When Chaos Overtakes Reason: Why good systems should not be allowed to fail

By Norman Katende

Every day, WhatsApp groups and other information-sharing platforms in Uganda circulate stories that leave us wondering how certain things are allowed to happen, and, more importantly, why obvious solutions are so often ignored.

There is an old saying that where chaos thrives, corruption rarely struggles to find room. The more confusing a system becomes, the easier it is for accountability to disappear.

About five years ago, the Uganda People’s Defence Force (UPDF) medical team encountered a problem familiar to public health workers everywhere: medicines were being supplied and used at a surprisingly fast rate, yet the only reliable way to tell whether they were being prescribed and dispensed as expected was too strenuous to utilise.

The solution was refreshingly simple: use technology.

The UPDF medical team developed a digital system to monitor prescriptions, drug distribution and accountability. But the benefits went beyond medicines.

The system also captured patient information digitally, cutting down mountains of paperwork and creating reliable patient records.

For returning patients, doctors could instantly pull up medical history and previous treatment, saving time, reducing duplication, and freeing medical teams to attend to more patients.

After a successful pilot at Mbuya, the UPDF rolled the system out across its military hospitals. The results were encouraging enough that the team believed the same approach could improve efficiency in government hospitals too.

One major national referral hospital was chosen as a testing ground. Its administration agreed to the trial, and the UPDF team arrived with its equipment and expertise.

Then, somehow, the wheels came off.

For about a month, the team struggled to get the system running. Network connectivity was poor. Equipment reportedly malfunctioned. Key technicians were unavailable. Computers allegedly went missing.

Eventually, the UPDF team packed up and returned to the barracks, where, we are told, the system continues to run smoothly.

That should give us pause.

If a digital system can improve patient records, track medicines, cut paperwork and make discrepancies easier to spot, why would any public hospital resist it working?

A properly functioning system could strengthen the fight against inflated patient numbers, questionable prescriptions, medicine leakage and other weaknesses that have long dogged public hospitals.

It would create a simple chain of accountability: what the doctor prescribes, what the pharmacy receives, what the store issues, and what the patient actually gets, all recorded, all traceable.

And that is precisely where the discomfort may begin.

Technology has an irritating habit of making things visible. Where private interests overlap with public health services, greater transparency can expose conflicts, irregularities, or opportunities for making money outside the formal system.

A computer cannot be persuaded to “look the other way” quite as easily as a person can.

Perhaps the Ministry of Health should take another look at this system, not as a UPDF project, but as a potentially valuable national health-management tool.

Bring the UPDF team back. Give the project a clear ministerial mandate. Appoint accountable officials, set measurable deadlines, and publish progress reports.

Uganda does not lack clever people or good ideas. What it often lacks is the determination to let good ideas survive the people who benefit from keeping things complicated.

Sometimes, the best way to fight chaos is simply to switch on the computer.