Afrobarometer Global Release

First of all, Happy Africa Day (yes, it is today, however underpublicised it may be). It was a good day for Afrobarometer to launch their Round 4 Results for surveys they have been conducting in 19 countries across the continent. I attended the Kampala release event today at the Serena Hotel, where Robert Sentamu of Wilksen Agencies delivered a presentation of the main findings, covering such topics as: democracy and regime consolidation, poverty reduction, globalization and cosmopolitanism, and the emergence of democratic citizens. Afrobarometer is a fantastic resource for scholars, journalists, civil society, political parties, and anyone else interested in public opinion, advocacy, policymaking, etc.

My one qualm with the findings of this release is that they paint a rather biased view of democracy and related issues in Africa. Why? Because Afrobarometer does not carry out surveys in countries where they have reason to suspect citizens will give "politically correct" answers for fear of repercussions by the state (i.e. Rwanda). This obviously leads to selection bias -- the countries where citizens are/feel "more free" to say what they really think are also probably more likely to be more democratic. Excluding those countries where citizens are not free probably paints an overly optimistic picture of democracy in Africa as a whole. Nevertheless, the findings of the release are very useful (particularly for each individual country) and quite intriguing.

So what are the key findings?

On Democracy:

The 20 African countries included in the Afrobarometer include many of the most politically liberal countries on the continent, including 7 countries ranked by Freedom House in 2008 as "Free." However, when we assess the quality of these regimes based on popular attitudes and perceptions, we do not find any consolidated democracies among them (although Botswana comes close). In fact, we find some consolidating as autocracies, but most countries are best understood as unconsolidated, hybrid regimes. They exhibit some key elements of democracy, such as regular elections and protection of core individual freedoms. But either the popular demand for democracy, or the perceived supply of democracy, or, in most cases, both, fall short of the standards of full democracy. But the trajectories of individual countries are extremely diverse, with some exhibiting sharp declines away from democratic consolidation, while others are steadily advancing.

On Poverty

Even with the significant growth that sub-Saharan Africa has experienced over the past decade, as of 2008 lived poverty (or the extent to which people regularly go without basic necessities) is still extensive. It has declined in nine of the Afrobarometer countries for which we have over-time data during this period, but it has increased in another six. Cross-national differences in economic growth help explain differing country trajectories in lived poverty. But a more complete picture must also take political freedom into consideration. Lived poverty is strongly related to country-level measures of political freedom, and changes in poverty are related to changes in freedom. This finding supports Sen's (1999) argument about the crucial importance of freedom for development. Using our alternative measures of both development and democracy, we corroborate the findings of others that there is a "democracy advantage" for well being and prosperity.

See more findings and related articles/papers from the Afrobarometer website here.


Following the main presentation, Managing Editor of the Daily Monitor, Daniel Kalinaki, made a thoughtful and eloquent presentation on the Ugandan context (excerpt follows):

As we head towards the next election in 2011, we find ourselves at a crossroads. We can choose to continue the personality-driven winner-takes-it-all political model where we have an election and petition every five years and then let our MPs and other politicians sleep on the job as long as they wake up and vote for their parties. Alternatively, we can choose a bi-partisan approach that puts Uganda first, that allows free and open debate about our burning priorities and how to achieve them, and which puts power back in the hands of the people.

Asking the politicians to decide which model to adopt is, like an African saying goes, asking the monkey to decide whether the forest should be cut down. It is up to the people to demand this right to be heard and served. The Afrobarometer survey and others like it help provide a reality check for our countries and provide useful information that can be used by the media, civil society, and progressive political groups to empower the public.

At the end of the day, however, the responsibility falls on every individual to inform themselves and others, in order to build political awareness and a critical mass of interested and involved publics who can mobilise, organise, demand and receive what is fairly due to them.

You can read the complete version on Kalinaki's own blog.

Look out in the daily papers for more articles on the Afrobarometer surveys in the coming days...

Gettleman rafts the Nile

So my parents visit in one week and, as luck would have it, the first NYT Uganda travel article in four years (I think the last was in 2005?) was published Sunday. What timing! (and good looking out Mom!) Unfortunately the whole thing was about rafting, which my beloved mother and father are not particularly keen to do. Not to mention, rafting was the only activity of consequence in Uganda, Gettleman? I think we deserve better than that (ok, fine, you mention other activities in the fifth paragraph but that hardly counts). At least the commentary is pretty amusing.

My favorite line? "The whole experience was like riding a bouncy castle through a tsunami." Hahaha. Not inaccurate at all.

Why Don't We Have a Global Fund for Maternal Health?

Asks a Tanzanian doctor in a Times article Sunday.

Well, cause someone would steal the money anyway. No? Ok, how about because the international community is preoccupied (is obsessed too strong a word?) by the much more exotic sounding tropical and infectious diseases (a virus that turns your insides to mush = exciting/terrifying, bleeding to death giving birth = boring). Not everyone gets Ebola or HIV or malaria, but most people either give birth or are the direct cause of someone else giving birth (and if nothing else, at least someone once gave birth to them). So maternal health is ordinary, banal, and just plain not-sexy. That is, unless it is tied to something exotic (see Prevention of Mother-to-Child Transmission of HIV -- PMTCT)...

The wards described in the article of the Tanzanian hospital are not different from those in Uganda. In Mugalo Hospital, around 80 to 100 babies are delivered every day, and there are certainly not enough beds for all the mothers. One medical student working in the labour ward described to me how the "fluids" from one mother giving birth flowed into the ears of another mother who was sharing her mattress one night during his shift.

I don't know what the solution is to the neglect of maternal health. In Uganda, maternal mortality statistics have barely budged in the past 20 years. The 2006 Uganda Demographic and Health Survey (depressingly) discusses the lack of improvement with regard to maternal mortality:

At first glance, it would appear that the maternal mortality ratio has declined significantly
over the last five years, from 527 maternal deaths per 100,000 live births for the ten-year period prior to the 1995 UDHS to 505 for the ten-year period before the 2000-01 UDHS, and to 435 for the ten- year period before the 2006 UDHS. However, the methodology used and the sample sizes implemented in these three surveys do not allow for precise estimates of maternal mortality. The sampling errors around each of the estimates are large and, consequently, the estimates are not significantly different; thus, it is impossible to say with confidence that maternal mortality has declined. Moreover, a decline in the maternal mortality ratio is not supported by the trends in related indicators, such as antenatal care coverage, delivery in health facilities, and medical assistance at delivery, all of which have increased only marginally over the last ten years.

No one cares about our nations more than we do

We appreciate support from the outside, but it should be support for what we intend to achieve ourselves. No one should pretend that they care about our nations more than we do; or assume that they know what is good for us better than we do ourselves. They should, in fact, respect us for wanting to decide our own fate.

Says Kagame in his op-ed last week in the Financial Times.

While I am concerned that certain individuals high up in the echelons of power actually care about themselves far more than their nations, I agree wholeheartedly with Kagame's sentiment. Especially the bit about supporting a country's own priorities, whether they be in health, education, infrastructure, etc., and not simply making up your own.

I wrote about donor distortions to Uganda's health sector in this week's Independent. I don't think many U.S. taxpayers, for example, realise that they are contributing more to fighting HIV/AIDS in Uganda than the Ugandan government is contributing to Uganda's health sector in its entirety. This is unacceptable on a number of levels. The current state of affairs is not the fault of only one party, but the donor/recipient relationship will never be equal and those involved should act/think accordingly, political correctness of "partnership" notwithstanding.

Afrobarometer shows waning faith in NRM

Afrobarometer recently released the findings from it's 2008 Round 4 Survey of Uganda. There were a number of interesting results. Among the most interesting to me were those on trust in government institutions, a major increase in support for presidential term limits since 2005, and the lack of NRM support in urban areas.

"Museveni not likely to win clear majority in 2011 elections" was the Daily Monitor's headline for a special report on the poll.

Trust in government institutions fell since the 2005 Afrobarometer survey across the board -- 20 percentage points or more for the president, the ruling party, the courts, the police and the electoral commission. Trust in the opposition party increased slightly, but was also was the least "trusted" to begin with.

Overall, it appears people are tiring of the incompetence and corruption of the ruling party, but the lack of support for the opposition suggests they do not yet see another good option outside of NRM. With less than 2 years until the 2011 elections, now is the time for the opposition to get serious about their campaign.

More analysis to come...

More on torture...

From the Great Lakes Peace and Security blog, an extended interview with the author of the HRW report on torture in Uganda, Maria Burnett.

Torture in Uganda

Torture has been a sensitive subject for the government of Uganda, and has led to the arrest of journalists who cover the topic. Human Rights Watch today released their 89-page report, "Open Secret: Illegal Detention and Torture by the Joint Anti-Terrorism Task Force in Uganda."

An article highlighting information related to the killing of four suspects can be found here.

A summary of the report, published in the Daily Monitor, is below:

JATT is torturing suspects - report

The Human Rights Watch will today release a report in which the Joint Anti-Terrorism Task Force (JATT), an arm of the Chieftaincy of Military Intelligence, is expected to be accused of wide-scale use of torture and illegal detention of suspects. The report is expected to put the government’s rights record in the spotlight.

Conducted between August 2008 and February 2009, the report lies on testimonies from former detainees.
This won’t be the first time the rights body takes issue with the government on abuse of human rights and freedoms.

Past reports have accused the government of torture, questioned transparency of security agencies and general transgression on the rule of law.

The last human rights report condemned the 2006 election violence, intimidation of the Opposition and raised concerns of fairness ahead of the 2011 elections.

When the beater is beaten, who wins?

This morning in Mulago hospital, a young man lay on a stretcher in the emergency ward, the side of his head split open over a lump that had swelled to the size of an apple. "Mob justice," explained a nurse. "They were found beating a woman, and so they were beaten." In the hall outside the room, two police officers waited for their suspects to be released. In the next room, patients waited to see the triage nurse, to register, to be whisked away to the appropriate ward, some of which remained too full to admit new patients.

I hoped the young man would make it, but I couldn't help thinking that he was taking doctors and nurses away from so many other patients who hadn't landed in the emergency room for beating someone (if in fact the story was correct, which it sometimes is not in the case of mob justice). I am sure the police saved the young man and his accomplice from the certain death they would have encountered at the hands of the mob.

According to Uganda's 2008 Annual Crime Report, released last month, the incidence of mob justice is on the rise. The statement read by Inspector General of Police Maj. Gen. Kale Kayihura, "Last year registered a 100% increase in cases of mob action leading to death, from 184 cases in 2007, to 368 cases in 2008. Of these instances, 232 suspects were lynched on suspicion of theft and 59 on suspicion of murder. Suspected robbers, burglars and witchdoctors were other categories of persons murdered through mob action."

He continued, "I am putting the public on notice that no one shall be allowed to take the law into their own hands, whatever the provocation or perceived justification. I have given strict instruction to the CID to apprehend and have all persons involved in mob action charged with murder."

I am not sure what the apparent increase in prevalence of mob justice indicates. The obvious explanation for mob justice is that people feel that the legal justice system does not work for them and therefore must take matters into their own hands. But why more so now than before?

Want a Condom? Think again in the land of ABC

Uganda has long been hailed for its success in fighting HIV/AIDS, bringing prevalence rates from a high of 20-30% (depending on estimates) to 6%, where it has remained for the past several years. The success was attributed, among other things, to the ABC campaign -- abstinence, "be faithful" and condom use. Well, I'm not sure about either the abstinence or the being faithful bit (though a new effort is being pushed forward with the be red campaign), but condom use remains tricky around here.

New Vision ran a fascinating piece in their Sunday edition, sending out reporters around the city/country asking to buy a condom from various shops. Results were mixed, but in general most were ridiculed, laughed at, or looked down upon for their purchase, where they were able to make it. It seemed to me the women fared worse...The men's accounts are here and here, the women's here, here and here.

This combined with the not uncommon idea that using a condom during sex is like eating candy with the wrapper on...

In any case, for those who thought promoting condom use abroad would be as (relatively) easy as it has been in the U.S. (where you often have 12 year olds putting condoms on bananas during sex ed class) should seriously think again, even in countries that have been supposedly successful in the fight against HIV/AIDS....

Rwanda Rwanda

I've just returned from a week in Kigali. Unfortunately my power adapter blew out the first night so I was basically computer/internet-less for the week (especially since internet at Bourbon Cafe is 4000 francs after the first hour!!! That's about $7). All that means is that I have a lot to catch up on. The most exciting thing for me was to visit King Faisal Hospital, Rwanda's main referral hospital. This place is seriously impressive. We spent about an hour with a Ugandan radiologist who had previously worked in both Mulago and Mbarara hospitals. Long story short, he became so frustrated with his inability to treat patients in Uganda that he took a chance on Rwanda. Since coming to King Faisal, he was able to acquire a new CT scan, a flouroscope, and a machine to do mammograms, among others. He is also excited about getting an MRI machine at the end of this year, which I believe will be the only MRI in Rwanda. There is also a digital x-ray so that films are no longer needed, and so that doctors and patients can share and consult on results much faster and easier.

The doctor (who prefers to remain anonymous) bustled about the radiology department, clearly proud of his work and the service he is able to provide to his patients. After a while though, he insisted he had to get back to work. "If a patient waits for more than 15 minutes," he says, "you'll have the ministry [of health] calling you the next day."

Much more on Rwanda soon. An amazing country and government, despite the fact that some (ahem! France) have beef with Kagame.

In other news, but on a related health note, I went with David (see "What Would You Do?") to the Surgery in Kampala today. At numerous clinics/hospitals, he has variously been diagnosed with: malaria, ulcers, cancer, and typhoid, to mention a few. So we went today to Dr. Stockley to get a second (ok, more like fifth) opinion. After 3 hours and $70 we walked away with a diagnosis and treatment. The culprit(s) for the pain and suffering he has been undergoing for the past few weeks/months? Bilharzia, amoebiasis, and internal yeast infection. No wonder he felt like crap. I couldn't help but think he would have been treated much better and faster if he had been a Rwandan instead of Ugandan citizen...but we have hope for the future. And I am a patriot, Mr. President. Are you?

Tomorrow I am off to Mulago for a story for the Independent. You can be sure I will be ranting in 24 hrs time...

$450 a month

That's what senior doctors are paid by the government of Uganda at Mulago hospital, according to the latest article on Mulago in the Daily Monitor. New recruits make only Ushs 626,181 (about $315 dollars) a month, still better than the Ushs 200,000 a month new teachers are paid (about $100), but it is not hard to see why doctors who have invested much more time and money in their education would hop on the next flight out of Entebbe to more enticing salaries abroad.

By contrast, in Rwanda, newly recruited doctors reportedly earn $2000. What is going on here? Or maybe the better question is, what is going on in Rwanda? As it happens, I am headed to Kigali on the 9am bus today, and hopefully some answers will emerge this week for me...

In the meantime, see this interesting discussion (hat tip Paul Collier and Jim Cust's Bottom Billion Blog) on Rwanda as "The World's Social Innovation Capital". More from Kigali soon....

Christmas Came Early for Uganda Police

It seems Uganda's Ministry of Works and Transport is tired of taking all the heat for the country's shabby roads and high road accident rate. Daily Monitor writes today:

All motor vehicles in the country must be compulsorily tested for road worthiness, the Ministry of Works and Transport has revealed.

In a new law that seeks to reduce road carnage, the ministry has proposed strict electronic testing of private vehicles at least once every year while public vehicles will be scrutinised twice a year.

“The system we are using currently to inspect vehicles is inadequate and out of fashion but this new system will be like an x-ray, and no vehicle without an inspection certificate will be allowed on the road,” Works Minister John Nasasira said.

Um, excuse me? An x-ray? We don't even have working x-rays in the hospitals! Ok, well at least they don't all work all the time. In any case, I highly suspect that bad drivers and bad roads account for the majority of road traffic accidents/deaths, not the vehicles themselves. Oh, and seatbelts. This drives me nuts. Parents, BUCKLE YOUR CHILD'S SEATBELT. You are wearing your seatbelt, make your child do the same. There is no excuse for putting your safety above theirs. If they don't like wearing them, tough! They are children. They are your responsibility.

But I digress. Back to the "x-ray" inspection....

The police should be overjoyed at this new initiative. Now, along with lack of third-party insurance, logbooks/paperwork or driver's permit (among other offenses), the police have another way to get some "lunch." Here is how it will go*:

Officer: [Steps into road blowing whistle and waving. Positions himself such that driver can only stop, unless he hits the officer and/or swerves wildly while simultaneously pretending not to see him]

Driver: Yes, good afternoon officer.

Officer: Good afternoon. Can I see your driver's permit?

Driver: Sure, here.

Officer: And inspection certificate?

Driver: Well, you see officer, after waiting two hours to get my vehicle tested, the power went out and the vehicle x-ray machine stopped working. And when it came on again, inspectors had gone for lunch. So I wasn't able to get the certificate.

Officer: Hmm. But now, eh, you must have that inspection certificate. I don't know what we do... [pause] I don't want to take you to the station. [pause] You will pay a big fine if we go to the station.

Driver: Yes officer.

Officer: So. What do we do? [pause, tries to ascertain if he must be more direct]. I don't want to take you to the station. [pause] You could give me something for lunch...

Driver: [pulls out wallet, slips a 10k note on the seat].

Officer: Ok then. Nice day.

End scene.

I still fail to understand why one must go to the station for a simple offense. Just give us a ticket! As it is, there is no incentive for either the police officer or the driver to abide by the law -- if you do, you will go the station, fill out paper work, and pay a huge fine. If you don't, the driver can part with 20k instead of 150k, right then and there, and the poorly paid officer can get a little bonus. Of course, not all not all officers and drivers will take the moral low ground. But I have a sneaking suspicion the majority do (I even know of someone who had to go to the ATM with the officer because he didn't have the amount required for "lunch"!!!). And why not, when those poor officers get paid pennies (ok, shillings) to stand in the scorching sun for hours at a time? Oh, and Nasasira, please stop deflecting blame and do your job. I don't care about decentralisation or KCC. You are the minister and you are responsible.

* As to whether I have ever encountered a similar situation, I will take the fifth.

Johnnie Carson is Obama's Pick for Asst. Secretary for African Affairs

"President Obama's nomination of Johnnie Carson to be Assistant Secretary for African Affairs is a strong choice. Carson is an accomplished career foreign service officer with an excellent track record on African issues spanning many decades and a range of positions. Carson has a deep understanding of our diplomatic capacities and the importance of regular interagency collaboration. I look forward to considering his nomination and hearing how he and the administration plan to address the many challenges we face on the African continent."

Says U.S. Senator Russ Feingold, who is the Chairman of the Senate Foreign Relations Subcommitee on African Affairs. Ambassador Carson worked in the Foreign Service for 37 years (serving in Kenya, Zimbabwe, Uganda, Portugal, Botswana, Mozambique and Nigeria) before joining the National Intelligence Council, serving as officer for Africa. See his complete bio here.

I understand he has been less than chummy with Museveni, criticising, among other things, his running for a third presidential term. What will Carson mean for Uganda? For Africa?

"Whether there are new ways for Museveni to re-invent himself and his government in the eyes of an Obama administration will now be seen," says analyst Angelo Izama in a November 2008 article in the Daily Monitor. "President Museveni’s appeal is waning. On the eve of the last election, senior US Africa policy heads, including Johnnie Carson noted that Uganda is a success story gone bad."

Museveni has allowed the potholes of his regime to grow wider and deeper in recent years, and now he is in for a bumpy ride.

This Week: Oil Roundtable

It's official. Uganda has oil.

But how much and what kind? What does it mean for Uganda's future? Who is calling the shots? Will it boost development, or will the oil curse strike again?

For answers to these questions and more, please attend a groundbreaking roundtable on Uganda's oil sector, sponsored by Kampala-based think tank Fanaka Kwa Wote and the U.S. Embassy Kampala.

What: Oil Roundtable
When: Thursday, March 19th, 9:30am to 12:00pm
Where: Protea Hotel, Acacia Road, Kampala
Who: Panel of experts and interested parties, including:

Professor Jacqueline Lang Weaver, University of Houston
Mr. Stephen Birahwa, MP Buliisa and Member of the Committee on Natural Resources
Mr. Brian Glover, Managing Director of Tullow Oil
National Environmental Management Authority
Uganda Ministry of Energy and Mineral Development
Uganda Ministry of Finance, Planning and Economic Development

Moderated by Managing Editor of The Independent, Andrew Mwenda.

Who needs electricity? Come on baby, light my fire

Does lack of electricity lead to more sex? Which leads to more babies? This is the argument Uganda Planning Minister (Ministry of Finance), Ephraim Kamuntu, has recently made according to the BBC's "Uganda Blackouts 'Fuel Baby Boom'". Without TV or other entertainment, Ugandans are falling into bed and making babies, leading the country to hold one of the highest population growth rates in the world, or so the story goes.

Meanwhile, in the U.S. condom sales are up, apparently for related reasons. What's the cheapest form of entertainment? No electricity and no entrance fee required (legally anyway), and it keeps you warm so you can reduce your heating bill! But in these times of financial hardship, U.S. consumers are apparently wary of accidentally ending up with a costly bun in the oven...hence condom purchases...

A few questions though...

In Uganda, sure, it may be dark, but you still have your seven other kids bounding around the house, how much time do you really have to sneak off and procreate some more?

Also, what about the men (and some women) who stay out in bars till 3am? They are there in numbers...I know because I can hear them when the Ntinda hotspots keep me awake at all hours of the night (and morning)...

Most importantly, what about countries with equally poor access to electricity? Why isn't their population growth rate as high as Uganda's? India, for example, has a population growth rate of 1.4% (according to the UNDP), and yet nearly 490 million people live without electricity.

Finally, I think population growth will fall only when couples have incentives to have fewer kids, or disincentives to have more kids. While in a taxi yesterday, the driver told me he had 14 children with three women. And wanted 2 more with a different woman. I am sure he makes far less than most couples in the U.S., but there is still no incentive (as he sees it) for him to stop making babies, electricity or no electricity.

Sorry Dr. Kamuntu, your argument falls flat. How many kids do you have by the way?

Why M7 Overestimates Himself

Ok, I don't understand Museveni's psychology enough to take a legitimate stab at why he seems to overestimate his own abilities. But a recent article in TIME (by the way, did you know that TIME is an acronym? "The International Magazine of Events") discussed precisely this issue -- namely, why people in powerful positions (from Obama to Putin to M7) tend to overestimate their own capacity.

The article discusses a new study by two Stanford researchers published in Psychological Science. Authors note, "By producing an illusion of personal control, power may cause people to lose touch with reality in ways that lead to overconfident decision-making."

How does M7 measure up?
Personal control. Check. Losing touch with reality. Check. Overconfident decision-making. Check...

M7 was until recent years hailed the "new breed of African leader." Just months after coming to power in 1986 he announced, “The main cause of Africa’s crisis is leaders who do not want to leave power. There is no reason why anyone should be president for more than ten years.” And yet here we are, in 2009, with two years until the next presidential election, and his fourth term is already inevitable in the eyes of many. So what happened? Was his personalisation of power inevitable? (see last week's article in The Independent, "Family Rule in Uganda" , for more info on the subject)

I don't think an experiment with Stanford students rolling dice can provide any definitive answers to these questions. Nevertheless, I find valuable research on the psychology of power, and why some leaders take their countries to moon while others drive them into the ground. I tend to think that individual agency plays a large role...but of course this is a subject of great debate. Does a leader shape society more than society shapes a leader?

Cabinet Reshuffle: Votes > Performance

I know, this should be obvious. The point of Museveni reshuffling cabinet was not primarily to ensure that the most qualified people become ministers of their respective ministries, but to secure votes for the not-so-distant 2011 presidential election. I know, but does government have to blatantly admit it?

In a recent interview with Uganda's Independent magazine, the Vice President of Uganda, Professor Gilbert Bukenya gave the following response to the following question:

Q: How do you regard the newly appointed cabinet; is it the best the President would produce?

A: This [cabinet] is a perfect combination which is going to lead us to the next general election with developments that will help us generate more support as the NRM party from the masses. The new cabinet has people whom I think are great performers and this is what the President needs as we move toward the elections in 2011. This does not mean that the previous cabinet did not have performers but I think these are vote winners.

And there you have it. Votes > Performance. No shame, no beating around the bush.

My other favorite part of this interview? In regards to his supposed shenanigans as reported by the Ugandan media:

"What these reports have done to me is denying me a chance to dine and mix with people in open places because during such times stories are made up, actually it's because of that that I decided to construct gyms and saunas in all my homes so that I work out privately."

Oh, really? Phew. Gyms and saunas in all your homes? Thank goodness, I was worried.

Who Cares About Cancer?

Cancer is not captivating. Or, at least, in sub-Saharan Africa it doesn't seem to be when compared with, say HIV/AIDS or malaria. Why is that? Is it the sheer numbers? The assumption that you are more likely to die of a communicable disease before you will ever develop cancer in this region? Or maybe, like global warming, it's a scary topic that it is easier to put off thinking about until tomorrow. Or the next day...Or the next day...

It seems like a lot of friends of friends are dying or have died from cancer recently in Kampala. On Sanyu FM this morning, a caller asked for advice on how to handle his relationship with a girl who had terminal cancer. While I have long been interested in health and healthcare in Uganda, I have never looked much into cancer prevalence or treatment. I assumed, at any rate, that treatment was prohibitively expensive for most people when available at all. But do we even have accurate figures on who has cancer and where? I went circles around the WHO Uganda site to find any figures. At best they have projections for 2005, based on 2002 burden of disease estimates. Not exactly what you might call up-to-date or very accurate.

I next went to Uganda's most recent Demographic and Health Survey, from 2006. I was shocked to find that in searching "cancer", there was a SINGLE result, out of 501 pages! It was a note on reproductive organ cancer made in reference to the Sexual and Reproductive Health Policy Guidelines that had been developed in 1994.

According to WHO's stats, cervical cancer is the most common form of cancer in women, followed by breast cancer. In men, the most common is prostate cancer, followed by esophageal cancer. Lung cancer is surprisingly low on the list (9th for men, not even ranked for women), given the number of people I see smoking around Kampala (of course this is not indicative of the rest of the country, but still, Kampala-ites are more likely to be diagnosed anyway I would imagine).

Uganda does have a Cancer Institute, which is almost definitely underfunded, understaffed and ill-equipped, though I haven't done much in-depth investigation of the place. While cancer may not yet be killing as many Ugandans as malaria or diarrheal disease (which primarily affects children), I have a strong suspicion that it is much more prevalent and pernicious than meets the eye. It may not be captivating, but it is killing. More on this to come...

Andrew on Aid (Again)

In his excellent new blog, Aid Watch, William Easterly has posted a video of Andrew Mwenda speaking at a recent conference at NYU. Sadly, my Internet connection is currently too slow to watch it, but I have spent enough time with Andrew at The Independent and around town that I am pretty sure I know what he is saying...essentially that foreign aid makes governments accountable (if at all) to donors instead of their own people, which has damaging consequences for many young and emerging democracies.

I generally agree. In some cases, there is little evidence that governments need to be accountable even to the donors, who seem to keep throwing money at programs and government coffers without following up to see that the money translates into measurable outcomes. Domestic taxes are a good (if obvious) solution. When people are coughing up their hard earned money to pay for public services, for example, they are much more likely to make sure that government actually delivers these services.

Tax collection is not easy, however, especially when the richest businessmen are often top government officials themselves, or have close ties to the government. Studies from the Economic Policy Research Centre in Uganda have found that tax evasion in the country is widespread (an altogether expected finding). I am sure we would be shocked to know the real amount that is owed to the Uganda Revenue Authority. It is also hard to tax the informal sector, which constitutes a large and largely undocumented portion of the economies of many developing countries. Nevertheless, improved tax collection should be a high priority for those looking to create real systems of accountability in countries like Uganda. But who are these people exactly? Politicians? Government officials? The most powerful people in the land? Mmmm, methinks not...

Not the First Lady I wanted in the news

Last week I noted the seemingly unusually frequent news stories related to First (and former First) Ladies around the world. I almost added at the end, "Who's next, Mugabe's wife?" Close, as it turns out. But instead it was Susan Tsvangirai, wife of the Prime Minister of Zimbabwe (Morgan Tsvangirai) who died in a car crash in Zimbabwe last Friday, March 6.

There has been some speculation that the crash was not an accident but a malicious attempt to oust the PM, but given the decrepit roads, poor driving and sky high car accident rates in the region, I would not be surprised if the official story (that the driver of the truck that plowed into the Tsvangirai's car) was true. In any case, it is a great loss and tragedy for the Tsvangirai family (which includes 6 children and two grandchildren).

There have been a number of high profile road traffic deaths in Uganda as well, which has one of the highest road accident/death rates in the region. Yet despite the fact that nearly everyone I know has lost a loved one to the roads, there is little to nothing being done to improve the condition of roads or people's driving. I don't understand why. It wouldn't seem to be a collective action problem, because everyone is suffering and I don't think one group is disproportionately affected. Perhaps it is a fatalistic mentality when it comes to the roads? I have heard multiple people explain these deaths as "God's will." Others have told me they do not wear seatbelts because they would rather be killed than maimed for life.

While I do not consider myself very religious, I do generally understand the "God's will" sentiment. I do not think it applies here however. It is not God's will that people within the Ministry of Transportation are not doing their job. It is not God's will that corruption eats up money meant for road construction so that in the end you have roads that have developed potholes before they are even completed (ahem! Northern Bypass). Submission to incompetence gets you nowhere at best and, evidently, killed at worst.