“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 is growing concern not because of the World Bank suspending loans and funds to the development projects or anything else. The ways the allocated funds and tax funds are used in the 10th Parliament shows their level of reckless spending and no concern of accountability.
This happens on the week the Daily Monitor shows reports of 80% of Primary Teachers that teach who can’t read while being government civil servants. These Teachers are the ones learning their inabilities to the future. So the misappropriate funds for the Educational Sector comes into fruition. The Universal Primary Education is surely improperly balanced together with the mismanagement of buildings and salaries; if they get salaries that usually never on time, teachers can wait for months upon months to get their pay. There are enough fallen and depleted schools.
While the Education Sector is in shambles the Members of Parliaments are allocating more money for their private cars. So they can drive around like King-pins in their constituency. They can ride around in the Toyotal Land Cruiser Prado and feel special while their citizens they represent have teachers who can’t read and supposed to teach Vincent grammar. That is just so special ignorance of their duty those 30 years of the Movement should have had enough time to make difference and not make the schooling system weaker.
This is happening in the week that the imported Anti-Retroviral Drugs (ARDs) where National Medical Store (NMS) are distributing medicines, but they are sold more expensively locally than internationally. The Ugandan population are doing the same as Americans who pays an extra fortune for their EpiPen Auto-Injector. Together with the other issues around in the Hospitals like Uganda Cancer Institute and their breakdown of hte Cobalt 60 Teletherapy Machine. That still isn’t fixed and was the only one in the great nation.
While the Health Care and Health Sector are not as functional as it should be. While this is happening the MPs have allocated funds and bought Tablets or Ipad’s for a fortune for themselves. Because these MPs need tablets to write notes and such even if am not sure Prime Minister Dr. Ruhakana Ruganda or Vice-President Edward Ssekandi can even use one of them. So they spending a on this while medicines are missing or empty at a time or another.
The MPs salaries, the MPs Allowance and the MPs wish to exempt their salaries from Tax. Together with appropriating lots of funds for travelling for days to the United States and Boston for a Seminar; together with the extended funds for burials, this is happening so they can have an extravagant lifestyle into the casket.
This is happening while the government institutions and programs are weak or nearly non-existence. They have surely ghosts like the ghost SACCO Mzee gave to a non-existing organization. While the MPs representing their people are living like royals in the National Assembly with fancy cars and houses while the unemployment levels are still strong and the educations of their kids are made by teachers who can’t even write. This shouldn’t be happening, but apparently it is.
The Governance is not really happening. Because the government are not steering towards any place, they are walking on clouds and not taking steps to change the deteriorating state of education and health care.
This is happening while the Government are adding more debt and is by end of the year having over UGX 26 Trillion. This is happening while the Roads Development that been borrowed to Uganda National Roads Authority from the World Bank has been suspended. So the worsen economic situation together with lack of funds for fiscal cash proves the weakness of the economy and the national policies.
This is happening also while the Ugandan Government has to tackle more refugees in Adjumani and other districts towards South Sudan as the neighbour continues with internal fighting. This together with the fluid borders into Democratic Republic of Congo. This has been done with armies and guerrillas in the past to get resources something that has led to another expensive debt to DRC for the Ugandan State.
So the mismanagement and maladministration of the Movement that have had the time to fix it has apparently been more sucked into their own rich-elite oblivion instead of serving their people. That is why the MPs are so into fixing themselves up nicely while the other are living in midst of utter poverty. So the debt is rising and inflation is rising. So the value of shilling isn’t worth much while the imports are more needed. NRM Regime is not having a fiscal policy as they are loose with spending without having secured funding. While making grand plans without having the output to secure borrowing…
I am sure there more things that could be discussed, but this is more than enough for today. As the proof is in the pudding; the budget and the inflated expenses of the Parliament shows how little accountability and transparency of their acts are. This is with the knowledge of months after the General Election 2016… the State House we’re broke right after for those that forgotten. Since the State House had used it resources in the Campaign that cost fortunes and after the election they had to get funds to pay the running expenses.
You think the government should be carrying itself better after been ruling for 30 years, but they are not. They are running like lackeys thieving the little pieces they can instead of building. Therefore the MPs are running the mill like the ability is only counted for when they are pocketed. That is why the greed of getting brown-envelopes is coming when the Mzee needs bills to pass. They get both monies and valuable produce to sell after being in the National Assembly. So with this in mind, the Speaker Rebecca Kadaga should silence herself and take care of her people instead of blaming the media… because they account to the people and the MPs should be more careful spending taxpayer’s monies, instead they use the budget for their own sake and not for the citizens who bleed for this. Peace.
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.