By Patrick Jaramogi
The fate of the 1.7 million Ugandans currently on antiretroviral drugs hangs in balance unless the worrying drug stock-outs are addressed with increased funds to the health sector.
Similarly, the lives of the 160,000 registered new HIV/AIDS infections set a new pace of worry regarding the issue of combating the global disease. According to reports, there is already a massive drug stock-out that health experts say may not reach June this year.
The World Bank estimates that the HIV/AIDS prevalence for people aged between 15-49 years in Uganda is rising from the previous 6.5 % to 7.6% (2015). But this increase in prevalence is not being addressed by government as funding to drug supplies has been at UGX100 billion for the last three years.
The situation even becomes trickier with the newly released World Health Organisation (WHO) guidelines. WHO in its new (2015) guidelines recommends antiretroviral therapy (ART) at any CD4 count for HIV positive people of all ages.
Currently those infected with HIV/AIDS and with CD4 counts below 380 can start the ARVs yet WHO says anybody who tests positive to HIV/AIDs should start on treatment. The guidelines also serves to cater for pregnant mothers, children from as low as 1 year old (who test positive for HIV) to start ART at any CD4 count.
According to the World Bank, if Uganda is to adopt these new guidelines, the current 80% enrolment will fall to 48% against a constant budget of 100 billion for ARVs.
Apart from Brazil that treats all people who test HIV positive, Uganda started treating all children and adolescents less than 15 years of age in 2014. An estimated 70,000 Ugandans died of HIV/AIDS related illnesses last year
Robust treatment and prevention initiatives have been implemented in recent years, leading to improved conditions for people living with HIV. Due to the implementation of antiretroviral treatment throughout the country there has been a gradual increase in the number of people living with HIV receiving treatment. However, as of 2015 more than 65% of adults living with HIV were still not on treatment.
Majority of the Ugandans who are at high risk of HIV infection include sex workers, whose prevalence lies at over 34%, adolescent young women and men aged 15-24 whose prevalence accounts for 4.3% (Women) and 2.5% for men. It remains shocking because according to statistics, of the over10 million individuals registered to have undergone HIV testing and counselling by 2015 across the country, 9% (900,000) were children below 15 years of age while adults were 90%.
What needs to be done?
With the 2016/17 budget set to be approved by Parliament by April 28 2016, the Civil Society organisations are trying to beat the deadline to have amendments to the health budget increased to cater for the short falls. According to the Ministerial Policy statement, the health sector budget allocation FY2016/17 is projected at UGX 1,460.920bn. this reflects a budget increase of 19.7% with major increments in Ministry of Health vote 104 by 32.4%, the Uganda Cancer Institute by 164.6%, Butabika Hospital by 18.2% and regional referrals hospitals by 15.4%.
The consortium of civil societies led by the Center for Health Human Rights (CEHURD) and Development has petitioned parliament and Finance ministry demanding that funding to the Primary Health Care (PHC) be increased. Primah Kwagala a programs officer at CEHURD while addressing the media at a health budget review conference in Ntinda on Friday said government should prioritise the enhancement of wages for health workers and the workforce attached in Health Center IVs and IIIs.
“We request that government substantially increase the budget for National Medical Stores for essential medicines, in particular doubling the budgeting investment of UGX 100 billion for HIV and TB medicine and ensure that those funds are released on time and in full,” she said. Primah notes that Parliament should pass a supplementary budget to cater for the HIV treatment stock outs in the public sectors that has caused massive disruptions for people with HIV.
Patrick Ojilong the Program officer AGHA observes that the funding for Primary Health Care development budget for local governments has reduced. “Ministry of Health needs to improve in their procurement planning to improve on absorption of funds as this will address issues of delay in shipment and wide consultations,” said Ojilong
Funding issues
Uganda’s experience has shown that donor funding is not a guarantee, and is becoming less available. Additionally, funding often comes with conditions that may not be in accordance with Uganda’s national goals.
PEPFAR (US Presidential Emergency Fund for AIDS Relief) is the major contributor to the international funding of HIV and AIDS around the world, particularly to African countries including Uganda. However, there are indications that PEPFAR is facing a number of global issues such as competing health and development demands across Africa; an ever-increasing burden of HIV/AIDS treatment; and continuous resource constraints due to global financial crisis and increasing domestic deficit.
With this being the case, more efforts have to be made by Uganda to increase their domestic resource mobilisation. The concentration of donor funding for HIV among a very small number of donors in Uganda suggests potential vulnerability should the magnitude of their funding commitments change in the future.