What you need to know:
- Former Speaker of Parliament Jacob Oulanyah is the second VIP to die in a foreign country while seeking specialised treatment in a space of two months after Bank of Uganda Governor Emmanuel Mutebile. In both deaths, government justified flying the deceased, abroad for better specialist care. However, three years ago, Parliament contentiously approved a $379m (Shs1.4t) vote from the Finance ministry to a private investor to finance and construct a world class hospital off Entebbe road, a project which has remained wet in the wings, writes Frederic Musisi
No sooner had Jacob Oulanyah’s death been announced by President Museveni through his Twitter handle on the afternoon of March 20th, the Ministry of Foreign Affairs in Kampala instructed Uganda’s embassy in Washington DC to take charge.
Oulanyah was airlifted 8,790 miles from Kampala to the University of Washington Medical Centre in the US Pacific Northwest coastal city of Seattle. The hospital is ranked among the best in the US for the six adult specialities, including cancer, gastroenterology and gastrointestinal surgery, urology, and orthopaedics and urology, complications for which the Ministry of Health’s medical board recommends more than a dozen VIPs for treatment abroad annually.
Since early February when he was airlifted aboard a Uganda Airlines Airbus airliner, according to corroborated accounts, the embassy which oversees Ugandans spread over the Midwest to the West Coast had been kept in the dark about the deceased’s admission at the hospital. The embassy was only engaged days earlier to secure clearance for the airbus A330-800 neo to land in the United States.
Oulanyah’s death was announced barely hours after senior government officials, including Speaker-elect of Parliament Anita Among, Chief Justice Alfonse Owinyi-Dollo, Health minister Jane Aceng and other friends had just returned from Seattle to monitor his health following weeks of speculation on social media that he was dead.
His body is expected in the country later this week, processed through a funeral home— Dayspring & Fitch Funeral Home—that was hired amid a welter of paperwork, including a comprehensive medical report done only by the Chief Medical Examiner. A burial programme too is expected to be released by tomorrow or Wednesday.
Tribute after tribute have continued to pour-in for the former Omoro County MP who served for 10 years as deputy Speaker of Parliament and was two months shy of making one year as Speaker.
Barely after Oulanyah was flown out, a section of Ugandans held protests outside the hospital in Seattle contesting a discriminatory medical apartheid that favoured high-profile citizens at the expence of other taxpayers who are left to die in Uganda’s ailing hospitals.
Dr Chris Baryomunsi, the Information minister, speaking at the vigil last Thursday, said the advanced treatment, the deceased needed—the Chimeric Antigen Receptor T Cell therapy (CAR-T), where you harvest bone marrow cells and you use genetic modification to change them, they then develop those receptors and they are infused again in the patient to attack the cancer cells—is available in three hospitals in the world. In Germany, France, and in Seattle where it was pioneered.
Uganda’s specialised hospital controversy
There has been a renewed debate about the construction and completion of the International Specialised Hospital of Uganda (ISHU) at Lubowa on Entebbe Road, which was supposed to offer first class treatment for VIPs—mostly government officials, the well-connected to the ruling class— and other Ugandans with means. This would result into saving millions of dollars of taxpayers’ money spent on treating VIPs.
Dr Baryomunsi said last Thursday that despite being flown for 8,000 miles, Oulanyah could not get the desired treatment because his bone marrow was already severely damaged by the time he was admitted.
In his speech last Friday after the Speaker’s elections, President Museveni revealed that Oulanyah had been initially treated in Dubai, United Arab Emirates mid-last year, and thereafter routinely seen by experts at the Uganda Cancer Institute. Officials from the Finance and Health ministries, initially stated that the much-vaunted ISHU, a 264-bed specialised healthcare project, would be completed by June 2021.
The hospital is meant to offer a wide range of specialities, including bone marrow transplants, advanced cardiovascular treatment, highly specialised surgeries, cancer treatment and organ transplant, and fertility treatment, among others.
In April 2021, the Health minister, Dr Aceng told the Parliamentary Health Committee that the completion date had been revised to September 2022. The site was handed over to the contractor in June 2019, she said, when heavy rains set in until early 2020 when the Covid-19 pandemic made a landfall in the country bringing everything to a grinding halt.
In an interview last Friday, the Finance ministry Permanent Secretary Ramathan Ggoobi acknowledged that the project was inordinately set back by three main factors; delay to acquire land from 2015 to 2019 when it was handed over, heavy rains and the Covid-19 pandemic and its associated lockdowns stretching over two years.
“The new completion date is now September 2024, and given the arrangement, for me to be candid, we had a weakness as government in the way in which the project was being handled. Only the Ministry of Finance and some bit of Health were involved, but now we have a steering committee spearheaded by the Prime Minister,” Mr Ggoobi said.
In March 2019, Parliament hurriedly approved the Ministry of Finance’s request for issuance of promissory notes amounting to $379.7m (Shs1.4 trillion) as security to the project developer, a led by shadowy company—FINASI, under a Special Purpose Vehicle known as Finasi/Roko special purpose vehicle (SPV), and the lenders as AFRIEXIM Bank, Eastern and Southern African Trade and Development Bank, and ABSABank (as the local agent).
A promissory note is a financial instrument that contains a written promise by one party to pay another party a specific sum of money either upon demand or at a given future date. “A promissory note is not a guarantee. It is not a loan. We are purely saying you give us the works equivalent to the money you are asking for and we issue a promissory note. What we want as government of Uganda is the hospital,” Mr Ggoobi said.
The current civil works, according to the project owners engineer—the Ministry of Health, stands at 25 percent.
Mr Ggoobi, under whose ministry the hospital project is shepherded, told Daily Monitor that they have so far issued seven promissory notes amounting to $120m (Shs431b), out of the $379m (Shs1.2 trillion) project cost, which is equivalent with existing civil works.
From one crisis to another
This, as FINASI, the lead developer, according to sources familiar with the matter is trying to shop around for a new civil contractor. FINASI is reportedly owned by the powerful Enrica Maria Aristidina Pinetti, who is feared in the corridors of power. Last month, she was awarded another multi-billion shilling deal to establish a coffee processing plant at Kampala Industrial and Business Park, Namanve.
MPs and other government officials have been blocked from accessing the hospital site for on spot checks without scheduled appointment. Prime Minister Robinah Nabbanja, who heads the steering committee for the project, was also recently blocked from accessing the site until she put her request to visit in writing.
Barely months after the FINASI/Roko SPV was handed the project site in 2019, a row ensued leading to a protracted legal battle. FINASI by then owned 95 percent in the SPV and Roko 5 percent. The two later agreed to settle the matter out of court.
Before the fallout, queries had been raised about the procurement stages—planning, planning initiation, contract award, and execution—for the SPV and the project itself. The plan to construct the specialised hospital dates back to October 2014 and later in May 2015 when government and the Finasi/Roko joint venture signed the project works investment agreement for designing, financing, construction and equipping of the hospital.
Besides the financial security, the government doled out 32 acres of land for the project.
After throwing out Roko, FINASI engaged Power China Guizhou Engineering Co. Ltd as the new contractor in mid-2019. Sources intimated that the owners engineer—Ministry of Health—did not approve the new contractor for about five months.
A few months into work, sources further revealed that FINASI got into disagreements with the Chinese company, Power China Guizhou Engineering Co. Ltd, which offered to undertake the work for a comparatively cheaper deal than Roko. It has since been rejected over substandard civil works.
The project has been beset by a number of problems, including cash flow as the financers refused or took long to cash in the promissory notes for the substandard work not in sync with the project agreement signed in April 2019.
The project owners’ engineer, Mr George Otim, was not available for comment. However, Mr Ggoobi is optimistic about the project.
“I understand bids were issued to get a number of people involved by — a new contractor by mid- next month, and a financing arrangement is being worked on,” he said. “For us now, we are working on new timelines so that we do not have any delays.”
Mr Ggoobi says despite the flak, the specialised hospital remains “a fantastic idea” and there are few people out there who can construct one.
“Of course, there are intervening variables to make the project work…it is a good thing. It does not put government in a situation where it guarantees. For example, it is not one of those projects where a developer doesn’t deliver work and they get paid. In other words, there is no money lost,” he told Daily Monitor.
The last published costs of treatment for VIPs abroad between the Financial Years 2013/2014 and 2015/2016 was estimated at Shs10 billion, excluding costs of flights, upkeep and attendants’ costs.
The list itself of who is given approval for treatment abroad remains a tightly-guarded secret. The University of Washington Medical Centre, according to highly placed sources, is yet to send the final invoice for Oulanyah’s treatment.
It remains to be seen whether the specialised hospital when completed, will offer affordable treatment to ordinary Ugandans or will be outpriced and only cater for high-profile figures.
To millions of Ugandans who are treated in dysfunctional hospitals, this will be yet another form of a discriminatory system at home replacing a practice of medical apartheid.