Winds of Change

Someone once described my reports of what’s really going on in the health sector in Sudan as ‘propaganda’. I wasn’t insulted or anything, but it did remind me of the huge gap between what happens in the offices and corridors of the ministry of health and what the situation on the ground actually is. Once I asked my consultant why the average citizen in somewhere like Ombada for example doesn’t see any of the good that comes from all this work we’re doing. He answered, quite rightly, that people will always be dissatisfied, and those that voice the dissatisfaction (and eventually overthrow their regimes), are not the average person from Ombada, but actually the better-off people from Alamarat (and Arkaweet), who are more educated, know their ‘rights’, and have much less to lose by voicing this dissatisfaction. But why should there be any dissatisfaction at all? Well, because most of the ‘good things’ we do are not related to building new hospitals or cutting user fees; rather they are root changes that take years to show their results, and even then the average person from Ombada, or Alamarat, or Arkaweet, will not know that the maternal mortality rate dropped by 60% over 15 years or that health insurance coverage reached 90% after it was just 33%. That’s the definition of public health.
Anyway, from the relatively short period of time that I have worked in the public service side of the health sector in this country, I have been surprised over and over again by just how not-so-bad this system and sector is. There is genuine concern for the people’s good, but not from everyone, ‘cuz not everyone cares that much. There is a lot of hard work and a lot of money being invested in hundreds of projects and initiatives that are really good and that affect thousands of peoples’ lives in a positive manner, but not everyone hears about them because most of the time they’re in places no one has even heard of. There is  a well-structured system of policies and guidelines and rules and plans, but people don’t follow them. Most of them don’t know they even exist. There are hundreds of well-qualified young (and old) people with vast degrees and experiences, but who are simply not motivated, or paid enough, to work as much or as hard as they are capable of. There are billions – and I mean BILLIONS – of dollars in foreign aid pouring in to this country left and right with detailed timelines, objectives and expected outcomes, but they’re not always used in the best manner. Not because they go into people’s pockets. They do, of course, just not as much as people think. It’s mostly because the people who don’t care so much, and who don’t follow policies and guidelines and rules and plans, and mostly don’t even know they exist, and who aren’t motivated or paid enough, don’t know how to manage all this money and most of it ends up going back to where it came from at the end of the year because of the poor management. So unlike popular opinion, that there is ‘no system in this country’ and that’s the main reason why it’s going to the dogs, it’s actually not the system, it’s the people working the system. Or supposed to be working it, actually. It’s not everyone in the system, but enough of them to keep the country’s health sector in the middle-ages.
However, there is hope.
Despite the crazy migration rate with around 80% of graduates on their way out, there is still new blood being pumped into the government. And a lot of these people are hardworking and smart. Also, a lot of that money coming into the system finds its way into capacity building programs, so almost everyone in the system gets training, ranging from simple local CPD activities and workshops, to overseas courses, to full time MSc degrees from respectful universities like Leeds and Washington. There are all sorts of overseas experts and companies and organizations entering and exiting the country, who share their time, expertise and money and lead projects and support strategies. Of course they make as much as they give, if not more, but there’s still good to come of it. My point is that it’s not great, but it’s also not all bad. Not everyone in the government is with the government, and I think I’m a prime example of that. Things are bad, but not as bad as we think. And, although it looks like things are getting worse (which I don’t deny they are), they’re still not getting as worse as they could. Does that make any sense? I am in no way congratulating the government on a job well-done (and if you think I'm turning soft just wait for my next blog post). And don't underestimate the worth and power of a few people: just like a handful of idiots are capable of squashing the country and pulling it down, a couple of handful of young people are capable of pulling it out and dusting off the dirt. Seriously. I’m just saying that there are some good things happening that not everyone hears about over the ruckus around hospital-selling and shooting prices and expired medication and vaccination scandals. Bas. Also, just for clarification, Mamoud Himeida does not represent the government. He is just the Khartoum state minister of health (meaning he is in-charge of Khartoum wu bas), and doesn't really have that many friends or supporters in the government after all. I don't need to remind you that Sudan has 16 states OTHER than Khartoum, which above mentioned state minister has no hand in ruining.
Speaking of which, the parliament has finally cancelled the tax on national-produced pharmaceuticals (it used to be 30% while imported pharmaceuticals were tax and custom-exempt), and the percentage from government budget allocated to health has been pushed up to 15% from the original 8%. Of course we are yet to see this on the ground, but having actually passed through parliament is still an accomplishment I think.
It is worth noting that those pushing for these changes are all women.