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.

Kenya: EACC investigation into Gov. Hassan Joho and Tom Mboya Primary School verifying his education!

Answer from the School to EACC:

 

Opinion: Everybody hates Governor Joho!

The Presidency and Regime under Uhuru Kenyatta and Deputy President William Ruto, must have some grand issues with Mombasa and Coast Region as they every week for the last month has attacked with all sorts of tricks against the Orange Democratic Movement (ODM) Deputy and Governor Hassan Ali Joho. That the Jubilee Alliance Party (JAP) and their cooperative measures to marginalize the opposition figure isn’t really working.

They have detained the man for wanting to see the first relaunch of the ferries as the Jubilee held rallies in his back yard as far back as the 13^th March 2017. They have since then blamed his government for lacking accountability and transparency, like the Central Government haven’t had enough issues with corruption scandals.

So President Kenyatta should be cautious attacking fellow peers in midst of re-election rallies, but it isn’t like he cares. Since he feels like he is Teflon and cannot be touch. When they attack his educational background, as they have attacked him before his accountability as a Governor. Therefore, all we see is steady attacks on the character of Joho.

Also said he was meddling with drug-dealers and importers, as they we’re having drug cartels, like the sugar cartels supporting Jubilee and Kenyatta. But hey, not that anyone really looks into the donor funding to the Jubilee from the Sugar and Coffee Cartels to the Kenyatta government. Still, all problems of crime in Mombasa County is Joho’s fault. As the corruption of the Ports is Joho’s fault, not that this has been issue since the independence. That even Jomo Kenyatta was working against the corruption on the Ports of Mombasa, even President Daniel Arap Moi we’re complaining when needed about the graft at Mombasa.

So after decades upon end with independence and second generation Kenyatta, the problems are still there. If they seriously wanted it to change, than John Githongo would still have a job and not been kicked-out the door by former President Mwai Kibaki! But that is a story the ruling regime doesn’t want to eat, still they easily eats of state coffers and thinks side-stories of undressing leaders of opposition makes the world and Kenyan citizens forget that.

I am sure Cabinet Secretary for Interior Joseph Nkaissery is trying to find the next charge he can put on the ODM Governor, as he has tried to revoke his guns and take away his security guards. So, there aren’t that many tricks left in the basket of peddling nonsense into the public sphere. They have used all sorts of demagoguery and misused their place as key leadership. Instead of being noble and show character, they have gone straight for the heart and attacked the character instead of the polices.

So the Jubilee has misused their opportunity to gain and show that they are better than Governor Joho, they have lost on public display, they have used the Kenya Revenue Authority (KRA) looking into his tax-record, Kenya National Examination Council (KNEC) looking into his educational history and also the added accountability, where the leadership of Jubilee claimed his county got 40bn shillings instead of the 16 billions shillings Joho claims the Mombasa County received from the Central Government.

The Jubilee under Kenyatta and Ruto have used all tools and tried to destroy the legitimacy of the leadership of Joho. Just like they fear him more than Raila Odinga, Stephen Kalonzo Musyoka or Musalia Mudavadi. Since they are all walking around like kings, while all of business of Joho is on the front pages.

That the state and their top leadership continues to pound on Joho, shows how little character themselves have, that they have to go after a governor when themselves going into National Elections. That they are going after a local politician, when they should go against the faces who could be Presidential Candidates. Since they are not touching the NASA/CORD leadership, instead they pick Joho as prey, but instead of clearing the flesh of the bones. They are instead creating their own wounds. Peace.

My letter to the Minister of Interior Affairs of Kenya Hon. Joseph Nkaissery on revoking firearm license of Govenor Joho

Dear Sir Honorable Joseph Nkaissery!

You honorable Interior Cabinet Secretary Nkaissery, I am writing you again. It is hard since you’re a man of your English. We both know the English language and respect it. But I am not writing a letter in the sense of the spoken word, but this is I will write to you about is more about what has happen in recent days.

As we all know there been smaller by-elections happening in Kenya, the country where you happen to be a big-man, with only two leaders above you, Honourable William Ruto and His Excellency President Uhuru Kenyatta.

It is in this context that you are ruling together with them and have powers through the parliament that is given by the appointment from His Excellency who has faith in your judgement, if not he would not have given you this chair and represent the government as you do.

Hon. Nkaissery, I want to write this to you in plain English, do you have an issue with Coalition of Democratic and Reform (CORD) and the Orange Democratic Movement (ODM)?  Or am I wrong? I hope I am wrong as you can make decisions that can either hurt or secure these men, just as the same decisions can do the same to your party-men in the Jubilee Alliance Party (JAP).

Why I am writing this letter to you in plain English is because the sense of double standard is evident during the last few days, when Governor of Mombasa Hon. Hassan Ali Joho (CORD) lost certain members of his security outfit, while also getting orders of delivering his gun to the authorities, while other leaders keep their VIP security guards while the opposition loses them.

There is a reason why wonder about that, because you wrote this on the 12^th March 2016: “In the case of Governor Joho, he should understand the rule of law must be respected and when he is asked to surrender his firearms, it is his duty bound upon him to do so. It is important that the Honourable Governor of Mombasa to note that the office he holds comes with the honor and dignity and the anger and demeanor that he portrays in public while feels provoked in whatever circumstances takes away that dignity”.

I don’t know if you have read what the Governor wrote to you and the authorities after you address him publicly.

He wrote a letter to answer your appeal on the 14^th March 2016:

“As you are well aware of Mr. Samuel C. Kimaru, the Chief Licensing Officer on the 10^th March, 2016, purported to revoke the Firearm Certificate Number 4773 by the above referred client Mr. Hon. Gov. Hassan Ali Joho” (…)”That Mr. Kimaru, did not satisfy himself that a reasonable and legal-basis for revoking the firearm exists in law and in fact” (…)”That Mr. Kimaru acted ultra vires and acted in gross breach of constitution” (Ahmednasir, Abdikadir & Company, AAC/GEN/2016, 14.03.2016).

Hon. Nkaissery that you today in the day ordered and gave the Governor two hours to deliver the arms, while you have already punished the opposition by taking their security guards, prove the bias is going to close courts of the president. That is how I understand you’re English. Justice Odunga on the case: “Only the firearm licensing board has powers to revoke a firearm certificate on lawful grounds. Kimaru acted ultravires (beyond his legal power or authority).” Justice Odunga once said on Security Act, “The court will not nurture the tumour of impunity and lawlessness. This tumour of impunity is like an octopus…”

So you are a man of Codes Cabinet Secretary of Interior Nkaissery, you should for once ask for forgiveness for your rash reactions, as you never acted in good faith towards the journalist covering the corruption in your ministry. This time it is a fellow brother who serves his district and constituency, maybe not for your party or up in high halls with the perfect etiquette and English as you commands, as your people in the cabinet speaks, but even filthy tasteless language and not moral codes can be a little dually. You claim that Governor Joho speaks in inferior language and therefore are not allowed to carry arms.

You Hon. Nkaissery also wanted the guns of MP Ferdinand Waititu. Your actions seem to be happening after a by-election that didn’t go the way of the JAP. Seems to be political motivated. By my reckoning hon. Nkaissery you have a bigger fish to fry then the guns and arms that the opposition leaders are keeping while serving as government officials.

Mr. Nkaissery in plain English: “Cabinet Secretary Major-General (Rtd) Joseph Nkaissery’s Interior and Coordination of National Government Ministry is perceived to be the most corrupt, a survey by the Ethics and Anti-Corruption Commission (EACC) shows” (Daily Nation, 15.03.2016).

So when you’re hard work right after by-elections it seems a little devious. While your ministry because of the perceived levels of corruptions, questions your authority, your leaders, your civil servants, government officials and the system that you’re in plain English controls with your authority.

So when you have that in your hands together with the predicament of losing to courts of taking away the guns from Governor Joho of Mombasa, while MP Waititu discredits your orders in the public. As they both knows the laws and now your powers, even if you can use the same as Office of Inspector General as you; you used the same had against the opposition. That still does not make your argument and orders correct, even if you serve as the government and you are part the top third men of power in Kenya, just under Hon. Ruto and H.E. Kenyatta; so you have a massive amount of responsibility and therefore should show respect for your position and title.

I would respect you even more if you talked in a manner of respect to your fellow citizens and not lecturing them on simple manners, while taking the laws into your own hands and act reckless against those who write about you or oppose you. As you now do what you can to take away security and security of governors, while Governor Kidero of Nairobi who happens to be your part of your party have 12, while Governor Joho has lost part of his security outfit. That prove a double standard, not only with the arms and guns, but the whole shindig has left a sour taste in the mouth of many. As you are serving the interior ministry, internal issues and internal security honourable Nkaissery, that means that you serve both the oppositions security and JAP security, so they all should be made sure to be safe and not only the men who are parts of your loyal subjects and yes-men in your hollow chambers. That is the picture that comes as you together with the Inspectorate General are even bending laws, so fellow country-men pre-judged by your judgement has to go courtside to reside and get justice. Because they not part of your powerful trio or the men who you trust automatically, and you should worry a bit hon. Nkaissery, as your ministry is not trusted when it comes to corruption.

Corruption Mr. Nkaissery is not only money between a police officer and his advisory that want to pass a check-point. The corruption is not only the once that scribes letter like this or writes in Daily Nation in 2015. The Corruption is the acts and ability to use the power of the ministry to personal gain, as you have used to threaten a fellow Governor Joho and MP Waititu, why haven’t you done the same to Gov. Kidero? Is Kidero okay because he has issues with the Tribunal so he does not more on his plate?

Honourable Nkaissery why I write to you is because of the perception people has of you and your ministry, the actions you put forward to people and the way you uses laws and language to gauge people around. You could be more powerful if you actually worked together with people and listened to people, as they believe your ministry is the most corrupt one, and when you get Justice Odunga saying your argument wrong and unlawful. The sad thing is that you are the one running the Police and the Courts, the man who set the standard for law-enforcement and apparently you prematurely went after fellow brothers in your country, who are citizens just like you, even if they can’t call that easily Hon. Ruto or H.E. Kenyatta.

So please Hon. Nkaissery, could you calm down and not just address opposition and threaten them next time? Could you honourable Nkaissery maybe get more advice and think strategy as you’re a man of language and law, you should set the precedence of not taking laws to seriously as you did before 2016 with the journalists following parliamentary actions, now you have gone after government elected leaders in the opposition like the Government of Mombasa and the Member of Parliament representing Kabete. An I wonder why you haven’t asked for the weapons of other who holds those roles and representatives, why you have chopped most security guards from men of opposition and not government or ruling-party. That you also tell how people are supposed to speak while you have gone out many times in a demeaning tone and fashion. As I don’t understand English as you, you have to forgive me. But let the people know all the ways people can speak in justified ways and how they can follow your laws, without going to court prematurely as the Governor Joho did today, because Mr. Mwangi of Nairobi might not have the connections you have Hon. Nkaissery or the once Gov. Joho had in court today. Maybe you could write a statement clarifies the different attitude and the rights as you have and your party-men towards the rest of us. 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.