According to the Global Fund to Fight Tuberculosis, Malaria and HIV/AIDs (GFTAM), an estimated 150,000 Ugandans die from AIDS, Malaria or Tuberculosis each year. There are almost 14 million people affected by these three deadly diseases in Uganda and yet they are also highly preventable.  The Global Fund is a multi-billion dollar international financing mechanism established in 2002 that aims to combat these diseases by providing financial grants to countries in need. The GFTAM also now has a window for health systems strengthening which is an opportunity for countries like Uganda to receive funding to address broader weaknesses in the country’s health system.

Clearly, Uganda’s health crisis fits the criteria for this type of assistance yet local politics are hindering our capacity to receive funding and fight these diseases. Currently 95% of all funds for ARVs/TB medications come from either GFTAM or PEPFAR. When GFTAM did not make a disbursement last March, Uganda experienced a serious TB drug shortage.

In the eight years the Global Fund has been in existence, Uganda has applied for and been approved for money in six rounds out of the nine (round five was not successful, round eight proposal was not submitted and in November 2009 round nine was not approved). A total of US$343 million has been committed yet less than half, US$158 million, has been disbursed to date. Why?

Quite simply, the government of Uganda’s lackadaisical approach to fighting corruption and mending the errors of our previous ways is affecting our ability to secure vital health care funding from the international community. 

In 2005, Uganda received bad publicity when the Global Fund suspended five grants worth US$213 million because of mismanagement of the previously released funds.  While the government of Uganda acted quickly and spent a lot of money to set up a commission of inquiry to investigate the mismanagement, they have failed to prosecute the people implicated and have yet to come up with a long term plan to ensure this type of corruption does not happen again.  In fact, while an estimated 300 people were accused in the mismanagement, only four have been prosecuted.  As recently as 2008, the Global Fund said again that Uganda had not done enough to guarantee the safety of the money.  We have not received a grant from the Global Fund since then. Coincidence?  Unlikely. 

Of course the international community is hesitant to dole out more money to Uganda when they lack assurances that the funds will actually go to the people in need.

The time is long overdue for the Uganda government to address corruption and recognise the effects this type of poor management has on the lives of real Ugandans. President Yoweri Museveni has declared a war on corruption. If President Museveni is really serious about fighting corruption, this is an opportune time to deal with the people who were in senior leadership positions and mismanaged GFTAM monies – people whose indiscretions are costing Uganda millions of dollars. The people with the greatest responsibility for mismanagement of GFTAM monies must be prosecuted and the money returned to the people of Uganda. The diversion of attention from the real criminals by punishing a few small fish as scapegoats is totally unacceptable. It is a sign of political hypocrisy and illustrates a lack of commitment to the people of Uganda.

Most importantly, Uganda needs to figure out a sustainable approach to providing transparency and accountability in how health care funds are spent to mitigate any other potential losses of funds.  Ultimately, we must create a system where corruption is not tolerated and the health of Ugandans is the utmost priority for all. 

Sandra Jaclyn Kiapi is an advocate and human rights specialist working with the Action Group for Health, Human Rights and HIV/AIDS (AGHA).

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