What you need to know:
- Uganda has continued to receive global plaudits for its handling of the Covid-19 pandemic since mid-2020 as the regime enforced stringent lockdown measures, including closing schools for nearly two years.
- The US aid agency, USAID, early this year paid glowing tribute to the country as “a leader” on the continent for Covid vaccination demonstrating that exceptional change is possible with targeted investment.
- But underneath this aplomb, lies accountability questions in regard to billions of shillings budgeted for the procurement of vaccines as most of those inoculated have relied on donated jabs, Frederic Musisi and Rita Kemigisa write.
A large crowd of people gathered at Kanungu Health Centre IV, a remote outpost in South-western Uganda, at the crack of dawn a fortnight ago. Word had spread across villages that it was the last day the facility was offering Covid-19 vaccinations.
Why would 200 people crowd a health centre to receive either the first or second jab on the last day of a supposedly long-running vaccination campaign? The answer depended on who one talked to.
The assistant Kanungu District health officer, Mr Kato Besisira, explained that whilst 46 percent of the district population had been inoculated, which in his view is comparatively good progress, others were reluctant to embrace the exercise.
But Mr Martin Niwahereza, a resident at the health centre, blamed the health workers. “For three days in the last weeks I would wake up early, leave everything else unattended to, to come here to get my second jab but they (health workers) would start vaccinating at 3pm,” he said.
This was the similar experience we encountered at Kabuule Health Centre III in Mityana District. Here, health workers only administer jabs when there are at least 10 people, which means that those who wake up early have to bear the brunt of waiting for others to arrive.
In south-east in Rubirizi District, the reverse is true. At both Kichwamba Health Centre III and Rugazi Health Centre IV in Bunyaruguru County, a few people or hardly anyone was in sight.
Ms Beatrice Kwenge, the acting officer-in-charge at Rubirizi Health Centre IV, said they have enough vaccine stocks but uptake is hinged on people’s behavioural change — for instance locals comply after listening to radio announcements.
The officer-in-charge of Kichwamba Health Centre III, Mr Johnson Muhumuza, said they also have a steady supply of vaccines but less turn-out.
“There are many unvaccinated people out there who serve as inspiration for most people not to come. Initially there was a rush for Johnson and Johnson but when it got finished somehow people lost interest,” he said.
The deputy Rubiri District chairperson, Mr Ventiono Byamukama, partly blamed the Health ministry for the vaccine apathy.
“For sure we have the supply of vaccines, but remember when Ministry of Health said when you get one type, say Moderna, for the first jab you have to wait after sometime to get Moderna for a second one, and then they changed positions that one can actually mix the vaccines. That created some fear among locals, especially in this age of misinformation,” he said.
At Mayuge Health Centre IV in eastern Uganda, residents accused health workers of demanding a bribe of Shs10,000 for a jab.
This resulted in apathy as many were reluctant to pay to get vaccinated. At Kapelebyong Health Centre IV in Teso, averagely five people are vaccinated each week while health workers have gone for spells without getting their allowance. It is only at Apac general hospital in Apac District that health workers turned up in the morning to vaccinate locals.
The Health ministry has designated vaccination centres across 136 districts in the country. However, this has been beset with problems such as apathy, shortage of jabs, and extortion—some health workers asking for money to administer jabs and to offer vaccination cards.
Dr Diana Atwine, the ministry’s permanent secretary, acknowledged reports of people selling vaccines and cards.
“I get so upset when I hear people talk empty like that. If you have evidence of some sort bring it forth,” she said. “We are not going to fight corruption by talking, and you yourselves have gone ahead to pay for the services that are supposed to free—you are part of the problem. Expose those people so we go for them. I only see things on social the media but where do I start.”
As at the weekend, according to the Ministry of Health, 16.6 million jabs had been administered countrywide.
Last month, March 20 marked two years since the coronavirus caused by the novel SARS-CoV-2), that originated from China’s Hubei Province in Wuhan and spread across the world in December 2019, made a landfall in Uganda.
The index case was registered at Entebbe airport and later several cases recorded at the Busia and Malaba border points as the virus barrelled deep inside the country.
The government responded swiftly with stringent measures, including closing off all border points and enforced lockdowns and dusk to dawn curfews in 2020 and in 2021 during the second wave of the pandemic.
Vaccines, touted as the most critical tool against the virus, became available in late 2020 starting in first world countries. Uganda received the first—donations—batch of 864,000 doses of the AstraZeneca vaccines through the COVAX facility, the world’s facility for universal access to Covid-19 vaccines on March 5, 2021.
Two days later on March 7, 2021 the Indian government donated another batch of 100,000 AstraZeneca vaccines bringing the available stock to 964,000 through donations.
It is against this backdrop that the country launched the first phase of Covid-19 vaccination campaign on March 9. At the time, the country’s cumulative Covid-19 caseload stood at 40,367, with at least 334 deaths, and 14,989 recoveries.
In an earlier address on February 11, 2021, Health minister Jane Ruth Aceng indicated that the government through the Health ministry and National Medical Stores (NMS), the statutory body mandated to procure, store and distribute medicines, had placed an order for 18 million AstraZeneca doses from the Serum Institute of India.
Of these, she said, 400,000 were expected in the country by mid-March that year and the rest would be delivered later in the year.
Dr Aceng said government would procure each dose of AstraZeneca at $7. This, was, however triple of what the European Union (EU) was paying at $2.16 per dose and double of what South Africa was paying per dose at $5.25.
She further indicated that government’s order would be confirmed by Serum Institute upon payment of a $5m down payment.
The cost of $7 per dose elicited suspicion and outcry from civil society actors. But later that afternoon of February 11, Parliament approved a supplementary of Shs18.6b under the Ministry of Health’s vote for procurement of vaccines. The request for a supplementary vote was tabled by the then junior Finance minister David Bahati.
The Shs18.6b was transferred to National Medical Stores (NMS) later on March 29, 2021, to place the vaccine orders. It was also the last time the country heard about the money.
“It speaks a lot to the limited transparency and accountability surrounding Covid-19 expenditure,” said Ms Christine Byiringiro, the programmes manager for governance at Uganda Debt Network, an anti-corruption non-governmental organisation.
As of March 29, last week, according to the Health ministry, Uganda had received 21.9 million vaccines. Of the 21.9 million jabs, the US government says it donated 12 million doses as of February as part of Washington’s vaccine diplomacy.
The balance of 9.9 million doses have also largely been donations; on June 16, 2021, the country received another batch of 175,200 AstraZeneca vaccines, on July 31, Norway donated 286,080 vaccines and China, 300,000 doses of Sinovac, among others. Other countries that have donated vaccines to Uganda include Spain, Denmark, France, Belgium, Germany, and Canada.
Several policy documents between 2020 and 2021 indicate budgetary allocation of billions of shillings for procurement of vaccines but there are no records that these vaccines arrived in the country.
In her written responses last August to the report of findings by the parliamentary ad hoc committee on the country’s national Covid-19 response, Dr Aceng detailed plans to acquire 18 million doses of China’s Sinopharm vaccines through the COVAX facility and nine million Johnson and Johnson vaccines procured through African Union (AU).
The Sinopharm and Johnson and Johnson vaccines were expected in the country by October and September 2021, respectively.
But six months later, the two consignments are not captured on the Ministry of Health’s update vaccine chart meaning they were either not procured or are yet to arrive.
During one of his addresses on Covid-19 on September 22, 2021, President Museveni said the batches of 1.2 million Johnson and Johnson, and two million Sinopham vaccines procurement by his government would arrive by the end of October and September, respectively, but are yet to be delivered almost six months later.
In another address on November 11 2021, the President said cumulative vaccine receipts stood at 15,541,890 doses of different vaccines. He said by the end of December, 2021, the country should have received AstraZeneca (1,257,700 doses; Sinopharm (1,713,600 doses); Sinovac (600,000 doses); Johnson and Johnson (9,950,400 doses); and Pfizer (2,919,150 doses), bringing total receipts to 31 million doses, which were to serve as a prelude to the full reopening of the economy in January.
Dr Atwine during an interview, however, said all money received for procurement of vaccines had been remitted to both COVAX and AU.
“The money we received was a small fraction of the money we asked for to buy the vaccines which was deposited. They even supplied us more than what we paid for. MOFEPD is working with World Bank to get more…once we get money we shall calculate the deficit. Because we may have to discount we got some donations,” she said.
The government gets the vaccines through three channels; donations, the major source so far, the COVAX facility which was co-founded by the World Health Organisation, the French government and EU and is led by the Global Alliance for Vaccines and Immunisation, and the Coalition for Epidemic Preparedness Innovations. The third channel is the African Union’s African Vaccine Acquisition Trust (AVAT) that acts as a centralised purchasing agent on behalf of the AU.
Besides donations, the government equally does not pay a penny to the COVAX facility. One official told this newspaper that AVAT has been generally slow at supplying vaccines across the board. The official hinted that while government had ordered for more doses, it had also received more donations which have covered the gap.
Ms Byiringiro said: “In March 2021 government provided Shs18b and then in June another Shs30b but as far we know no single vaccine has been procured. Remember the talk of inflating vaccines when it turned out that Uganda was spending $7 on a single dosage double what South Africa and triple what EU was spending?”
In May 2021 when India was battling a resurgence in the Covid caseload, the Serum Institute noted that it would not supply vaccines until at least December 2021 to help the Indian government tackle the deadly second wave.
Auditor General John Muwanga in his latest audit submitted to Parliament early this year detailed that while money had been transferred to NMS no vaccine had been delivered by end of the audit year last June.
NMS spokesperson Sheila Nduhukire declined to respond to our inquiries. But while appearing before the parliamentary committee on the Covid-19 response in July, both the NMS director general, Mr Moses Kamabare, and the Finance minister could not account for the Shs18b.
Mr Kamabare further told the select committee that in this Financial Year 2021/2022, Shs560b was allocated for vaccine procurement but had only received Shs80b with the rest of the money still held by the Ministry of Health.
The parliamentary health committee early this year tasked NMS for a full accountability for billions allocated during the last two 2020/2021-2021/22 for procurement of vaccines. In this FY 2021/22, at least shs80b was allocated.
The Auditor General’s report also details that little progress has been registered after billions of shillings that were doled out to research projects under the Ministry of Science of Technology for Covid-19 vaccines and treatment.
On February 17, the ministries of Finance and Health inked a financing agreement with the World Bank for provision of $180.3m (Shs641b) for procurement of Covid-19 vaccines.
Uganda’s Covid-19 response received global plaudits in the early days, when the country, whose workforce has immense experience in dealing with outbreaks such as Ebola, cholera, Marburg, and Crimean Congo fever, registered a few cases over a period of several months during and after the lockdown.
Mr Peter Eceru, the programme specialist for health and human rights advocacy at the NGO, Centre for Health, Human Rights and Development, told Daily Monitor that the argument that Uganda has performed comparatively well in combating the pandemic should not come at the expense of accountability.
“The argument that we did well is not conclusive. The circumstances where we live as a country are different from those countries that were hit hard. There has to be a balance for value for money and the money we sank in,” Mr Eceru noted.
He said: “It is difficult to ascertain where the money went. So, what we’ve not been told is whether the money for procurement of vaccines went back to the Consolidated Fund because we remember as a country we suffer from the chronic diversion of funds problem.”
The opaque award of contracts and dubious accountability are eliciting questions that require the piercing of the veil, which may require conducting a forensic audit.