Why we shouldn't pour away the baby with the bathwater

By Prof George Kirya

"Don't throw the baby out with the bathwater" is a German idiom that can be traced as far back as 1512 used to simply refer to an avoidable error in which something good is eliminated in the process of trying to get rid of something bad.

In modern day management and corporate governance, it is used to mean keeping your eyes on the ball; learning how to separate the essential from unessential. 

I would like to use the above idiom in specific reference to Uganda Health Marketing Group (UHMG) an indigenous Non-Governmental Organisation that I have been closely associated with; most recently as its board chairman.

Founded in October 2006, with a vision of promoting "a good life for all Ugandans" through increasing access to quality and affordable healthcare solutions, to especially the hard-to-reach and vulnerable populations of Uganda.

UHMG's core areas of intervention include: HIV/AIDS, Sexual and Reproductive health, Maternal and Child Health, Malaria and Non-communicable diseases (NCD's).

Working closely with Ministry of Health (MoH) and guided by the national health policies and frameworks, over the past 11 years, UHMG has developed strong and growing expertise in social marketing, procurement and supply chain management, health communication, advocacy, private sector engagement through franchising and use of technology for health.  

To achieve this ambitious goal, the founders of UHMG believed in and have indeed built a strong stakeholder network of like-minded partners, such as the United States Agency for International Development (USAID), UN development agencies specifically UNFPA, Planned Parenthood Global, among others, all in collaboration with the Ministry of Health, District Local Governments, Civil Society Organisations and the private sector. This has been complemented by very strong community structures which have enabled reach end mile service delivery and distribution of health products and services.   

Over the last 11 years, our social behavioural change communications campaigns have reached over 21 million Uganda- 75% of the Ugandan population. We have backed this up with the distribution of affordable sexual reproductive health products such as moon beads, oral contraceptive pills, condoms as well as water purification solutions.

As a result, between 2013 and 2017, we have cumulatively distributed 1,880,541 long-lasting insecticide nets and 299,013, 888 condoms. Through our network of 256 Good Life Clinics (GLC) across the country we have offered several Ugandans a series of integrated services in sexual and reproductive health, maternal and child health, HIV/AIDs, malaria and nutrition.

Much as there is still much work to do, our interventions have directly contributed to the positive improvement on some indicators as reported in the Uganda Demographic Health Survey Report (2016).

For example, modern contraceptive use rose to 39% from 35% in 2011 and total demand for family planning has increased to 67% and as a result, there has been a 48.5% reduction in unintended pregnancies recorded, from 386,235 in 2013/14 to 198,764 in 2016/17. However, there is still work to be done as the unmet need for family planning has gone up to 67% (2016) from 64% (2006).

We have also registered significant reductions in infant mortality from 71/1000 in 2006 to 43/1000 in 2016, while comprehensive knowledge on HIV prevention has gone up to 87%. 

To create sustainability of the business, four years ago, the board and management created the Product Facility (PF) Business Unit- a strategic business unit that provides supply chain management solutions including forecasting, procurement, storage and distribution of pharmaceuticals and other related health commodities.

In four years alone, business net worth for this unit has grown by over 786% from $300,000 to now $2.66m. In February 2015, we signed MOU with MOH for Alternative Distribution Strategy (ADS) in the private sector and this still ongoing up to December 2018. We have also signed four distributorship agreements- with Adcock Ingram for Malaria Rapid Diagnostic Tests, Vaster Gard for mosquito nets and Life Straw products and SRI Trang for gloves which is our number one product.  

Because of such a solid reputation and a good track record of project implementation, UHMG in November 2015, was awarded the USAID Social Marketing Activity project (SMA), a four-year, $24m, cooperative agreement for a health sector-wide programme. SMA's major goal was to contribute to a reduction in new HIV infections, total fertility, maternal and child mortality, malnutrition and malaria, and to improve access to family planning. The programme also focused on improving utilisation of and increase the uptake of health-related social marketing products and services among under-served Ugandan consumers and communities in rural and urban areas.

Sometime this year, UHMG's regular internal compliance reviews picked up a fraud alert. Following comprehensive internal compliance processes, five project staff who were implicated in the fraud were subjected to disciplinary proceedings and were subsequently dismissed. 

These cases were further reported to the Office of Inspector General (OIG), the USAID office responsible for detecting and preventing fraud, waste, abuse and violations of law and to promote economy, efficiency and effectiveness in the operations of USAID.

However, the reporting procedure was found to be non-compliant with USAID's Cooperative Agreement and Regulations. Unfortunately, USAID terminated the Cooperative Agreement citing: "Default to Report Fraud". 

The termination by USAID, unfortunately meant that as an organisation, we had to let go of almost all the programme staff; a painful but necessary step to especially, ensure the sustainability of the remaining business units and staff.

However, all staff were treated humanely and their terminal benefits paid.  

Needless to mention, we also understand that the sudden termination by USAID and the subsequent restructuring of the organisation has had and will most likely in the near future impact on the livelihoods of our stakeholders, especially staff and suppliers, we would like to call for calm and patience.

Specifically, I would also like to address myself, on an ongoing online campaign by former staff asking that senior leadership of the organisation should step down a way of accepting responsibility and in the hope that our donors may reconsider their position on UHMG.

While we appreciate their deep concern for the organisation, I wish to call upon these former staff to give us some time to get to the bottom of the matter.

UHMG founders, the board and management are committed to mending the relationship with USAID through strengthening UHMG's compliance and internal control systems and ensuring that staff abide by organizational policies and donor regulations among other initiatives.

But these things take time.

Having integrity has been and continues to be crucial to our success and we shall leave no stone unturned.

However, I must also add that, yes, collective responsibility is key, but so is individual responsibility. Everyone must take full accountability of their individual actions and adhere to our zero tolerance to corruption policy.

UHMG is at its most critical time in its history. How well we resolve this issue is important in defining our future.

Steadfast leadership, focused stakeholder engagement but more importantly, justice for all are going to be key facets on which this recovery strategy is built.

We must give justice time to work and avoid social media-based mob justice- because justice for one, is justice for all- just like, a good life for all Ugandans starts with a good life for one Ugandan.

The writer is the board chairman of the Uganda Health Marketing Group (UHMG) an indigenous Non-Governmental Organisation.