How dedicated officials help the public from within corrupted systems
In many countries in Africa, public services are inadequate or dysfunctional. Yet some public servants manage to provide effective healthcare, public transport, emergency assistance, or necessary paperwork, despite corrupt or mismanaged systems. But why are these practices ignored, or sometimes even deliberately side-lined, rather than used as examples for emulation, by the authorities? Why do good civil servants so often seem to need to keep their heads down? A new ZAM transnational investigation shines a spotlight on those “within the system” whose work can inspire the fight for change. It also exposes what appears to be a massive lack of political will to facilitate such change at the top.
One nurse against a hierarchy
“We do quality monitoring, and our central hospitals are doing well,” writes the Principal Secretary of Malawi’s Department of Health, Dr Samson Mndolo, in response to ZAM’s questions about the widely observed problems of filth, overcrowding, and pilfering of medicines in the country’s dilapidated hospitals. One small psychiatric hospital in Zomba in the east of the country stands out as an exception – but while Dr Mndolo’s department has allocated an excellence award to Zomba, and even sends interns to train there, it appears not to feel the need to help reproduce Zomba’s practices of passion, professionality, and transparency. The other hospitals “are doing well”, after all.
While the ZAM reporters wonder in which universe the good doctor – the highest functionary in the Ministry of Health – exists, at least he sends answers. Which makes Malawi’s authorities significantly more responsive than the ones in the other four country case studies.
Perhaps Malawi is a bit more alert to being challenged, at least. That may be because one uppity psychiatric nurse by the name of Immaculate Chamangwana stood up twenty years ago, at a budget meeting at the same Ministry of Health, to tell the assembled dignitaries that much more money was needed for the hospital where she was in charge of over 400 beds and over 1,600 admissions of people per year. The Zomba Mental Hospital, then as now, cared for patients who were suicidal, suffered from schizophrenia, or were fighting against ropes and chains their desperate families had bound them with. Often, they had infected wounds, were HIV positive, had fever from malaria, or suffered from other physical illnesses. And the department had allocated only the equivalent of US$ 6,500 for the institution for the year.
Malawi may be poor, but it isn’t that poor, certainly not with the millions in development aid for healthcare it receives. So Immaculate Chamangwana told the hierarchy that this was simply not good enough, “which you would understand if you were admitted.” It worked. The nursing director went home with more than double the initial budget, and from then on started building the hospital, hiring young, passionate healthcare workers, and setting firm standards for accountability and transparency. Zomba Mental Hospital now handles 2,734 admissions per year, up from 1,675 in 2006, when Chamangwana first became acting director. The number of patients lost to disease has gone down from 60 in 2006 to eighteen in 2021. “If they could just tackle mismanagement in the entire health sector,” says public accounts specialist Wales Chigwenembe wistfully, “We could really do better.
A system thing
Federal Medical Centre (FMC) Ebute-Metta in Lagos State, Nigeria, has much improved from the time it had broken roofs and patient files strewn all over the place. Now clients like Smart Ogbe and his mother come from far away, even when in need of emergency care: “I can get my mum’s treatment quicker and better here,” he says. “There are no queues, and you are also not stopped by people asking for bribes at every turn.” Proper management, which is what Adedamola Dada brought in when he became Chief Medical Director in 2017, is not that hard to figure out. Dada explains: “It’s about building human beings, building the structures, and building the process in the workforce. It’s a system thing.”
The system in FMC Ebute-Metta is built on appropriate monitoring, bookkeeping, stocktaking of drugs, discrepancy alerts, and transparent filing, all helped by automation. These features, to those who have a modicum of management expertise, are not rocket science, but other hospitals all over Nigeria seem to be led by Ministry of Health appointees who have difficulty figuring this out.
Which is perhaps not surprising, since the Ministry of Health does not even have its own website or contact details in order. There is no phone number to call, the contact form does not work, and the spokesperson herself, Patricia Deworitshe – though often in the news when she presents governmental press releases and speeches – simply does not answer direct calls or WhatsApped questions, even when sent repeatedly over a week.
A manager who needed his head examined
Ghana, too, is familiar with incompetence in its state machinery. Perhaps the success of the State Transport Company, after a history of bleeding losses and near-bankruptcy, is because nobody wanted the position to head it in the first place. This phenomenon – just like in Malawi, where a mental hospital position also did not attract many careerists – might be called the advantage of disadvantage. After all, as a Ghanaian political observer and op-ed writer at the time wrote, the President, who appointed the MP who had come forward to volunteer for the post, had thought the man in question “needed his head examined.”
But the MP in question, a former parliamentarian and businessman with a marketing background called Nana Akomea, simply had a sense of customer service. Akomea brought the State Transport Company back from the brink, doubling the number of staff from 400 to 800 and even making it profitable – the STC is now the only income-generating state enterprise in Ghana. Akomea’s explanation is simple: “Which customer walks half a kilometer, when other buses are nearby?” The new management brought buses back to the city terminal, got the vehicles maintained and the drivers trained, installed wifi and a functional customer call service, and voilà! To the chagrin of less-organised (and often breaking-down) private rickety-bus operators, customers now used the state bus service again.
It wasn’t rocket science here, either. The question to ask, the team found once again, is perhaps not what was so special about what managers like Chamangwana, Dada, and Akomea did, but why the previous managers, and the managers elsewhere in the public service, don’t.
If the president wants it
An answer of sorts was found in Uganda, where high-quality management processes were seamlessly introduced, maintained, and even surpassed, in the driver’s license office. Remarkably, this happened by order of the president himself. Ageing autocrat Yoweri Museveni (79), in his decades of ruling Uganda since 1986, has been known for his largely unsuccessful efforts to run the whole state by himself. He has, however, had incidental and irregular successes in certain sectors. When he put his mind, and a battery of loyal functionaries, to it, the Uganda Revenue Service perked up for a while. So did Kampala City management. Now, it is the turn of the Uganda Driver’s License Service, an office from where Ugandans, document in hand without having paid a bribe, have reported exiting almost jubilantly. “Amazingly efficient, it took me only one hour,” is just one post out of hundreds on social media.
Ugandans were, and in the case of most government departments still are, used to waiting for state documents in up to 100-metre-long queues outside in the blazing sun or pouring rain, preyed upon by middlemen promising to move you forward in exchange for money, and then still not getting the service after going through the same ordeal time and time again. The one exception was the driver’s license office, which had been privatised for two decades and was functioning well as a private business. There had been an uproar when the cabinet announced that it was to become a state-run entity again; the public worried that the office would become yet another corrupt and dysfunctional state service.
But when the state resumed ownership of the UDLS in 2020, just in time for elections, citizens were amazed to find that processes that the private company had introduced, such as a coherent and well-monitored database, efficiently managed staff, and transparent accounting, not only remained in place, but were improved upon. “This is because our department is closely monitoring,” the Transport Ministry boasted, mentioning Key Performance Indicators and other good management practices. Uniquely among the five countries in our investigation, project coordinator Andrew Kagoda proudly tells our reporter about plans to replicate these efficient document-processing systems in the traffic police departments as well as the national identity and passport offices.
But when the team checks on the progress at the national identity and passport services, reality kicks in. Some citizens have been trying to get ID cards since 2014, having spent hundreds of dollars on bribes in the meantime. One interviewee reports living from cash jobs, unable to vote or have a bank account. The head of the ID service, when reached by phone, explodes in anger, blaming old machines and lack of funding, then fails to follow through on an agreed meeting, where the reporters had planned to ask about millions that have gone missing at her office. A spokesperson, asked when the announced replication of good practice will take place, only says that the ID office has heavy tasks to fulfil, then stops answering altogether.
Just two years before new elections in 2026, when Museveni will be 82, and all citizens will need new IDs to vote, with democratic opposition to one-person-rule growing, we are back in the old Uganda.
A life-saving governor
It is only in Kenya that the team finds a political leader who appears to be consistently backing public servants’ efforts to do a good job. Governor Muthomi Njuki of Tharaka-Nithi county, a rural sub-state in Kenya’s eastern parts, seems to have a sense of public service himself, too. He has established a group of health volunteers who check on those who are poor and sick, getting them to hospital at the state’s cost when needed. He has objected to new million-dollar headquarters for his county government, preferring to stay in old, corrugated roof-buildings, because the expenditure is just too much. In another effort to save money, he has fired 130 functionaries whose duties and qualifications were not clear. With his prudent administration, skilful approaches to donors to top up the budgets where needed, and headhunting of the bravest and most passionate to take up difficult jobs, he has also built a formidable rescue service encompassing paramedics, firemen, and other emergency services to assist at road and other accident scenes.
Shiny red fire trucks parked under trees in three offices’ yards in his county are praised as beacons of hope by citizens, whose children used to drown in rivers, whose shops used to burn down, or who were left to perish on roads after car crashes.
Shiny red fire trucks are beacons of hope
Fire and rescue brigade chief Alex Mugambi, who personally set up the entity in 2017, credits the governor for supporting his (Mugambi’s) professional proposals, explaining that for a public servant like himself to receive political backing for improved service is exceptional in Kenya, too. “(In other counties) I have seen fire engines going to fight fire without water. Some of (my colleagues) are then stoned or even killed by angry mobs, who suspect them of laxity, but it is not their fault.” A fire chief from such a county, who complains that his rescue brigade does not “have the resources to carry full water reserves in our trucks”, does not want to be identified for fear of losing his job. Another fireman reports having to work with a broken pump and without any fireproof clothing: “we just wear cotton shirts.”
When ZAM presents the above complaints to the Council of Governors, the platform where Kenya’s 47 counties’ leaders meet, a spokesperson responds that he cannot “issue a response at the moment” because the Council “needs to receive the complaints formally.” Sadly, it is impossible to do so because presenting complaints formally would require revealing the identity of ZAM’s sources, who all fear repercussions if this were to happen.
A new question
Puzzlingly, Governor Njuki is just as reluctant to answer the team’s questions as the other politicians and officials who were approached for comment in this investigation. “I care about saving lives,” is all he says, staying mum on incompetence and malfunction in other regions in Kenya, or even about political fights he has had, or still has, with rival politicians (who once accused him of corruption). No, he cannot comment on counties which “have their own leadership,” he says, which might be because quite a few of those are led by fellow ruling party members.
Is it, in the end, even more difficult for a politician to stand up against systems of rot, and fight corruption from within, than it is for a nursing director or a bus manager? If that is so, then the next question presents itself: how can both levels of fights-from-within be supported?
It is a question that ZAM intends to pose to both change-makers in the countries where we work and to development partners who profess to support social justice and accountability.
Note: There are plenty more functionaries in African state systems who try to do a good job for the public. ZAM has reported on such “good civil servants” before, for example here and here. Sadly, in both these reports it was observed that the protagonists were not given a chance to carry out the services they wanted to provide, or were sidelined or even attacked for trying to do so.
This transnational investigation was coordinated and edited by ZAM's investigations editor, Evelyn Groenink.
Read all the investigative articles in this series: