By Flavia Nassaka
Will the new non-cash approach help ensure Shs1.3 trillion is not swindled?
Uganda has set a goal to completely eradicate malaria by 2020 which is a steep target as the disease still kills over 100,000 people per year, mainly children. Although WHO has identified sleeping under an insecticide- treated mosquito net to be at the frontline in the battle against malaria, only an estimated 40% of the people in Uganda have the nets. Now, the Global Fund has given Uganda yet another grant to fight Malaria, Tuberculosis (TB) and HIV.
The grant, worth about US$421 million (about 1.3 trillion shillings), is the same amount the health ministry received as its budgetary allocation for 2015/2016.
On June 25, Prime Minister Ruhakana Rugunda, Finance Minister Matia Kasaija, Health Minister EliodaTumwesigye, and Global Fund representatives signed off five grants worth US$226 million (745 billion shillings) for buying drugs, net distribution, and expansion of the national medical stores. US$176 million has been set aside for HIV, US$14 million for strengthening health systems, US$22 million for tuberculosis and US$14 million for malaria.
With the money, Anti-Retroviral Therapy (ART) coverage will increase to 69% of people living with HIV by 2017 from a baseline of 44% in 2014, prevention of Mother-to-Child Transmission of HIV will be increased from 85% to 90% by end of 2016, and efforts will be made to have all people with TB tested for HIV and ART given to the co-infected.
According to Dr. Jim Arinaitwe, the coordinator of Global Fund in the Ministry of Health, the grant will be implemented through both the public and private and public sector, including The AIDS Support Organisation (TASO).
TASO will monitor government health activities and ensure other civil society organizations get people, community groups, and leaders reform harmful gender-based and socially discriminatory practices that hinder access to health services by vulnerable groups such as pregnant women, prostitutes and fishermen.
Uganda has been receiving Global Fund grants since 2002. However, in 2005 the funds were halted over allegations of corruption and misappropriations. Alice Kaboyo, a former State House employee, then-Health Minister Jim Muhwezi, his deputies Dr Alex Kamugisha and Mike Mukula were among those charged in connection with misappropriation. Some of them were acquitted. Also, in 2005, an audit revealed graft leading to suspension of five grants by the Fund but they were reinstated months later. Again in 2007, the country lost US $16 million on grounds of poor performance and misappropriation of funds.
Given Uganda’s blackish history with global funds, the new Minister of Finance Matia Kasaija has issued warnings against misuse of the funds. He said to achieve vision 2040, Uganda needs a healthy population and that beneficiaries of the grant will not be made to suffer because of the motives of a few unscrupulous people. He therefore said public servants will be answerable incase of any misappropriations. The Health Ministry has also set tougher ways of ensuring that the funds reach the intended objective that involve ensuring that officials do not handle cash.
Dr. Asuman Lukwago, the permanent secretary in the Ministry of Health said instead of Uganda battling with competition and bureaucracies in the procurement process that sometimes leads to swindling money, his ministry will instead send the specifications and quality of the products needed to the Fund which will order the drugs and nets directly from the manufacturer. The ministry will only be responsible for distribution.
“It’s even cheaper. Some nets are manufactured in China at about $3 apiece. We requested Global Fund to do this for us but we can always buy them ourselves if we get a cheaper option. The problem is that Ugandans are not yet disciplined,” he said when asked whether shipping in products will not cause unnecessary expenditure for Uganda.
When The Independentcontacted Prof. Vinand Nantulya who is the Global Fund’s chairman of the Country Coordinating Mechanism (CCM) on June 27, he said problems with the old approach meant that Ugandans at the grassroots were not benefiting as money remained in the hands of the few. He said early results about global fund buying nets are encouraging whereby over 2.2 million nets havealready been given away to recipients. To curb stealing medicines when already in stock, Lukwago said that they have already put in place internal controls such as setting up health monitoring units, health worker mentoring aimed at making medics behave professionally and also labeling of materials for it to be clear to everyone that they are not for sale.