Prof Anthony K. Mbonye’s book; Uganda’s Health Sector Through Turbulent Politics (1958-2018), serves up nearly 156 pages of a scathing critique of the ministry of Health and its officials, which makes it that much more controversial – coming from a senior medical doctor and former employee of the ministry.
In the book, the former ministry of health official says top jobs at Uganda’s ministry of Health were not awarded on merit but depended on who was closer to the first family and who lobbied best.
The book, released to bookshops around Kampala last month, describes in fine detail the extent to which one’s connectedness determined one’s place. Mbonye, a former acting Director General of Health Services, lifts the lid on how top positions were stuffed with underserving political appointees, killing staff morale and leading to resignations of experienced personnel.
Its insider revelations make for a gripping read which probably explains why copies were allegedly bought off the bookshelves hours after release, probably to limit circulation. It also shows the extent to which intrigue at the top of one of the country’s most critical sectors paralyzed work.
Mbonye, who resigned in January 2018, says the ministry is now grappling with “demoralized staff who feel that the institutional mechanisms to advance their professional careers are no longer relevant.”
“Thus, there is little incentive to work harder since they feel they have little hope for promotion,” he writes.
During his time at the ministry of health, Mbonye didn’t have a good working relationship with the current permanent secretary, Dr Diana Atwine. Atwine was the all-powerful head of the health monitoring unit in State House, which enjoyed the patronage of President Museveni.
He was also not seeing eye-to-eye with then Director General of Health Services, now the minister of Health Dr Jane Ruth Aceng. Often, their disagreements spilled into public view and the media. It is little wonder then that the book picks particular interest into how these officials reportedly wormed their way into the ministry largely as political appointees.
“In 2008, I had met Dr Diana Atwine on a trip to Cape Town, South Africa to attend a conference on cervical cancer, organised by Princess Nicky from Nigeria. She was accompanying the first lady Mrs Janet Museveni to the same conference and it was the first time I had spoken with her.”
“After exchanging pleasantries, she began complaining about corruption in the health sector and poor service delivery…I didn’t take these allegations seriously at the time since I don’t engage in discussion where no valid evidence is presented. Little did I know that she had been spreading this discourse to justify her appointment as the director of health monitoring unit based in State House. Indeed, her strategy seems to have succeeded and she was appointed as its first director.”
Mbonye alleges that the job that was given to Dr Aceng had a more deserving candidate.
“Dr Nathan Kenya-Mugisha was interviewed as the sole candidate for the post of Director of Health Services, and he [had] already successfully passed the interview phase. Given his experience, it was assumed that the president would sign swiftly and confirm his appointment, as had always happened,” he writes.
Instead, Mbonye notes that the whole ministry was left bewildered when a junior officer, Aceng, was announced to the position (Director of Health Services).
“Nobody imagined that a junior doctor, not even a superintendent of a hospital, would apply for the post of permanent secretary and pass the interviews at the Public Service Commission,” Mbonye writes “…Perhaps we had believed in the traditional practice of an open interview and appointing the best officers based on merit.”
“…Dr Jane Aceng from Lira Hospital, after failing in her application for the post of medical superintendent, was accelerated to the post of Director General of Health Services and later minister of Health. She engaged in infighting with staff and fellow ministers.”
He notes that rumours of Aceng’s appointment had been “largely ignored because these were at the time little-known junior doctors who lacked adequate experience, and it was assumed that they wouldn’t pass interviews anyway.”
Mbonye writes that for Dr Christine Ondoa, who was in 2011 appointed minister of Health, there was no rumour but her appointment replacing Dr Stephen Malinga sent shockwaves around the ministry.
“Even appointed officials seemed shocked at their selection,” he writes.
“Dr Ondoa had earlier began calling herself ‘Pastor Ondoa’, and while we were in Oyam district to launch the Prevention of Cancer of the Cervix campaign, she told me and others around her table that she was a prophet! She was a member of the ‘born-again Christians’, and it was said they would go to the State House to pray,” writes Mbonye.
Mbonye writes that the new crop called themselves “The New Team” and they targeted “experienced and more senior officers, initiating a campaign of harassment to have them removed from their posts” as part of their supposed cleaning-up of the health sector.
“During several meetings, they openly abused, ridiculed, and humiliated officers, and in 2012/13 several experienced staff had to leave the ministry.”
“I, then the commissioner of community health, was amongst them and took a sabbatical leave to concentrate on research and teaching.”
He writes that other officials who left included; Dr Paul Kagwa, assistant commissioner health promotion; Dr Rachel Seruyange, the programme manager Uganda National Expanded Programme for Immunisation; Dr Jenifer Wanyana, assistant commissioner reproductive health.
Mr Paul Luyima in charge of environmental health chose early retirement. Mbonye writes that it was when these power struggles at the ministry threatened to completely derail Uganda’s health sector that President Museveni re-assigned some of the ‘New Team’, including Ondoa.
When Ondoa was dropped as minister of health and appointed the Director General of Uganda AIDs Commission, Mbonye recalls that she “set off the same fights and confusion, as had taken place when she was a minister of Health.”
“… her clash with the board chairman at UAC Prof. Vinand Nantulya, again attracted the attention of the president; and to the relief of many, she was again relieved of her position and Dr Nelson Musoba replaced her as Director General,” he writes.
Mbonye also claims that at times, posts would be advertised at the ministry but because the applicants were not favoured by the ‘New Team’, they re-advertised the positions. He gives the example of the post of Director of Health Services (clinical and community) which was advertised in 2012 after Dr Kenya-Mugisha was hounded out.
“I, as well as a number of other commissioners and doctors applied and five of us were short-listed.”
“At 9am when the interviews were supposed to start, the members of the Health Service Commission were summoned at the ministry of Health headquarters for an urgent meeting with Dr Ondoa. We waited until 11am to be interviewed. We believe they were given instructions to fail us”.
The post was re-advertised in 2014 and when Mbonye reapplied again, he says, Aceng ensured that they passed over him.
Mbonye also notes that when Dr Ruhakana Rugunda was appointed premier and left Dr Elioda Tumwesigye, who was then minister of state general duties, as acting minister of Health, some New Team members refused to respect him.
Here, Mbonye pulls out Dr Sarah Opendi, minister for Primary Health Care. Dr Opendi had been a minister before Elioda and “she felt she was senior to him in that sense”.
Speaking to The Observer yesterday, Atwine did not directly respond to the issues raised in the book. She instead said that there are “many things that one can talk about but this book is not worth talking about.”
She said the book was written from “pure hate.”
“That is it. There is nothing more,” she said. “It is okay; let people who want to read it read but someone who can analyse knows it is nothing. I would expect someone who was a professional in the health sector to discuss situational analysis and systems for young people to read instead of being trivial and attacking personalities.”
“There is nothing, really nothing, nothing in that book.”