Members of Civil society organisations have demanded that the Ministry of Health be withdrawn from being the main implementer of Global Fund grants in the public sector.
They also demand that the Country Coordinating Mechanism should work with the Ministry of Finance, Planning and Economic Development.
This follows a report by the Global Fund’s Office of the Inspector General during its routine audit that has indicated irregularities in governing the fund’s money in Uganda.
According to a New Audit of Global Fund Grants in Uganda: 70% of the health facilities visited reported stock-outs of anti-retroviral medicines, 68% of facilities reported stock outs of anti-malaria medicines, 64% of the facilities reported stock-outs of TB medicines.
This happened despite that fact that 54% of the funds disbursed between 2013 and 2015 are unspent. Where is the problem?
Titled: “Audit of Global Fund Grants in Uganda” and dated 26 February 2016, the report says the Global Fund disbursed US$623 million to the Republic of Uganda since 2002.
The country has made significant headway in the treatment of the three diseases, for example: new HIV infections have decreased from 140,000 in 2010 to less than 100,000 in 2014, the number of people receiving anti-retroviral treatment for HIV has gone up from 21% in 2010 to 50% in 2014; and malaria prevalence in young children has decreased from 42% in 2009 to 19% in 2015.
The OIG auditors identified stock-outs of key medicines, particularly those to treat HIV, in 70% of 50 health facilities visited which could result in treatment disruption for patients.
Furthermore, 54% of the health facilities visited had accumulated expired medicines.
68% of facilities reported stock-outs of anti-malaria medicines and test kits and 64% of the facilities reported stock-outs of tuberculosis medicines of between one week and three months.
The OIG concluded that the supply chain system does not effectively distribute and account for medicines financed by the Global Fund.
There were reported cases of theft, including 40 cartons of artemisinin-based combination therapies; an unexplained difference of US$21.4 million between recorded and actual stocks at the central warehouse; and a difference of US$1.9 million between commodities received and actually dispensed to patients from January 2014 to June 2015 in eight high-volume facilities visited by the auditors.
The OIG also noted problems around the data which are essential to ensure quality of services and to inform decisions to fight the three diseases. For example, 30% of facilities visited had either under or over-reported results related to malaria; 43% of patients were treated for malaria without a confirmed diagnosis and/or with negative results.
Twelve per cent out of the 50 facilities visited were testing for HIV using expired test kits and, contrary to national guidelines, 14% of facilities visited did not perform confirmatory tests on clients diagnosed as HIV positive.
This increases the risk of patients getting false HIV results.
Finance ministry spokesman, Jim Mugunga, says the financial management of the grants was the responsibility of the health ministry.
“The ministry of finance is as concerned as is the GF [Global Fund] with the current and persistent shortcomings. We have since brought the issues to the attention of the ministry [of health] and further up to the attention of the Office of the Prime Minister,” Mugunga is quoted byThe Observer.
On how functional and accountable the Global Fund Focal Coordination Office (FCO) was, Mugunga again pointed out that the issues around this matter were being addressed by the ministry of health – the line ministry under which Global Fund grants fall.
Old ghosts; Global Fund scandal 2008
According to New Vision, at the time of investigations, $10m (sh25b) was missing, although some sources put the figure at $37 (sh95.8b).
The money was meant for malaria and tuberculosis drugs programmes.
The scandal sucked in former health minister Jim Muhwezi and his then deputies Mike Mukula and Alex Kamugisha.
Some of the known culprits include the director of economic affairs in the President’s Office, Teddy Cheeye and former production manager of Uganda Television, Fred Kavuma, who are currently on remand in Luzira Prison over the scam.
Although many of people have since been absolved of wrongdoing by court, Mike Mukula was told recently that he has a case to answer.