Act first, think later - a Ugandan approach to policy making
The title of this article has been ringing in my head for a while now. I have taken considerable time to reflect on the implications of the phrase and how it applies to the way policies are made in Uganda.
Before I go deeper, I will preface that I have no personal vendetta against any individual that will be mentioned in this article. I am simply trying to analyze the situation and provide my perspective on it.
Furthermore, before I get accused of being anti-government, I will also preface that I am not anti-government. Again, I am simply trying to analyze the situation(s) and provide my perspective on it.
In this rumbling, I will focus on three main public sectors of the governnment:
- health
- infrastructure development, and,
- ICT and innovation
1. Health
According to government budget reports, the share of the health budget to the national budget in FY 2025/26 stood at 8.1%, slightly above the 7.6% recorded the previous year. While this remains significantly below the Abuja Declaration target of 15%, the consistent allocation above 7% demonstrates some level of commitment to improving healthcare services.
This implies that the government is allocating a paltry USD 23 for every Ugandan citizen to use for health services. This is a single person’s meal in a restaurant in Kampala, and it is supposed to cover all healthcare needs for an entire year.
The real challenge is not merely how much is allocated today, but whether those allocations are sufficient to meet future healthcare demands.
An instance is the issues of Americans scaling back on aid for health in Uganda. This has led to a significant reduction in funding for critical health programs, including those focused on HIV/AIDS, malaria, and maternal health.
How can we future proof against these shocks if we are not investing enough in our own healthcare system?
Are we always going to be beggers?
What happened to fighting neo-colonialism or the fight against colonialism should be paused when it comes to healthcare?
–
More to the above, the recent decision to stop paying medical interns (graduates required to do 1 year placements in order to obtain practicing licenses) is another example of policymaking that appears to focus on immediate cost savings while overlooking broader systemic implications.
Medical interns form a critical component of Uganda’s healthcare workforce.
According to World Health organisation (WHO) statistics, Uganda has 1.58 medical doctors per 10,000 people, less than 1 pharmacist per 10,000 people and 16.9 nurses and midwives per 10,000 people. This is below the WHO recommended doctor-patient ratio of 1:1000.
In many public hospitals, medical graduates provide frontline services, manage patient loads, participate in emergency care, and support already overstretched senior medical personnel. Removing their allowances may reduce expenditure in the short term, but it introduces serious long-term risks.
First, it discourages talented graduates from entering or remaining within the public healthcare system. Many interns depend on these allowances for accommodation, transportation, and basic living expenses. Without financial support, some may seek opportunities outside the country or outside the medical profession altogether.
Why would a young graduate choose to move to go deep into Alebtong and yet they can just move into a private clinic in Kampala and earn more than what they would get as an intern (0 UGX per month)?
Second, hospitals will definetely experience reduced service capacity. Fewer interns translate into increased workloads for existing healthcare workers, longer waiting times, delayed treatments, and ultimately poorer patient outcomes.
Third, the policy may accelerate the already significant brain drain affecting Uganda’s healthcare sector. Countries facing shortages of healthcare professionals continue to recruit aggressively from developing nations. Removing support mechanisms for young doctors effectively increases the attractiveness of foreign opportunities. America is notoriously recruiting healthcare professionals from Africa, and Uganda is no exception even when there’s a “freeze” on foreign talent recruitment in other sectors.
The ultimate victims are not the interns themselves but ordinary Ugandans who rely on public health facilities. A policy intended to save money today may result in higher healthcare costs, reduced service quality, and worsening health outcomes in the future.
2. Infrastructure development (specifically roads)
Think of a scenario.
You want to build a road from point A to point B. You have two “operational” options:
- Option 1:
You can build a high-quality road that is durable, has proper drainage, and can withstand heavy traffic (think traffic growth in the next 10 years). The caveat is that this option will cost more money and take more time to complete.
- Option 2:
You can build a low-quality road that is cheaper and faster to complete, but it will require frequent repairs and may not last as long. The upside is that you can quickly connect point A to point B and start reaping the benefits of improved transportation. The downside is that you may end up spending more money in the long run due to maintenance costs and potential safety issues.
In Uganda, it seems that the government always opts for option 2. There are numerous instances of roads being built with substandard materials, leading to rapid deterioration and the need for costly repairs. This approach may provide short-term benefits, but it ultimately results in higher costs and reduced safety for road users.
Infrastructure should be designed not only for current demand but for projected demand decades into the future. When roads are built too narrow, you will eventually face the costly process of expansion, land acquisition, compensation disputes, utility relocation, and reconstruction.
The financial implications are substantial. Expanding an existing road is often far more expensive than building adequate capacity during the initial construction phase. The economic implications are equally severe. Traffic congestion increases fuel consumption, reduces worker productivity, delays logistics operations, and raises the cost of doing business.
For the local population, the consequences manifest as longer commute times, accidents, increased transport costs, and reduced quality of life.
For businesses, congestion translates into inefficiency and lost competitiveness.
For the economy, it represents a hidden tax on growth.
3. ICT and innovation
The current State Minister for ICT is Hon. Joyce Juliet Nabbosa Ssebugwawo.
I highly doubt (with all due respect) that if you were to ask her to grab a laptop, connect to the internet, open a web browser, and send an email, she would be able to do it without assistance. (I stand to be corrected).
This is not a personal attack on her, but it does raise concerns about the level of understanding and expertise in the ICT sector at the ministerial level.
I am not trying to argue that only engineers or highly technical people should lead technology ministries. Leadership requires a myriad of skills - political, stakeholder management, and strategic vision.
However, technology is no longer a support function in a VERY fast changing landscape; it is infrastructure.
Entire nations are relying on technology for economic growth, social development, and national security.
Decisions regarding cybersecurity, digital identity, artificial intelligence, cloud infrastructure, data governance, and digital public services require deep appreciation of technical realities.
It could be argued that there are technocrats within the ministry who can provide technical guidance, but ultimately, the minister is responsible for setting the direction and making informed decisions.
I can not imagine the current minister negotiating a tech deal with bureacrats from a tech company like Microsoft, Google, or Meta. A traversty!
In the end, it’s the innovators, entrepreneurs, and the general public who will bear the consequences of ill-informed policy decisions in the ICT sector of an aged minister very oblivious to the demands of the current technical or regulatory landscape.
Good policymaking requires systems thinking and abhors siloed thinking. Every decision should be evaluated not only on its immediate impact but also on its second-order and third-order effects.
What happens five years later?
What happens when the population doubles? (We are a very fertile country in terms of re-production)
What happens when demand exceeds capacity?
What happens when skilled professionals leave?
What happens when technology evolves?
Shall we have a competitive advantage in the future if variable X changes from a% to b%?
Ultimately, Uganda’s future will not be determined solely by the policies it adopts today but by whether those policies anticipate the realities of tomorrow.
The difference between successful economies and struggling ones is often not the quality of today’s decisions but the ability to foresee and cushion against tomorrow’s consequences.