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.
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