A health worker takes a blood sample from a person. At least 25,000 new HIV infections were recorded last year, according to UAC. PHOTO/FILE
With the fate of a flagship programme created by the USA to help countries like Uganda achieve HIV/Aids epidemic control hanging by a thread, the Museveni administration has been advised to ringfence Shs300 billion for the forthcoming Financial Year (FY) to stave off any disruptions.
Since its inception in 2003, the US government has channelled more than Shs20 trillion via the US President’s Emergency Plan for Aids Relief (Pepfar) to prop up the HIV/Aids fight in Uganda. But with the pause button having been hit following the Trump admin- istration’s freeze on US spending, stakeholders involved in the HIV/Aids fight in Uganda have urged the Museveni administration to have Plan B if funding from Pepfar is cut off entirely.
The funding freeze and stop-work orders implemented by the Trump administration are set for an initial 90-day period, with a review currently underway. Organisations involved in Uganda’s HIV/ Aids fights met the House Committee on HIV/Aids this week, and made clear that there is a funding gap that ought to be addressed.
"The Parliament together with Ministry of Finance should redirect the budget priorities and increase funding for HIV services with an additional lumpsum of Shs300 billion to cover medicines, laboratory supplies and other commodities previously contributed by Pepfar,” Dr Vincent Bagambe, the director of planning and strategic information at Uganda Aids Commission (UAC), told lawmakers on Thursday.
“This should be in addition to the current commitment of Shs500 billion annual increments budget support. The long-term goal should be to cover all antiretroviral therapy and commodity costs, allowing partners to focus on supporting other activities such as capacity building, social support and protection, supervision,and technical assistance,”he added.
In addition to funding HIV/Aids prevention, Pepfar has also supported care and treatment services, as well as tuberculosis research. Experts anticipate that cuts in funding will affect not only research but also essential life-saving programmes “This is the time for the government to take full leadership of the HIV response and to ensure that the gains made against the pandemic are not reversed but rather HIV services are domestically sustained for a long time to come,” Dr Bagambe opined.
“Given the uncertainties surrounding the donor support, it is important to review the HIV programmes and transition them from the current donor-supported emergency models,” he added. Ticking time bomb Ms Ruth Ssenyonyi, the board chairperson of UAC, described the current situation as “a ticking time bomb” that risks undoing tremendous strides made in the past two decades.
“Eighty percent of our funding is from donors, so we are at a dangerous corner,” Mr Ssenyonyi said bluntly, adding,“ We don’t want to get into an accident because anytime the funding can be taken away from us,which has already been done. It affects our plans. So we need to find alternative ways to handle this crisis right now as we think of what else will happen later on.” The siren calls also went off when Ms Flavia Kyomukama, the executive director of People Living with HIV (PLHIV), emphasised the urgent need to explore alternative funding mechanisms to sustain the critical, life-saving programmes previously supported. “We need a catch-up plan now. Let’s see this as an emergency; otherwise, people are getting demoralised and demotivated to even wonder if they should swallow [the life-saving medications] now after all there will be no medication in the next 90 days,” Ms Kyomukama noted.
A lifeline?
While referring to the assessment done on the stocks last computed before the Trump administration brought in the spending freeze last month, UAC officials disclosed that the first-line medicines and related supplies are able to run Uganda up to December.This is pending another review on the same.
“We had a meeting with the Ministry of Health but that was a quarterly meeting, that was just before we went into this crisis...the commonest used first line had stocks last up to December 2025. But for the others the quantities were varying from commodity to commodity,” Dr Bagambe said.
He was, however, quick to report that another meeting is yet to convene to conduct a deeper assessment of the exact extent of the crisis to establish the exact amount of stocks Uganda requires. “We are planning to have a specific meeting with the Uganda Aids control programme and those are the specifics that we are going to tighten. So the responses that we are going to give you will be able to provide the different commodity levels on type by type,” Dr Bagambe said.
Other implications Dr Musoba put the annual funding gap at anywhere between $100m and $150m, noting that people who have attempted to downplay the purchase of condoms fail to grasp its critical importance.
“There are areas that remain solely funded by donors, especially on HIV prevention. Information campaigns are one of them. Condoms are the other. We don’t have the government of Uganda funding for condoms.Condoms are a key prevention for HIV. They are 100 percent funded by donors,” he said.
“Male circumcision, which has been found to contribute to 60 percent to averting new infections, is still fully funded by donors,” he added. Already, the effects of the interruption in funding are biting the research component at academic institutes such as Makerere University’s School of Public Health.The school relied on the same donor funds to conduct research, to generate fresh knowledge to inform strategies deployed to contain the scourge.
“They [donors] do this [research] work through universities. This research had a lot of value to the work that we do on HIV because it brings in new knowledge, and efficiencies and also builds human resource capacity, especially health workers. There is that gap,” said Dr Micheal Etukot, the executive director of The Aids Support Organisation (Taso).
What next?
Lawmakers learnt from Dr Bagambe that “UAC conducted the 2023 National Aids Spending Assessment (BASA), whose report shows that Uganda spends Shs1.928 trillion annually to deliver all HIV services.” He further disclosed that 60 percent of the aforesaid total or Shs1 trillion ($323m) “is spent on putting the people living with HIV on treatment and for laboratory monitoring.”
He added:“Out of this Shs1 trillion, [the] government of Uganda provides Shs230 billion, with the balance being contributed by donors (mainly United States government and Global Fund).” According to Dr Bagambe, Pepfar provides about Shs340 billion ($91.9m) funding for health systems strengthening, including support for human resources. This, he added, “includes salaries for 4,333 clinical workers (doctors, pharmacists, laboratory technologists, nurses, midwives, and mental health workers) deployed across 2,000 facilities in Pepfar-supported districts and the over 16,690 community health.”
Ms Sarah Netalisire, the chairperson of HIV/Aids committee, has pledged to support the organisations in the fight against the scourge and mobilise support from the House Committees on Health; Presidential Affairs and Budget. Her aim is to apply pressure on the Cabinet to include a Shs1.928 trillion allocation for HIV/Aids programmes in the 2025/2026 annual budget. This was after UAC boss, Dr Musoba, rallied MPs to extensively debate the matter on the floor.
“So chair, we request that you take this to the floor of Parliament because as Parliament you are in charge of appropriation. You rework the budget because as a country, it is not just our people but our sovereignty is at stake,” he said. Loud silence in Parliament Attempts by Oppositional legislators to offer their two cents on the funding in- terruption were unsuccessful. Mr Thomas Tayebwa, the deputy Speaker of Parliament, said the matter would be extensively handled during consideration of the 2025/2026 National Budget Frame- work Paper (NBFP). The NBFP was, however, passed without conclusive responses furnished to the House on the same.
