On June 5, the Ministry of Health permanent secretary (PS), Dr Diana Atwine, published a press statement titled, ‘Ministry of Health clarification on cost of Covid-19 testing’.
That clarification to the country followed criticism from Kampala Central Member of Parliament (MP) Muhammad Nsereko, who had taken to social media to lament about the $65 (Shs239,350) cost that government said it was incurring in testing every Ugandan for the coronavirus disease.
Mr Nsereko’s sweeping allegations prompted Dr Atwine to respond in a detailed statement. That explanation, however, did not satisfy President Museveni, whose office instructed the Internal Security Organisation (ISO) to investigate and establish the true cost of Covid-19 testing.
A joint investigation by the East African Centre for Investigative Reporting’s (EACIR) online publication Vox Populi, and Saturday Monitor can reveal that in June, Lt Gen Muhoozi Kainerugaba, the senior presidential adviser for special operations, directed ISO to ascertain the true cost of Covid-19 testing.
In their intelligence briefing sent to Gen Kainerugaba that EACIR and this newspaper have seen, the country’s lead domestic spy agency found evidence that “the PS Ministry of Health in her rebuttal to claims made by the Mr Nsereko makes assertions that are mixed, factual and non-factual. The PS categorises the cost of Polymerase Chain Reaction (PCR) test kits as per manufacturer’s cost of Personal Protective Equipment (PPE), and Sample collection, transportation medium and triple packaging.”
According to the USA-based National Human Genome Research Institute, sometimes called “molecular photocopying,” the polymerase chain reaction (PCR), is “a fast and inexpensive technique used to “amplify” or copy small segments of DNA. Because significant amounts of a sample of DNA are necessary for molecular and genetic analyses, studies of isolated pieces of DNA are nearly impossible without PCR amplification.”
PCR is often touted as one of the most important scientific advances in molecular biology as it revolutionised the study of DNA, “to such an extent that its creator, Kary B. Mullis, was awarded the Nobel Prize for Chemistry in 1993.”
In her media statement, Dr Atwine gave the following costs for PCR Test Kits that the government of Uganda and development partners had procured, or were in the process of procuring; Altona PCR kits each procured at $25 (Shs92,000), GeneXpert kits each procured at $19.8 (about Shs72,900), ABI kits each procured at $17.2 (about Shs63, 300), COBAS 6800/8800 Kits each procured at $18.9 (Shs69,600).
The dossier by ISO, which EACIR and Sunday Monitor have seen, indicates that Lt Gen Muhoozi was briefed that “The GeneXpert kits procured at $19.8 (Shs72, 900) per kit tally with the price in a quotation for the same that puts the price at $198 (Shs729,000) for a pack of 100 tests kits. The other prices for PCR test kits mentioned by the PS are in the range of the prices for the available PCR test kits on the market worldwide.”
They also found that the Personal Protective Equipment (PPE), which the PS Ministry of Health said costs $2.25 (Shs8,200) per test is “a justifiable cost.”
Dr Atwine detailed the costing as follows: masks N95-$0.7 (Shs2,500), face shields-$0.5 (Shs1,800), safety eye goggles $1.5 (Shs5,500), latex gloves $0.2 (Shs700), aprons plastic re-usable-$3 (Shs11,000) and gowns-surgical $1.5 (Shs5,500).
However, the PS allocated “the highest cost centre for testing Covid-19 to sample collection, transportation medium and triple packaging at $36 (Shs132, 500) per test per person.”
When the ISO investigators independently verified this cost, doing so by obtaining quotations from the same supplier, they found that “the price quotation secured from the manufacturer of GeneXpert test kits for nasopharyngeal swab collection kit of 100 units costs $231 (Shs850,000), which translates into $2.31 (Shs8,500) per test per person.”
The investigators, for instance, secured a price quotation from Ahmad Sayed, the regional sales manager of Beijing Genomics Institute (BGI), a copy of which Saturday Monitor has seen, that indicates, “BGI PCR test kits+RNA Extraction kit+Viral transport Medium and Swab, which is a total solution package for testing Covid-19 at $2,200 (Shs8m) for a pack of 100 units, translating into $22 (Shs81, 000) per test for purchase of 10,000 kits, while the offer for purchases of 20,000 units and above the price is reduced to $2,000 (Shs7.3m) for a pack of 100 translating into $20 (Shs73,650) per test per person.”
In fact, in publicly available information that was used to tie the loose ends of the investigation, the operatives discovered that “the prices of sample collection and transportation medium range between $0.3 (Shs1,100) and $3 (Shs11,000) per Kit.”
Spotting the inflation
On the basis of these findings, it was observed that “the sample collection, transportation medium and triple packaging, which the PS Ministry of Health puts at $36 (Shs132, 500) per person per test, is inflated by $33.69 (Shs124, 000) per test per person compared with the price offered by GeneXpert Infinity systems.”
Additionally, “the price of PCR tests, including sample collection, transportation medium and packaging that the PS assigns a cost of $65 (Shs239,350) per person per test is inflated by $45 (Shs165,700) or $43 (Shs158,350) per person per test when compared with the quotation by Beijing Genomics Institute (BGI).”
As of June, “loss of public funds to a tune of $4,232,912 (Shs15.5b) has been occasioned on the procurement of highly-inflated sample collection and transportation kits. The 125,643 Covid-19 tests carried out as on June 5 at $65 (Shs239, 350) per test cost the country $8,166,795 (Shs30b) could have been carried out at a cost of $2,512,860 (Shs9.2b) if the country had procured the complete Covid -19 complete solution from BGI.”
Even more, the President’s office was briefed that whereas it is public knowledge that the government of Uganda received donations for Covid-19 testing from World Health Organisation, United Nations Children’s Fund (Unicef) and Jack Ma (Chinese philanthropist), “the country has not been informed in certain terms the quantities and the exact materials donated. There is strong belief in the health sector that the tests carried out so far have been using donated kits and not procured kits.”
Accordingly, investigations have been launched to establish whether indeed the ministry actually made all the Covid-19 imports and Uganda Revenue Authority, which has access to such information, will be furnishing the President’s Office with the relevant data while the Finance ministry is expected to advise on full details of the payments for Covid-19 test kits and swabs so far made by the ministry.
Health Permanent Secretary Dr Diana Atwine and Commissioner in charge of Laboratory Services and Diagnosis, Dr Susan Nabadda, both said they were locked in meetings and did not respond to offer comments to our follow up phone calls and text messages on the matter.