The Du­pli­ca­tion of In­sti­tu­tion roles in the fight against HIV/​AIDs

By: MUSA MU­GOYA

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.