CSOs decry the low Global Fund absorption

Civil Society Organizations (CSOs) have decried the low Global Fund absorption, saying the act may put the government of Uganda at risk of losing existing Global Fund monies amounting to $5,465,688 by December 2017.

They have also called upon government to take immediate action to prevent imminent stock-outs of test kits, essential HIV drugs and preventive tuberculosis medicines.

These latest concerns come just one year after the Global Fund Inspector General released an audit detailing the government's chronic mismanagement of public and donor resources resulting in pervasive stock-outs that undermine the national HIV response.

The projection of commodity gaps in the country highlights a serious shortage of:

1. Test kits of US$9 million between June 2017- March 2018
2. ARVs of US$29.6 Million between July 2017- September 2018; US$11.9 Million is needed between July and September 2017 and US$ 17.& is needed between October and March 2018} and,
3. Isoniazid Preventive Therapy of US$ 7 million.

At a press conference held at Fairway Hotel on Monday, CSOs regretted that billions of Global Fund money is likely to be returned to Geneva if it is not used by December this year, which is putting funding and supplies of medicines at risk.

"Does it mean that we have ended HIV/AIDS, TB and malaria fight?"  wondered Margaret Happy of the International Community of Women Living with HIV East Africa. Adding, " Government must act immediately to re-program and absorb all unspent funds all current Global Fund grants by 31^st December 2017 or it risks losing critically needed funds."

This grave situation comes at the same time that Uganda is applying for the next round of Global Fund funding that will only be able accessible from 2018-2020.

Moses Nsubuga, popularly known as Supercharger, an HIV activist, urged government to immediately increase absorption of Global Fund monies and prevent stock-outs of life-saving medicines and test kits.

Moses Nsubuga, popularly known as Supercharger, who has lived with HIV for over 15 years. Photo by Elvis Basudde

"It is unacceptable that we are currently at risk of losing millions of dollars in funding. Government must reprogram funds to ensure that people living with HIV have medicines that they need to remain healthy," Nsubuga said.

Maureen Milanga, from Health Gap, argued that this is latest example of chronic mismanagement of essential health funding by the Ministry of Health. Last year, the Global Fund Inspector General found stock-outs of key medications in 70% of 50 health facilities visited.

"Despite publicly committing to take corrective action, this latest information shows that more work must be done to prevent recurrent stock-outs. Furthermore, the Government of Uganda contribution to the budget is projected to decline by 48.1bn," said Nsubuga.

Following the reductions, the health sector budget is projected to reduce by 534.8bn; from 1,827.26 FY 2016/17 to 1,292.46 FY 2017/18. With this reduction in funding for health, civil society groups worry that the current low absorption of the Global Funds monies in country will impact negatively on the need to address prevention, treatment and care of HIV/AIDS, TB, malaria and systems strengthening in the country.

The civil society organizations call upon the Ministry of Finance and Economic Development and the Principal Recipient 2 (TASO) to develop detailed work plans on how they will accelerate absorption of the current funds in country, come December 2017, and they also request the Country Coordinating Mechanism (CCM) to monitor this work plan closely and render any necessary support to address and bottlenecks.

Joshua Wamboga, executive director of the Uganda Network of AIDS Service Organizations(UNASO) revealed that Uganda has been allocated US$465,057,044 for HIV, TB, Malaria and building resilient and sustainable systems for health for the period 1st January 2018 to 31 December 2020.

The 2018-2020 allocation amounts are dependent on meeting co-financing requirements: 15% of Uganda's allocation totaling to US69, 758,557 will only be made available upon additional co-financing commitments from the Government of Uganda.

According to the allocation letter dated 15^th December 2016 from Global Fund Geneva, any remaining funds from an existing grant, unused by 1^st January 2018, will be deducted from the new grant allocation further increasing the gaps in the programs.

Background

The Global Fund progress review for the period of 1 January -30 June 2016 noted that the budget execution rate remains low at only 27% of funds disbursed to the Ministry of Finance spent, poor absorption was attributed to delays in contracting and procurement for construction works, Community Health management Information Systems and recruitment of staff.

The country also has outstanding financial management issues from previous of delayed funds of ineligible expenditures amounting to US$ 33,520; late remittance of statutory deductions UGX 129,930,079 and the closure of district specific Global Fund Bank Accounts.

This coalition of CSOs, activists began working together in 2010 with the aim of pushing for a more effective HIV response on the part of the government and donors.

They include the Uganda Network of AIDS Service Organizations (UNASO), International Community of Women Living with HIV Eastern Africa (ICWEA), Coalition for Health Promotion and Social Development (HEPS Uganda), Action Group for Health, Human Rights and HIV/AIDS (AGHA), and the Health Global Access Project (Health GAP), THETA, MARPS Network, AIC, TASO, NAFOPHANU, NACWOLA, MAMAS CLUB and UGANET.