Toward an AIDS-Free Generation

U.S. Chargé d’Affaires, Virginia Blaser made a statement recently about the on-going support by the USA for healthcare in Uganda and for the fight against HIV/AIDS in particular. You can read the statement in full here.

This statement of support comes at an interesting point in time. The Uganda Ministry of Health has just recently announced that a recent survey shows the prevalence of HIV has increased to 7.3% of adults, that’s about 1.2m people, more than double the number estimated 7 years ago.

In Uganda, with the support of Target TB, Touch Namuwongo (IMF) has improved access to health education and HIV testing in the community through outreach work. Here a fully trained community healthworker undertakes blood tests at a mobile clinic.

In June the Government of Uganda announced that the allocation of national budget to the Healthcare sector would be reduced from 9.8% in 2011/12 to just 7.6% this year. Depending on the exchange rate this is equivalent to about $307m.

In her statement, Blaser starts by reminding us that since 2004, the American people have invested over $1.7 billion in support of the national HIV response in Uganda. Most of this has been channelled through PEPFAR, for which we should always give a note of thanks to former President George W. Bush.

In 2003, Bush launched the President’s Emergency Plan for AIDS Relief (PEPFAR), pledging $15 billion to end the suffering and save lives threatened by the AIDS epidemic. In 2008, Congress agreed to provide $38 billion more.

In Uganda an estimated 600,000 people living with HIV need to be treated with ARVs but only 330,000 are currently receiving these life-saving drugs and of those the USA directly supports funding for 314,000. Antiretroviral treatment, ART, means that a person living with HIV can expect to live as long as their fellow countrymen who are HIV infection free.

We know that ensuring early and sustained access to ART for all those that need it will be a very significant intervention in the fight to reduce the growing numbers of new infections. So it is good to hear Blaser state:

the PEPFAR program in Uganda will review its programs to ensure that we prioritise treatment expansion to ensure all who need ART receive it

On July 5th Blaser stated that $425m will be given in Aid to boost Uganda’s health sector. This is more than 60% of the total Aid being given by USA to Uganda and is some 40% more than the GoU budget allocation.

That budget allocation is coming under increasing scrutiny. Blaser urges the GoU to increase the allocation to the 15% committed in the Abuja Declaration. Whether or not the country can afford to reach that target, it should perhaps be a little more circumspect before revealing that it spends some $150m to send VIPs overseas for healthcare treatment.

It is clear to me that fighting HIV is more than just about GoU budget or Aid from USA. That budget and Aid need to be used more effectively, we need to focus our attention on proven interventions that we know will work. Implementation will involve many different partners from all parts of the health sector and as Blaser says:

By working together, we can free Uganda from this terrible epidemic.  Let us all fight together for an “AIDS-free generation.”

Response to Affordability, Rationing and Aid

Tony writes:

I have read this article with great interest, and concern as its such a complex problem but need to be solved by us all as world citizens.

Yes times are very hard at the moment, yes the UK can be proud of its record of being one of the first countries in line to give aid to those most needing it, but as the article says funds are not unlimited and services have to be rationed, the dilemma is to who.

Those people who have to make these heart breaking decisions have a terrible task as how do you turn away a mother and child who is sick and needing help, more so if you know the cost of the actual treatment can be so low in western standards but if money is not there !!!!!

All governments of the world should do more to solve these ongoing problems which are not solved by money alone, as the need to educate and to show the way forward for self-sufficiency is the utmost priority or these problems just occur year in year out as we have all seen

However we can all help but I think from a funding point of view (General Public) there is a willingness to give more but adverse press about diversion of funds (corruption) misuse of money, or just waste caused by local infrastructure problems deters many people from giving more.

At this time of severe economic problems the questions are raised all the time as to why the UK should give to say :- India (5th largest Industrial country in the world) and others who are seen to have more available money themselves than us, but who turn their back on providing funds and services to their own people’s needs.

Of course the arguments are put forward that it’s in our commercial interests to give and no doubt that’s true but many countries in the same position give nothing or very little so yes the UK should be proud of its people’s efforts in spite of concerns about the use of the money given.

Maybe, if the General Public funds could be seen to be directed at the problems, and where people themselves could monitor the progress their money was achieving, then I think some of the hesitation would go and more money would flow.

Whatever the solution is, Now is not the time to stop giving as surely we all have a Duty of Care to each other and 0.7% of National Income is a small price to bear for the help it gives to saving so many lives.

UK Aid as a share of National Income

In the last few weeks there’s been a lot of discussion about UK overseas aid. (on Twitter #AidReview)

DFID has just completed a thorough review of all the programmes that it supports and has announced some changes planned for the next few years.

Essentially the UK Government is committed to sharing up to 0.7% of our national income to deliver results such as:

  • secure schooling for 11 million children – more than we educate in the UK but at 2.5% of the cost
  • vaccinate more children against preventable diseases than there are people in the whole of England
  • provide access to safe drinking water and improved sanitation to more people than there are in Scotland, Wales and Northern Ireland
  • save the lives of 50,000 women in pregnancy and childbirth
  • stop 250,000 new-born babies dying needlessly
  • support 13 countries to hold freer and fairer elections
  • help 10 million more women get access to modern family planning.

Getting to 0.7% will mean an increase of some 50% in cash terms over the next 4 years.

I first came across this chart on Owen Barder’s Blog:

In his announcements last week Andrew Mitchell noted that UK Aid to Uganda will increase from £68m pa to £98m and will be focussed on these top priorities:

  1. Improving the quality of essential services, especially for the most vulnerable
  2. Supporting the recovery in northern Uganda
  3. Improving maternal and reproductive health
  4. Driving growth through training, job creation, financial services and trade
  5. Improving government accountability and transparency so that future oil revenues are spent effectively.

I am hoping that our projects in Lira and in the Makindye Division of Kampala might benefit from some of this funding, as we seem to be closely aligned on the first 3 in particular.

Health Budgets Compared

The UK Government has allocated £122b to the 2010 health budget. So for each of its 62m population that equates to £1,956 per annum. That’s a lot and is one of the reasons for the current NHS review.

The Government of Uganda has allocated £482m on a purchasing power parity basis. (£1 in Uganda can buy what it would take £2.50 to buy in the UK.) There are 33m people living in Uganda, so that equates to just £14.43 per person, per annum. That’s clearly not enough and one of the reasons for the poor delivery of health services.

That means in the UK we allocate more than 135 times the budget per person compared to Uganda.

The UK allocates 18% of its total budget to the health sector; in Uganda the percentage is 10%. Some are saying that perhaps 18% in the UK is too much and some say that the GoU should honour its 2001 Abuja pledge to allocate 15% to the health sector. Whilst that would be a 50% increase in real terms, one can see quite quickly that it would still leave the Uganda per capita allocation very small compared to the UK.

If both governments allocated 15% of national budget to the health sector a person living in the UK would be allocated £1,674, whilst in Uganda it would be 78 times less than that, just £21.60.

So what should be done…

There are of course no easy answers but we will explore a few options in future posts.

Advent: Day 10 Dr. Richard

Photo by VSO/Ben Langdon

This is Dr. Richard as many of us will remember him, enjoying being with the kids on Hope Ward. He made a huge difference in his time with us as a voluteer with VSO. There are more photos of him on the VSO website here.

Even after their VSO stint was finished, Richard and Patricia continued to help, encourage and support us. They came back for an extra 3 months to help us move into a larger health facility in Lira, northern Uganda and are now helping to raise funds for our maternal and child health programme there.

Here’s what Dr. Richard says about working with VSO:

“I hadn’t realised VSO would want people of my age. All my VSO contacts went overseas straight out of university, so I was a little tentative when I contacted VSO and said “I’m an old git, I have reasonable health and these talents, are you interested?” And I really did expect them to say no but was pleasantly surprised.”

BBC News – Brown says global economy reliant upon growth in Africa

BBC News – Brown says global economy reliant upon growth in Africa.

So Gordon Brown made his political re-appearance here in Kampala. It’s an interesting speech in which he says some things that I absolutely agree with, see below, and sort of wish he might have been more vocal about the same whilst he was UK Prime Minister. You can download the full speech here.

To help economies develop across Africa, he said nations needed to increase access to broadband internet, which he said less than 1% of people currently had access to.

Agreed, I’ve seen the huge difference that fast internet has made to life and business in the UK; so badly needed here in EA.

Turning his attention to the developmental aid given to Africa, he said this needed to increasingly focus on private sector wealth creation, and not just providing services for the poor.

“The job of aid is to kick-start business-led growth and not to replace it,” he said.

“And so I believe we need to focus not just on poverty, but on wealth.”

I agree and that’s what we’re looking for; developmental aid that will help the private sector to grow and expand its services. This sector already provides more than 70% of healthcare services in Uganda and could do a lot more, better and faster, with adequate and appropriate funding (long-term loans not hand-outs).

We must of course maintain the focus on what matters, saving and improving lives:

After the speech, Bernard Aryeetey, from the charity Save the Children, said a long-term growth strategy for Africa was vital but should not be to the detriment of investment in health systems and education.

“Making sure that children are able to go to a clinic when they are ill and get a decent education must be tackled in parallel with a drive to increase economic growth through technological advance.

“Saving children’s lives does in fact contribute to economic growth.”

Addicted to Aid

Ida commented on one of our recent postings:

I get annoyed that services that are run effectively and efficiently cannot access the help they need to continue their work. I hope that your proposal for a PPP is accepted as it a great idea!

BTW: this is old programme but wondered whether you saw it

You can link to the posting by clicking here.

This Panorama programme is almost 2 years old but sadly it is still very current.

picture inserted here, if I had any bandwidth 😦

More than 70% of healthcare services are delivered in Uganda by the Private sector (which includes for-profit, Mission and not-for-profit NGOs) and yet very little of the total Aid and, for that matter, such a small percentage of the country’s healthcare budget, ever finds it way into this sector.

Private is not bad, and just because an organisation is set as a For-Profit is not a good enough reason to shun it.

IMG is a private-for-profit employing more than 800 local people right across the organisation, from top level directors to temporary staff engaged from time-to-time when we need more maintenance or another building. We pay our own way. Our ethos is not one of “for-profit”, in fact most of our profit has been re-invested as we continue to build and develop our services. We believe in Development and Outcomes.

We run and support our own not-for-profit, NGO, called International Medical Foundation. Through IMF we reach out to thousands of Ugandans who cannot afford to access healthcare services and that includes not being able to afford services provided at public centres. Service at the latter is not “free”. You may be able to get a free consultation, if the clinical staff are present and available, but you still have to pay for tests and treatments.

Uganda needs the private sector healthcare organisations and these need to be included in overall country budgeting and in the design and planning of new Aid disbursements.

We could do more, better and faster with the right interventions and partnerships. Donor countries and organisations could help by providing access to long term borrowings at decent interest rates (as outlined recently by the IFC, World Bank). Lack of available and appropriately priced funds is a serious impediment to the growth and development of the private sector. We’re not seeking hand-outs but we do need well structured long-term finance.

We need Development not Aid.