits about him to keep ahead of the long arms of the international institutions and his government!





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Enough food IF….

Did you make it to Hyde Park in London on 8 June 2013?


If you are food poor regardless of where you live this was about you. See food poverty doesn’t affect Africans only and if you thought so, think again. Here in the UK over 500,000 people rely on food banks, because the food has become so expensive

The IF campaign run by several International Charities and aims to lobby the UK and other G8 countries on two aspects FOOD SECURITY and TAX AVOIDANCE.

These charities argue that there is enough food for everyone but 2 million children are dying of hunger every day because

  1. large corporations are buying up land in developing countries and using it to grow food that is then shipped out those countries
  2. land is used to grow bio fuels so the west can drive cars that do not damage the environment
  3. seeds are too expensive and women in particular cannot access them
  4. large corporations dodge tax in developing countries which means that governments  in those countries are denied a revenue that could be put towards feeding their citizens
  5. moreover that the G8 countries should give more aid that will fund access to food and the UK government in particular should enshrine into law the UN target for developed countries to give 0.7% of GNI in aid


I can’t argue with the sentiments of this campaign at some level and yet I do have a problem with it and I wrote about some of my reservations in this post over at Africa on the Blog.

I think  most of the reasons that people are going hungry are first and foremost structural in nature and when I raised this point with one of the leading NGOs behind this campaign at a recent meeting I was told it is not in their remit to address structural problems.

It is my belief that in order to tackle these structural problems we need a huge dose of political will.

Lets take the EU’s agricultural policy. A consequence of this policy is that surplus food is damped on developing countries markets with a consequence of killing of agricultural businesses in those countries.

To compound this situation, certain agricultural products from African countries are excluded from the EU’s common market. This is something that the G8 should be lobbied about and address as a matter of urgency


If you are a farmer in a developing country you currently have no real hope of fighting the level of  protectionism in western markets and  depending on your product you may be excluded from the local market because the surplus food from western will end up on the local market as food aid.

Besides EU policies,  the policies of the World Trade Organisation to liberalise trade have failed to address protectionism amongst developed countries and instead produced a situation in which a few global companies rule the world.

The IF campaign has argued that if these global ompanies paid taxes in developing countries then that money would be available to feed the poor and hungry. I am not entirely convinced by that argument either.

It is not to say that I support non payment of tax but instead  that some of these countries such as Uganda, already have too much food but there is no political will to get it to those that have none. Moreover corruption and misuse of aid money in that country is well documented .  Uganda for instance reduced the incidence of HIV throughout the 1990s because the Museveni’s government made HIV reduction a priority. Could the same drive and energy be applied to food poverty reduction?

Could the EU and the USA reduce subsidies to their farmers?

Secondly we need to look at the effect of the policies of the World Bank and IMF on global poverty and hunger. An interesting article  by Chossudovsky  entitled, ‘Global Poverty in the Late Twentieth Century’ analyses the extent of the impact of the policies of these institutions on developing countries. Chossudovsky argues that  the IMF and World Bank have imposed practice such as the Structural Adjustment Programme (SAP) on the developing world and killed off internal markets and industries within the developing world and necessarily increased poverty, unemployment and hunger. He notes too that, trade liberalization has seen the relocation of firms to underdeveloped regions to access cheap labour, creating unemployment in western countries on the one hand and left citizens in the developing countries unable to afford basics like food and shelter on the other. 

Although this an old article I would argue some of the issues it raises are still relevant today. SAPS have been replaced by Poverty Reduction Strategies but the basics of the policy have not changed much. Countries have to meet political and economic conditions before accessing  help from these instituions.  Think Greece


The point I am trying to make is that at some level this campaign is simplistic as it fails to address the fundamental failures of the international structure that disadvantages those in developing countries. Furthermore, if the global companies create jobs in the G8 countries, can the governments of those countries do anything about their tax dodging  and risk losing several jobs and foreign direct investment?

Another reason I have a problem with the IF campaign is that it feels like MAKE POVERTY HISTORY before it, those going hungry are unlikely to have a seat at the top table, their voices are missing we don’t know what they would like the G8 to do that will improve their lives.

Don’t get make wrong, I am not saying that we should not address the issue of food poverty. Having grown up in Uganda, I have first hand experience of being food poor. In my case it was not because my parents were poor  but it was due to civil wars that meant that we could not access the food that was going to waste on farms and gardens.

This is still the situation in some parts of Africa such as Mali, Central African Republic and Congo. Food poverty in this instance is directly linked to political instability and no amount of matching in Hyde Park will mitigate civil wars.  Furthermore, there is an awful lot of food going to waste and most of that food is transferred from developing to developed countries.

Political will is required to address this level of inequality most of which exists in the international structure. The focus should not therefore be on governments of developed countries  only but governments in developing countries too. This  level of inequality requires more than a campaign in a pretty London park.



Your thoughts please?


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