The PANAFRICAN Review
be effective . This entails , among other things , setting standards and ensuring that local authorities abide by them and that they obey the spirit and the letter of the law that outlines their responsibilities and obligations to the communities over which they preside . The idea that autonomy is important in enabling local governments to make decisions in line with local circumstances disregards realities such as the potential for elite capture of newly created institutions and the power and knowledge asymmetry between them and local communities that renders the latter incapable of holding them to account .
In the end , evidence suggests that neither centralization nor decentralization holds the key to strong and effective service delivery systems . Rather , it is the capacity of the state and the incentives that drive the ambitions of its leadership that really count . Nowhere is this more evident than in Rwanda , for example . In Rwanda , the need for autonomy of local authorities is finely balanced with a key imperative : to ensure that they play roles that contribute to enabling the government to fulfil its overarching ambition of achieving socio-economic transformation . The government understands that this can only be achieved through the efforts of a healthy population within the context of peace and political stability . The ambition to ensure a healthy population explains why Rwanda has been able to build a health sector that , for the most part , has been able to surmount the challenges described above and deliver services more effectively and with greater impact than countries in its neighbourhood and beyond have been able to do .
Dr Frederick Golooba- Mutebi is a Ugandan-Rwandan independent researcher and former academic .
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Countries with Efficient Health Systems Have Fared Better Against Covid-19 . But What Does That Mean ?
Ndayisaba Gateka
In the modern world , many of the societal pillars that were initially thought of as separate continue to reveal themselves as intimately intertwined . A discussion on education brings forth the need to , especially for Africans , rewrite what has been understood as history . A conversation on security comes with the imperative of economic stabilization . And concerns on demographics raise the issue of food security ; while examining national healthcare matters reveals infrastructural gaps . It suggests , therefore , that holistic solutions to our wide-ranging challenges require leaders to see the bigger picture . This has become evident in efforts to create efficient health systems in Africa .
Accordingly , efficient health systems can only be provided by leaderships that strive to link the gaps in the nation ’ s social structure and its corresponding dynamics . In other words , any people-oriented leadership must take into account people ’ s social determinants – the conditions in the environment where they are born , where they live , learn , play or work –
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