Governance by Performance, Accountability by Threat

Dear Editor,

There is a now familiar rhythm to governance in Guyana: urgency is declared, stern warnings are issued, systems are announced, and the public is told that failure will no longer be tolerated. This week, the stage is the healthcare sector. Yesterday, it was GuySuCo. Before that, driver’s licence fraud. The script changes, but the performance remains the same.

President Irfaan Ali’s latest address to senior health officials—complete with threats of dismissal, strict compliance orders, and bold declarations about “world-class” standards—fits neatly into this pattern. It is governance by spectacle, where the appearance of control is carefully projected, even as outcomes remain stubbornly inconsistent.

The President’s insistence that there is “no excuse” for medicine availability to fall below 90 percent is, on its face, reasonable. After all, the State has allocated an unprecedented $161.1 billion to the health sector. Billions more have been poured into infrastructure, pharmaceuticals, and systems. Yet, the very need for such a warning raises an uncomfortable question: if the resources are there, why are the results not?

The answer does not lie at the level of nurses or clerks. It lies in the architecture of procurement, oversight, and execution—areas that have repeatedly been the subject of presidential intervention, public admonishment, and, ultimately, very little visible accountability.

We have seen the pre-dawn meetings before—summoning procurement officers and project engineers to account for delays, discrepancies, and inefficiencies. We have seen the impromptu early-morning inspections at construction sites, where cameras capture urgency and frustration in equal measure. These moments are crafted to signal hands-on leadership. But what follows them? Where are the sustained audits, the transparent findings, the sanctions that extend beyond rhetoric?

Because without those, these interventions risk becoming little more than political theatre.

The introduction of the Materials Management Entity (MME), with its digital dashboards and standard operating procedures, is being presented as a turning point. It may well be a useful tool. But systems do not enforce themselves. Dashboards do not discipline institutions. And software cannot substitute for political will.

If anything, the centralization of procurement and the tightening of approval mechanisms—particularly for emergency purchases—raise additional concerns. In a system already vulnerable to opacity, layering authority without strengthening transparency can just as easily consolidate control as it can improve efficiency. Who monitors the monitors? Who ensures that the new system does not simply relocate old problems into a more technologically sophisticated framework?

The President’s warning that those who operate outside the system will be “sent home” would carry weight if Guyanese had confidence that such consequences are consistently applied. But recent history offers little reassurance. High-profile pronouncements have not translated into equally high-profile accountability.

And so, the credibility gap widens.

Even the pivot to “attitude” and “customer service,” while not without merit, risks oversimplifying a deeply structural problem. Yes, patient experience matters. Clean facilities matter. Professional conduct matters. But these are downstream issues. They cannot compensate for upstream failures in procurement, logistics, staffing, and governance.

It is easier to demand smiles at the front desk than to fix leakages in billion-dollar supply chains.

The government’s vision of a modern, efficient, and patient-centered healthcare system is not in dispute. What is in dispute is the method of delivery. Announcements are not achievements. Deadlines are not outcomes. And threats are not substitutes for systems of accountability that are transparent, institutionalized, and immune to political cycles.

July 1 will come, and the new system will be declared the sole platform for managing pharmaceuticals and supplies. There will be reports, briefings, and likely another round of assurances. But the real test will not be in the rollout—it will be in the results that follow quietly, long after the speeches end.

Are medicines consistently available? Are procurement processes transparent? Are failures investigated and punished? Are improvements sustained without presidential intervention?

These are the metrics that matter.

Guyanese are not asking for more performances. They are asking for proof—evidence that governance is no longer something that happens in dramatic bursts of visibility, but something that works, quietly and reliably, every single day.

Until then, the cycle continues: announce, admonish, threaten, repeat.

And with each repetition, the distance between rhetoric and reality grows harder to ignore.

Sincerely,

Hemdutt Kumar