#OutToLunch The easiest way to regulate medical bills in private hospitals

By Denis Jjuuko

The High Court in Kampala issued orders to force government to regulate medical bills for COVID-19 patients. The worst place to be for an average Ugandan today is to be in need of an Intensive Care Unit (ICU) bed so you could see another day. It is understandable that the high court came to the side of the people in need of ICU and High Dependency Unit (HDU) beds but it is the wrong thing.

Uganda subscribes to the liberal economy theory where everyone charges what they want. Demand and supply determine how much people charge. In early June when many people were dying and as Ugandans looked for anything that could help them survive COVID-19, lemons, and I mean lemons, went from Shs100 in some markets in Kampala to Shs2000 each!

If you need a taxi in rush hours, they triple the transport fare from A to B. Each fuel station in Kampala from the same brand has a different price per a litre of petrol. In Bakuli near Mengo, a litre of petrol is cheaper by about Shs500 than in Ntinda or Bukoto.

Schools charge as exorbitant fees as medical facilities. A kid in a nursery school who is trained how to use a potty, which it already knows pays more than those at some universities. The reason is because parents are very excited when their offspring are still young. As they grow, the excitement wanes but also there are more options. Some people go to universities while others abandon school and go do other things since they are adults.

The point is that in Uganda everyone charges whatever they want whether it is medical or not. And this didn’t start with COVID-19. Pediatricians to examine a child for flue charge as much as Shs100,000 in consultancy fees!

How is the government going to regulate these fees? Cancer patients long before COVID-19 have been paying enormous bills yet the government spends USD150 million a year on average taking its officials abroad for treatment. This is enough money to set up hospitals here.

I was looking at the Kampala COVID-19 ICU/HDU Dashboard set up by the Association of Anesthesiologists of Uganda that give real time update of the availability of ICU/HDU. A hospital in one of the suburbs set up originally in a home less than 10 years ago has 17 ICU beds — the most in any private facility. How did they get them? This hospital is run by a couple who are as old as the NRM has been in power. How did they set up the facility where the government has failed?

The easiest way for the government to regulate medical bills and even school fees is by building more hospitals and schools. Most people in government today who make decisions were either born in public hospitals or at home by traditional birth attendants. The majority if not all went to public schools. Today, nobody with some little income wants to take their kids to public schools. People rather take on unbearable debt borrowing school fees to give their kids a fighting chance later in life than sending them to a school where they won’t learn much.

Uganda’s population has significantly grown over the last 30 years from 18 million to 45 million today but the public facilities such as schools and health facilities haven’t. If we had working public schools and hospitals, we won’t be running to court to regulate anything. The super wealthy would take their kids to the few expensive private schools while the majority would be fine with public schools. The same with hospitals.

The best way to regulate medical bills in private hospitals is by having effective public hospitals in adequate numbers to match the population. The private hospitals will then charge what is acceptable to stay in business. They would also improve their service to attract the super wealthy customers. The same would be for schools.

Today, we have 529 members of parliament. The argument for the proliferation of political constituencies is to serve the population. Why don’t we flip the chart and ensure that before a constituency is set up, there is a proper well managed hospital and public schools to serve the increasing population? Do people want more MPs or more hospitals and schools? The money spent on a single MP every five-year term is enough to set up a hospital and a school in that area. If we invested in such for 10 years and then bring in MPs, the MPs wouldn’t have to buy 25-year-old Toyata Supercustom vans and paint them with a cross and the word ambulance.

The writer is a communication and visibility consultant. djjuuko@gmail.com

Tags: COVID19 Treatment in Uganda, Denis Jjuuko, Mulago hospital, Out to Lunch, Private hospitals in Uganda

Out to Lunch

#OutToLunch: Rampant unemployment is a key national security issue

By Denis Jjuuko The public service ministry recently announced that more than 40,000 people applied for 287 jobs across different government ministries, departments and agencies. More than 28,000 of those who applied qualified, meaning they were selected for aptitude tests which were to be held at the Mandela National Stadium at Namboole. It must be frustrating looking for job in Uganda. The news came after a bombshell report emanating from research by the Inspectorate of Government (IG) and the Economic Policy Research Centre (EPRC) that indicated that Ugandans pay a whopping Shs42.34b annually to district service boards to get jobs. Averagely, the report indicated, 130,000 people pay bribes to land jobs. The people who ask for these bribes know that the jobs are scarce and people are desperate and willing to do anything to land the jobs. When somebody who bribed their way to a job gets employed, it means a few things. First, the person is not the best for the job. They just had the money to pay a recruiter. The best candidate may not have had the money and therefore wasn’t considered. Because the person knows they only got the job through bribery, they will continue bribing their way into senior positions. That is how we end up with incompetent people in positions of authority. People who can’t execute anything and making sure things don’t work or looking at everyone who is competent as a threat or what people call work politics. The people who are competent end up doing very little at work so that the incompetent boss doesn’t feel insecure and threatened. That is how we end with yes people—they won’t advise their bosses. They will do whatever the boss wants whether it makes sense or not. Remember, there are no jobs and these people have families to feed. Rocking the boat isn’t something that they want to do. Second, the people who bribed their way to jobs will only hire those who pay them a bribe. That way you end up with a corrupt layer at every level and an incompetent lot everywhere. Service delivery is impacted. Government then fails to create jobs that young people can apply for and get on merit. Third, because the public service is corrupted, the private sector suffers too. People can’t start and run businesses professionally. The people who are in positions because they paid a recruiter will endlessly try to get a return on their investment (read bribe). Procurement processes will be compromised. Payment for services and goods delivered will be frustrated unless somebody is paid. The bribery doesn’t end at public service. We recently saw many statements from politicians who lost elections for positions in their political parties claiming their rivals won through bribery. Some wondered why people were bribing for positions that were actually “voluntary.” We hear that candidates for Members of Parliament in some constituencies spend more money than they would get in the five years they would spend in the office should they win. If somebody spends more money than they would be officially paid, it means they are doing so to illegally get something. Somebody who sells their house to get money for election will do anything to get their house back. That is how we end up without jobs and seeing young energetic people leaving the country for the Middle East not to do highly technical jobs but menial ones or being trafficked for sex like we recently heard from a BBC investigation. Government has been saying that they are intending to grow the economy to US$500 billion annually. Great stuff but with rampant corruption, it will be a tall order. There is a need to nip corruption in the bud in order to create sustainable jobs for the working age population. Otherwise, we shall continue to see thousands of people filling up soccer stadiums to apply for a few jobs they know they stand no chance of getting. That is what they call desperation. And desperate people can do pretty much anything. Unemployment ends up being a key national security issue that the government must urgently address. The public have a chance to play a key role here by voting people in 2026 not because they bribed them with a t-shirts or some cheap alcohol but those who can address the challenges they face such as unemployment. The writer is a communication and visibility consultant. djjuuko@gmail.com

October 13, 2025

Out to Lunch

#OutToLunch: What employees should know before launching a side hustle

By Denis Jjuuko On Friday 29 August this year, I was invited to speak to the staff of Uganda Registration Services Bureau (URSB) about side hustles for corporates during their end of month Fireplace session. The Fireplace is an internal meeting where guest speakers discuss various topics every last Friday of the month. Here is an abridged version of my presentation. I believe others could find an interesting thing or two. In August 1972, Idi Amin launched his so-called economic war which led to the expulsion of Asians. In the months that followed, Uganda experienced unprecedent inflation. With the economy in free fall, many workers realized that their salaries were no longer sufficient. At Makerere University, the country’s premier higher institution of learning, professors took to driving taxis to supplement their income. One professor, until recently a minister in Museveni’s government, was the taxi driver. His colleague, an education professor, was the ‘turn boy’ or conductor. Others became teachers in secondary schools. Their wives turned the garages of their residences into unofficial canteens. Amin’s economic war led to the birth of side hustles in Uganda, where employees do something outside their official jobs to supplement their incomes. The importance of side hustles was further cemented in 1990s when the Structural Adjustment Programme led to thousands of people losing their jobs. Recent mergers of government agencies (rationalization as they call it) and closure of funding organizations like USAID continue to make employees think of life beyond their offices with polished floors. So, if you are thinking of starting a side hustle, what key things should one think about? Here are a few points to ponder. Time: Side hustles for people doing 8-5 jobs should not be too time consuming. Get a hustle like buying and selling land, flipping houses, buying and selling cars, bonds and unit trusts (if you can call them side hustles), or even supplies. Bars, salons, and restaurants require a lot of time when starting which you may not have as you have to concentrate on your job as well. Also, workers in such sectors are unreliable. You don’t know which day they will not turn up. Or when they will sell a crate of beer and replace it creating an impression there are no customers. Still, you don’t want to stay awake in a kafunda so that a few men not eager to get home can finish their beer and leave to enable you close the day’s operations. Cash payments: Avoid side businesses where most of the payments are made in cash. You don’t know when the workers will disappear with it. Most side hustles are small and may not have systems to protect revenues especially in the beginning. Side businesses where people pay in the bank are better. There you can protect your revenue. I know there are mobile money payment codes these days but there are still a few issues with them to be fully embraced. Small is beautiful: All business plans show profitability at one stage. Also, however much research you do, there will always be stuff you will only learn when doing the business. Start small and allow yourself to learn the trade. Don’t throw all your life savings in a business at the beginning. Don’t borrow to start. If you are to borrow, maybe from family. Start with your savings or pool money with others. Six months rule: Before you quit your job to fully concentrate on the side hustle, instruct your bank to send 100% of your salary to an investment account or unit trusts or bonds. Don’t touch this money. Now, see if you can rely on the side hustle for six months. Pay all business and personal expenses from the business. That way you will know if the business is profitable or if you have been subsidizing it with your salary. That way you will avoid looking for a job a few months of leaving one. Do what others are doing: Your side hustle doesn’t have to be innovative or ground breaking. Do what others are doing. See a sector you can invest in, where you can easily raise start up capital and get going. But run it better than others. Ground breaking ideas can then be implemented when you have money you can afford to lose or can raise the required capital from angel investors. Cashflow is the lifeblood of business: Look for businesses which have good cashflows. Planting trees that mature after 20 years should be for people investing for retirement. But doing something that brings in money regularly helps keep the business operational without necessarily relying on the salary or salary loans. Do people need to do typical side hustles? Should everyone do business? There is no clear answer. One just needs to find a model that works for them. Apart from some telecoms and banks, many businesses in Uganda that publicly publish their returns show net profitability of around 10%-15% annually. This means that an employee who invests in treasury bonds or unit trusts is likely to earn the same percentage without any hustle of running after the ever-elusive customers. It can also be a strategy of accumulating capital to venture into capital intensive side hustles that don’t require a lot of time like real estate. The writer is a communication and visibility consultant. djjuuko@gmail.com

September 25, 2025

Out to Lunch

#OutToLunch: Unambitious delayed projects, potholes creating a self-doubting population

#OutToLunch: Unambitious delayed projects, potholes creating a self-doubting population By Denis Jjuuko A few years ago, I used to frequent Addis Ababa, the Ethiopian capital to largely attend meetings at the African Union headquarters. If you kept away for a few months, you would return to a city that you wouldn’t recognize. A new flyover would exist within a few months. You would see people laying down railway lines and find these huge buses providing public transport. Addis Ababa in the mid 2000s was a construction site that was turning slums into hotels of certain status and other infrastructural projects. They seemed to deliver their projects without much delays. One thing I also noticed about Ethiopians is that they claimed to have the biggest everything. A cab driver or a university professor would quickly tell you that they had the biggest market in Africa — the Merkato, equivalent of our Owino. They claimed they had the largest number of cows on the continent, biggest airline, largest number of producers of leather products and coffee, biggest army and even the most beautiful women. Although some of these claims may be true and others could be debatable, Ethiopians have come to believe that they have to do the biggest things. And they go ahead and do them. Just the other day, Ethiopian Airlines launched perhaps the biggest hotel in Africa. Ethiopian Skylight Hotel in Addis Ababa boasts of 1,024 modern rooms. That is perhaps why they decided to utilize River Nile a little bit more, they didn’t go around building a 100 Megawatts dam. They went for 5,150MW. The Grand Ethiopian Renaissance Dam (GERD) that was launched a few weeks ago is, true to Ethiopian style, billed as one of the largest infrastructural projects on the continent. And like roads and railway lines in Addis Ababa, the hydroelectricity dam, which cost US$5 billion to build was completed in 14 short years. It had many challenges such as protests from Egypt over the use of River Nile — like they do whenever anyone else wants to use the Nile waters as well as funding, technical skills and even bloody wars. But the project never got derailed. Compare it to the Grand Inga Dam in the Democratic Republic of Congo, perhaps the world’s wealthiest country, and you will understand what I am saying. Or just look at some of the countries where it takes a year or more to build a single kilometer of a dual carriage road without interchanges and bridges. To build the GERD, Ethiopia got most of the funding from local contributions in form of donations, and selling of bonds locally and to Ethiopians in the diaspora among other sources. They got very little foreign debt to achieve their project which ideally should ensure affordable electricity access to many people in Ethiopia while exporting some to neighboring countries thereby getting much more foreign revenue. Ethiopia is not some country in America, Europe or Asia. It is actually considered part of East Africa and a mere two hours by air from Entebbe. They face similar challenges like us. Wars, famine, draught and diseases among others. Like Uganda, they are landlocked and depend a lot on agriculture. In fact, we have just toppled them as the largest coffee exporter on the continent. They still produce more coffee though only that they consume a lot of it domestically. Since we are so similar and ideally neighbors, what do they have in their DNA that we don’t? How can they run an airline with more than 150 aircraft while we struggle with about six including leased ones? How can they build flyovers in Addis in months while we take decades to complete ours? Or build small hydroelectricity dams with defaults while they complete mega ones? There is a need to dream big by technocrats and be intentional about building a culture that leads us to achieve our targets and on time. We can have as many patriotic lectures as we wish but if people are driving over potholes every day and have them normalized as the way of life, we won’t achieve more ambitious targets like GERD. We will end up with a population that self-doubts itself. Businesspeople will not dream of creating mega factories or big businesses. Their ambitions will remain importing a few containers from China, driving an old Landcruiser, building a storied house in a slummy area, and another in the village and a few apartments. An ordinary Ethiopian seeing the country launching GERD or the largest hotel on the continent will dream of something as big. The writer is a communication and visibility consultant. djjuuko@gmail.com

September 25, 2025