Gay law: Govt plans for post-donor cuts

Bubulo East MP John Musila displays his anti-gay attire during plenary at Parliament on March 21. The Uganda government is worried that its US counterpart could stop HIV/Aids support over the anti-gay law. PHOTO/FILE. 

What you need to know:

  • Government has reportedly listed increased spending on life-saving HIV drugs, addressing corruption and wasteful expenditure, and local manufacturing of medicines to cushion the impact of anticipated cuts.

Health officials yesterday said Uganda is preparing to meet possible budget shortfalls following threats by foreign partners to withhold critical funding for the country’s HIV/Aids response because of the anti-homosexuality law.

 Government has reportedly listed increased spending on life-saving HIV drugs, addressing corruption and wasteful expenditure, and local manufacturing of medicines to cushion the impact of anticipated cuts.  

The government, according to Dr Henry Mwebesa, the director general of Health Services at the Health ministry, plans to invest Shs150 billion for anti-retroviral drugs (ARVs), up from Shs100 billion last year. 
“The government is contributing Shs150 billion for buying anti-retroviral drugs. The rest is provided by development partners,” Dr Mwebesa said, adding that he is still optimistic “they will not cut the funding”.

At the Uganda Aids Commission (UAC), the lead government agency in the fight against HIV/Aids, Director General Nelson Musoba confirmed the planned increase in local funding.
“As government, we would like to take the lead but it will take time because it is stepwise,” Dr Musoba told Daily Monitor this week.  
“The Ministry of Finance has indicated that they will provide an additional Shs50 billion to what they were giving… but the contribution is not yet at the level where we want it to be,” he added.  

Both officials were commenting on last month’s revelation by President Museveni that the American government could stop HIV/Aids support over the anti-gay Bill. The President signed the locally very popular Bill into law last Friday.

“One of the things they’re (donors) threatening is to kill our 1.2 million people who have been surviving on the US President’s Emergency Plan for Aids Relief (Pepfar) funds to buy drugs for HIV/Aids, so that we don’t buy the drugs for our people and they die. 
“This is a simple matter which we can fight but parasites can’t fight. If you fear to sacrifice, you cannot fight. In order for you to fight, I want to first cure you of parasitism. Europe is lost and they also want us to be lost. Those who want an easy life will end up being prostitutes,” President Museveni said.

Dr Charles Ayume, the chairperson of the parliamentary Health Committee, also acknowledged that the government will incrementally take charge of the HIV/Aids fight.
“This new development may make the conversation stronger but the discussion has been there,” Dr Ayume said, adding “If the government was frugal and plugged the holes of some wastages, we could be able to support, in the mid-term and long term”.

Dr Ayume observed that with “donor fatigue” driven by the global economic downturn, “the government has had this in mind and the donors have a strategic plan to see how to wean off the country”.

“… This year, there has been an increment of Shs50 billion towards anti-retroviral medicines. That money is not enough but the government is committed to increasing the budget for HIV/Aids response,” he said.  
Every year, at least Shs1 trillion is spent on anti-retroviral medicines for at least 1.4 million Ugandans living with HIV/Aids. 

A year’s supply of ARVs per person costs about Shs685,000, according to a 2020 report by the United States Agency for International Development, meaning Shs150 billion would cover requirements for only 214,000 persons.
Ms Mary Borgman, the country coordinator for Pepfar, said two weeks ago that a meeting to approve Pepfar support for Uganda next year was indefinitely deferred in light of the Anti-Homosexuality Bill.  

But Health minister, Dr Jane Ruth Aceng, believes Uganda will manage.
“We cannot in any way sell our values. If you want to support me, do not attach conditions to your support. Support should come as support, not with conditions. Do not force us to learn what is not our culture. Give it willingly,” Dr Aceng said. “So, if they want to cut it off, it is okay. Uganda will rise up, and Uganda shall manage”.
“We are manufacturing anti-retroviral drugs, anti-malarial drugs, and many other essential drugs. We have highly trained personnel who are capable of doing this if we set our priorities right. We don’t lack the resources …,” she explained.

Ms Sarah Netalisire, the chairperson of the parliamentary Committee on HIV/Aids, also advised the government to accelerate plans to establish the HIV Trust Fund to cushion the country from potential shocks.  
It is time, Dr Lulume Bayiga (Buikwe South MP) said, for the government to take advantage of its investments in companies like Cipla Quality Chemicals Ltd.
“Such companies make HIV medicines and they are supplying other countries. We need to look into our capacity and we weigh,” Dr Lulume said.

Dr Lulume, on the other hand, said: “There are certain considerations in health diplomacy where any country cannot just remove aid in medicines and health supplies just because of a misunderstanding, even if there is conflict …,” Dr Lulume said.

Among its other products, Cipla Quality Chemicals produces a 3-in-1 fixed-dose combination (Stavudine + Lamivudine + Nevirapine) of ARVs at its Luzira, Kampala factory. The company’s chief executive officer, Mr Ajay Pal, yesterday confirmed their ability to step in.
“We can supply the ARVs needed in the country. We manufacture a wide range and we keep on expanding the portfolio based on need. We are only utilising 50 percent of the capacity,” he said. 

Mr Pal confirmed that they also supply ARV’s to South Africa, Botswana and Zambia. 
He said while imported ARVs are more expensive, “the cost per patient, if you buy from here, is significantly lower because logistics cost is lower than importing”.
Dr John Kamili, a pharmacist who has worked with Cipla Quality Chemicals, revealed that the Global Fund for HIV/Aids, Malaria and Tuberculosis, and the US, do not support local manufacturing.

“Procurement programmes by [donors] do not harness the regional manufacturing process. They still protect their manufacturers as we are locked out,” Dr Kamili said. The pharmacist said most donors buy drugs from India and China. 
“Our suggestion is that we should source those products from local markets,” he added.