Press Release by the Secretary to the Authority National Drug Authority: Clarification on Drugs Recalled by National Drug Authority (13.12.2019)

Mzee complains today about waste, however he haven’t rehabilitated sugar industry or revamped pharmaceutical industry either!

“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 8^th 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.

Even when the Ugandan Gov. have the funds for health care and medicine; they still mismanage the funds or does not procure the necessary kits, staff or proof of use of the Global Funds; findings from the Audit Report of February of 2016 from The Global Funds!

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).

Executive Summary:

“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).

Pervasive stock-outs:

“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).

Afterthought:

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.

Reference:

The Global Fund – ‘Audit Report Global Fund Grants to the Republic of Uganda’ (26.02.2016) – Geneva, Switzerland.

Uganda – The Annual Report Audit General for FY ended 2014 – Value for Money Audit Volum 5: Quotes and Outtakes from this.

This blog here will be focused on the ‘Office of the Auditor General’ who released ‘Annual report of the Auditor General for the Financial Year ended 30^th June 2014 – Volume 5 Value for Money Audit’. What you will read is actual quotes from the paper or report. Here you get a vivid picture of how the financial year (FY 2013-2014) was in reality.

I haven’t taken everything from the piece. It would be too long and you might end up bored. Here is what should get your mind boggling and wonder. How could this be this way? Why is it like this? How did it end up like this? What does this tell me about the economic practices in Uganda? And so on. If you start to think like that, then it was worth using my time. Enjoy the quotes from the report. Hope you catch some wisdom.

When it comes to managing Public Debt:

“Public debt is incurred primarily for financing budget deficits, development of domestic financial markets, supporting the country’s Balance of Payment (BOP) position/foreign reserves and monetary policy objectives. In Uganda, public debt is managed by the Ministry of Finance, Planning and Economic Development (MoFPED) in liaison with Bank of Uganda (BoU). Government borrows internally from domestic markets through issuance of Treasury bills and Bonds by the BoU and externally through Bilateral and multilateral borrowings. Currently, over 60% of the public debt is external debt and 40% is domestic debt. GoU borrowing has been rising over the years from USD 5.7 billion in Financial Year (FY) 2011/12 to USD 7 billion in FY 2013/14. The growing National debt, if not properly managed, could revert to unsustainable levels as was the case in the past”.

“Interest rates on domestic debt have overall stabilised in recent years relative to their peak in 2011/12. However, they remain a cause for concern due to their high contribution to overall debt service costs and the relatively high yields which they attract stand in stark contrast to those achieved by comparator nations with similar credit ratings”.

When it comes to roads:

“The Uganda Road Fund invested a total of UGX 914 billion in road maintenance activities during the three years under review (2011/2012, 2012/2013 and 2013/2014),4 with a total of 4,565km of roads maintained. Despite the increasing investment, there are reports and persistent public outcry about the poor state of roads and the deteriorating quality of works being executed. The physical and financial performance reports of designated agencies in FY 2011/12 revealed the following issues: budget indiscipline, poor absorption of road maintenance funds, inaccuracies in reporting, lethargy of Designated Agencies (DAs) in complying with reporting requirements, widely varying unit costs, risk of loss of funds through end of year procedures, and grave underperformance of periodic maintenance works” (…) ”The road maintenance needs in Uganda cannot be met due to limited resources, for example for FY 2011/2012, the total maintenance needs from the agencies was UGX 413.95bn, and the budget provided by the Ministry of Finance, Planning and Economic Development (MoFPED) was UGX 280.95bn, indicating a 32% deficit” (…) “The road maintenance equipment inventory maintained by the URF is incomplete; the inventory is only for 12 (55%) of the municipalities and it is outdated as it was submitted in January 2011”.

When it comes to Gas and Oil:

“Through a review of reports on procurement submitted by the oil companies to PEPD, it was noted that from 2010-2013, the oil companies spent a total of USD 1,171.8 million on purchase of goods and services. Of this, USD 329.9 million was paid to Ugandan service providers, representing 28% of the total spend for all the companies in the period under review” (…) “The Ugandan service providers comprised about 73% of the approved suppliers which implies that the total value of the procurements from them was less than their relative number” (…) “Ugandans employed in the oil and gas sector by the oil companies overall rose from 69% in 2012 to 80% in 2014, absolute numbers of employees decreased from 546 to 432 between 2013 and 2014; in particular, the nationals dropped from 370 to 347 over the same period” (…) “For all the 27 jobs advertised in the newspapers, attracting over 700 local applicants, none was appointed, citing lack of experience in the oil and gas sector. Instead, the recruitment report submitted by the CNOOC to PEPD recommended recruitment of expatriates” (…) “According to the Industrial baseline survey done by the Joint Venture partners (CNOOC, TEP and TUOP), 60% of the workforce required for the next phases will be technicians and craftsmen, which translates to a demand of 7,800 and 1,800 technicians and craftsmen at the peak and plateau phases, respectively, of development and production. With the current total of only 86 UPIK graduates, there is doubt that the projected demand will be met by the time production starts (2018)” (…) “There are still several areas with clear potential for enhancing national content, such as: establishment of a clear regulatory framework, performance targets and indicators for national content; determining the level of state participation; local supplier development; employment and training of Nationals by the oil companies and government; ensuring gender parity and involving host communities”.

When it comes to the Healthcare:

“The Uganda Health Systems Strengthening Project (UHSSP) is a project administered under the Ministry of Health (MoH)” (…) “UHSSP, is a five year project, which was established in 2010, commenced operations in February 2011 and is due to end on 31st July 2015. The UHSSP project is jointly funded by the Government of Uganda (GoU) and the World Bank to a tune of USD 14.31 million and USD 130 million, respectively” (…) “UHSSP was set up to bridge the existing gap of supply and maintenance of medical equipment in 46 selected health facilities in order to improve the quality of health care delivered to patients. The project has spent USD 24 million (UGX 60.480 billion) on procurement and supply of these medical equipment, yet some of the equipment remains unused in the facilities where it was supplied” (…) “For instance, at the time of audit field visit in September 2014, the project had supplied anesthetics machines to 165 HCIVs at a cost of USD 2,063,085.75, however, all the HCIVs visited were not utilising this equipment because they lacked the technical expertise to effectively utilise the equipment. In a related instance, 2 auto strainers valued at USD 25,345.68, which were issued to Mubende and Moroto Regional Referral Hospitals, are not operational because of lack of qualified staff” (…) “observations conducted during field visits to the seventeen selected beneficiary health facilities, it was noted that some of the equipment supplied, worth Euros 3,954.67 and USD 1,209,879.09, was not being used at all while other equipment was not optimally utilized” (…) “Through field inspections, it was observed that health facilities namely Mwizi had no power supply while others such as: Moyo, Aduku, Aboke Pakwach had unreliable solar power supply, and therefore, were not providing emergency obstetric care services when needed” (…) “that various equipment supplied by the project, worth USD 319,676.35 and Euros 347.24, required additional logistical supplies to be effectively put to use. Such equipment included anesthesia units which required regulators, oxygen cylinders and other reagents while incubator cultures, incubator baby, defribrators, counting chamber, colorimeter required Medias, distilled water, thermometers, tubes and batteries”.

When it comes to handling Public Debt Part 2:

“Uganda benefited from the various Debt relief initiatives like the Heavily Indebted Poor Country (HIPC) Initiative in 1998, the Enhanced HIPC in 2000 and the Multilateral Debt Relief Initiative (MDRI) in 2006. Despite these initiatives, GoU borrowing has been rising over the years from USD 5.7 billion in Financial Year (FY) 2011/12 to USD 7 billion in FY 2013/14. The growing National debt, if not properly managed, could revert to unsustainable levels as was the case in the past” (…) “In the FY 2013/14 Public debt increased to USD 7 billion up from USD 6.4 billion in F/Y 2012/13, reflecting a 9.38% increment in one year alone, the increment was way above the GDP growth of 6.2% in the FY 2013/14. Domestic debt accounted for 9.55% (UGX 1,437 billion) of the National budget, 2014/15 an increase of 1.65% (UGX 397 billion) from 7.9% (UGX 1,040 billion) in financialyear 2013/14. External financing on the other hand increased from UGX 2,660 billion in F/Y 2013/14 to UGX 2,733 billion of the National budget, 2014/15 an increase of UGX 73 billion. As non-concessional borrowing increases, the need for proper debt management becomes even much greater” (…) “On average, 60% of public debt is external loans of which Multilateral loans constitute over 80%. The domestic debt is largely derived from the sale of bonds which constituted an average of about 60% over the period FY2011/12 – 2013/14 “ (…) “In evaluating whether the debt, acquisition process facilitates debt sustainability, the audit mainly focussed on the acquisition of external debt since it constitutes over 60% of the National debt portfolio” (…) “The 2012 corruption scandal involving the Prime Minister’s office resulted in a changed relationship between multilateral lenders to the Ugandan government and a consequent reduction in the amount of aid in the form of direct budget support. Budget support in 2011/12 amounted to 168m USD, but reduced to 24.1m USD in 2013/14. The shortfall has in part been filled through domestic financing” (…) “The lack of coordination between debt and cash management functions contributed to inaccurate forecasting of cash needs. This exacerbated the problem of unplanned cuts to government programmes and led to the needless issuance of short-term debt, with the associated debt service costs” (…) “it was noted that local government authorities still held significant cash balances accrued from non-tax revenues and unutilised balances which were not remitted to the Consolidated Fund regularly, and that some accounts containing cash lay dormant, risking embezzlement” (…) “the current economic conditions characterised by reduced exports and a depreciating Ugandan Shilling against the dollar (30% for the last 4 months) there is a risk of stress which can affect future sustainability. Interest rates on domestic debt remain a cause for concern due to their high contribution to overall debt service costs (78%)”

When it comes to Health Care Part 2:

“Over the past three financial years 2011/12, 2012/13 and 2013/14, there has been an 18% increment in the funding of RRHs from UGX 53.86 billion to UGX 63.56 billion” (…) “Jinja nd Lira RRHs revealed that Jinja RRH which ran a 13-bed Intensive Care unit only used 6 of the beds, leaving 7 beds idle in the unit while Lira RRH had not utilized its 16-bed ICU since FY 2012/13. The Hospital Directors of Jinja and Lira RRHs explained that more nurses wouldhave to be deployed as each bed required at least 2 full time nurses to the unit to ensure full utilisation of the unit without compromising the quality of care. The unit would also require full time doctors and an anaesthesiologist. In Lira RRH, management explained that the ICU had not been commissioned and that its underutilisation was also due to the absence of an oxygen plant” (…) “With the current ICU bed capacity in Uganda of 61 in all public and private hospitals, 23 unutilized ICU beds in Jinja and Lira represents a wasted resource. It is estimated that about 10 critically ill patients were deprived of ICU admission daily and as a result succumbed to their illnesses” (…) “Hospital managers in response attributed this to the lack of bio medical engineers and high costs of repairing the equipment, for instance, according to Jinja RRH, the maintenance of the En-Visor ultra sound machine and the repairs of the Duo-Diagnostic big x-ray machine requires not less than UGX 15 million, and without a medical equipment maintenance fund, it is a challenge to maintain and repair the radiology and imaging machines. Management of Fort Portal RRH attributed the low usage of the x-ray and ultrasound machines to stock-outs of the supplies, such as reagents and films required for the operation of this diagnostic equipment” (…) “The average doctor-patient ratio per year in RRHs was 12440:1 implying one doctor for 34 patients per day while clinician- patient ratio was 10652:1 annually implying one clinician for 29 patients” (…) “For example; Kabale, Fort Portal, Masaka and Mbale Regional Hospitals referred some special cases to Mbarara RRH for services like CT scan, renal dialysis, neurosurgeon, paediatric surgery. In addition, lack of adequate staff has led to referrals to the National Referral Hospital and this has further resulted in the congestion and handling of cases at National Referral Hospital which cases could be handled by the RRHs. The process of referrals is costly and in some cases patients lose their lives in the process of reaching the health facility to which they have been referred”.

 When it comes to Management of Sewage in Urban areas:

“Poor sanitation costs Uganda 389 billion shillings annually, equivalent to 1.1% of the national GDP” (…) “Fifty six percent (56%) of the pipes in Kampala were built in the 1940s and 86% of these have been operational for 35 years or more” (…) “National Water and Sewerage Corporation (NWSC)” (…) “NWSC had spent UGX 10.9billion towards sewage management activities in the areas under its jurisdiction over the last three years” (…) “the volume of sewage generated in the different towns and the volume of sewage collected and treated by NWSC, a study conducted by Mott Macdonald on behalf of NWSC in December 2012 estimated that by 2014, a total of 238.9 ML of wastewater would be generated of which, only 8.38ML would be collected and treated. This leaves approximately 230.52 ML of generated sewage uncollected and therefore not treated”.

Short ending:

I hope this was worth your time and also giving you an indication on the matters on the ground. This is just a fragment on the matters and what got told in the report. This just comes as gift to you. Especially to all of you who don’t use time reading the report on your free will or are lucky enough to get the report in your mailbox. Never the less, hope you got enlighten and also got a picture on how the monies is spent in last FY. Peace.