Uganda may be barred from global fund again

Tuesday October 2 2007

By KELVIN NSANGI

Just months after having its suspension from the Global Fund lifted, Uganda once again is on the brink of falling off the list of beneficiaries of the Geneva-based organisation that provides money to help fight Aids, tuberculosis and malaria.

The government now has only two weeks to achieve what it has so far failed to achieve over the last two-and-a-half years to manage a simple tendering process for the supply of 1.8 million Insecticide Treated Nets (ITNs) worth $13.4 million for protecting children under 5 years of age.

Malaria accounts for 20-23 percent of deaths among children under 5 in Uganda. This is much higher than the national average of in-patient deaths resulting from malaria, which stands at 9-14 percent.

Under Round 2 of the Global Fund, Uganda was offered $35 million for a two-phase three-year anti-malaria programme. The first phase lasting two years and worth $23 million succeeded in increasing the number of home treatment packs (Homapak) at $9.6 million all over the country but procurement for the nets failed to kick off.

The Ministry of Finance, known as the principal recipient of the Global Fund money, has been fidgeting with the tender process for two years until the deadline for using the money expired. Luckily for Uganda, all programmes and deadlines were extended by four months to compensate for the time last year when the country operation was under suspension because of poor management of the first grant to fight Aids from the Global Fund. Now the extension expires on July 15, but Uganda has not even awarded the tender, let alone started the procurement of the nets.

The immediate effect of this failure will mean the automatic cancellation of the second one-year phase worth $12 million meant for re-treating the nets, social mobilisation and monitoring. (Obviously you cannot re-treat nets that you never bought, nor monitor a programme you have not implemented.)

Mr Keith Muhakanizi, the deputy secretary to the Treasury, told Sunday Monitor, however, that things are now moving forward although he could not say why they had taken so long. "The tender is in progress at the moment," he said without elaboration.

The Ministry of Health Spokesman, Mr Paul Kaggwa, said Uganda would definitely qualify. He said there was a meeting held last week at the Ministry of Finance chaired by Permanent Secretary Chris Kassami on the same matter. "The controversy at the moment is about procurement and which company should supply the nets," he said.

He added that the decision on which company should supply the nets is being sorted out between Uganda and Geneva.

"There are long-lasting nets that could take six years without being re-treated and those that take three years. Uganda obviously would go for the long time ones."

Widespread use of ITNs has been found to curb the incidence of malaria by half. If the procurement mess is not sorted out by July 15, a Ministry of Finance source said, Uganda will be wasting its time presenting proposals for Round 6, which covers all the three diseases: Aids, TB and malaria.

Ministry of Health officials and managers of the Country Coordination Mechanism are busy writing the proposals. The CCM provides overall co-ordination, policy guidance and oversight of all Global Fund activities here.

The Finance source said that the committee that vets the proposals in Geneva has run out of patience with Uganda. Members on the committee are comparing it with Rwanda next door whose programmes are being implemented meticulously, and see no reason why Uganda is failing to manage a simple procurement process.

"This is all due to poor management and planning for the three diseases whose treatment and prevention the Global Fund sponsors," said Ms Beatrice Were, a noted HIV/Aids and human rights activist with ActionAid International. "It all comes to one thing: that is, we don't have the competence as a country to handle the emergency fund. And, it is not government alone that is blamed but even the civil society organisations."

Malaria kills 2-3 million people a year worldwide, with 80 percent of the cases occurring in Africa. "Malaria continues to be the number one cause of ill health an number one killer of Ugandans," Health Minister Stephen Mallinga said in a statement on Friday to mark the start of the "comprehensive" indoor residual spraying to kill mosquitoes that transmit malaria parasites .

Malaria accounts for nearly 30-50 percent of all outpatient consultations and at least 20 percent of hospital admissions in Uganda.

The news on malaria is particularly worrying coming shortly after reports that ARVs, drugs that HIV/Aids patients use, were running out fast.

When Uganda's suspension by the Global Fund was lifted on November 11 last year, having been slapped on August 23, an interim management mechanism headed by the Ministry of Finance as the principal recipient was put in place. For example, the ministry was required to oversee procurement.

More importantly, however, the government was required to have agreed a "sustainable arrangement" by June 1, 2006; implemented it by September 30; and seen off the caretaker management firm, Ernst & Young by October 2006.

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