Uganda blames Global Fund bureaucracy for drug problems

KAMPALA, Uganda (AA) – Uganda’s Health Ministry is blaming the Halima Athumani to Fight AIDS, Tuberculosis and Malaria’s bureaucracy for inadequacies found by auditors.

Speaking to Anadolu Agency, State Minister for Health Chris Baryomunsi said that most of the monies from the Global Fund are spent outside Uganda. “Much as they want to blame our government, the problem is with their system, we only handle 5 percent of the funds.”

But Baryomunsi says Uganda procures drugs and other supplies using systems set up by the Global Fund, adding, “The delays being cited are occasioned by the bureaucracies in the budget for procurement processes that also give us strict regulations on which international firms we should purchase the drugs from.”

Approximately 90% of grant funds are spent on the procurement, storage and distribution of health commodities.

The audit notes that while Uganda has made progress in the control and treatment of HIV, tuberculosis, and malaria with a reduction in new infections and incidences, the challenges cited, if not addressed, will result in treatment disruption for patients.

They also identified stock-outs of key medicines, particularly those to treat HIV, anti-malaria medicines, tuberculosis medicines, and test kits of between one week and three months and use of expired test kits.

Musa Bungudu, the UNAIDS country director, said the findings are not surprising, but “definitely a reason for concern, [and] if they are not addressed, I think Uganda stands the risk of losing support from Global Fund and even other partners.”

The report also cites the loss of $21.4 million in expired drugs. Bungudu said, “It’s not 21 million Uganda shillings, this is dollars, someone is lacking and missing those drugs, but also someone is missing the opportunity to test.”

He adds, “If one person cannot access treatment, that is going to affect the work we are doing.”

Baryomunsi said through the National Medical stores they ensure that whichever drug comes to the country, the shelf life is checked and those that don’t measure up are not allowed in.

On expired test kits, he said those come from third party donations. “Some agencies donate supplies in plenty, some of which we already have.” A health interagency committee has now been set up to resolve the issues raised in the report.

Uganda has aligned its anti-retroviral therapy policies to the latest guidelines from the World Health Organization and UNAIDS. This has not only boosted the number of people qualifying for HIV treatment but also resulted in a funding gap of $92 million for HIV and $9 million for tuberculosis.

But Baryomunsi told Anadolu Agency the money was spent early due to the increased number of people needing antiretroviral therapy. “We shall in future do proper planning and budgeting, but what use does it make for people to die because of lack of drugs because we are keeping money for 2017?” he asked.

Lillian Mworeko, regional coordinator of the International Community of Women Living with HIV Eastern Africa, differs. She accuses the government of diverting money for electioneering, depriving the Treasury of resources needed for life-saving medicines. She added, “The government must immediately complete a transparent and detailed gap analysis to close the funding gap.”

Baryomunsi told Anadolu Agency that the Cabinet will be meeting next week to create an HIV trust fund and complete its operational guidelines. “We shall put in our own domestic resources that will be used to procure ARVS, fund counseling and testing services.” He added, “The funds will be used in case external support doesn’t flow and isn’t reliable.”

Uganda accounts for 5 percent of the global HIV burden and takes third position in Africa. The country has a generalized epidemic, with 1.5 million people living with HIV and an estimated prevalence rate of 7.3%.

While Baryomunsi denied Uganda has a stock-out challenge, Mukili John, coordinator of the National Forum of People living with HIV in the Otuke district in Eastern Uganda, said they still lack ARVs for children and adults. “We have been borrowing drugs from different health centers, yet many go without drugs for weeks, including Septrin.”

John, like other coordinators, told Anadolu Agency, “Our clients are going without drugs for weeks and when they come, some now have rashes and swellings in the mouth.” He added: “We have been forced to ration the drugs, instead of giving a client a refill of one month we give them for two weeks or send them away when there is nothing.”

Uganda has faced a malaria outbreak especially in Northern Uganda since last July. The epidemic by February had affected over 1 million people, killing 658. The Health Ministry last month dispatched a team of 374 health workers to combat the unusual outbreak of malaria.

The OIG report noted that some health facilities visited during the audit either under or over-reported results related to malaria. Some 43 percent of patients were treated for malaria without a confirmed diagnosis and with negative results.

Mworeko questioned if they can trust all results given to patients. “How can we take our Health Ministry seriously when this is happening and somebody from outside comes here to tell us that actually the test kits you are using are expired and we cannot detect that as a country?” he asked.

There were reported cases of theft, including 40 cartons of artemisinin-based combination therapies; an unexplained difference of $21.4 million between recorded and actual stocks at the central warehouse; and a difference of $1.9 million between commodities received and actually dispensed to patients from January 2014 to June 2015 in eight high-volume facilities visited by auditors.

Dan Kimosho, public relations officer of the Uganda National Medical stores, mandated with the supply of drugs in the country, faults a system error for the mishap. He told Anadolu Agency that they are looking at upgrading their system from the current Maps and Fage system. “When you look at the figures cited in the report it’s quite big, but there was typically a system error,” he said.

Baryomunsi said they are currently negotiating with the Global Fund among others to be allowed to buy drugs and medical supplies from local manufacturers at cheap prices. “This will see an end to cases of drug stock-outs and importation of drugs so as to avail them cheaply to our people.”

In 2009 Uganda was blocked from accessing Global Fund monies due to abuse and misuse of sources, leading to court cases. It was later reinstated in 2012 after developing a roadmap to address previous abuses.

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