Tag: National Medical Store
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 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.
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Opinion: Mzee don’t want to bother foreign investors with taxes, just give him a Presidential Handshakes!
Well, I am biased, as the President are visiting Dubai for 4th Global Business Forum on Africa on the 2nd November 2017. President Yoweri Kaguta Museveni is trying to cater to foreign investors. People who he usually cater to at the State House, so he can get favors and Presidential Handshakes. That is why he isn’t bothered with taxes, because the tax-holidays and possible offerings will be huge for the investors who comes in. That is what the National Resistance Movement (NRM) are doing, especially if it is for instance a nations offering the state loan, than the same state can come with state-companies to build infrastructure like Chinese companies coming in after offering loans to the same NRM government. Therefore, just look at what he was saying yesterday, which is weird, but fit a pattern.
“Since you are business people, we must be talking about profits. When you talk of Uganda and Africa, you are talking about peace as an enabling environment; which we have. We have raw materials, and have a population of 40 million people that’s’ a market. And if we talk of integration we have a four tear market” (…) “In Africa, the demand is there and growing because we have been under-consuming while the rest of the world the demand is falling because they have been over consuming” (…) “There are plenty of raw materials, minerals, tourism and so on so when you invest there you have access to all these” (…) “I don’t have to bother investors with taxes, what I want is for them to invest, use our raw materials, create jobs, add value and promote exports” (State House Uganda, 2017).
Well, so the President trying to say to foreign investors, you don’t need to pay taxes for your output, just cater to me. The state you don’t have to bother about, just bother about catering to the State House and me. We will add value and promote exports, we will agreements and make sure you get the value on our resources and low-payed workers.
We know who is the biggest taxpayers in the republic, because of Uganda Revenue Authority own statement in the media on the 31st October 2017, which stated names like Mr. Alnasir Virani Gulam Hussein Habib, Dr. Sudhir Ruparelia, Mohammed Hussain, Nakayima Janat, Karia Minex, Karia Kunnal, Alykhan Hudani and Dayalijil Karan. Who are sounding like foreign investors and they are on the top 25 biggest taxpayers in Uganda. So the state has already connected families from abroad to invest there in various businesses. This shows there are already people who is not worried about taxes, but about the output of their companies.
Some of these investors has made big names, while others have worked more in silence. Still, this shows that the top earners even promoted by URA and Doris Akol. Proves how they are working, as there wasn’t that many own citizens on the list. That shows that the foreign investors must get a special advantage and special agreements at the state house for their dealings. Especially, considering how it has been done, just for tearing down markets in Kampala for own investors and financial agreements. This has been done and arranged from the State House without consultation with locals, neither KCCA or the renters of these markets. That is how the NRM and Museveni do deals in favor of him and if he get ill-gained funds, he will support the “development”. It is in similar fashion he exposes his intent in Dubai.
That the State doesn’t need taxes or need structures to facilitate for foreign investors, they just needs agreements with State House and then it is all fair-game. It is insane, but fits the Modus Operandi of the Musevenism and NRM regime. Give him a Presidential Handshake and you can operate as you want in the Republic. Peace.
Reference:
State House Uganda – ‘President Museveni woos Arab investors to Uganda “We have the raw materials, human resource and market”’ (02.11.2017) link: https://www.africa-newsroom.com/press/president-museveni-woos-arab-investors-to-uganda-we-have-the-raw-materials-human-resource-and-market?lang=en
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Opinion: It’s ironic that President Museveni is talking about disciplining the government!
“The three arms of government and their sub-branches must have discipline. For example I have been involved in disciplining the army. We should do the same for other sub-branches of government. If the Judiciary is also disciplined in fighting corruption, citizens will lead a good life.” – Yoweri Kaguta Museveni on the 1st October 2017, State House Entebbe.
Its just one of these days that hearing the news and seeing the tweets of the President, makes me laugh and wonder if he listen to himself. He knows his system and has made his garden. The way the government steers and govern is because of his policies, his regulations and his support. It is not like there been other ruling for last 30 years in Uganda. The Republic has been under the control of Museveni and his National Resistance Movement (NRM).
The NRM has suffocated all other free-will and control. Therefore, Ministers, Members of Parliament and others seek guidance and funds directly at the State House in Entebbe. Even foreign investors meet there to make agreements. Everything is nearly sanctioned out there. The Discipline now is more on the narrow-minded government that is run from there. The institutions and the procedures are not so important. Since most things happening is with the words from “above”, meaning the President and his close advisers.
It is not rocket science to know where the benefactor or the reason for lacking structures. That is because government waits for their go sign by the State House, they are waiting for funding of the projects and institutions from the State House. The projects and the works of the State House and under the Prime Ministers Offices are the key organizations within this government. They might say all of the massive cabinet has part to play, but that is the facade.
Therefore, it is ironic for a man so controlling and so disorganized that it gives sometimes way to the unthinkable. Just like the Presidential Handshake, that was sanctioned by the State House, but taken form the wrong account. That was the problem for the President, not that the corrupt behavior was occurring on his watch. Its like he talks against himself. Because he has no problem speaking anti-corruption, but if corruption benefit his cronies – its fine and dandy!
I am not surprised by him at this point of time, its fit his narrative. He says what he expects and wants out of others, but the next day he finds a way to benefit or use the loyalty of his cronies. Not like he would have excepted the UCC not to listen and stop the suspended MPs to hit the airways and be broadcast on TV. He rather being himself on radio and in the spotlight, but will accept anyone else sharing the same space.
President Museveni is the proof of someone saying something noble, but doing opposite. He might say something insane, but act rational. Therefore, you never know where you have him. I will never believe him actually disciplining the government, if doing so. It means they are all blindfolded and following his guidelines. It does not mean building proper governance and protocol, neither is institutionalize the departments and ministries, it is all about his will and his stature.
When it comes to Museveni, discipline is about following him. Not building transparent and proper government institutions. Peace.
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NRM Letter to President Museveni: “Re: Memorandum of Important Issues Affecting Our Party and The Running of Government under the National Resistance Movement” (03.03.2017)
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Opinion: Tired of NRM apologists defending the record of President Museveni!
It is depressing, it is sad and it tormenting to listen and read the defenses of National Resistance Movement. The defense of the 31 years of rule, the rule of the for life President Yoweri Kaguta Museveni and his cronies. The cronies and their 10th Parliament, the By-Elections that are rigged in favor of the NRM Regime. The government of Uganda is totally controlled by the one in-charge, the President and kingpin.
The Parliament are following orders and making amends to seem to be different. Therefore, the results of elections are more to just show overpower, but not to have real elections. As the NRM sends buses and pays of villages with small-fees and commodities. There aren’t anything fruitful or sincere by the regime. The ones who put dissidents in the Nalufenya prison. Where they will be beaten, tortured and get ill. As well, as in the overcrowded prison in Luzira. The organized silence of opposition, as their rallies are filled with tear-gas and police brutality. If not the ones who are feared by the NRM are put on treason charges and called terrorists.
President Museveni with his patronage, his bloated State House, the massive cabinet and the Presidential Advisors. There certainly enough ghosts, fake bills and misuse of state reserves to write books ten times thicker than the bible. We can know by the lost trillions of the Petroleum monies, as the “Presidential Handshake” is a drop in the ocean. As the UNRA and other agencies has misused the taxpayers monies. This happens with such ease and lacking finesse, but the agencies looking into graft and corruption is compromised, because the ones leading it are loyal Musevenist.
That the government and budgets are bloated. That the financial and economic state is in deep distress, as the state is suffering from lacking provisions and revenue. As well, as they are struggling with the stop of donor friendly relationships. People’s and Foreigners trust in the leadership of Museveni has been dwindling. President Museveni are also already prospecting the revenue of the oil and petroleum, even before it has surfaced. Therefore, the future will also be compromised by the deals done today.
The defenders of the NRM now, does not believe in real democracy, as they defending the rigging and militant Movement. A President who has no trouble with killing and destroying to stay in power. The ones defending him has no trouble to stand by a man who empties the treasury and state reserves with no hesitation. As well, as the men and woman who stays by the regime, are easily taking land and resources, they are eating of the plate and selling it back to the Ugandans. This with impunity and without any consideration of the ones who loses their chances.
It is a nation who has a government, not based on merit, but on loyalty. The loyalty to Museveni and his agenda. The agenda to work for him and his ideas. Not work to develop the nation, but develop the estate of Museveni. The idea of real Movement is ploy from the master himself. He just needs shadows to work for him and for envelopes. Not a real party who deliver policy or working for the future Republic. No the Movement is now a shell used pounce out the empty ideas of greed, nurture of the estates of Museveni and of the staging the power of the old-man with the hat!
President Museveni and his apologists knows all of this, they live by this and has faith that this is ideal and the dream. That someone comes with empty promises and lives by the fake party celebrating the 1986 coup. The coup that overruled the government and the old constitution, that President Museveni couldn’t pigeonhole. That has he done to his own and plans to do it again for his 8th Term.
The apologists can say he created safety, but he also created warfare and civil-war to get to power. Some called it a revolution, other calls it a takeover. But with time it wasn’t for the idea of a people’s government, but more a government and state built around the revolutionary, who didn’t really believe in the words he spoke.
The ones defending him, is defending a lie and that for the sake of eating. Not for the benefit of the Republic or the public. The struggling public is pawns, they are just needed props now and then for the Movement. As they praise their master, as they know if they get to close or too ambitious they are surely losing their place. Therefore, all of them are loyal cadres, elite and patrons who surely basks in the pasture of the President. But really, they should know it is on borrowed time. No-one knows how long the patronage and military can be serviced, how long they can all live on the charade and the misuse of power.
Certainly, the President knows this too, therefore, he uses all ways to make sure and get people on board. Even if that lets people starve, let them cheat on food reliefs and even use refugees as bailing-out card on the struggling economy. That is solely made of the patronage and grand-corruption orchestrated from the seat of the President at the Okello House. He can created all sorts of schemes and manufacture new ways of promoting better agriculture or better yields, but it is all ploys of generating more funds for his own. Not for the public to earn or get better output of the seeds and seedlings. If so, than the agricultural should be booming after 30 years in power.
However, the defense of this will be in the patronage and by the spokespersons appointed by the President. These ones will make a fuzz and say the Opposition never was a viable option and never had the leadership to overturn the Movement. The Movement has always been the only option, they say and use new ways of saying so. But that doesn’t make it true, as the rigging and the intimidation is used to forge this facade. The flawless untouched ballots doesn’t exists, there has been all sorts of play to get the will of the President.
President Museveni, even detain opposition, he uses safe-houses and some like Sam Mugumya are detained in the Democratic Republic of Congo, with no plan of getting him home. Him and others are lingering abroad as the political prisoner lingers in uncertainty. This is the legacy of the revolutionary, who became the draconian and the militarized government who uses all means to stay. He uses all methods on earth, Machiavellian and Orwellian blended in a Yellow Color with no fear of repression… no fear that the Movement can be touched, but when the moment appear. Than the Ugandans shouldn’t lose it, because they have already lost so much in the name of Museveni. Museveni has stolen the past and the present. His men has rewritten the history and tried to become the grand hero, and the generations from the rebellion is dwindling away. The young generation only knows the folklore and should beware, it is not all what it seems. The ghosts are not only in the budgets, but they are haunting the President from the past. They are the ones he stole to gain power and to silence the opposition. These souls will ask in the after-life, why he did what he did to them and also why he punished their grand-kids. Since they all lead the same faith. They all got to feel the pain, with no mercy from the leadership controlled by the President.
That is why there are no defending a man like Museveni. He has used all tricks, even was able to deceive the west for decades to pay for his decadence. Certainly, he must laugh about the dumb-white men and their agendas. His grin must be wide thinking of all the sorts of cars, airplanes and ranch expansions that are paid by the friends of direct-state aid. They have kept his roof and his ammunition, to oppress and to relief his patronage. Therefore, if someone is defending this man. Think of his track-record and all the souls he has left behind. Peace.
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Opinion: These two ideas shouldn’t be thing in 2017: Goats for tuition fees and Jerrycan-Irrigation!
In the Republic of Uganda and Zimbabwe there are two issues that should not occur or need to happen, as the societies under Zimbabwean African National Union Patriotic Front (ZANU-PF) and National Resistance Movement (NRM), that President Robert Mugabe and President Yoweri Museveni has been the Executives for decades.
These two republics has both their issues concerning these gentleman, though not the same. Still, the republics has some dire needs. You know so, when President Museveni has to spread this message in the year of 2017:
“I continue to encourage farmers to use drip irrigation. Even as we wait for government to roll out mass irrigation, farmers can irrigate their crops with basic tools like bottles. No one should let seedlings go to waste on claims of drought yet we are surrounded by water” (Yoweri Museveni, 16.04.2017).
The Jerrycan and bottle irrigation mantra in the land of steady progress, you can wonder and pound about the agriculture reforms that was about to happen when the NRM came into power. Where the wealth creation and the cash crops we’re supposed to change the economic landscape. Still, since the Movement ceased power in 1986, the same President as back-then has to spread the message of a drip-drop irrigation system based on bottles and jerrycans. Instead of modern agriculture, because of how he misused the state reserves and the donated aid. Therefore, the lacking facilitation of agriculture. So it is sad to know that the President Museveni has to propagandize the jerrycan irrigation system, like it is a fantastic invention and something that would really be a paradigm shift.
Than you have in Zimbabwe, the county of the Lancaster House Agreement, the ZANU-PF elite and the Bond-Notes, with a massive movement behind the voices of opposition, as well as the financial troubles under President Mugabe. Who has turned the Southern African breadbasket unto a food-import heaven as his land-reforms has destroyed the agricultural production as well as the economic climate. Therefore this news shouldn’t be a thing of 2017!
“Parents who cannot raise tuition fees for children can offer livestock in lieu of payment or do chores for learning institutions, a Cabinet minister has said. The Sunday Mail understands that several State-run primary schools in Glen View, Harare have already adopted the arrangement. Primary and Secondary Education Minister Dr Lazarus Dokora told this paper last week, “Our schools have to be flexible and ensure those who do not have money to pay fees can work. For example, if there is a builder in the community, he/she must be given that opportunity to work as a form of payment of tuition fees” (…) “On the issue of livestock, the community has to arrange a market where everyone participates; from the school authorities, local leadership and parents themselves to avoid parents being duped” (Gwete, 2017).
So in the proud republic of Zimbabwe the Cabinet Minister Dr. Lazarus Dokora, says parents who doesn’t have enough cash to pay tuition fees can now pay in livestock or goats. We know by now that the faith in the Bond-Notes is abysmal, still that the Republic has such little cash flow; that can take animals as payments. Shows the neglect of the state, the little money circulation and the financial vows right now. If the financial market and the currency we’re in a better condition, than such massive amount of parents wouldn’t have to trade their goats and livestock so their kids can go to school.
That under President Mugabe, the citizens have to use their livestock and goats as trading tools, or even as currency because of the lack of stable financial policies. This shows the draconian state and what sort of government that is in charge. When they are more concerned about their Mercedes Benz’s than the population!
That the Zimbabwean people and citizens of the Republic run by Zanu-PF should feel betrayed by the lack of governance and care of the taxpayers funds. The Zimbabwean people should be in sorrow as even as their state is insufficient, it now has a plan not to only eat their monies, but also take their animals. So that the future of Zimbabwe can learn how to read and write, even type and some hopefully understanding better what it means to be a Statesmen. A Statesmen that cares about its constituent and their struggles, not just eat of it and leave them to rot. That is what the Zanu-PF elite does right now.
What we have have seen with these two stories is clear lack of policies and wish to intervene in the struggles of the citizens. We can see two governments, that is Zanu-PF and NRM, who clearly are both out-of-time and out-of-pocket as they scrap their best ideas to salvage some hope. The hope is that some can be duped by the idea and support the so-called progress. That it is progressive to take goats as currency to pay for tuition and the other revolutionary idea of using bottles and jerrycans to irrigate the dirt. That President Museveni and President Mugabe is over-due is proof with this. The milk is thick and nasty. The milk is not drinkable and if so you will vomit. The reality is that these men doesn’t see or doesn’t want to see.
They are eating of the plate and sells their propaganda, the own mindset of lies and deception, and it has been said so many times that the old-men believes. Even if it isn’t so. The manufactured reality and the destruction of the society, is the reasons for these tales, many factors involved, but the Presidents has been there through the stages. They have seen it all and created policies that has changed to this level of underdevelopment. If they really did care, than the countries would have looked different. If they would have created parliaments for serving cadres for the people and not their own bellies like right now. That is why many of them think these sort of policies are acceptable and even profess to them. Therefore, the republic’s are living in a state they doesn’t deserve and the citizens are used as pawns. Peace.
Reference:
Gwete, Wendy – ‘‘Pay school fees with goats, labour’ (15.02.2017) link:
http://www.sundaymail.co.zw/pay-school-fees-with-goats-labour/
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31st Celebration of NRM Regime with a Yellow Jerrycan’s into the future!
The National Resistance Movement had their Celebration Party and unleashed their new ruling-party national newspaper. I thought that was the New Vision? Apparently, I am other we’re wrong on the Bukedde and New Vision ass-kissing mission during the three decades of President Yoweri Kaguta Museveni. Well, there is so much to celebrate for the NRM!
They have yet another election that rigged and had a new number of sole candidates without any competitions. This is a real victory like stealing candy from a little kid. The NRM can be so celebratory as they are having a too small Parliament, having to few cars for their MPs, added more debt every year into the state coffers with added interest rates on these loans. Together with the waiting of petroleum monies that seems more and more likely to happen closer to 2020 than ever.
NRM can celebrate that they have had a bunch of Vice Presidents, but none has outlasted the long-serving rebel on the throne, that has installed the Jerrycan irrigations as the State cannot afford proper relief or modern irrigation to the their farmers. The cash crops are also struggling as well as staple-food, even the cattle is dying in the cattle-corridor. The NRM has certainly built a perfect nation.
The Uganda Airways, Uganda Telecom, Uganda Broadcasting Company and others are either gone, near depleted or living on their last legs. UTL the phone company is dead-broke and on life-support. UBC is the only State financed Television Company that couldn’t afford to get licence to send the African Cup of Nations from Gabon this AFCOM2017. NRM has so much to celebrate.
Certainly the lucky guests who got a Presidential Handshake can be all smiles and grin, as the illegitimate government are postponing and struggling with infrastructure projects, as they are all embezzlement projects for the UNRA to trick monies out of the state. The expenses or building roads have sky-rocketed, the Mukono – Katosi Road Project and Kampala – Entebbe Expressway is examples of the open-air bazar of looting under the NRM.
We can question the ambition of the NRM, as they have included all sorts of missions and promises. Most of them shelved out every election cycle, but then forgotten when the NRM MPs and President has entered the Parliament Avenue. The certainty of Steady Progress isn’t there, except for puppy talk of the loyal Musevenists.
This can be said as National Medicak Stores (NMS) are often empty of needed medicines or issuing issues with the sale of copy medicines that we’re not supposed to be on the market. The Hospitals lacking medicines, enough trained personnel, lacking payment structures and salaries as the nurses and teachers even have cash-crops or other jobs to survive. The lacking structure and care for the Health Care is evident as the Nobel men and honourable are travelling abroad for their curing of sickness, as even some of the Generals are suddenly dying as they are travelling to their Asian allies.
We can question if the NRM should celebrate that Nakasero Hospital is now seen as the National Referral Hospital instead of the historic hospital, the Kings Hospital Mulago, the Mulago Referral Hospital Complex that is even missing a well-working cancer machine. The only one that was last bought in 1990s and early in the reign of the NRM! The NRM forgot their mission and let it dwindle like so many other institutions; there are many hospitals without working X-Ray machines and other needed equipment to help the sick patience. This is happening on the daily. The responsibility of this fate is their maladministration and it’s all in the hands of the NRM.
Certainly they can take their Jerry-Cans into the future, with the yellow t-shirts and yellow flags. Still forgetting their mission and their purpose, they have forgotten why they exists! Since they are now only bowing their knees for the Mzee instead of workingfor the citizens. Right now the liberation was only liberating Museveni, but letting everybody else being under his mercy. That isn’t freedom, liberty or justice. That is a dictatorship and Museveni is dictating everything and behind all acts. Just like the biggest scam of 2017, the Presidential Handshake. That proves how little NRM Regime has to really celebrate. Peace.
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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.
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