A health worker analyses blood samples collected from people living with HIV/Aids. Shortage of funds, coupled with Covid-19 disruptions, have affected HIV/Aids outreach programmes. PHOTO/FILE
The annual funding gap in HIV/Aids response has swollen from Shs525 billion in 2020 to Shs595 billion in 2024, hamstringing the fight amid the rising disease burden. Uganda currently has close to 1.5 million people living with HIV, an increase from one million in 2010 as over about 38,000 new HIV infections are registered annually.
How does the support for the fight against HIV/Aids in Uganda measure up?
Our assessment of the funding contributions for the response indicates that there was reduced support from the country’s main donor, the US President’s Emergency Plan for Aids Relief (PEPFAR) despite the low domestic funding. The PEPFAR support declined from $426 million (about Shs1.57 trillion) in the 2022/2023 Financial Year to $388 million in the 2023/2024 (Shs1.43 trillion) financial year, after Uganda enacted the Anti-Homosexuality law in May 2023.
PEPFAR office in Kampala says the law is discriminatory and that it would affect their work and access to HIV/Aids services by key populations.
Should we be in any way surprised by declining funding?
Yes and no. The declining funding should not come as much of a surprise because the US government and other donors have earlier advised the country to prepare for the “transition” away from donor dependence.
Dr Elizabeth Ekirapa Kiracho, a health policy specialist at Makerere University School of Public Health, says the country cannot sustain the fight if the donors withdraw right now.
“They still need to continue supporting us as a country, because the issue of HIV/Aids in particular is a major problem, and so donors should not withdraw at this point. The transition should be gradual because we still need to get support from them,” she reasons.
Dr Ekirapa says although there is some improvement in domestic funding, the contribution of Uganda’s government to the health sector and HIV fight has been significantly low.
“National Aids Spending Assessment shows that about 80 percent of our funding for HIV comes from development partners, and only 13 percent comes from the government,” she says.
“Although that reflects an increase from five to 13 percent, it still shows that the government contribution is low, and the government needs to increase the funding and there is a need for more focus on prevention. So, the advocacy we are doing, really one of the major things is to say the government needs to increase its funding,” she adds.
What does Uganda’s HIV/Aids report card look like?
Apart from the 38,000 new HIV infections registered annually, the country experiences around 20,000 Aids-related deaths yearly. This shows declines from 97,000 new annual infections and 53,000 Aids-related deaths in 2010.
Health experts indicate that with the current trend, the country might have to hit the 2025 target of reducing annual new infections to 15,000 and annual deaths to 10,800.
The country is also racing to end HIV/Aids as a public health threat, a target the experts say will require increased efforts on prevention of infections, increased domestic funding, and learning and embracing more effective interventions.
Is the government of Uganda ready to step up to the plate?
Statistics from Uganda Annual Joint Aids Review Report for the 2023/2024 financial year indicate that the Government of Uganda’s funding towards HIV/Aids increased from $80.6 million (Shs298 billion) in 2020 to $100.4 million (Shs371 billion) in 2024. This was, however, extremely low when compared to the funding needs, which stood at $732.5 million (Shs2.7 trillion) in 2020 and $851.5 million (Shs3.16 trillion) in 2024. The Global Fund, however, increased its support towards the response from $99.7 million (Shs368.8 billion) in 2020 to $135 million (Shs499 billion) in 2024.
“We are told that the medicine (ARV per patient) costs around $18 (Shs66,600) if you purchase locally and yet it costs $11 (Shs40,700) if you purchase externally.”
How best can state actors boost the capacity to locally produce medicine?
Mr Ajay Kumar Pal, the Chief Executive Officer of Quality Chemical Industries Limited (Qcil), which makes ARVs, says they face many challenges.
“The challenges we have include access to financing and cost of financing, which affects all local manufacturers. The other challenge is access to technology in the space, finding the right partners and market access,” he says.
“In Uganda, we have a good footprint, but in the East African Community we still have a challenge,” he observes, adding that the company can make enough first-line ARVs for all Ugandans living with HIV. He also says they are setting up a manufacturing plant to make injectable drugs for HIV/Aids treatment and prevention.
Dr Medard Bitekyerezo, the chairperson of the National Drug Authority (NDA), says boosting the capacity to locally produce medicine will be essential in the transition away from donor dependence and also create jobs for the population.
He reveals they have increased taxes on drugs produced outside Uganda as a way of supporting locally manufactured drugs.
“The government should earmark money at a very cheap cost, specifically for boosting industrialisation of this country. We shouldn’t be talking about 14 percent (interest rate) but should be around three percent,” he adds.
Decline in Donor Support.
“Funding and donor fatigue is a serious and a real issue. Resources are not unlimited and there are emerging demands from climate change and the Russian war in Ukraine.’’ – Former US Ambassador Natalie Brown
Situation.
“The government needs to increase its funding, and there is a need for more focus on prevention... The drugs that are locally manufactured are more expensive than the drugs that are externally manufactured.’’ – Dr Elizabeth Ekirapa Kiracho
What will it take to get donors back on board?
It is hard to say, really. The former United States Ambassador to Uganda, Ms Natalie Brown, told this newspaper earlier in an interview that “funding and donor fatigue is a serious and a real issue.”
“We all know that resources are not unlimited and there are emerging demands from climate change and the Russian war in Ukraine which affect us all. We have many refugees coming to Uganda and all of these create new demands and new pressures on both Uganda and donors,” Ms Brown said.
“So we want the government to take greater and greater ownership of the programmes that we are running in the partnership. This doesn’t only require money but good governance, addressing corruption, transparency and stability,” she adds.
Ms Mary Borgman, the PEPFAR country coordinator, in a high-level dialogue on HIV/Aids funding this month, re-echoed this. She, however, indicates that the US government would continue supporting the country as the transition happens.
“It is 20 years of PEPFAR and the US government remains a committed and strong partner in the global health response, fighting HIV and then ending HIV as a public health threat by 2030,” she says.
What solutions are we looking at?
Ms Borgman, the PEPFAR country coordinator, says sustainability will be key, adding: “PEPFAR is consistently looking at the lessons we have learnt and where we need to go. And the sustainability discussion is key. We need to talk about where we are going and a piece of that is local manufacturing and ensuring we have capacity and accessibility.”
PEPFAR and Global Fund have been procuring most of the products such as Anti-retroviral (ARV) drugs and testing kits from manufacturers outside the continent.
Dr Ekirapa says the purchasing from foreign manufacturers is partly due to the relatively higher cost of locally manufactured drugs and lack of approval from the US Food and Drug Administration (FDA).
“Local manufacturing is good but the current evidence shows that the drugs that are locally manufactured are more expensive than the drugs that are externally manufactured,” she said.
