The dog fights at Health ministry through Prof Mbonye’s eyes

When Prof Anthony Mbonye succumbed to peritoneal cancer two weeks ago, Lucy Nakyobe, his wife, blamed his death on the fights her husband endured when he worked at the Health ministry. 

“...as a family, we believe my husband’s health complications began from the many public woes that he suffered at the Ministry of Health, which precipitated stress and ulcers that later developed into the killer condition that has claimed his life,” Ms Nakyobe said during a funeral service for Mbonye at their home in Ggaba, Kampala.

Ms Nakyobe’s comments enlisted reaction from social media with Charles Rwomushana, a former intelligence operative and political commentator, pointing to how Mbonye’s “tormentors” had “boycotted” his funeral service and his burial in Ibanda District, western Uganda.

Prof Mbonye had, during his 16-year tenure at the ministry, worked as an assistant commissioner of Health Services in the department of community health, commissioner of Health Services, director in charge of Clinical And Community Health, and director general of Health Services. His last position was advertised while he still occupied it, forcing him into retirement in 2017.

Ms Nakyobe, who for a long time has been in the corridors of power having served as the State House comptroller since 2010 before being appointed by President Museveni this year as secretary to Cabinet and head of Public Service, was talking about the hostilities between her husband and Dr Diana Atwine, the incumbent Permanent Secretary in the Health ministry, and Dr Jane Ruth Aceng, the Health minister, and Christine Ondoa, who served as Health minister between 2011 to 2013.

Prof Mbonye in his 2018 book, Uganda’s Health Sector through Turbulent Politics (1958-2018), laid bare the troubles in Uganda’s health sector and exposed the genesis of his fallout with Dr Atwine, who for quite some time had been Museveni’s personal doctor, Dr Aceng, and Dr Ondoa.

The trio belongs to the balokole, a radical and avowed born-again brand of Christians.
Today, Prof Mbonye’s book which was designed and printed in the United Arab Emirates (UAE) by Print Farm FZE can’t be found in bookshops in Kampala or across the country. 

It’s said the copies unexplainably vanished from the shelves, but not before The Observer newspaper reviewed the book in 2019 and was closed for a couple of weeks by the tax body, the Uganda Revenue Authority (URA), on the account that the publication hadn’t paid taxes.

But the newspaper then insisted their closure had everything to do with the review of the book that didn’t go down well with some of the people adversely mentioned, like Dr Atwine.  

But Dr Atwine, who had previously denied having a hand in the closure, didn’t respond to our repeated phone calls and text messages, but Mr Emmanuel Ainebyoona, the Health ministry spokesperson, said: “We have already respond that that book is full of lies. It’s an old book.”

When The Observer asked Dr Atwine in 2019 about the contents of the book, she dismissed it as purely motivated by malice.

“That is it. There is nothing more,” she said. “It is okay; let people who want to read it read but someone who can analyse knows it is nothing. I would expect someone who was a professional in the health sector to discuss situational analysis and systems for young people to read instead of being trivial and attacking personalities,” she said.

In his 160-page book, Prof Mbonye wrote how since 2010 the Health sector has been managed by both junior and inexperienced officers appointed to influential positions of minister (Dr Christine Ondoa and Dr Aceng) Permanent Secretary (Dr Atwine) and Director General of Health Services (Dr Aceng).  

“Has this affected service delivery in the health sector?” Prof Mbonye rhetorically asked.

He answered: “Yes, it has done so in two ways; the immediate effect has been on the demoralisation of staff who feel that the institutional mechanism to advance their professional careers is no longer relevant.

“Thus, they see little incentive to work harder since they feel they have little hope of receiving a promotion.”
The second way, Prof Mbonye said, is because the staff occupying senior political and management positions lack the requisite knowledge and the experience to apply standard rules, regulations and procedures, which has negatively impacted service delivery.

In the chapter titled, ‘Politics and a crisis of leadership in the Health Sector (2010-2018)’, Prof Mbonye first talks about former Forum for Democratic Change presidential candidate Kizza Besigye’s campaign strategy that he says exposed the rot in the Health sector when he unexpectedly showed up at dilapidated health centres during the campaign trail.

“On December 5, 2015, Dr Kizza Besigye visited Abim Hospital, which was widely covered on NTV television, and revealed the poor state of the hospital that was dilapidated. This and previous reports of the shortage of drugs and supplies in health facilities, the absenteeism of health workers and cases of drug theft, placed significant pressure on the NRM government to address the situation,” Prof Mbonye writes.

Before the Dr Besigye episodes, Prof Mbonye, says Dr Atwine, who he describes as “then little known but very vicious” had sought to capitalise on her closeness to the First Family, in a bid, he says, was to ascend to the hierarchy of the Health sector, but without much success.

At A-Level, Prof Mbonye says of Atwine’s academic performance, “She gained an E in Chemistry, a B in Biology and a D in Physics. In addition, she scored a Credit 3 in General Paper and a Credit 5 in Sub-maths with a total of 12 points.
“Thus, it is rather surprising that she was admitted to a medical course with such low scores,” he writes.

Dr Mbonye wrote of how he bumped into Dr Atwine in 2008 during a trip to Cape Town, South Africa, to attend a conference on cervical cancer, organised by Princess Nicky from Nigeria.

“After exchanging pleasantries, she began complaining about corruption in the Health sector and poor service delivery,” he wrote referring to his first impressions of Dr Atwine.

“As a researcher, I enquired whether she had data to support her allegations. I didn’t take these allegations seriously at the time since I don’t engage in discussions where no valid evidence is presented. Little did I know that she had been spreading this discourse to justify her appointment as the director of the Health Monitoring Unit based at State House. Indeed, her strategy seems to have succeeded and she was appointed as its first director,” he writes.

After bagging the position of director at the State House Health Monitoring Unit, Prof Mbonye says Atwine is believed to have successfully convinced President Museveni that the Health sector was rotten and that it was time to clean it up.

Immediately after the elections of 2011, he wrote that rumours began circulating at the Ministry of Health headquarters in Kampala that Dr Aceng, who was then acting medical superintendent of Lira Hospital, was to be appointed as the director general of Health Services, and Dr Asuman Lukwago was to be appointed Permanent Secretary.

“These rumours were largely ignored,” he wrote, “because these were at the time, little known junior doctors, who lacked adequate experience, and it was assumed that they wouldn’t pass the interviews anyway.”

Although Dr Aceng would eventually be appointed director general of Health Services, Prof Mbonye says Dr Nathan Kenya-Mugisha had been interviewed as the sole candidate for the post and he had already successfully passed the interview phase.

Prof Mbonye says nobody imagined that a junior doctor, like Dr Atwine, not even a superintendent of a hospital, would apply for the post of Permanent Secretary and pass the interviews at the Public Service Commission.

“Naively perhaps, we had believed in the traditional practice of an open interview process and appointing the best officers based on merit. It was within this system that we ourselves had progressed within the Health sector and nurtured our abilities over time. Indeed, this is the process which helps build strong health systems all over the world,” Prof Mbonye wrote.

Before being appointed as Permanent Secretary of Ministry of Health, official records show that Dr Atwine had worked at St Francis Hospital Nsambya, before joining the Uganda Joint Clinical Research Centre (JCRC). It’s from here that Museveni tapped her to State House where she was given the title of President’s private secretary in charge of medical affairs.  

In 2009, Dr Atwine was tasked to head what was officially known as the Medicine and Health Services Delivery Monitoring Unit, precisely tasked to investigate corruption in Uganda’s Ministry of Health. 

However, on June 29, 2010, Prof Mbonye writes that President Museveni appointed Dr Aceng as the director general of Health Services; around the same time in 2010, he says, Mr Museveni had appointed Dr Lukwago as deputy Permanent Secretary and later, on May 27, 2011, the President appointed Dr Ondoa as Health minister, replacing Dr Steven Malinga, who has since passed on.

The shock at these appointments, Prof Mbonye says, reverberated through the Ministry of Health headquarters, and even the appointed officers, seemed shocked at their own selection.

“Dr Ondoa had earlier began calling herself Pastor Ondoa.” Prof Mbonye wrote, “and while we were in Oyam District to launch the Prevention of Cancer of the Cervix campaign, she told me and others around her table that she was a prophet!” he says, adding, “Ondoa said how she was a member of the ‘born-again Christians’ and it was said that they would go to the State House to pray.”

Museveni’s recruits at the Health ministry, according to Prof Mbonye, called themselves ‘The New Team’, and claimed how the President had invested his trust in them to clean up the Health sector.

“However, was the Health sector thoroughly corrupt?” he asked. “Were they themselves [‘The New Team’] free of corruption?” 

Prof Mbonye singled out Dr Aceng. He said she had previously been investigated over a case of stolen anti-malaria drugs from Lira Hospital, where she was then the acting medical superintendent.

“The drugs were allegedly found in her private clinic, and the case was registered at Lira Police Station under Ref CRB-1653/06 for unlawful possession of government stores (drugs). This case was widely publicised at the time in The New Vision of July 3, 2006, under the heading, ‘Lira doctor quizzed over missing drugs,” he writes.

Though the National Medical Stores (NMS), the government body that procures, stores, and distributes essential medicines and medical supplies to health facilities across the country, wasn’t delivering what’s expected of them. 
Prof Mbonye says ‘The New Team’ to everyone’s surprise, openly advocated it in every meeting they attended; and rudely and forcefully rebuked anybody who dared to challenge them.

Soon cracks started to emerge in ‘The New Team’ and it could no longer hold itself together, he wrote. Once Dr Lukwago started to criticise NMS, Prof Mbonye says, his former allies began a campaign to isolate him and subsequently remove him from his job.

“It is alleged that they formulated a sinister trap and hoodwinked one Mr Alex Gumisiiriza, who was working on the Global Fund accounts, to open an account at Bank of Uganda, and claimed Dr Lukwago wanted to steal NMS funds through this account,” he says.

The aim, he says, was to charge Lukwago in the Anti-Corruption Court, then interdict him as he struggled with the court process. 

“This was one of the schemes they had used on other officers to harass them out of their permanent positions. To implement this scheme, they sought allies in the Criminal Investigation Directorate (CID) of police and in the Inspectorate of Government (IGG),” he wrote.

Dr Lukwago survived by a whisker the plot to have him ousted. It is believed that he used the Muslim lobby group to plead with the President to keep him on. With such scandals playing out in the media, Prof Mbonye writes that Museveni was left with no option but to relieve Dr Ondoa from her position as a minister of Health. 

Later, she was appointed director general of Uganda Aids Commission, but Prof Mbonye insists that since old habits die hard, her arrival at the Commission set off the same fights and confusion.

“In particular, her clash with the chairman of the Board at Uganda Aids Commission, Prof Vinand Nantulya, again attracted the attention of the President; and to the relief of many, she was again relieved of her position and Dr Nelson Musoba replaced her as director general,” he wrote.

At the Ministry of Health, Ondoa, he says, was replaced by the rather “affable” Dr Ruhakana Rugunda, who he calls “a good listener, team builder and inspires the people who work under him.”

When the position of director of Clinical and Community Health was re-advertised in 2014, Prof Mbonye says, he applied with the likes of Dr Jacinto Amandua, Dr Charles Olaro, and Dr Alex Opio.  Though he had emerged as the leading candidate, he claims Dr Aceng led a frantic effort “to make sure they passed me over”.

“To this end, she enlisted one person on the interviewing panel and they allegedly failed me during that interview, to the surprise of the entire Commission. I understand that one of the commissioners asked Dr Aceng why she had failed me despite the fact that I clearly addressed her questions. She sheepishly stated that I had many cars parked in my compound. The same commissioner further asked her how this was related to awarding me low marks, and I am told she remained quiet. After discovering that Dr Jane Aceng had a hostile attitude towards me, we developed a cold working relationship from then on,” he writes.

About the book. 

Today, Prof Mbonye’s book which was designed and printed in the United Arab Emirates (UAE) by Print Farm FZE can’t be found in bookshops in Kampala or across the country. 

It’s said the copies unexplainably vanished from the shelves, but not before The Observer newspaper reviewed the book in 2019 and was closed for a couple of weeks by the tax body, the Uganda Revenue Authority (URA), on the account that the publication hadn’t paid taxes.

But the newspaper then insisted their closure had everything to do with the review of the book that didn’t go down well with some of the people adversely mentioned, like Dr Atwine.