They don’t build hospitals any more, they just build clinics...

The news found me thinking about opinion polling in Africa, having just come across a rather big claim by a well-known pan-African polling organisation.

Apparently, the demand for democracy by citizens in African countries is at an all-time high. For those sold on the idea that what Africa needs more than anything else is democracy, by which they mean regular elections and frequent changes in leadership, claims of this sort usually generate much excitement and a determination to fight on.

What citizens are said to want, however, is only half the story. The other half is that ordinary Africans believe that their leaders are not at all keen to grant their wishes.

And where they do so, not least by organising “competitive elections” in which several political parties participate, citizens remain lamentably unhappy about the poor quality of their democracy.

The explanation for this is simple: When they are being sold the idea of competitive elections, they are made to understand that competition among rival political elites will help solve their problems such as poverty and lack of access to good-quality social services.

And then campaigns come. They attend massive rallies, sing, dance, and generally make merry. On election day they vote for candidates of their choice. And then, after that, nothing changes in their lives. Poverty remains. Services do not improve. Sometimes their quality continues to deteriorate.

Well, the news that found me thinking about these things was that of the death of Michael Sata, until recently the elected president of Zambia, one of Africa’s most celebrated liberal democracies and also one of its most peaceful countries.

Mr Sata is the latest of Africa’s presidents to die in a foreign country to which he had been taken in search of medical treatment. Unlike him, many of the others were anything but poster boys of the democracy-promoting fraternity.

What unites them, however, is one of the massive failures of post-colonial Africa: The absence of health facilities of the kind its political elite would want to spend their last days on earth in, and the millions of dollars aid-dependent governments spend on sending the politically well-connected and their families to other countries for medical care.

To comprehend the enormity of the problem, consider this: It has been reported that in 2012, the government of Uganda spent $150 million to evacuate the privileged for medical care outside the country. Without a doubt, billions of dollars flow from Africa into countries whose governments have had the good sense to invest in modern health care systems.

To appreciate the impact of this financial haemorrhage, look no farther than the Ebola crisis ravaging parts of West Africa, including two celebrated democracies, Liberia and Sierra Leone. Now of course, so deadly is Ebola that even in the most organised health care systems boasting the world’s foremost experts in infectious diseases, it does cause some panic.

And so it is to be expected that in disorganised Africa, an outbreak is bound to cause a stampede, as families with patients in locations with no healthcare facilities to speak of, run around trying to take them to hospitals in faraway places, infecting large numbers of other people in the process.

And then they arrive at understaffed, ill prepared, ill equipped and dilapidated hospitals, most of them dating from the colonial period. What should one expect, but more infections and more deaths?

The situation would turn out differently if, even amid weak disease surveillance systems, there were strategically located and functioning hospitals.

At the very least, those who spread infection as they struggle to reach far-flung hospitals or those who leave dysfunctional facilities to return home with the disease would infect far fewer people.

A key puzzle in all this is why most African governments, whether so-called democracies or dictatorships, have neglected tertiary health care and chosen instead to focus attention on building health centres that have no capacity for tackling serious diseases, while sending their officials and their families elsewhere for care.

There are many explanations, of course. Some are technical and linked to inadequate skills for organising and managing complex systems requiring high-level co-ordination capacity, thanks to the departure of qualified and experienced professionals for greener pastures. And then there is politics.

In Africa, sitting governments don’t lose power because of failure to deliver social services. Nor are they able to hold on to it because of their spectacular performance in that domain. Where they do not seize power by force, they tend to “manage” voters and elections via bribery and rigging.

And while we are at it, let’s not forget the role of donors. For many years, they have favoured services that focus on the needs of the poor, on the grounds that they tend to suffer from and die of easily curable diseases, with modern hospitals seen as serving mainly the elite. Not true, as Ebola has shown.

Ultimately, arresting the rot and redefining priorities will require collective efforts led by effective governments, conventionally democratic or not, under visionary leadership.

Frederick Golooba-Mutebi is a Kampala- and Kigali-based researcher and writer on politics and public affairs. E-mail: [email protected]