Health

OPINION: How U.S Donor Support is Affecting HIV/AIDS in Uganda

Former US Secretary of State Rodham Clinton speaking with a mother at the Reach Out Mbuya Clinic in Kampala, Uganda

By: Robert Agenonga

Museveni’s regime has relied on donor support more than any other government in Uganda’s history.

Donor resources in 2011/2012 accounted for 46 percent USD860 million of total health expenditure.

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In comparison, what is ed government funding accounted for only 15 percent USD283 Million of the health expenditures.

USAID funded 5-year project whose goal was to support government of Uganda and partners to design and implement quality health communication interventions that contribute to reduction in HIV/AID’s infections, approved total fertility, maternal and child mortality, malnutrition and Tuberculosis TB.

The project involves innovative health communication approach, capacity strengthening, increased collaboration among partners and extensive research and knowledge management for health communication.

‘Obulamu’ campaign reached an estimated 10.3 million people with information and referral to HIV prevention and treatment, family planning, TB as well as nutrition and breast feeding services.

Radio, TV, interpersonal communications, community mobilization and social media platforms were used to reach out to the audiences.

Apparently, USAID is implementing SUSTAIN project to support the Uganda Ministry of Health to strengthen comprehensive HIV care prevention, laboratory and Tuberculosis services at selected regional referral and one district health care facilities.

The SUSTAIN project focuses on early warning indicators of treatment failure during the ongoing project quarterly mentorships and performance reviews, including prescribing practice, client retention and appointment keeping.

Arua regional referral hospital is one of the 12 regional referral hospitals supported by USAID/ project- Strengthening Uganda’s Systems for Treating AID’s nationally – SUSTAIN project to deliver comprehensive HIV/AID’s services.

The SUSTAIN project scope for Arua Regional Referral Hospital consisted of only laboratory strengthening until 2013.

At that time voluntary medical male circumcision services were introduced. Later, in July 2014, the project took over support from comprehensive HIV/AID’s services from Medicine San Frontier MSF .

These included prevention of mother to child transmission of HIV/AID’s, HIC care and treatment, and management of Tuberculosis and multi drug resistant MDR Tuberculosis.

Arua Regional referral hospital is the largest hospital in the west Nile sub region of Uganda, with a bed capacity of 394.The hospital offers general and specialized services such as medicine, gynecology, and research among others.

According to 2014 census report, Arua regional referral hospital serves a population of approximately 1.6 million people from the districts of Zombo, Nebbi, Koboko, Maracha, Yumbe, Adjumani, Moyo and Arua.

The hospital also serves people from the neighboring parts of South Sudan and Eastern Democratic Republic of Congo.

SUSTAIN utilizes the chronic care model approach to offer comprehensive HIV support for prevention services, including; HIV testing and counseling, prevention of mother to child transmission of HIV, voluntary medical male safe circumcision , and Tuberculosis screening and treatment.

The project aims id to improve patient’s ability to care for themselves, provide services to the community, and improve the efficiency of clinic services provision.

The project supported renovation of the main laboratory, including, roof replacement, new terrazzo floor, workshops, air conditioning, water supply and space extension. Backup power system, solar system installed upon completion of renovation work. New laboratory equipments were supplied for example automated machines CBD FACS Callibar for CD4, Cobas C311 for Chemistry tests and Sysmex for hematology in addition to supportive equipment such as roller mixer, refrigerator, and centrifuge among others.

The project also supported training of laboratory staff on the use of the new machines. Biomedical engineering technician was recruited. The project provided ongoing assessment of the workshop to establish renovation and equipment needs; it supported the acquisition of a workshop vehicle to support transport needs and bio medical equipments and repair toolkits.

Most of the resources to finance HIV response in Uganda to date have come from USA donor.

Resources mobilization to fund the AID’s response also has been influenced by donor fatigue and by high levels of corruption within government ministries as the recent evidence in the office of the prime minister scandals when direct aid was haltered after evidence of fraud by office of the Prime Minister. Donors noted that if future donor’s funds are moved to direct funding of projects rather than basket funding, donors funding will be meaningless without any multiplier effects to the community.

While donors funding for HIV dramatically increased, it has been misappropriated.

Across sub-Saharan Africa, up to 20% of total spending on health is used for HIV services, and of this over 85% is estimated to come from international funding rather than in country sources. In Uganda, the fiscal liability to maintain services for all those who are currently receiving it is estimated to be as much as 3% of Gross Domestic Product GDP.

There is concern that the current funding mechanism for HIV programs in Uganda may be difficult to sustain and service providers are not sure if they will continue their work without donor support.

Since 1990, 45 billion USA dollars has been spent in development aid for health. The aid comes primarily from donor governments and philanthropic organizations which the USA leads in the contribution.

Uganda is among 51 countries that rely on international sources of funds. Over 20 donors contribute over $400 million annually.

There were an estimated 1,500,000 people living with HIV in Uganda by 2012 and by the end of June 2013, 567,000 eligible persons were estimated to be receiving Antiretroviral Therapy  ART. Unfortunately, despite the scale up of HIV services in Uganda, there is increased prevalence which has qualified Uganda to be the third in HIV prevalence rate in Sub Saharan Africa.

The United State Government Presidents Emergency Fund for AID’S Relief PEPFAR funded programs invested over USD$ 1.8 Billion in HIV related financing for Uganda between 2004 and 2011.PEPFAR currently contributes over 85% of the national HIV response through projects implemented by international and local NGO’s which provide free HIV services or significantly support such services at public facilities. PEPFAR funding has already reduced and now requires cost sharing assurance from the government if it is to continue.

PEPFAR has committed significant technical and financial resources to the fight against HIV, working with local partners in Uganda to promote prevention programs, increase the number of patients receiving antiretroviral therapy ART and strengthen national coordination and monitoring of programs.

USAID support for strengthening of Uganda decentralized health system and strives to improve the quality of and access to HIV services, maternal and child health services was a land mark in history of struggles against HIV epidemic in Uganda.

USAID supported a numbers of CSO’s to address HIV prevention, care and treatment programs , including provisions for OVC through direct grant funding to NNGO’s, the Inter Religious Council of Uganda and mechanism such as the USAID –CORE initiative  which was supported by USAID Washington DC based office.

The CORE initiative expanded services for youth and for OVC by facilitating collaboration between Government of Uganda and CSO’s .This included enhancing the effectiveness of the Uganda Aids Commission in coordinating efforts to reduce vulnerability to HIV among youth and providing capacity building and technical support to NGO’s and CSO’s for improving programs quality and sealing up youth prevention, and care and support activities for OVC.

The bulk of the work in the fight against HI in Uganda remains largely at the hands of donors.

It is no doubt that Museveni‘s regime of has relied on donors support more than any other government in Uganda.

HIV/AID’S was identified in Uganda in 1982 in a fishing village on the western shores of Lake Victoria .Since then the disease has had a very dangerous effects on the people, economic and social structures of Uganda.

In the late 1980’s, Uganda experienced the worst epidemics. This was exacerbated by social stigma and insecurity related to economic crisis and war.

By 19997, the Ugandan health system was strained to a breaking point in a country where the per capita health expenditure at it best was under $3.HIV patients related illness occupied more than 55 percent of the beds in the hospitals. By 2000 the numbers of HIV bed ridden patients had increased to 70% according to the ministry of Health reports of 2001.

In 1998, an estimated 1.9 million people were living with HIV/AID’s according to UNAIDS’s reports of 1999.AIDS’s had overtaken malaria as a leading cause of death among people aged 12-49 years and AID’s was responsible for 12 percent of all deaths. More than 500,000 people had lost their lives to HIV/AID’s epidemic, leaving behind an estimated Two million orphans who had lost one or both parents. Extended families were the only solutions to cater for these increased numbers of orphans.

As the epidemic continued to spreads and increase in Africa in the early and mid 1990s, prevalence rates in Uganda were reported to be declining particularly from 1993.

Development partners and donors that supported the struggles against HIV/AID’s in Uganda began using Uganda as a success story and an example to argue that, with proper resources and appropriate prevention messages, HIV/AID’s could be controlled.

Donors concentrated on two indicators of Uganda’s strategies 1-the important roles of the political leadership in speaking openly about HIV/AID’s   at an early stage; and the government assumed use of the approach of abstinence, being faithful and condoms use ABC as a combination that reduced HIV prevalence .When the Uganda’s success stories were told, along with those of Senegal and Thailand, the reason for scaling up global funding for HIV program was set up.

The writer is a freelance journalist and Blogger.

agenongarobert@gmail.com

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