By Andrew Mwenda

The picture of the front page of New Vision of yesterday tells us the problem of our nation’s public policies towards health. Uganda is a very poor country with public spending per capita of only $170 per person this financial year. Compare this to USA which is budgeting $21,265 per person! Simply put, even with the best intentions, Uganda cannot afford to provide a large basket of public goods and services to all her citizens to the quantity and quality we demand or desire. Health spending this financial year is about $12 per person. That is pea nuts.

Therefore our government needs to prioritize its health spending on those areas where it can get the highest impact on the largest number of citizens. The biggest cause of death in our country is malaria and anemia due to malaria among children under five years. The others are communicable diseases such as diarrhea, cough, TB etc. and pneumonia. Indeed we have a low life expectancy at 64 years in very large part because of high infant and child mortality.

Given the reality above, the most cost effective solution to our health problems and one that can have the most impact on the largest number of our citizens lies in public health (prevention measures), not curative (clinical) medicine which prioritizes hospitals and doctors. We need to focus most of our energies investing in improved sanitation, access to clean water, better hygiene, better nutrition and vector control such as eradicating mosquitoes plus immunization and vaccination. There we would save a lot of lives.

So why is public debate in Uganda obsessed with cancer treatment when it is not among even the top ten killers of our people? The answer is simple: public (democratic) debate in Uganda is dominated by elites who cannot be killed by malaria but can be killed by cancer. The noise they make on social and traditional media, in parliament and civil society forums is to make public policy towards health serve their interests at the expense of the interests of the poor whose children die in large numbers due to these simple diseases I’ve listed above. This is not to say the poor don’t suffer from cancer but rather to acknowledge that cancer is not a leading killer in our country. Ours is democracy for the few educated and well off elites, not the poor majority.