A Death Sentence in Uganda

The NY Times Lens Blog has a heartbreaking slide show and story called Breast Cancer as a Death Sentence in Uganda.

Apparently there is only one hospital in the country that treats cancer and, for a variety of reasons, women often wait until it’s too late to make the trip to the capital.  By the time they do, the cancer has metastasized and there is little that can be done.  Here are some excerpts:

“Jessy Acen would get one shot (of chemo) and then wait two weeks until she got the next shot, so instead of going back and forth to her village — which was a $10 bus ride — she would sleep outside of the hospital on a cardboard box while she was waiting for the next round of chemo. She had two sons back in her village that she hadn’t seen in several months and it was just a heartbreaking.”

“Some who have the resources are able to get radiation. Many of them have to bribe themselves to the front of the line. There’s one radiation machine that sometimes serves four different countries. People coming from South Sudan, Congo, Uganda and parts of Kenya all go to this one radiation machine so there are lines and lines of people waiting.”

h/t scarlettlion

Is this progress? The $640 toilet seat arrives in Uganda

From Uganda’s Daily Monitor:


The Public Accounts Committee yesterday refused to accept explanations from Defence ministry officials over the purchases which are captured in an Auditor General report under consideration in the House. Army officers bought a saucepan for almost Shs2 million and spent close to Shs8 million on a gas cooker in transactions which have astonished a House committee probing suspected corruption in the military.


The exchange rate is around 2500 shillings / $ so that translates to a $800 saucepan and a $3200 gas cooker.


Sound familiar? I guess Ugandan institutions really are converging to American institutions.


Even the excuses sound familiar: “Ms Edith Buturo, the stand-in accounting officer at Defence, attributed the prices to a “war situation”. “


The Devil is in the Details: Teacher attendance policies in Uganda

While governments have made a lot of progress in enrolling children in primary schools, trying to hit the 2015 goal of universal primary enrollment, there is a lot of concern about the quality of education these children are receiving. In other words, we wanted to increase education, but we incentivized only schooling and there can often be a big difference between those two constructs.

One of the reasons postulated for poor performance is high teacher absenteeism, especially in harder to monitor rural schools.

Over at Brookings, Ibrahim Kasirye describes an ongoing research project that searches for cost-effective ways to improve teacher attendance.


The project employs monitoring by the Head teacher, by parents, and by both groups with and without financial incentives for teachers.

Here’s a summary of preliminary findings:

When head teachers are in charge of reporting and financial incentives are attached to these reports, independent spot checks show a statistically significant gain of more than 10 percentage points in teacher attendance.  By contrast, effects of non-incentivized schemes and schemes managed by parents alone (because parents on average overstate actual presence more than head teachers)  have weaker and statistically insignificant effects.

We also find that both head teacher and parent monitors systematically understate true teacher absenteeism…   Interestingly, and perhaps more worryingly, truly absent teachers who are reported as present make up about 10 percent of all reports, irrespective of the identity of the monitor or the financial stakes involved. 

So monitoring without financial incentives doesn’t work, and financial incentives can improve attendance, but financial incentives also create opportunities for corruption (presumably when Head teachers report an absent teacher as present so that teacher can get their 30% bonus, there is a kickback to the monitor involved somewhere).

While teacher attendance is most likely to be universally preferred to teacher absenteeism, even increased teacher presence is no guarantee of improved outcomes, as the quality of the teacher and the infrastructure of the classroom are also very important.

Hat tip to Justin Sandefur




Transparency..you’re doing it wrong!

I think all development economists and practitioners would agree that transparency is crucial in the distribution and spending of funds.  After reading this article about President Museveni in Uganda, though, I question whether everyone is using the same definition of transparency.

Yoweri Museveni, Ronald Kibuule

Here is the now infamous photo of Museveni giving $100,000 worth of cash in a white garbage bag to a youth group.  Note that he also gave out a minibus, a truck and 15 motorcycles at the same gathering.  The photo has stirred outrage in Uganda, as it is an obvious tactic to buy the youth vote in an area of the country where the president is weak.  The government, however, declares that the bag of cash was done in the name of transparency:

“Minister for the Presidency Frank Tumwebaze defended the donation, ‘Quite a few times people have requested the president for money and have stolen it. Giving it in broad day light means that the youth can see who has their money,’ he said. ‘The president is not taking the money to Las Vegas, he’s supporting income-generating schemes.'”

Unfortunately, Museveni has never shown a lot of respect for transparency.  For instance, he typically runs out of money halfway through the year and asks for supplemental funds.  The article notes that “Lawmakers approved $23 million for the president’s official household in the last budget, but at least $74 million has already been spent and more will be needed before the year is up, according to lawmakers handling the presidency’s latest budget proposal.”

The critics, making some sound counterpoints, note that:

a. “It sets a bad example in a country that depends on foreign donors to finance about 25 percent of its budget.”

b.  “There should have been a system to make sure the youth spend the money properly.”

c.  “There’s no system of accountability to make sure we get it back if these youth mismanage it.”

Indeed, it’s one thing to show the donation in public, it’s another to just hand over bags of cash with no accountability, no bureaucratic system of fund distribution, and no follow-up.