The current “standoff” between parliament and President Yoweri Museveni on whether to allocate Ush39 billion to health or defence is one of the many false debates about the budget process in Uganda.

An uninformed observer would think that there is a serious policy difference between the legislature and the executive.

For those who have followed the budget making process in Uganda over the past 15 years, parliament is posturing, not trying to correct executive excesses.

In the financial year 1997/98, the government of Uganda allocated Ush58 billion to the health sector. According to Uganda Revenue Authority, the dollar exchange rate for that year averaged 1,142.

This means government allocated $50.5 million to health. In the 2012/13 budget, the government of Uganda has allocated Ush838 billion ($335 million at today’s exchange rates) to health. Therefore, the dollar value of the health budget has grown by 560 per cent.

Equally, the population of Uganda in 1997 was 20 million, meaning that per capita expenditure on health was Ush6,350 or $2.5.

Given our current population of 35 million, this financial year’s budget translates into per capita health spending of roughly Ush24,000 or $9.6, an increase of nearly 300 per cent.

Is there a noticeable improvement in the quality of healthcare delivered by the government of Uganda as a result of this budget expansion?

Anyone visiting our hospitals and health centres would be appalled at their state of disrepair, the poor equipment used and the absenteeism of medical workers – not to mention their poor pay.

So, public debate in Uganda needs to shift from inputs to outputs, from budget allocations to services delivered, from more money to value for money and from policy pronouncements to policy outcomes.

Before we agree that any more money is allocated to health, let us first ask whether the money currently allocated is being used appropriately to maintain, renovate and build hospitals and health centres and to furnish them with medical equipment and drugs; and if it pays for the services of medical workers like doctors and nurses.

These activities are not an end in themselves; they are supposed to be a means to an end, to produce specific healthcare outcomes like reducing infant mortality, child morbidity and incidence of diseases like malaria, etc.

Do people who go to hospitals and health centres get a service commensurate with what is spent? Have these services become better as the budget has increased?

I have personally visited Mulago and other hospitals like Kiryandogo in Nakasongola, Kambuga in Kanungu, Itojo in Ntungamo and been appalled by their state of disrepair, understaffing, congestion, broken beds, malfunctioning equipment and uncollected garbage.

In her autobiography, My Life’s Journey, Janet Museveni admits to this state of affairs. She says that during her first campaign, she went to Itojo Hospital to solicit votes but what she saw made her feel like crying.

“Every time I attempted to speak, I choked with sadness,” she writes, “Eventually I told the staff that I was sorry that such a dejected place could be called a hospital, since a hospital is a place where the sick come to be made well, but I pointed out that no one could get well in that place. It seemed to me that a patient would come with one disease and leave with another.”

Some studies suggest that there has been improvement in the health of our citizens — life expectancy has gone up, infant mortality and child morbidity have reduced etc.

However, this may have more to do with private healthcare services than government ones.

Therefore, let the executive to account for the Ush838 billion spent on the sector per year – not to mention what donors spend off-budget, which is close to Ush700 billion – before another dollar is thrown into the bottomless pit of the health sector.

In fact, after my visit to Somalia and witnessing first hand how professional UPDF has become and how commendable a job it is doing, I am more inclined to support a budget increase to them— parliament had wanted the money carved out of the defence budget.

There has been real reform in the army. As a result, we no longer have news about ghost soldiers, junk helicopters, junk tanks, expired food rations and undersize uniforms that had turned the army into a springboard for private profiteers and around which I built my investigative journalism career.

In November 2009, the New Vision reported that a government audit had revealed the existence of 100 ghost hospitals in Western and Central Uganda alone.

If an audit were conducted on the Ministry of Health payroll, we would be shocked at the number of ghost medical workers and the money spent on them per year.

Mid this year, the Daily Monitor reported that the president had ordered an investigation that found that our country spends $150 million (Ush375 billion) on the health treatment of top government officials abroad. Can we first end this profligacy by our rulers?

Moreover, a World Bank study in 2008 found that 80 per cent of Uganda’s health budget is spent on hospitals in urban areas that serve only 20 per cent of the population.

The study also found that 80 per cent of public sector medical workers in Uganda work in urban areas where only 20 per cent of the population lives.

What is clear from the above is that the democratic process in Uganda has failed to represent the interests of the ordinary citizen. Instead, it seems to reinforce the urban bias – a tendency to allocate ever more and more resources to serve a narrow urban elite.

The standoff between Museveni and parliament is not about delivering healthcare services to our diseased citizens.

It is about which group of elites gets the chance to steal the Ush39 billion – whether it is those who work in defence or those who work in health. This is not a policy difference that Ugandans need to take seriously.