Efficiency, consistency and excellence are things that we as Africans always seem to struggle with. As the world heads more and more towards automation and precision you cannot help but wonder when Africa will catch up. We always seem several steps behind and that translates to a decade or more for most innovations.
Simple things seem to fail us. You will be hard-pressed to find an African country or town where the public transport is predictable and runs like clockwork. Using public transport in Africa to commute for time-sensitive things like work requires you to build in considerable lead time into your journey, something that inevitably contributes to inefficiency and lower productivity of the workforce who show up late, leave home very early, get home late and so on. This undoubtedly must affect quality of life and work-life balance, for example.
Then there is the lack of predicable and consistent systems that characterises most of our way of doing things. Endless queues to get simple things done such as acquiring a national identity card, passport, driver’s license and so on are the norm. The ensuing corruption that this promotes either a result or a causal factor, or likely both – your guess is as good as mine. In some countries you can do or at least start most of these processes online and get notified via email and so on.
At my workplace I am confronted daily by caregivers with patients in the hospital wards gathering outside my window, gossiping on family matters and smoking, much to my annoyance and repeated intrusion to ask them to keep the noise down or not smoke outside my window. Who can blame them though – there is no shelter or decent sitting area for them to use. Meaning I also have to deal with dodging stagnant water and watching clothes drying outside my office window as they use the tap outside to wash their clothes and the hedge to dry them. Yet everywhere you look in the premises there is endless construction of more wards and hospital facilities. Yet not a thought to the caregivers.
This is in stark contrast to my recent experience in Bahrain, a small island state in the Middle East. The public transport runs like clockwork. People seem to know what they are doing and go about it with purpose and efficiency. It would seem there is a place for everything and everything in its place.
Coming from my setting, it was staggering to see the efficiency with which nurses, cleaners and all worked in the hospital. Then there were the beddings, towels, face masks, protective gowns and gloves that were available for caregivers of patients in the corridor storage outside the ward for them to get and use at will. We joked that if that were back home the caregivers would have collected those things and taken them home. You would likely notice on everyone’s clothes linen and towels marked “Bahrain General Hospital” or the like. That is if the caregivers ever got hold of them in the first place. Very likely it would be the hospital employees, doctors and nurse’s homes where you would find those beddings and linen.
Contrast this to most African countries where gloves, let alone face masks are hardly enough to cater for the health workers themselves. Shortages of basic supplies and drugs are the order of the day, partly due to “lack of money” as we are told or just lack of proper inventory management systems at times. One could argue that we misuse even the little money that we have much of the time, with some drugs and supplies expiring on shelves.
Some might say this is an unfair comparison, after all Bahrain is far wealthier than my own and most African countries. But I say these matters go beyond wealth. Nigeria is a case in point. Wealth is no factor there yet look at how it is in tatters when it comes to such things. Perhaps you could argue that South Africa is a good African example, but even then, not consistently. Two other African countries that come close are Botswana and Rwanda. But all seem far from ideal when compared to places like Bahrain, the UAE and Europe, for example. I do not mean to say that all is rosy and perfect in these places, but clearly, they get it right more times than we do.
By my observations, the problem is multifaceted. You cannot talk about such matters without pointing out the corruption that is in Africa. That, no doubt, is a major contributor to what is going wrong. But like a vicious cycle it is also perpetuated by the same situation. The problem though is not the corruption. There is something far bigger that is the problem.
I say it is a lack of a culture of excellence amongst us as Africans. We do not always seek to do and give our best in what we do. In fact, the opposite is often true. The moto seems to be to get as much money for doing as little as possible, whether by doing little work or by other unethical means, starting with the top leadership in our political circles. This inevitably trickles down to the entire population.
But, as Africans, we do excel when placed in countries and institutions that require such excellence of us. Even in our own countries, those who work for international organisations that have such work ethic will attest to this. Such organisations often stand out in an environment that is otherwise mediocre.
So, as individuals we have what it takes. What is lacking is making such work ethic and commitment to excellence an intrinsic part of all that we do, whether we are being watched to do it or not. Indeed, whether we are being paid for it or not. We need to start taking pride in doing things well and building our reputation for doing things well.
But, no doubt, that is easier said than done. In my opinion, it starts at the very top. At national level it starts with the president. Paul Kagame of Rwanda, love him or hate him, is one good example. His unwavering commitment to making this country excel and willingness to do whatever it takes is paying off as Rwanda is being recognised globally for leading Africa in many areas. That from its dark history of genocide only a few decades ago.
I like to call him a “benevolent dictator” who has his country’s best interests at heart. Perhaps that is what much of Africa needs. Democracy, in my opinion, has not been good for us at all and has probably contributed to much of the corruption we see as greed and the need for votes and short-term considerations overshadow all else.
If the president or whoever is on top leads the way others will follow. The late Levy Mwanawasa of Zambia was a good example too, though much of what he did has been undone by his untimely death and subsequent cluelessness and greed of ensuing leaderships. Zambia would be in a very different place had his kind of leadership and low tolerance for corruption continued.
So, if the top leadership has that ethic it trickles down to the members pf parliament and the ministers and from there the permanent secretaries, the directors and so on.
But even in other institutions the same is true. The top leadership matters and whatever goes on in an organisation has to, at some level, reflect the level of thinking and capability of those who lead it. Thus, excellence starts from the top in all things, it cannot be sustained from the bottom. Leadership is key.
It also starts with our education system and its duty to implant the right values in our children. If taught from an early age that we must do things well and give our best at all times in all that we do, Africa’s younger generations can do a lot more than those before them.
But herein lies the problem. This “overhaul” is uncomfortable and undesirable for some. The old guard will not leave quietly. Those that benefit from what is wrong will not relinquish their power and influence. For some it is simply lack of ability and not being willing to admit that they have done all they could and it was not good enough and that others should try.
I have seen this attitude kill us, politically, academically, scientifically, business -wise, you name it. But it can be stopped. It just takes some radicalism. It just takes some fresh thinking. It just takes some risk-takers to get the ball rolling and instil that vision.
My call to Africa is “let us all commit to excellence in all that we do and at all times.” Change will come. Wakanda can be our reality, even without vibranium.
Cholera has devastated Zambia at the current moment and one wonders why year in and year out we have to face this menace. From experience, I have seen that we do not do enough to prevent its occurrence and the reasons may not be that straightforward and apparent to many.
In my time as the National Health Programme Coordinator at the Zambia Red Cross around the mid 2000s, I represented the organisation on the National Epidemic Preparedness, Prevention, Control and Management committee of the Ministry of Health. One of the ongoing cries of the Red Cross and many donors at the time was that we needed to focus more on prevention rather than waiting for outbreaks of cholera to occur and for this reason a national cholera contingency plan was proposed by many government partners.
However, at the time there was never any traction from government to come up with such a plan, much to the frustration of many of the partners. As Red Cross, we thus set out to develop a “Zambia Red Cross Cholera Contingency Plan” that would have allowed us to raise funds for cholera prevention activities from our donors, who had expressed interest in funding such a plan. It would also have enabled us to meaningfully engage the various in-country partners and donors that were necessary to successfully pull off such a plan. We did not call it a national cholera contingency plan in order to avoid stepping on the governments toes and emphasised that our plan could be a small part of the national contingency plan once that was worked on.
I set out to write to various partners to call for a meeting to discuss such a plan. Rather naively, I was so focused on results and getting things done that I forgot about the very fragile ground of government and partner politics that is always at play in the health sector.
Shortly after the invitations were sent out, the Secretary General of Zambia Red Cross, Mr Charles Mushitu, called me to inform me that the Director of Public Health (I cannot remember if that was the exact title at the time with the ever-changing nomenclature at MOH), was rather displeased about our proposed meeting and wanted to see me immediately.
For obvious reasons I will not state his name but I recall it was a very brief and rather hostile meeting. I was asked what year I graduated and what my credentials were and what gave me the right to call such a meeting. I was told in no uncertain terms that that was his role and I had no right to do so. My confidence was not faded and I explained the intention of the plan, stating that it was a small Red Cross plan and not a national one and that it would be far cheaper to prevent the disease than to wait for an outbreak and tackle it then.
Needless to say, MOH discouraged all partners from attending our meeting and it never happened. Such an idea upset too many norms and it appeared even the partners were weary of upsetting MOH by being part of such an effort. So political expediency won at the end of the day, despite the overwhelming need for such a plan.
But I learnt some lessons from that, one of which is that cholera is “big business” and, at least at that time, was a big factor in not having the political will to prevent it. Outbreaks bring money. Big money. Emergency money. Money that does not need to be accounted for so strictly. During such emergencies financial rules are relaxed in order to tackle the situation quickly and, so is the intention at least, effectively. So why stop an outbreak that benefits some who may be involved in tackling it? It is all too easy and tempting during such times to take a few dollars or kwacha here and there for personal gain. Of-course there are the additional legal ways money is made, such as more allowances for personnel and so on. Even some donors at such times utilise such emergencies to lobby for more funding for the response that also beefs up their organisation’s coffers and assists in meeting other costs generally. I would hope that is not the situation we still find ourselves in.
Preventing cholera, from a public health perspective is simple: promote hygiene, clean up the environment, disinfect known highly vulnerable areas, provide safe water and better sanitation facilities and so on. I oversimplify as the logistics of this could be quite daunting, but in essence that is what it is.
The current things that are being done now by the army and other players are commendable but what stops us from doing such things before outbreaks occur? Complacency on the part of key players such as the council to keep the city clean has to be considered. An overstretched health system, political pressure to please and appease street vendors and so on also contribute. Though one has to be careful about blaming cholera on street vendors as the evidence for this is rather weak, though one cannot argue against cleanliness generally.
But largely, we suffer from a lack of any long term plan to tackle the problem. Every year we have an outbreak, run around like headless chickens and when the outbreak ends we go back to business as usual. We wait for the next outbreak.
No one seems to ask; how do we continue with the efforts we have made now to prevent the next possible outbreak? It will be a shame, but am sure it will happen, to let the city of Lusaka go back to the filth and crowded streets we had before the current clean up. Instead we should be looking to keep it this way. Why can’t food outlets be tested all the time and not just during outbreaks? Why can’t people be encouraged to practice good hygiene all the time? It is all possible and can be sustained. That is the only way to end cholera outbreaks.
So, a simple matter such as cholera turns out to be a little more complex, thanks to a little greed, politics, complacency, inadequacy of infrastructure and other factors.
How long will we wait before we demand “no cholera” rather than “stopping the spread of cholera”? I would like to see this be a campaign matter, I would like to see donors add more pressure on the government to prevent it.
But mostly power lies within us the people, every one of us, to demand decency and what is right: a clean and cholera free country is our right! We should hold those responsible accountable to deliver on this.