“In this regard, we need to learn and apply lessons from emerging economies such as India, whose total healthcare industry revenue is expected to increase from US$ 110 billion in 2016 to US$ 372 billion in 2022 in response to deliberate investments in telemedicine, manufacturing of medicines and health technologies, medical tourism, health workforce training and risk pooling/health insurance, among others. In order to achieve this, we need to plan in a harmonized way. In Uganda, for instance, we, indeed, have a nascent pharmaceutical industry producing Aids/HIV, Malaria, Hepatitis-B, pharmaceuticals, etc. drugs. These are, however, still using imported pharmaceutical grade starch and imported pharmaceutical grade sugar. The pharmaceutical grade starch and sugar are crucial for making tablets and syrups for children’s medicines. Yet, the starch is from maize and cassava and the pharmaceutical grade sugar is from sugar. I am told the drugs would be 20% cheaper. Moreover, apart from helping in the pharmaceutical industry, more refined sugar is also needed in the soft drinks industry. Uganda is squandering US$34 million per year importing refined sugar for the soft drinks, about US$ 20 million for importing the pharmaceutical grade starches not including the other raw materials, US$ 77million for taking patients to India etc. Africa is incredibly rich but wasteful” (Yoweri Kaguta Museveni at THE OFFICIAL OPENING OF THE JOINT EAC HEADS OF STATE RETREAT ON INFRASTRUCTURE AND HEALTH FINANCING AND DEVELOPMENT, 22.02.2018).
Seems like the 1980s World Bank loans to restart Kakira Sugar Works hasn’t done enough, since the Ugandan state did right after the National Resistance Army takeover of the state. They went into an arrangement with the World Bank getting loans for the company, to restart. That deal was done 8th March 1988. As the documents said back in 198:
“Uganda currently imports US$15-20 million worth of sugar annually, which ranks second only to petroleum imports. Import substitution through restoration of domestic production capacity is therefore a high priority and eminently justified given the considerable comparative advantage Uganda enjoys as a result of its landlocked situation. Conditions for sugar production at Kakira are highly favorable. Cane growing benefits from excellent soils, good rainfall distribution (requiring only limited sunplementary irrigation) and relatively low levels of inputs of fertilizers and pesticides. The project brings back to the Kakira complex the original owners who have a demonstrated ability to manage sugar operations at Kakira and elsewhere” (SUGAR REHABILITATION PROJECT, 08.03.1988).
Therefore, what the President said today, the Sugar Rehabilitation Project, which was done to stop the heavy imports of sugar and for consumption, has clearly not worked as projected. Since his own state is squandering their resources and not even following the loans to make the project work. That is my take on it. The president of 32 years has clearly mismanaged this and not finished his job. Since he hasn’t been able to rehabilitate the industry.
When it comes to pharmaceutical industry there massive challenges, not just the sugar starch for medicine coverage of the pills. Nevertheless, the whole arrangement, since the technology to operate these machines are imported, as well is the parts. Not only the sugar starch, but also the ingredients are imported too, than you have few companies who has automated manufactures, which makes hard to make medicine on a larger scale. It is also high operation cost, because of use of back-up generators because of blackouts and shortfall of electricity. Because of this, it is expensive to have cold storage of the medicine and have a storage for the final products.
So the Idea from Museveni that it is simple, it is the whole system around it, that makes it more profitable to import ready made medicine, than actually produce it. Even if the added value of production would be there, but with the circumstances put by United Nations Industrial Development Organization, seemingly it is from 2009. However, the state of affairs hasn’t changed that much.
We can really estimate, that the adjustment and the needed organization to pull forward both industries during the years of NRM hasn’t been totally fruitful. If so, why would he complain about the imports of sugar and medicine, when he hasn’t been able to make it function with his 32 years of reign? Someone who has 3 decades, should have the ability and time to find the information, finalize plans and execute as seen fit. That is if he cared about the industries in question and their possible engines for growth and riches of Africa. Nevertheless, he hasn’t cared and haven’t used the time wisely. He has used the time bitching and not acting. That is just the way things is and it isn’t becoming better either.
He could have made sure that the pharmaceutical industry had energy, had the sufficient organization behind it to make the medicine, not only import and assemble certain medicine, he could have made sure the sugar industry was profitable and had the equipment to make the refined sugar used in the pharmaceutical industry. However, both is a lost cause, because it takes money and time. Both, is something he doesn’t have, since the narrative isn’t making him wealthy.
Alas, he we are at the status quo, with a President running for life and complaining about waste. When he has wasted 32 years and not made effort to change it. It is all talk and no fire. Peace.
This saddens me and eats my heart out, as much as the knowledge of the famine in Isingiro and the lacking systemic enterprise or structure of the Ugandan Government, which is continuing to faltering, not serve the public. This has proven earlier in the year of other hospitals without X-Ray machines, lacking medicines and ordinary sanitary products. Together with the only Cobalt 60 Teletherapy Machine in the country at the Uganda Cancer Institute at the Mulago Hospital Complex we’re broking down and not having planned to be changed.
On the 1st November the President Yoweri Museveni closed down the Makerere University and its affiliated programs because of strikes that have occurred during the year. This is happening since the staffs at the Academic Institution haven’t gotten paid for months upon months, while the students want their lectures to be paid. What the outcome of it came quickly as the Mulago Hospital we’re telling that their programs of interns we’re suspended together with the closure of the University.
Key Information from 11th November:
“Dr Asuman Lukwago, the outgoing ministry of health permanent secretary, said the education ministry was responsible for the university and therefore, there is nothing his ministry could do to save the situation. “We would be contradicting ourselves. Ministry of education is responsible and not us as ministry of health. There is nothing we can do,” Dr Lukwago told daily Monitor in a phone interview” (Namagembe, 2016).
So because of First Lady Janet Museveni lacking integrity and ability to sort out the issues internally in the Ministry of Education the biggest Hospital and others are hurt. It is visible that the decisions have repercussions of the lacking leadership in the Ministry of Education and under Minister Janet Museveni who hasn’t carried out her position; since she hasn’t been able to sort out the allocation and the central leadership of the famous University.
“The initial health care is available but there is a shortage of specialists,” Dr Bangirana said. To improvise the available staff, Mulago hospital spokesperson, Enock Kusasira said the hospital has resorted to giving more attention to critical cases considered as life threatening.“We are concentrating less on out patients especially those whose cases are not life threatening,” Kusasira said. At the hospital, patients have to wait for hours before seeing the health workers. The case is not different from other affiliate hospitals and health facilities” (Namagembe, 2016).
Certainly the situation at the Mulago and affiliated Hospitals has been put into trouble with the suspension of Makerere. When the Ministry of Health Sarah Achieng Opendi has to defend the records of the actual numbers of deceased infants you know the system, the structure is rotten to the core. This isn’t really working and the innocence is dying. They are just read the statement in today’s Monitor!
31 New-borns deceased:
“The reports, according to Hon. Opendi asserted that the issue arose after the closure of Makerere University and the subsequent withdrawal of Senior Health Officers (SHOs) from the facility. “The Ministry of Health would like to strongly refute these allegations as baseless and a total misrepresentation of facts,” she said” (…) “Since the withdrawal of Senior House Officers on Nov 1, 2016 to date, Mulago Hospital has unfortunately lost 31 newborns,” she said adding that the deaths were majorly as a result of severe birth asphyxia and complications associated with prematurity” (…) “Severe Asphyxia is largely caused by prolonged labour, which is a consequence of late referrals. According to this statistics, Mulago Hospital has lost approximately one newborn per day due to unavoidable circumstances,” she added” (Mugume, 2016)
There is surely and have been deceased infants and babies during the famine and cause of the Isingiro, where the Republic and the government have dropped sorry loads of food-relief to the staving public; which has waited for months upon end. Sort of the same way the empty pockets of Makerere University lectures has been short-changed for months upon end. This is systemic maladministration from the head. What is worst is that the ones that are in charge are walking away, but the ones affected are being hurt. It is the innocent, the kids, the rural families; the ones are not MPs with flashy cars, lavish salaries but no taxes and all other perks. The same month that Makerere is closed the Income Tax Amendment that stops MPs for getting tax and the same month the MPs add-on more fees for “service car” in their duty.
The new-borns are dying at Kawempe Hospital, a Hospital that is affiliated with Mulago Hospital Complex. The Promise from Enock Kusasira we’re more a pre-warning than facts of their mission. They couldn’t control the effect of the closure of Makerere, as the President didn’t think of the effects or knew of the effects. His micro-management has caused severe effect for dozens of lives, not only the students that have their studies postponed and their degrees put-on hold. But the lives at Mulago and affiliates have been hurt.
The innocent children born into the world, doesn’t care about misrepresentation, taxation without representation or skimming funds. They care about their sanitary, loving mother and father; and occasionally food. They don’t care about the flashy cars for the MPs or the Ministry of Health Sarah Opendi’s resignation to the force of Janet Museveni.
Each family that has been affected by the decision of the President should be asked for forgiveness from the state, they lost their new-born. They lost their kid and the future of new-born something that should been made sure by the state. The State lost their way when they are responsible for the neglect of taking care of the mother and her baby at the hospital. That is supposed to be a safe-zone and make sure the families are in good hands. Each one of them are one too many to lose. The President has their souls on his hand, since he caused the effect and made the decision to suspend Makerere University. That has in return cause the innocent loss of lives.
This is how much that the President cares about the civil service, his teachers, his ministries and the citizens. He offers a Visitations Committee instead of allocating funds and giving way so that the Makerere can open and save life. More the public display of utter nonsense is more casual than actually acting on the loss of life. The innocent lives dies while the President orders are lingering, not only at Kawempe Hospital, but at the regions of Isingiro and Karamoja; the President couldn’t care less as the help showed has to be shown on the NTV and UBC before he cares.
The reckless policies and ineffective are now insulting to the public in Uganda, time for President Museveni to take charge and show leadership; has to make the right decisions and might even have to cough up some ghost-monies, some other shadow funding to pay his civil servants at the Hospitals and at the University! Peace.
Namagembe, Lilian – ‘Health ministry stuck as Mulago crisis deepens after Makerere closure’ (11.11.2016) link: http://www.monitor.co.ug/News/National/Health-ministry-Mulago-crisis-deepens-Makerere-closure/688334-3448994-747buj/index.html
Mugume, Paul – ‘Minister Opendi Speaks Out on Neonatal Deaths at Kawempe Hospital’ (23.11.2016) link: http://www.chimpreports.com/minister-opendi-speaks-out-on-neonatal-deaths-at-kawempe-hospital/
There been reported how the Global Fund has gone through and report how the donor funds to Government of Uganda (GoU) and the Ministry of Health. As the Value for Money way of auditing and describing the state of the programs that has been funded by this donor funding; this is especially against the diseases like Tuberculosis, HIV/AIDS and Malaria. This is the situation of the funds and how it was used. This is interesting to see how the Government of Uganda has been coming to accountability and responsibility toward the procurement and accessing the monies, as they was not using the allocated funds or unaccounted for. There is questions for why certain projects are so slow in procurement and why there is too little of specialized kits in the National Medicine Stores (NMS) as they had budget for a dozen more than; when the audit was happening. That is a worrying sign. But look at the quotes from the Global Fund report from February 2016, and see what the important pieces from it are!
“The Global Fund support in Uganda:
Since its inception in Uganda in 2002, the Global Fund has signed a total of 20 grants amounting to USD 1 billion, USD 623 million of which had been disbursed to the country at the time of the audit” (…)”The grants are implemented by two Principal Recipients, The Ministry of Finance Planning and Economic Development and The AIDS Support Organization (TASO). The Ministry of Finance has delegated responsibilities with respect to implementation of the grants to the Ministry of Health” (…)”Approximately 90% of Global Fund grants to Uganda are spent on the procurement of medicines and health products. The Secretariat’s Pooled Procurement Mechanism procures all health commodities with the exception of tuberculosis drugs which are procured by the Global Drug Facility” (P: 4, 2016).
Ratings of the work:
The rating of the operations tells a story on how the services are delivered in the country. As the Programmatic and Performance where you can see the accuracy and support decision making to check the quality service, second part is the Financial and Fiduciary how to use the actual grants and check them in an effective manner, this two both the Programmatic and Performance, and the Financial and Fiduciary is handled in a Partial Plan to become Effective (P: 5, 2016).
The Health service and Products which is the ability of the supply chain, deliver services, account the quality assured medicines and health manners in timely manner; the second rated work is the Governance, Oversight and Management it is the quadrate and the effectiveness of the grants and implementations of the arrangements. These two parts is not run effective by the government (P: 5, 2016).
“The Global Fund has signed a total of 20 grants amounting to USD 1 billion, USD 623 million of which has been disbursed to the Republic of Uganda since 2002” (…) ”Approximately 90% of grant funds are spent on the procurement, storage and distribution of health commodities. The Global Fund’s Pooled Procurement Mechanism buys the majority of the medicines and health products on behalf of the country, which has significantly improved procurement timelines and reduced commodity prices” (…)”Uganda has made progress in the control and treatment of HIV, tuberculosis and malaria with a reduction in new infections and/or incidence. However, if unaddressed, pervasive stock-outs of key medicines at all levels will result in treatment disruption for patients. Seventy per cent of the 50 health facilities visited during the audit reported stock-outs of at least one critical medicine, with HIV drugs being the most affected of the three diseases” (…) ”Differences of USD 21.4 million were noted between book and actual stocks at the National Medical Stores for 15 commodity types procured by the government and the Global Fund. The audit could not apportion the variance between the government and the Global Fund since the stores’ inventory system does not segregate physical stocks by source” (…) ”16.5 million condoms that should have been distributed for free were sold through social marketing. The funds generated from the sales (USD 0.2 million) remain unaccounted for” (P: 6, 2016).
Executive Summary Part II:
“The country’s change of HIV treatment policy and scale up plans have increased the number of patients eligible for treatment without a corresponding increase in government funding. This will result in a treatment funding gap of at least USD 90 million in 2016 if not addressed.
Consequently, the Global Fund is ‘front-loading’ commodities planned for 2016/17 to 2015 to address medicine shortages” (…)”Twelve per cent out of the 50 facilities visited were performing HIV tests with expired test kits and, contrary to national guidelines, 14% of facilities visited did not perform confirmatory tests on clients diagnosed as HIV positive. This raises the risk of clients getting false HIV results” (…)”The Secretariat, in collaboration with the Ministry of Health, has introduced data quality assessments. Vacant positions are to be filled to address the data related issues. However, funding for tools, training and supervision remains a challenge” (…)”There was also weak management of advances with some remaining outstanding for over 20 months. Value added taxes amounting to USD 0.3 million had also not been refunded to the programs. The audit identified expenses for which there was not adequate supporting documentation, amounting to USD 3.9 million” (…)”While the country lacks adequate funding to cover key activities, it has a low absorption of the limited grant funds that are sent to the country. The OIG noted that only 46% of funds disbursed to the Ministry of Finance between January 2013 and June 2015 had been spent at the time of the audit” (P: 7, 2016).
“70% of the health facilities reported stock-outs of anti-retroviral medicines and HIV test kits of between three weeks and four months” (…)”68% of facilities reported stock outs of anti-malaria medicines and test kits in the previous six-month period” (…)”64% of the facilities reported stock-outs of TB medicines of between one week and three months” (P: 9, 2016).
“Use of medicines to treat other diseases: The audit noted that 32% of the 50 facilities visited treated 1,254 Hepatitis B patients with anti-retroviral medicines. The quantification of anti-retroviral medicines does not take into consideration their use for the treatment for Hepatitis B patients. This has contributed to stock-outs of anti-retroviral medicines for HIV patients who are the primary target of these medicines” (P: 9, 2016).
Gaps in HIV counselling and testing practices:
“Twelve per cent out of the 50 facilities visited were performing HIV tests with expired test kits” (…)”Contrary to national guidelines, 14% of the facilities visited did not perform confirmatory tests on clients diagnosed as HIV positive” (P: 11, 2016).
Inadequate and ineffective condom procurement and distribution processes:
“Condoms that should have been received in country in 2011 were only received in late 2013 due to a protracted procurement processes” (…)”Contrary to the grant agreement, 16.5 million condoms that should have been distributed to users for free were provided to Marie Stopes Uganda, a contractor, by the Ministry of Health and sold through a social marketing mechanism” (P: 12, 2016).
Subsidized anti-malarial medicines not accessible and affordable:
“Consequently, medicines are sold above the recommended price that is UGX 5,000 and not UGX 3,500” (…)”there is no instituted mechanism to ensure that the subsidized medicines are distributed outside the big cities to malaria endemic areas” (P: 12, 2016). “Key positions budgeted for under the Global Fund grants also remained vacant: for example, 17 out of the 43 pharmacists and HIV, TB and malaria focal points for the regional performance monitoring teams were not at post during the audit” (P: 13, 2016).
Difference between what they have funded to get and what they had at NMS:
“Between Global Fund commodities issued by national Medical Stores and received by health facilities: The National Medical Stores inventory system indicated that 3.7 million test kits had been issued to a facility, but the facility recorded a receipt of only 3,000 kits. While the National Medical Stores indicated that the variance amounting to USD 2.41 million may be due to errors in the inventory management system, this could not be verified by the OIG auditors. The variance also affects the closing quantities based on the inventory management system and actual stock at the national medical stores” (P: 14, 2016).
“In-country quality assurance of medicines: The National Drug Authority charges 2% (amounting to USD 3.8 million from January 2013 to June 2015)39 of the “free on board” value of medicines and pharmaceutical products for in-country quality assurance. While bed nets and condoms had been tested, there was no evidence that medicines (including anti-malaria and anti-retroviral) supplied by the Global Fund were tested by the Authority” (P: 15, 2016).
“Questionable value for money: Charges of USD 3.8 million (from January 2013 to June 2015) by the National Drug Authority for testing of medicines, for which there is no evidence that testing actually happened” (…)”Cancellation of an order for the purchase of HIV test kits under the Pooled Procurement Mechanism which has resulted in a loss of USD 427,500. The manufacturer has indicated that the commodities have already been manufactured and cannot be supplied to any other country due to level of customization requested by the Ministry of Health” (…)”Payments amounting to USD 254,921 related to value added taxes that has not been refunded by government” (…)”The implementers incurred ineligible payments amounting to USD 93,400. These related to payments for activities not included in the approved grant budget, or excess payments to service providers” (P: 19, 2016).
This here shows worrying signs as the Health Care and Global Funds is either not utilized or misused, understocked even when the NMS is supposed to have dozen of kits for instance. The amount of monies not allocated even when budget for. That is a normal issue for the Government of Uganda under the NRM-Regime.
Just like the condoms that was supposed to enter Uganda in 2011, arrived in 2013. That proves the ability of the government to stall the procurement even when they have donor-funding to get the necessities. One key issue is that health facilities are lacking the necessary medicines for the treatment of Tuberculosis, HIV/AIDS and Malaria. The planning for securing the allocations is also lacking, therefore the planning and allocations is missing even when the funding from Global Funds is there, showing that the transactions between the Government of Uganda, National Medical Stores(NMS) and the International Companies who make the kits and medicine. Another factor is the longstanding time the health facilities are without needed medications and that should be worrying for the Ministry of Health.
The worst thing about this is that people who need the treatment have to wait for it or not get it in time as the health care facilities do not have it. That is the thing that worries me while reading through it, seeing the person who needs the care and medicine not getting it. So the Government of Uganda, Ministry of Health and National Medical Store (NMS) has a decent job to do. Especially since the matter of making procurement procedure and facilitate together with the different parts of governments organizations to deliver to the patient at a facility or the pharmacy. Peace.
The Global Fund – ‘Audit Report Global Fund Grants to the Republic of Uganda’ (26.02.2016) – Geneva, Switzerland.
“Uganda holds an election this Thursday and President Yoweri Museveni’s 30 years in power is at stake. One major issue is healthcare and whether the President has done enough after opposition leader, Kizza Besigne exposed the condition of the medical system. Catherine Byaruhanga reports.” (BBC News).