According to the Ministry of Health, Human Resources for Health Recruitment Plan
(2011-2020),the health sector is currently grossly understaffed with nearly half of the approved positions being vacant. A deeper analysis of the current staffing reveals yet another dimension of this problem in that majority of the staff in post are either support or administrative staff. Qualified health workers including doctors, midwives, nurses and allied health professionals are in shortage and more especially in hard to reach rural districts and the new districts. This situation seriously compromises the performance of the sector and particularly in its contribution to national development. According to the trend analysis of the performance of the health related indicators done in the National Development Plan, it is unlikely that the MDG targets of these indicators will be met if the same trend continues. Infant mortality needs to improve from 76 to 41 while under five mortality needs to improve from 137 to 60 and maternal mortality ratio from 435 to 131 by 2015/1016 which is just 4 years away. Further according to the 2009/10 health sector performance report 7 out of the 8 HSSPII PEAP indicators fell short of the set targets. The percentage of deliveries in health facilities were at 33% against the HSSPII target of 50%. The % of approved positions filled by qualified health workers was at 53% at the end of HSSPII falling short of the 65% HSSPII target. Inadequate number of skilled personnel to deliver the Uganda National Minimum Health care package especially of mother and child health, communicable, non communicable and nutrition services was one of the key challenges highlighted in the performance report. The need to urgently address the current HRH crisis that the sector faces is therefore a high priority agenda. The gross understaffing is partly attributed to insufficient recruitment in all local governments for close to four years due to limited wage bill ceilings. Even when wage ceilings provided for recruitment, the funding for the DSC was not adequate to cover the recruitment costs leading to under utilization of the wage bill. Difficulty in attracting certain cadres of staff especially medical officers, dispensers, lab technicians and anesthetic officers has also posed a major challenge to previous recruitment efforts. It is no wonder therefore that even in districts which have relatively higher proportions of their approved posts filled, the major positions filled are those of support staff with low proportions of qualified health workers.
The districts currently have on average only 52% of the staff they need to work (this reduced from 53% after the creation of new districts). In real terms the sector needs approximately 49,000 staff in the district health systems excluding the national and regional referral hospitals but has only 25,000 staff are in post currently. This means that for the sector to be fully functional and perform according to expectations there is need to recruit at least 24,000 more health workers.
Additionally the limited motivation and retention packages given to health workers has contributed to poor performance, absenteeism and even inability to retain critical cadres even where health workers have been recruited. Currently, health workers receive a meager consolidated Duty Facilitation Allowance
(DFA) of Uganda shilling 90,000/- for senior consultants and other senior staff and 45,000/- for the lower level staff. This amount has remained the same for the last five years.
The health sector wage bill has remained constant at 178.07 billion, yet the costing of the HSSIP indicates that in 2011/2012, 688.02 billion will be required to recruit a sufficient number of health workers as per the current staffing norms. The health sector BFP indicates there are plans to recruit an additional 1000 health workers in 2011/2012 but requires an additional 1.8 billion.
Proposal: CSOs cognizant of the constrained resources recommend the recruitment of at least 5000 staff in the next financial year (FY 2011/2012). The cadres to be recruited would comprise mainly qualified health workers i.e. doctors, midwives, nurses and allied health professionals. According to the Human Resources for Health Recruitment plan, this translates in a total wage need of 34 billion and 2 billion to cater for recruitment costs incurred by the DSCs. it would be cost effective to allocate 2 billion to recruit 5000 than 1.8 billion to recruit 1000 health workers. Currently the health sector wage bill is 178.07 bn and increase of this by 34bn would bring the total sector wage bill to 212.07 bn. In order to retain existing healthworkers, and to attract skilled applicants to the positions, we propose additional motivation and retention packages in the form of increasing the DFA based on performance for all cadres of health workers from a minimum of 45,000/- and 90,000/ to 200,000/= and 400,000/- respectively.
If this is done the staffing level would move to 65% and if the trend is continued in subsequent years the NDP target of 85% staffing level would be met by 2014/2015 and subsequently this would have a positive effect on the national development goals. Payment of increased DFA based on performance will have a positive effect on motivation, and increase the capacity of the health system to retain all cadres of qualified health workers.
Friday, March 25, 2011
Thursday, March 24, 2011
Urgently fill the key technical positions at the Ministry of Health,
There is saying that when the elephants fight, the grass suffers. I am writing to express concern about the prolonged delays in filling key technical leadership positions at the Ministry of Health (MoH). When there are leadership gaps, the health system and ultimately health consumers suffer. According to the World Health Organisation, “A health system is the sum total of all the organizations, institutions and resources whose primary purpose is to improve health.” A health system needs not only staff, funds, information, supplies, transport, communications but also overall guidance and direction from people with key technical expertise. The MoH in Uganda has not had a Permanent Secretary (PS) since 2009 and Director General of Health Services (DGHS) since early 2010. When Ms. Nanono was suspended from the position of Permanent Secretary in 2009, the DGHS was appointed to act as the PS. When the then DGHS retired in early 2010, the Director, Clinical and Community Services (C& C), Dr. Nathan Kenyamugisha was appointed to act as both the DGHS and the PS. This went on for about eight months. Then the position of Deputy PS was created in late 2010 and Dr. Lukwago Asuman was appointed to fill this position and to act as the PS. However, the position of DGHS was never been filled and the Director (C & C) has been acting in this position for over 12 months as well as filing his own position. Dr. Kenyamugisha (with all due respect) is expected to handle the job of the DGHS in an acting position efficiently for prolonged periods of time yet this amounts to work overload if he is still the Director (C & C). The Ministry of Health has suffered a technical leadership gap for far too long. Yet, the political leadership is filled with three ministers and a presidential adviser on health. Additionally, there is a parallel monitoring system in the names of Medicines and Health Services Delivery Monitoring Unit under the Office of the President which is performing the work which should partly be done by the health professional councils and support supervision by MoH officials.
No explanation has been provided why these key positions have not been filled and why the positions of PS and DGHS have to be filled by acting persons for over 12 months. Are there no competent people for these positions? To appoint someone in an acting position should be a temporary solution while steps are being taken to fill the position permanently. The professional councils and the support supervision system need to be strengthened instead of creating parallel structures and increasing costs of public expenditure. The concern authorities should take steps to appoint competent persons to these positions instead of increasing the number of political appointees. We need a strong ministry of health with competent leadership to provide overall guidance and direction in order to improve health outcomes.
No explanation has been provided why these key positions have not been filled and why the positions of PS and DGHS have to be filled by acting persons for over 12 months. Are there no competent people for these positions? To appoint someone in an acting position should be a temporary solution while steps are being taken to fill the position permanently. The professional councils and the support supervision system need to be strengthened instead of creating parallel structures and increasing costs of public expenditure. The concern authorities should take steps to appoint competent persons to these positions instead of increasing the number of political appointees. We need a strong ministry of health with competent leadership to provide overall guidance and direction in order to improve health outcomes.
Government should increase budgetary allocation for ART, PMTCT and other Essential Medicines,
The overall resource envelope available has grown by about 5% from 7,552 billion in 2010/2011 to 8,004.1 billion for 2011/2012. However, budgetary allocations for the majority of the sectors including health have not changed from last financial year. Infact, the health Sector Budget Framework paper indicates that the health budget will remain at 660 billion in 2011/2012. The Ministry of Health has internally increased the budgetary allocation for Essential Medicines from 201.73 billion to 204.43 billion. This will contribute to ensuring that health facilities receive adequate stocks of essential medicines and health supplies. However, the percentage of the budget allocation to health (including donor support) has gone down from to 8.7% to 8.2%. Government has once again failed to meet the Abuja target of 15% to which Uganda committed in 2001
Domestic investment in Essential Medicines and Health Supplies (EMHS) particularly for Anti Retroviral Therapy (ART) and Prevention of Mother to Child Transmission (PMTCT) in particular remains very low compared to the needs. Funding for EMHS/National Medical Stores (NMS) will remain at 201billion in 2011/2012. Of this allocation, 90 billion is support from the Global Fund. Although there has been a slight increase in availability of medicines since Vote 116 giving NMS autonomy was enacted in August 2009, owing to the funding gap, the supply of EMHS still does not match the current need.
According to the Ministry of Health STD/ACP, a total of 578, 860 PLHIVs (by January 2011) in Uganda required ART but only 263, 154 on ART. Of these, 99, 170 are children but only 19, 903 are on treatment. According to Uganda’s proposal to Global Fund Round 10, to reach the treatment target to provide for 50% of the PLHIV, at least 2443 patients have to be put on treatment in 2011. To reach the treatment target of 61%, at least 92, 756 people have to be put on treatment in 2012. Bearing in mind that Uganda’s proposal to the GFTAM Round 10 (HIV) was unsuccessful, there is need to increase domestic investment in HIV treatment and PMTCT scale up.
The costing of the HSSIP indicates that to address the EMHS need would require 877 billion in 2011/2012, yet only a less than quarter of this has been allocated (201 billion). Moreover, Uganda largely relies on donor funds (PEPFAR, GFTAM, CHAI and other partners) for ART and PMTCT supplies. Of the 201 billion allocated, 90 billion is support from GFTAM Round 7 and 60 billion from GoU for ARVs and ACTs, and only 50 billion has been allocated for other EMHS.
Furthermore in 2010, the Government introduced the BASIC KIT system which supplies a pre determined set of EMHS to HC IIs and IIIs. The KIT does not contain all drugs on the Essential Medicines list of 2007 but also some critical EMHS like panadol are supplied in minimal quantities. For example, Essential medicines for mental health and epilepsy were introduced into the essential medicines list in 2007, however, there is still a critical shortage of mental health drugs. According to BASIC NEEDS, an organisation working to advocate for increased access to mental health services, health centres (HC) IIIs receive only one tin of chlorpromazine (25mg) and one tin of Phenobarbital (30mg) for uncomplicated epilepsy. In effect the HC can only treat 1 or 2 adults with schizophrenia or bipolar affective disorder and 3 children with epilepsy every two months. “There is now a danger of over 99% of those who had already started treatment relapsing (experiencing symptoms again) due to limited supply of medicines, the ripple effect of which will be the reversal of the gains made in reducing the treatment gap for mental disorders and epilepsy.” Insufficient supply of EMHS limits the ability of health workers to deliver the Uganda National Minimum Health care package especially for maternal and child health, communicable, non communicable and services.
There is need for additional domestic investment in the procurement of cotrimoxazole, anti-tuberculosis medicines, diagnostic and monitoring equipment and medicines for mental health and priority essential health commodities. GoU must increase the budgetary allocation for ARVs, and other EMHS especially those provided in the BASIC KIT and allocate a budget for PMTCT to cover the treatment gap. In addition to the 201 billion, an increased allocation to of an additional 100 billion, with a focus on scaling up domestic investment in ART, PMTCT, cotrimoxazole, anti-tuberculosis medicines, diagnostic and monitoring equipment and doubling the supply of EMHS in basic KIT (HC II & III) in order to reach the goals described in the NDP and HSSP III. Increasing financing for EMHS will ensure that essential, efficacious, safe and good quality and affordable medicines are available, which will contribute to strengthening the management and organisation of the national health system
Domestic investment in Essential Medicines and Health Supplies (EMHS) particularly for Anti Retroviral Therapy (ART) and Prevention of Mother to Child Transmission (PMTCT) in particular remains very low compared to the needs. Funding for EMHS/National Medical Stores (NMS) will remain at 201billion in 2011/2012. Of this allocation, 90 billion is support from the Global Fund. Although there has been a slight increase in availability of medicines since Vote 116 giving NMS autonomy was enacted in August 2009, owing to the funding gap, the supply of EMHS still does not match the current need.
According to the Ministry of Health STD/ACP, a total of 578, 860 PLHIVs (by January 2011) in Uganda required ART but only 263, 154 on ART. Of these, 99, 170 are children but only 19, 903 are on treatment. According to Uganda’s proposal to Global Fund Round 10, to reach the treatment target to provide for 50% of the PLHIV, at least 2443 patients have to be put on treatment in 2011. To reach the treatment target of 61%, at least 92, 756 people have to be put on treatment in 2012. Bearing in mind that Uganda’s proposal to the GFTAM Round 10 (HIV) was unsuccessful, there is need to increase domestic investment in HIV treatment and PMTCT scale up.
The costing of the HSSIP indicates that to address the EMHS need would require 877 billion in 2011/2012, yet only a less than quarter of this has been allocated (201 billion). Moreover, Uganda largely relies on donor funds (PEPFAR, GFTAM, CHAI and other partners) for ART and PMTCT supplies. Of the 201 billion allocated, 90 billion is support from GFTAM Round 7 and 60 billion from GoU for ARVs and ACTs, and only 50 billion has been allocated for other EMHS.
Furthermore in 2010, the Government introduced the BASIC KIT system which supplies a pre determined set of EMHS to HC IIs and IIIs. The KIT does not contain all drugs on the Essential Medicines list of 2007 but also some critical EMHS like panadol are supplied in minimal quantities. For example, Essential medicines for mental health and epilepsy were introduced into the essential medicines list in 2007, however, there is still a critical shortage of mental health drugs. According to BASIC NEEDS, an organisation working to advocate for increased access to mental health services, health centres (HC) IIIs receive only one tin of chlorpromazine (25mg) and one tin of Phenobarbital (30mg) for uncomplicated epilepsy. In effect the HC can only treat 1 or 2 adults with schizophrenia or bipolar affective disorder and 3 children with epilepsy every two months. “There is now a danger of over 99% of those who had already started treatment relapsing (experiencing symptoms again) due to limited supply of medicines, the ripple effect of which will be the reversal of the gains made in reducing the treatment gap for mental disorders and epilepsy.” Insufficient supply of EMHS limits the ability of health workers to deliver the Uganda National Minimum Health care package especially for maternal and child health, communicable, non communicable and services.
There is need for additional domestic investment in the procurement of cotrimoxazole, anti-tuberculosis medicines, diagnostic and monitoring equipment and medicines for mental health and priority essential health commodities. GoU must increase the budgetary allocation for ARVs, and other EMHS especially those provided in the BASIC KIT and allocate a budget for PMTCT to cover the treatment gap. In addition to the 201 billion, an increased allocation to of an additional 100 billion, with a focus on scaling up domestic investment in ART, PMTCT, cotrimoxazole, anti-tuberculosis medicines, diagnostic and monitoring equipment and doubling the supply of EMHS in basic KIT (HC II & III) in order to reach the goals described in the NDP and HSSP III. Increasing financing for EMHS will ensure that essential, efficacious, safe and good quality and affordable medicines are available, which will contribute to strengthening the management and organisation of the national health system
Friday, April 23, 2010
Opening Remarks at Civil Society Consultative Meeting on HSSP III
Representatives from MoH
Representatives from CSO on HPACs;
Representatives from CSO
Distinguished Guests,
Ladies and Gentlemen,
Welcome to this Civil Society Consultative Meeting on the Draft Health Sector Strategic Plan (HSSP III).
Thank-you for honoring our invitation and we hope that we shall continue this partnership. This meeting has been organized by AGHA and UCOBAC. AGHA is a health rights advocacy organization, recently appointed the CSO representative on the IHP+ Taskforce. UCOBAC focus on vulnerable children and mobilizes communities to participate in health related decision making.
This is a historic day for all of us! For the first time, we as CSOs have organized ourselves together to strategically review and provide input into a key policy document in the health sector.
This meeting builds on a meeting organized on March 10th 2010 for the same purpose for a select group of CSOs that reviewed the first draft of the HSSP III from a health and human rights perspective. While some of the recommendations of the last meeting have reflected in the New Draft of HSSP III, the majority have not. There is still opportunity to influence the development of this policy document especially because next week on the 26th and 27th, the MoH had organized a TRM which will be attended by our representatives on HPAC and its TWG.
Three points I want to communicate in these opening remarks.
1. To the Ministry of Health particularly, CS is not a homogenous entity. CSO are diverse, have varying mandates and modes of working. Some CSOs are in direct service delivery, others are involved in capacity building activities for communities, others are in advocacy, and others involved in monitoring. It is imperative for MoH to understand and appreciate the diversity within CSO bearing in mind their different roles and unique contribution to the sector. Important to remember is that CSOs represent you and me, in organized groups and form an important resource for M & E, and for promoting public accountability in the use of public resources. Civil Society represents the voice of the communities, the public and even the very civil servants who work in MoH who cannot voice their concerns publicly.
2. To the CSOs gathered here today-lets us participate actively. We have been provided an opportunity to review HSSP III and provide strategic input. Please let us make the best of the day. Ask questions to MoH officials and to our representatives on HPAC and the TWGs. As we deliberate throughout the day, let us bear in mind our differences and respect diversity in skills, knowledge, capacity and ability to engage. This meeting is also meant to support and strengthen the capacity of CSOs to understand and engage in Policy process. Our differences should enrich and add value to the discussions. HSSP III is our document, and MoH is merely playing a stewardship role in putting it together. At the end of the day we want this document to reflect our voices and the voices of the people we represent and not the thoughts of a Consultant.
.
3. As CSOs, we need to step up efforts to get coordinated so we can work better with Government. We need to build our mutual capacity to participate in and engage in policy processes. In the new IHP + arrangement, we as CSO will have specific roles to play in holding Government and HDPs accountable if they fail to fulfill their obligations. Let us become very well versed with the Content of HSSP III, today and after it has been approved and endorsed by Government, so that in future we shall be equipped to play our monitoring role and effectively promote mutual accountability between Government and Donors.
With these few words, you are welcome once again to this meeting.
I wish you fruitful deliberations.
Representatives from CSO on HPACs;
Representatives from CSO
Distinguished Guests,
Ladies and Gentlemen,
Welcome to this Civil Society Consultative Meeting on the Draft Health Sector Strategic Plan (HSSP III).
Thank-you for honoring our invitation and we hope that we shall continue this partnership. This meeting has been organized by AGHA and UCOBAC. AGHA is a health rights advocacy organization, recently appointed the CSO representative on the IHP+ Taskforce. UCOBAC focus on vulnerable children and mobilizes communities to participate in health related decision making.
This is a historic day for all of us! For the first time, we as CSOs have organized ourselves together to strategically review and provide input into a key policy document in the health sector.
This meeting builds on a meeting organized on March 10th 2010 for the same purpose for a select group of CSOs that reviewed the first draft of the HSSP III from a health and human rights perspective. While some of the recommendations of the last meeting have reflected in the New Draft of HSSP III, the majority have not. There is still opportunity to influence the development of this policy document especially because next week on the 26th and 27th, the MoH had organized a TRM which will be attended by our representatives on HPAC and its TWG.
Three points I want to communicate in these opening remarks.
1. To the Ministry of Health particularly, CS is not a homogenous entity. CSO are diverse, have varying mandates and modes of working. Some CSOs are in direct service delivery, others are involved in capacity building activities for communities, others are in advocacy, and others involved in monitoring. It is imperative for MoH to understand and appreciate the diversity within CSO bearing in mind their different roles and unique contribution to the sector. Important to remember is that CSOs represent you and me, in organized groups and form an important resource for M & E, and for promoting public accountability in the use of public resources. Civil Society represents the voice of the communities, the public and even the very civil servants who work in MoH who cannot voice their concerns publicly.
2. To the CSOs gathered here today-lets us participate actively. We have been provided an opportunity to review HSSP III and provide strategic input. Please let us make the best of the day. Ask questions to MoH officials and to our representatives on HPAC and the TWGs. As we deliberate throughout the day, let us bear in mind our differences and respect diversity in skills, knowledge, capacity and ability to engage. This meeting is also meant to support and strengthen the capacity of CSOs to understand and engage in Policy process. Our differences should enrich and add value to the discussions. HSSP III is our document, and MoH is merely playing a stewardship role in putting it together. At the end of the day we want this document to reflect our voices and the voices of the people we represent and not the thoughts of a Consultant.
.
3. As CSOs, we need to step up efforts to get coordinated so we can work better with Government. We need to build our mutual capacity to participate in and engage in policy processes. In the new IHP + arrangement, we as CSO will have specific roles to play in holding Government and HDPs accountable if they fail to fulfill their obligations. Let us become very well versed with the Content of HSSP III, today and after it has been approved and endorsed by Government, so that in future we shall be equipped to play our monitoring role and effectively promote mutual accountability between Government and Donors.
With these few words, you are welcome once again to this meeting.
I wish you fruitful deliberations.
Friday, April 16, 2010
Health Trends in Uganda This Quarter
This quarter was both good and bad. The health sector Budget Framework Paper F/Y 2010/2011 reveals a decline in the budget from F/Y 2009/2010 by about 17 billion Uganda shillings. This is a result of a drop in donor funding. DANIDA, a major supporter to the health sector will from December 2010 be transferring to the water sector, leaving a gap in the Technical Support to the planning department, financing for Essential Medicines and Health Supplies, among others. The already under funded sector, particularly the financing of EMHS will suffer next FY if the funding gap is not covered.
Also this quarter, the newspapers were filled with stories of drug stock-outs and arrests of health workers for purportedly stealing drugs. These arrests were initiated by the Medicines and Health Service Delivery Monitoring Unit (MHSDMU). Most outstandingly was the arrest of the Programme Managers of the Malaria Control Programme in the Ministry of Health. Although mismanagement of public resources is an offence and must be prosecuted, these arrests are creating a perception that drug stock-outs are being solely caused by health workers. Even with the revision of the drug distribution system with the National Medical Stores having autonomy and control over distribution of drugs, stock-outs are still rampant. It is therefore important that in fulfilling its mandate, the MHSDMU must repackage its message to convey to the public that drug stock-outs are being caused by a multitude of including low funding, problems with supply chain, and the capacity of NMS to deliver drugs in a timely manner.Other stories reflect that National Medical Stores is making efforts to address shortages.
Maternal health issues next dominate the media.There is a cry in the media for men to be involved in maternal health issues.
THE BLOOD SHORTAGE HAS CONTINUED.
After a long wait, the Global Fund to fight AIDS, Tuberculosis and Malaria (GFTAM) fulfilled some commitments to the people of Uganda. Under Round 7, GFTAM has given Shs 170 billion Uganda to fight malaria. The money, according the State Minister for Primary Health Care, Mr James Kakooza, is meant to buy 17.5 million mosquito nets to be distributed free-of-charge to Ugandans, especially pregnant mothers and children who are more vulnerable.
The Minister of Health, Dr. Stephen Mallinga signed the global International Health Partnerships (IHP+) compact in February 2009. Efforts are now being taken to develop a country compact. AGHA was appointed to represent non facility based civil society organisations on the International Health Partnerships (IHP+) Taskforce. The IHP+ has been described as the translation into practice of the Paris Declaration on Aid Effectiveness for achieving the health-related MDGs through better aid coordination and a focus on results.
Also this quarter, the newspapers were filled with stories of drug stock-outs and arrests of health workers for purportedly stealing drugs. These arrests were initiated by the Medicines and Health Service Delivery Monitoring Unit (MHSDMU). Most outstandingly was the arrest of the Programme Managers of the Malaria Control Programme in the Ministry of Health. Although mismanagement of public resources is an offence and must be prosecuted, these arrests are creating a perception that drug stock-outs are being solely caused by health workers. Even with the revision of the drug distribution system with the National Medical Stores having autonomy and control over distribution of drugs, stock-outs are still rampant. It is therefore important that in fulfilling its mandate, the MHSDMU must repackage its message to convey to the public that drug stock-outs are being caused by a multitude of including low funding, problems with supply chain, and the capacity of NMS to deliver drugs in a timely manner.Other stories reflect that National Medical Stores is making efforts to address shortages.
Maternal health issues next dominate the media.There is a cry in the media for men to be involved in maternal health issues.
THE BLOOD SHORTAGE HAS CONTINUED.
After a long wait, the Global Fund to fight AIDS, Tuberculosis and Malaria (GFTAM) fulfilled some commitments to the people of Uganda. Under Round 7, GFTAM has given Shs 170 billion Uganda to fight malaria. The money, according the State Minister for Primary Health Care, Mr James Kakooza, is meant to buy 17.5 million mosquito nets to be distributed free-of-charge to Ugandans, especially pregnant mothers and children who are more vulnerable.
The Minister of Health, Dr. Stephen Mallinga signed the global International Health Partnerships (IHP+) compact in February 2009. Efforts are now being taken to develop a country compact. AGHA was appointed to represent non facility based civil society organisations on the International Health Partnerships (IHP+) Taskforce. The IHP+ has been described as the translation into practice of the Paris Declaration on Aid Effectiveness for achieving the health-related MDGs through better aid coordination and a focus on results.
The Global Aid Architecture for Health: Road Map for achieving MDGs?
It is 2010, five years left to 2015- the timeline set for achieving Millennium Development Goals (MDGs). There is a sudden rash by actors in the global and national health system to step up efforts to improve maternal, newborn and child health, and to combat malaria, TB and stop the spread of HIV/AIDS. Sub-saharan African (SSA) countries like Uganda have committed to reach the MDGs, and created the Abuja target of 15% of public spending going to health. Developed countries committed to reach 0.7% of GDP going to Official Development Assistance (ODA). Africa has the highest disease burden, yet the lowest level of financing on health. 41 SSA governments allocate less than 15% to health. Out of Pocket Spending (OOPs) dominates private financing in most countries. In Uganda for example, the per capita expenditure on health is US $ 10, of which half is provided by government and the other half if OOPs.
In the recent past, many initiatives including PEPFAR and the Global Fund to fight AIDS, Tuberculosis and Malaria (GFTAM) have come up to fast track the race to achieve the MDGs. Others include the International Health Partnerships and related initiatives including, the Harmonization for Health in Africa (AHA), the Catalytic Initiative, (CI), the Providing for Health (P4H) Initiative, GAVI’S Health System Strengthening (HSS), the Global Fund-National Strategy Applications, The Health Metrics Network, (HMN), the Global Health Workforce Alliance (GHWA), MDG Africa Initiative. Other initiatives include the Millennium Challenge Corporation (MCC) and Millennium Challenge Account (MCA).
In 2008/2009, the High Level Taskforce on Innovative health financing (HLTIF) chaired by UK Prime Minister Gordon Brown and World Bank President Robert Zoellick supported the global advocacy for more funding to strengthen health systems for MDGs 1,4,5 and 6.The HLTIF Identified a menu of innovative financing mechanisms to complement traditional aid and bridge the financing gaps which compromise attainment of the health-related Millennium Development Goals (MDGs). Now the World Bank, GAVI and GFTAM are proposed yet another platform for Health Systems Strengthening. Moreoever, new ODA commitments have been announced:
• A US$1 billion expansion of the International Finance Facility for Immunization (IFFIm)
• US$360 million worth of debt conversions – Global Fund's Debt2Health Initiative
• The launch of a VAT tax credit pilot scheme called De-Tax, expected to raise up to US$220 million a year in VAT resources
• A new mechanism for making voluntary contributions when buying airline tickets, expected to raise up to US$3.2 billion by 2015
• US$515 million for results-based funding programs for health (RBF)
To crown it all, the United States Government has introduced a new legislation, the Global Health Act, to “establish a strategy to coordinate health-related US foreign assistance, to assist developing countries in improving delivery of health services, and to establish an initiative to assist developing countries in strengthening their indigenous health workforces.”
But how do these initiatives translate to the national level? Who is really benefiting? Is aid the solution to Africa’s problems?To some extent, aid has contributed to the health of people in SSA and Uganda in particular. PEPFAR and GFTAM are primary funders of ART. PEPFAR providing $38.6 million for ARVs. Uganda has scaled up ART for approximately 170,000 adults, including 16,000 children. However, more than 350,000 people (including 50,000 children) are in urgent need of treatment. There have been some successes scored for child health. However in terms of Maternal Mortality, progress is very slow. MMR in Uganda has been stagnant at 435/100,000 for the past decade.
However, aid must not be viewed in isolation. What countries like Uganda require is increased and better allocated domestic for strengthening their national health systems in order to achieve the MDGs. Aid is not the solution to Africa’s problems. Most resources should come from countries’ contributions. There is therefore need for domestic advocacy to raise attention to national budgeting processes and channel private spending into risk pool in avoid over spending by individuals. It is therefore importance for external aid to be only catalytic and temporary with a focus on results and efficiency gains. SSA countries need to grow economically in order to have higher GDPs that will enable them take care of the health of their people. What SSA countries need are free markets to sell their cotton, coffee, tea, and other products. The discussion of the global health architecture must not be in isolation, but in the broader context of economic development and growth.
In the recent past, many initiatives including PEPFAR and the Global Fund to fight AIDS, Tuberculosis and Malaria (GFTAM) have come up to fast track the race to achieve the MDGs. Others include the International Health Partnerships and related initiatives including, the Harmonization for Health in Africa (AHA), the Catalytic Initiative, (CI), the Providing for Health (P4H) Initiative, GAVI’S Health System Strengthening (HSS), the Global Fund-National Strategy Applications, The Health Metrics Network, (HMN), the Global Health Workforce Alliance (GHWA), MDG Africa Initiative. Other initiatives include the Millennium Challenge Corporation (MCC) and Millennium Challenge Account (MCA).
In 2008/2009, the High Level Taskforce on Innovative health financing (HLTIF) chaired by UK Prime Minister Gordon Brown and World Bank President Robert Zoellick supported the global advocacy for more funding to strengthen health systems for MDGs 1,4,5 and 6.The HLTIF Identified a menu of innovative financing mechanisms to complement traditional aid and bridge the financing gaps which compromise attainment of the health-related Millennium Development Goals (MDGs). Now the World Bank, GAVI and GFTAM are proposed yet another platform for Health Systems Strengthening. Moreoever, new ODA commitments have been announced:
• A US$1 billion expansion of the International Finance Facility for Immunization (IFFIm)
• US$360 million worth of debt conversions – Global Fund's Debt2Health Initiative
• The launch of a VAT tax credit pilot scheme called De-Tax, expected to raise up to US$220 million a year in VAT resources
• A new mechanism for making voluntary contributions when buying airline tickets, expected to raise up to US$3.2 billion by 2015
• US$515 million for results-based funding programs for health (RBF)
To crown it all, the United States Government has introduced a new legislation, the Global Health Act, to “establish a strategy to coordinate health-related US foreign assistance, to assist developing countries in improving delivery of health services, and to establish an initiative to assist developing countries in strengthening their indigenous health workforces.”
But how do these initiatives translate to the national level? Who is really benefiting? Is aid the solution to Africa’s problems?To some extent, aid has contributed to the health of people in SSA and Uganda in particular. PEPFAR and GFTAM are primary funders of ART. PEPFAR providing $38.6 million for ARVs. Uganda has scaled up ART for approximately 170,000 adults, including 16,000 children. However, more than 350,000 people (including 50,000 children) are in urgent need of treatment. There have been some successes scored for child health. However in terms of Maternal Mortality, progress is very slow. MMR in Uganda has been stagnant at 435/100,000 for the past decade.
However, aid must not be viewed in isolation. What countries like Uganda require is increased and better allocated domestic for strengthening their national health systems in order to achieve the MDGs. Aid is not the solution to Africa’s problems. Most resources should come from countries’ contributions. There is therefore need for domestic advocacy to raise attention to national budgeting processes and channel private spending into risk pool in avoid over spending by individuals. It is therefore importance for external aid to be only catalytic and temporary with a focus on results and efficiency gains. SSA countries need to grow economically in order to have higher GDPs that will enable them take care of the health of their people. What SSA countries need are free markets to sell their cotton, coffee, tea, and other products. The discussion of the global health architecture must not be in isolation, but in the broader context of economic development and growth.
Friday, February 5, 2010
Uganda MUST do more about Global Fund
According to the Global Fund to Fight Tuberculosis, Malaria and
HIV/AIDs (GFTAM), an estimated 150,000 Ugandans die from AIDS, Malaria
or Tuberculosis each year. There are almost 14 million people
affected by these three deadly diseases in Uganda and yet they are
also highly preventable. The Global Fund is a multi-billion dollar
international financing mechanism established in 2002 that aims to
combat these diseases by providing financial grants to countries in
need. The GFTAM also now has a window for health systems strengthening
which is an opportunity for countries like Uganda to receive funding
to address broader weaknesses in the country’s health system.
Clearly, Uganda’s health crisis fits the criteria for this type of
assistance yet local politics are hindering our capacity to receive
funding and fight these diseases. Currently 95% of all funds for
ARVs/TB medications comes from either GFTAM/or PEPFAR. When GFTAM
didn’t make a disbursement last March, Uganda experienced a serious TB
drug shortage.
In the eight years the Global Fund has been in existence, Uganda has
applied for and been approved for money in six rounds out of the nine
(round five was not successful, round eight proposal was not submitted
and in November 2009 round nine was not approved). A total of $343
million has been committed yet less than half $158 million has been
disbursed to date. Why?
Quite simply, the Government of Uganda’s lackadaisical approach to
fighting corruption and mending the errors of our previous ways is
affecting our ability to secure vital health care funding from the
international community.
In 2005, Uganda received publicity when the Global Fund decided to
suspend five grants worth $213 million because of mismanagement of
funds. While the Government of Uganda acted quickly and spent a lot
of money to set up a commission to look into the mismanagement, they
have failed to prosecute the people implicated and have yet to come up
with a long term plan to ensure this type of corruption does not
happen again. In fact, while an estimated 300 people were accused in
the mismanagement, only four have been prosecuted. As recently as
2008, the Global Fund acknowledged that Uganda had not done enough to
guarantee the safety of the money. We have not received a grant from
the Global Fund since then. Coincidence? Unlikely.
Of course the international community is hesitant to dole out more
money to Uganda when they lack assurances that the funds will actually
go to the people in need.
The time is long overdue for Uganda’s government to address issues of
corruption and recognize the effects this type of poor management has
on the lives of real Ugandans. President Yoweri Museveni has declared
a war on corruption. If President Museveni is really serious about
fighting corruption, this is an opportune time to deal with the people
who were in senior leadership positions and mismanaged GFTAM monies –
people whose indiscretions are costing Uganda millions of dollars. The
people with the greatest responsibility for mismanagement of GFTAM
monies must be prosecuted and the money returned to the people of
Uganda. The diversion of attention from the real criminals by
punishing a few small fish as scapegoats is totally unacceptable. It
is a sign of political hypocrisy and illustrates a lack of commitment
to the people of Uganda.
Most importantly, Uganda needs to figure out a sustainable approach to
providing transparency and accountability in how health care funds are
spent to mitigate any potential other losses of funds. Ultimately, we
must create a system where corruption is not tolerated and the health
of Ugandans is the utmost priority for all.
HIV/AIDs (GFTAM), an estimated 150,000 Ugandans die from AIDS, Malaria
or Tuberculosis each year. There are almost 14 million people
affected by these three deadly diseases in Uganda and yet they are
also highly preventable. The Global Fund is a multi-billion dollar
international financing mechanism established in 2002 that aims to
combat these diseases by providing financial grants to countries in
need. The GFTAM also now has a window for health systems strengthening
which is an opportunity for countries like Uganda to receive funding
to address broader weaknesses in the country’s health system.
Clearly, Uganda’s health crisis fits the criteria for this type of
assistance yet local politics are hindering our capacity to receive
funding and fight these diseases. Currently 95% of all funds for
ARVs/TB medications comes from either GFTAM/or PEPFAR. When GFTAM
didn’t make a disbursement last March, Uganda experienced a serious TB
drug shortage.
In the eight years the Global Fund has been in existence, Uganda has
applied for and been approved for money in six rounds out of the nine
(round five was not successful, round eight proposal was not submitted
and in November 2009 round nine was not approved). A total of $343
million has been committed yet less than half $158 million has been
disbursed to date. Why?
Quite simply, the Government of Uganda’s lackadaisical approach to
fighting corruption and mending the errors of our previous ways is
affecting our ability to secure vital health care funding from the
international community.
In 2005, Uganda received publicity when the Global Fund decided to
suspend five grants worth $213 million because of mismanagement of
funds. While the Government of Uganda acted quickly and spent a lot
of money to set up a commission to look into the mismanagement, they
have failed to prosecute the people implicated and have yet to come up
with a long term plan to ensure this type of corruption does not
happen again. In fact, while an estimated 300 people were accused in
the mismanagement, only four have been prosecuted. As recently as
2008, the Global Fund acknowledged that Uganda had not done enough to
guarantee the safety of the money. We have not received a grant from
the Global Fund since then. Coincidence? Unlikely.
Of course the international community is hesitant to dole out more
money to Uganda when they lack assurances that the funds will actually
go to the people in need.
The time is long overdue for Uganda’s government to address issues of
corruption and recognize the effects this type of poor management has
on the lives of real Ugandans. President Yoweri Museveni has declared
a war on corruption. If President Museveni is really serious about
fighting corruption, this is an opportune time to deal with the people
who were in senior leadership positions and mismanaged GFTAM monies –
people whose indiscretions are costing Uganda millions of dollars. The
people with the greatest responsibility for mismanagement of GFTAM
monies must be prosecuted and the money returned to the people of
Uganda. The diversion of attention from the real criminals by
punishing a few small fish as scapegoats is totally unacceptable. It
is a sign of political hypocrisy and illustrates a lack of commitment
to the people of Uganda.
Most importantly, Uganda needs to figure out a sustainable approach to
providing transparency and accountability in how health care funds are
spent to mitigate any potential other losses of funds. Ultimately, we
must create a system where corruption is not tolerated and the health
of Ugandans is the utmost priority for all.
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