Ebola fight draws govt, donors apart

The health minister, Dr Ruth Aceng, speaks on the floor of Parliament on November 2. PHOTO/DAVID LUBOWA

What you need to know:

  • No longer at ease: The telltale signs that state and non-state actors are not on the same page were starkly apparent during a high-level meeting on Thursday, with a leak that forecasts as many as 500 Ebola-related deaths a major point of reference.
  • There is concern that the uncoordinated interventions between the donors and government may result in further spread of the deadly disease.

The government and donors are following different scripts in their responses to the Ebola Virus Disease (EVD) outbreak, leading to rivalry, duplication and wasteful spending, this newspaper can reveal.

Details of the uncoordinated interventions blamed for a rather lethargic official response came to the fore during a meeting in Kampala on Thursday.

As a result, some implementing partners are on the ground working without the knowledge of the Ministry of Health, while teams from multiple entities are overlapping on logistics management, surveillance and risk communication mandates.

Whereas the World Food Programme (WFP) said it had deployed a substantial part of $6.8m (Shs25.8b) it pooled to provide food for Ebola patients, Uganda government officials told the meeting that the contractor had terminated supplies to Ebola treatment centres over non-payment. We could not independently verify this claim because access to the treatment centres are restricted and the Ebola response expenditures are not readily available to the public.

A representative of the agency did not directly address the less-than-favourable mention of WFP.
However, the reported sudden stop of food supply prompted bureaucrats in Kampala to turn to the World Health Organisation (WHO) for bailout, and the Ugandan officials separately negotiated the daily cost of feeding an Ebola patient in Mubende, the initial epicentre, from Shs62,000 down to Shs35,000.

The Health minister, Dr Ruth Aceng, at the meeting turned the heat on development partners and their partners, demanding that they account for money they received in the name of fighting Ebola in Uganda.

“There have been several announcements, either on social media or press releases of resources spent,” Dr Aceng said in apparent reference to disclosures by, among others, the United States and United Kingdom that they had contributed Shs86b and Shs9.3b, respectively, to support response to the epidemic.

‘Show me the money’

The United Nations International Children’s Emergency Fund (Unicef) indicated that it had repurposed $1.2m (Shs4.6b) of its internal finances and borrowed an additional $3m (Shs11.4b) from an emergency kitty to fight EVD.

“I want to see it (the money). I want to feel it. I want to know what this money is doing. I want to be able

to stand and say ‘yes, together with our partners, we mobilised this amount of money, this is what it has done’,” the minister  said.

The strident remarks, without being directly linked, come a week after the United States Ambassador to Uganda Natalie Brown, who attended the Thursday meeting, said Washington had side-stepped the government and channelled support through implementing partners due to concerns over official graft.

“Corruption is a very serious challenge,” she told a press conference last Wednesday, citing past revelations by the Inspectorate of Government (IG), Uganda’s official Ombudsman.

The IG in October last year reported that Shs20 trillion, which is nearly half of the country’s budget, was haemorrhaged through procurement, budgeting, health care, taxation and education provision corruption. Ambassador Brown, while reaffirming her government’s support, appreciated some of the milestones highlighted by Minister Aceng in coordinating the response to the contagion.

Donors hold ground

The donors defended working through implementing partners with whom they said existing agreements enable fast-tracking of help needed in emergencies that otherwise would snarl up in bureaucratic engagements.  

A handful development partners such as WHO, Unicef, the Centers for Disease Control (CDC) and Usaid, the US government’s overseas development arm, provided partial accountability and donors said their declaration of received and pending finances may have given an impression to inform the minister’s diatribe.

The WHO country representative, Dr Yonas Tegen, underscored the importance of ensuring continuity of other essential health services, even as efforts are concentrated on the Ebola fight.

Projected deaths

As Kampala weighed the decision, the Daily Telegraph, a UK newspaper, citing a confidential October 31 Ministry of Health internal document, reported this week that Uganda projects Ebola will have killed 500 people by next April.

The Minister of Health, Dr Ruth Aceng (right), addresses a section of the case management teams at the Ebola treatment unit at Mubende Regional Referral Hospital on October 6. PHOTO/FILE

The publication quoted unnamed sources who claimed that the best case scenarios—of lower deaths and contained spread—have passed and the country should brace for headwinds of accelerated morbidity and mortality due to alleged concealment of cases and victimisation of officials who speak out on missteps.

At the meeting, Dr Aceng blamed the donors for the leak, and questioned their motive. “You sit on the Incident Management team [of the Ministry of Health], that is where food is cooked, where the onions are cut. If you do not like the style, then speak up with the incident team,” she said, adding: “Why do you wait for everything to be done, and if you do not agree, then you start publishing wrong information. Why are we struggling to blow the Ebola situation out of proportion? Why?”

UK responds to leak

The British High Commissioner to Uganda, Ms Kate Airey, regretted the publication in a UK title of information that minister Aceng deemed inaccurate. She said the newspaper sourced its information independently and did not even contact her regarding the story.

The donors also raised questions about delays in updating Ebola statistics, arguing that such lapses could have resulted in the kind of “wrong” reporting.

Dr Aceng cautioned against premature disclosure of financial help, and said government had held back approval of supplementary budget in the mistaken belief that development partners had poured in a lot of cash yet the Health ministry has not received a penny.

The ministry budgeted Shs76b for the first three months of emergency response, which contrasts with the $112m (Shs425.5b) that UN Resident Coordinator Susan Namondo said they had budgeted to use over six months.

The variance in financials capture the mismatch between the government and the world body as well as development partners on the other hand in planning and execution of the Ebole response. But there is more that rendered Uganda vulnerable despite its latest sabre-rattling.

Agree to disagree

Caught without cash at the onset of EVD, which WHO estimates kills anywhere between 20-90 percent of patients, Kampala sought virement to allocate $6m (Shs23b) from a World Bank-funded programme at the Health ministry to Ebola response.

This notwithstanding, Third Deputy Prime Minister Rukia Nakadema said they cannot just watch development partners dole out funds to partners without accountability. “As a country, we would like to know how much resources have been used and whether they were used in appropriate interventions of mutual accountability,” she said.

Ugandan bureaucrats were reportedly spending Ebola response money on deployment of rapid response teams, contact tracing, laboratory personnel, procurement of reagents and kits, human resource development, training in infection prevention and control and clinical care, printing of educational materials.

After deliberations, the government and development partners agreed to harmonise their disparate Ebola response plans within two weeks.

They also agreed that all implementing partners obtain formal authorisation from the Director General of Health Services and report directly to the heads of the different pillars specified in the Ministry of Health’s response plan.

Background 

The government confirmed an outbreak of the Sudan strain of Ebola in the country on September 20, and the disease had, according to the Health ministry’s November 8 update, killed 54 out of 136 infected persons.

Eighteen patients remain hospitalised and 62 have recovered while epidemiologists are racing against time to locate some 2,187 contacts as Masaka City becomes the new frontier of infections alongside Kampala and Wakiso that registered outbreaks weeks earlier. 

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