Uganda Fails to Pick $28m Malaria Cash

As malaria continues to kill hundreds of Ugandans every week, the Ministry of Health has for over a year failed to collect a huge consignment of the latest approved modern drug worth more than Shs50 billion provided by the Global Fund, Daily Monitor has learnt.

Because of confusion in the procurement process, 15 million doses of Coartem, one of the two modern malaria combination remedies recommended since 2002, cannot be brought into the country and the Global Fund's approval for the money has now expired.

Requisition

The drugs were requisitioned by the ministry on behalf of the country's myriad of anti-malaria programmes, through the Country Coordination Mechanism (CCM), the national structure for accessing Global Fund resources to fight Aids, TB and malaria.

There have been several rounds of proposals submitted to the Global Fund, which have been approved but Uganda has not managed to use up all the money due to failure of the procurement system.

Other malaria control materials such as Insecticide Treated Nets (RBM) initiative and insecticides under Round 2 were never procured either.

The Ugandan Health Ministry says it is not their fault and has placed the blame squarely on the World Health Organisation (WHO). According to Dr John Rwakimari, the Malaria Control Programme manager in Uganda's Ministry of Health, the ministry has done "everything possible" but WHO headquarters in Geneva had not yet played its part to secure the funds to procure the drugs.

"We have done everything that we are required to do. We have even written on several occasions to remind them but there is no response yet. The drugs cannot be procured if the funds are not remitted from Geneva. But we are still waiting," Rwakimari said by telephone recently.

However WHO Uganda office spokesman Benjamin Ssensasi said, "Our role in the Global Fund is just technical. We don't handle money. The money is handled by the government. We only come in to procure or help locate where the drugs can be procured."

Health minister Jim Muhwezi could not be got for a comment and his state minister Alex Kamugisha was reported out of the country.

But according to the Global Fund, a $158m (about Shs280 b) grant was approved under Round 4 for use over five years of which $66m (Shs115b) was for immediate disbursement for use in the first two years.

Of the $66m, some $54m was meant for purchasing ACTs, the modern recommended malaria therapies.

Rwakimari said the delay in having the drugs delivered had greatly affected the ministry's malaria control programmes, "but there is not much that we can do."

The CCM decided to purchase 15 million doses of Coartem at $28 million from the Swiss manufacturer, Norvatis under WHO negotiated terms. Although a dose of Coartem costs $40 on commercial terms, under the WHO deal it is bought at $2.4 for adults and about $1 for infants.

WHO gets a commission of 3% as arrangement fees for processing the subsidised deal, in this case about $800,000.

The monitoring committee of the Global Fund, which has raised the issue, said more than a year since the negotiations were concluded and the funds approved in February 2004, Uganda has not placed the order and last week, the Global Fund cancelled the donation.

It is now listed under the Fund's red-flagged items. However, Rwakimari said the tenders were placed in the media and evaluated but could not be implemented due to the delay in availability of funds from WHO.

The ministry's malaria programme decided to discontinue the use of chloroquine and fansidar in 2002 when it was found to have a terribly high failure rate of 36 percent, with 23 percent of all deaths of children under five years being caused by malaria, the disease that kills up to 100,000 people in the country every year.

A failure rate above 15 percent is considered unacceptable for a therapy by WHO standards. However, the recommended therapies of ACTs was found to be expensive and the Global Fund was approached with a proposal to buy the drugs, insecticide treated nets and spray materials under affordable WHO negotiated rates.

Uncertainity

The cancellation of Uganda's donation now makes the implementation of the 2002 malaria drug policy more uncertain because the country cannot afford the drug outside the WHO brokered terms at $40 per dose for its population.

Because the drugs have a short shelf life (they expire after 2 years), large consignments are manufactured on order and the manufacturers require six months from the time a firm order is placed with them.

Placement of a firm order could not be made before the deadline because of confusion in the procurement system, with bureaucrats in the health ministry questioning, among other things, how the WHO was going to spend the 3 percent arrangement fee it charges for processing the transaction.

As late as last month, MOH was still asking basic procurement questions that were supposed to have been asked before February 2004 when the Global Fund approved and signed the donation.

It is now not clear when Uganda will start providing the modern drugs as part of the malaria prevention and treatment campaign.

In Africa, Zambia and Ethiopia have already implemented the use of ACTs under the WHO Arrangement.

AllAfrica.com