The Duplication of Institution roles in the fight against HIV/AIDs
Since 1983, when the first cases of HIV/AIDs were documented in Uganda, [900 cases reported by 1986 and rising to 6,000 cases by 1988], the country took drastic measures to address the virus. Measures ranging from changes in policy, institution to legal actions were undertaken. The first major step was the establishment of a national AIDS Control Program (ACP) and the National Committee for the Prevention of AIDS (NCPA).
This was followed by the establishment of the Uganda Aids Commission (UAC) by the Parliamentary Statute No. 2 of 1992, putting it under the Office of the President. Its mandate was to oversee, plan and coordinating Aids protection and control activities throughout Uganda.
These interventions enabled the country which was regarded as one of the most hit with the HIV/AIDs epidemic on the African continent to realize a reduction in the prevalence of the virus from 18% in 1992 to 6.1% in 2001. On a sad note, the prevalence has risen to 7.3% in 2014, with young females between the age of 14 and 24 being affected more than their male counterparts.
However, the establishment of different institutions with similar mandate is a mere duplication of activities. A case in point is the presence of the ACP in the ministry of Health and the presence of the UAC in the Office of the President. Important to note is the budgeting for the UAC is made under the Health Sector although it does not report to Ministry of Health. In terms oversight, it reports to the Office of the President.
In light of the above, in its Report on the National Budget Framework Paper for FY 2016/17, the Parliamentary Sessional Committee on Health recommended that the law establishing the Uganda Aids Commission be amended so as to have it answerable to Ministry of Health and eliminate the duplication of the roles on Aids Control.
This oversight on the part of Government does not stop on duplicating the roles of its agencies and institutions but it also reflects a wastage of the already inadequate resources for the fight against the epidemic. The earlier government realizes and addresses this the better. Putting the UAC in the Office of the President also inhibits soliciting funding from donor agencies because it is very rare for donor to fund programs under State House.
For instance in the same report, the Health Committee observed that in the first quarter of FY2015/16, there was a loss of Ugx 17bn(US$4.5m) for purchase of ARVs (these are drugs used by patients who are on the HIV treatment) by National Medical Stores due to the depreciation of the shilling against the dollar. This means that there was shortage of drugs for the patients on the HIV/AIDs treatment, a gap that would sometimes be filled by donor funding.
The committee further observed that in order to ably implement the new government policy of testing and treating all patients with HIV based on the 2013 treatment guidelines, there is need for additional Ugx 151bn to supplement on the proposed budget of the Ugx 100bn to cater for the procurement of ARVs. Therefore, parliament should urgently urge government to expedite the process of dissolving the UAC such that the resources being allocated to it most especially in terms of wages can be channeled into the key priorities of procuring drugs for the HIV/AIDs patients under the ministry of Health. In the current FY2015/16, UAC Vote was allocated a total budget of Ugx 7.75bn comprising of wage, non-wage and development expenditure.
Bringing UAC under ministry of health and subsequently under the Parliamentary committee on Health will help in streamlining the Aids Control activities because of their technical capacity to play necessary oversight. But as of now with UAC, under the Presidency and Parliamentary Committee on Presidency even the least oversight cannot be realized.
Lastly, the Ministry of Health should also expedite the process of developing the regulations on the HIV and AIDs control Act so as to facilitate the operations of the Aids Trust Fund for easy mobilization of resources for the fight against HIV/AIDs.