Pages

Monday, March 1, 2010

Homosexuality- what Ugandans say.

By Esther Nakkazi

Last week, I went to cover a meeting of the Coalition on Human Rights and Constitutional Law at Imperial Royale Hotel in Kampala. Tempers flared as people spoke emotionally while debating the anti-homosexuality bill.

The guest speaker was Professor Makau Mutua, a Kenyan scholar in law, gender, and sexuality. He spoke about human rights, why people are homophobic, and argued that there is no single “normal” sexual orientation—what is normal is what is natural to each individual.

Before I get back to that discussion, let me take a step back to a conversation with my neighbour from Spain, Anna Maria, who came to Uganda for a journalism fellowship under the International Federation of Journalists (IFJ). She is a political writer attached to one of Uganda’s daily newspapers, The Monitor.

Anna Maria and her husband, Ernesto—who speaks very little English—arrived in Uganda about two months ago. They live in the apartment just above mine in Kiwatule.

One Tuesday morning, as is often the case, Anna Maria and I left home together for work. We boarded a taxi (a 14-seater matatu), and as usual, began discussing the previous day’s events. She had attended a press conference by the Forum for Democratic Change (FDC) and was reflecting on the party’s candidates, Dr. Kizza Besigye and Maj. Gen. Mugisha Muntu.

She mentioned that she had missed an opportunity to ask what she felt was an important question: why the opposition remained largely silent on the anti-homosexuality bill, despite frequently speaking about democracy and human rights. It was a fair question, but time had run out before she could raise it.

Our conversation shifted to how homosexuality is viewed in Spain, where, from her perspective, it is largely treated as a matter of human rights. We became so absorbed in our discussion that I did not notice the silence that had fallen over the taxi. The other passengers were listening.

In the front seat sat a man who had been following our conversation closely. He suddenly turned, visibly irritated, and asked Anna Maria whether she really thought it was proper to practise homosexuality.

“In Uganda, we shall never accept it,” he said. “We have to protect the traditional family.”

His views were not unusual. Many Ugandans hold similar opinions. Those who think differently are often people who have been exposed to other perspectives, are open-minded, or both.

The man then asked Anna Maria what she would do if her son married another man. By now, his tone had grown sharper, and he was staring directly at her. She calmly tried to explain that if her son were gay, it would be his choice, and while she would not encourage it, she would not interfere.

He responded by saying that in countries like hers, people are encouraged to become gay, which made her raise her voice slightly in response. Then he said something that stunned her: if his son were to engage in homosexuality, he would kill him.

Mob justice is not uncommon in Uganda, and Anna Maria was unfamiliar with how quickly situations like this can escalate. I also recalled how an American reporter working on a similar issue had once nearly been deported.

Soon after, Anna Maria reached her stop and got off. As I prepared to alight shortly after, the man turned to me again and repeated his view: that Africa would never accept homosexuality.

He also expressed a common fear—that if Uganda did not pass a law outlawing homosexuality, a large part of the population would become gay.

I stepped out of the taxi and continued on to another day of work.

Fast forward to last week’s meeting, where Professor Mutua delivered a compelling talk. He explained why homosexuality should be understood as a human right, challenged the idea that it is “un-African,” and explored the deeper reasons behind widespread homophobia on the continent.

During the discussions, Odonga Otto, a Member of Parliament, made it very clear that he was thinking and speaking like about 90 percent of his colleagues in Parliament. “MPs do not consider homosexuality a right, and it will never be a right in their lifetime in Uganda,” he said. 

The author of the Bill, Bahati, holds the same position—that homosexuality is not a right. Period.

As the discussion progressed, one issue stood out clearly in the seminar, which was mostly attended by lawyers and human rights activists: many Ugandans would not accept homosexuality as a human right.

During the workshop, there was a demand for a scientific explanation for homosexuality. Some participants, including MPs, told Prof. Mutua that if there were scientific evidence explaining why people become homosexual, the debate would be different. They were convinced it was a health problem.

Even if research were to be carried out, it is unlikely that it would be done in Africa. Many people in Uganda believe it is a learned habit, and as one pastor alleged, it is even motivated by money. “We can treat them psychologically and talk them out of the habit,” he concluded.

Here are some thoughts and observations on this issue. It is possible that homosexuality has existed in some African societies, even in Uganda—who knows? But prior to this Bill, few people seemed to pay much attention to it.

Now, some in the community feel that they are being pressured and coerced into engaging with and debating homosexuality. A woman who frequently travels for international meetings recently told me, “It is not our agenda at all. We have more serious problems, and I feel uncomfortable when I am constantly exposed to discussions about homosexuality.” 

Many others have expressed similar sentiments. For a country like Uganda, which faces many pressing challenges, some question whether this should be a priority.

Secondly, the way people debate and interpret issues depends on many factors. The ability to listen and engage in discussion without becoming emotional or confrontational is rare and does not necessarily depend on one’s level of education.

Much of the fear expressed in Uganda is that if homosexuality is not outlawed, a large number of Ugandans will become homosexual. One explanation for this fear lies in the nature of society. In Uganda, as in many African countries, communities are closely knit—everyone’s life is seen as everyone’s business. Cultural norms are strongly enforced, and anything that falls outside accepted standards is often judged harshly.

This brings me to another point raised by Prof. Mutua—that homosexuality is often considered “un-African.” Mr. X, the man in the taxi, asked Anna Maria, “Why do you people bring homosexuality here?” In his view, she represented an entire culture.

For many Ugandans, the voices opposing the anti-homosexuality Bill are largely external, apart from a few local human rights activists. This creates the impression that a foreign perspective is being imposed on a society that believes it has the right to determine its own values and direction.

Public condemnations by prominent international leaders, while African leaders remain largely silent, have not helped the situation. The Bill itself is a private member’s Bill, and its sponsor, Bahati, has not always been able to defend it convincingly in public discussions. In one televised debate, for instance, the argument appeared disorganised. This creates an opening for opposition, but the strong external pressure may also harden local resistance.

I will say this again: the homophobia is intense, but so is the pressure from outside. My sense is that the Bill may ultimately not be passed—practically speaking, it would be difficult to enforce, given how many people could be affected, including those in churches and the medical profession. 

However, when external actors push too strongly against it, it can make local communities feel alienated and more determined to resist what they perceive as outside interference.

As Anna Maria later reflected, the longer she lives in Uganda, the more she understands reactions like that of Mr. X. There are many factors that shape how societies tolerate or reject different ideas, but one thing remains clear: meaningful dialogue is still limited.

There is a proverb in Uganda that says people from underground cannot tell those living on the surface how hot the sun is or how bright it shines—they are from underground. Those on the surface can decide for themselves whether the heat is too much and choose to plant trees for shade. But when those from underground insist too strongly, people above may become stubborn.

(Disclaimer : These are reflections based on what I have heard through interviews and observed as a journalist, as well as my own views. Interestingly, a friend recently told me not to write about this topic at all—she called it “demonic.” I am a Christian, but I value open discussion and understanding what people think.

Ends

Wednesday, February 10, 2010

Look beyond treatment-Uganda scientists on US antimalarial drug quality study

By Esther Nakkazi

This week the US published a report from a study on the quality of anti-malarial drugs in Uganda and other African countries.

But Uganda scientists have different opinions saying although the study was good and relevant, there are more pressing problems with malaria, which kills at least 300 people, per day, mostly children under five years and pregnant women in Uganda.

Some Uganda scientists think the study was a 'commercial ploy’ by the malaria industry but all agree there is a bigger problem than impure drugs. They pointed out that the resistance problem for malaria drugs is more of a bad consumer behaviour problem rather than purity of drugs.

In Uganda, drug resistance is manifested because many people misuse drugs properly rather than taking low quality anti-malarials. Dr. Myers Lugemwa, officer in charge of malaria research at the ministry of Health said even if it sounds like common sense but the fastidious behavior of patients  probably caused by ignorance and cultural beliefs brings about drug resistance.

He said many patients seeking treatment have cheeky behaviors like ceasing to take medicines when they feel better and sharing medicines with neighbors and friends.

So for Uganda and many other countries the issue of quality of drugs is not a primary concern but accessibility.

“We are only taking what is available, we can not just have people die because the drugs are not good quality. We have tested them and found them effective,” said Dr. Lugemwa.

National Drug Authority (NDA), the Uganda regulatory body officials said they test all the drugs that come to the market and they are dealing with counterfeits on the market but the laboratories are registering a downward trend in quality testing failure over the past decade.

“There has been a drop in drug failure rate in our laboratories over the last 10 years. But there are problems with consumers due to self medication, incomplete doses and as a result drugs become ineffective,” said Fredrick Ssekyana, the spokesperson for Uganda National Drug Authority (NDA).

The reactions follow the release of a report that said that the most effective type of malaria-fighting drugs sold in three African countries including Uganda are often of poor quality, raising fears of increased drug resistance.

Between 16 per cent and 40 per cent of artemisinin-based drugs sold in Senegal, Madagascar and Uganda failed quality testing, for reasons including impurities or not containing enough active ingredient, the survey found.

'I am alarmed by these results because it means there are many cases of malaria that are being only partially treated, and that just guarantees acceleration of artemisinin drug resistance.'— Rachel Nugent, Centre for Global Development

The study was the first part of a 10-country examination of antimalarials in Africa by the U.S. and the World Health Organization.

Artemisinin-based drugs are the only affordable treatment for malaria left in the global medicine cabinet. Other drugs have already lost effectiveness due to resistance, which builds when not enough medicine is taken to kill all of the mosquito-transmitted parasites.

If artemisinin-based drugs stop working, there is no good replacement and experts worry many people could die.

"It is worrisome that almost all of the poor-quality data that was obtained was a result of inadequate amounts of active [ingredients] or the presence of impurities in the product," said Patrick Lukulay, director of a nongovernmental U.S. Pharmacopeia program funded by the U.S. government, which conducted the survey. "This is a disturbing trend that came to light."

NDA officials said they also have a problem with increasing drug counterfeits on the market, which is a global evil, but it is working with Interpol to curb the vice.

“We have people who change expiry dates, drug labels and even make pills using cassava flour,” said Ssekyana.

The three-country report also found bad drugs in both the public and private health sectors, meaning governments — some buying medicines with donor funds — are not doing enough to keep poor-quality pills out.

All of the drugs tested from the public sector in Uganda, however, passed the quality tests. But 40 per cent of the artemisinin-based drugs in Senegal failed.

"There are countries where donated medicines are not subjected to quality controls, they're just accepted," said Lukulay. "There are countries in Africa where Chinese products have been donated and found to be unacceptable later in the public sector."

Donations come in during epidemics or seasonal disease outbreaks, simultaneously and generously, and they are accepted by non-governmental and faith-based organizations unconditionally, according to NDA officials.

“We urge that the donations are subject to the same tests but we usually re-export or destroy them and the costs are borne by those who donate them,” said Victoria Birungi Kwesiga, inspector of drugs at NDA.

Nearly 200 samples underwent full quality control testing in a U.S. laboratory to examine the amount of active ingredient present and drug purity. For both drugs, 44 per cent from Senegal failed the full quality testing, followed by 30 per cent from Madagascar and 26 per cent from Uganda.

“I think this is a commercial ploy to discredit other drug companies super ceding others,” said a pharmacist in Wandegeya a suburb in Uganda.

“They should look beyond treatment to prevention. Recently I heard in the media that Uganda mosquitoes are resistant to DDT, they should focus on the parasite,” said Rhona Nankya a nurse in Kampala.

In all three countries, the antimalarial brands collected from various areas and sectors tended to either do well across the board or poorly, which could prove helpful for governments working to ban low-grade drugs.

Results from the other countries surveyed — Cameroon, Ethiopia, Ghana, Kenya, Malawi, Nigeria and Tanzania — have not yet been publicly released by the WHO.

Ends-

Thursday, February 4, 2010

Celebrating Two Decades of Groundbreaking HIV Research: MRC/UVRI’s Legacy

By Esther Nakkazi

On February 2nd, we marked the 20-year anniversary of the Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) partnership in HIV research, celebrated in Entebbe. While medical research may not seem glamorous, its importance is undeniable, especially when findings shape policies that impact millions of lives.

As a journalist, I didn’t always pay close attention to how scientific research informs policy. However, freelancing has allowed me the freedom to explore diverse angles for different publications. In 2006-2007, while writing for RealHealthNews under UK editor Robert Walgate, I learned to spotlight the policy implications of research. 

One story that stood out during that time was about male circumcision as an HIV prevention strategy, based on studies conducted in Uganda, Kenya, and South Africa. Although groundbreaking, it is yet to be fully implemented as policy in Uganda.

Over the past two decades, MRC/UVRI has excelled as a multidisciplinary research hub, shaping HIV policies, guidelines, and treatment protocols in Uganda and beyond. Its contributions have even influenced international guidelines.

Cotrimoxazole: A Game-Changer

One of the unit’s pivotal studies in the 1990s demonstrated that the antibiotic cotrimoxazole (commonly known as Septrin) could cost-effectively prevent secondary infections in HIV patients with weakened immune systems. This finding transformed HIV care, leading to widespread adoption of cotrimoxazole treatment across Africa.

Today, the unit continues to push boundaries. Dr. Paula Munduri, who manages the HIV research program, is planning a new study to determine whether cotrimoxazole remains necessary for patients whose immune systems have recovered under antiretroviral therapy (ART). If proven unnecessary, this could save costs and reduce the pill burden for patients, enhancing treatment adherence. The trial, expected to start in mid-2010, has already secured funding—a testament to the unit's enduring impact.

Sustaining Research Excellence

At the anniversary celebrations, British High Commissioner Martin Shearman announced £40 million in funding to support the unit over the next decade. This investment underscores the importance of ongoing research, particularly in areas like HIV vaccine development and tackling resistance to antiretroviral drugs.

One of the most intriguing studies underway seeks to understand why a small group of people have natural immunity to HIV. These individuals, despite exposure to the virus, remain uninfected. Led by Dr. Pietro Pala as part of the International Centre for HIV Vaccine Immunology (CHAVI), the research involves analyzing samples from sero-discordant couples in Kampala, collected since 2007. Unlocking the secrets of these immune systems could pave the way for an effective HIV vaccine.

A Regional Reference Laboratory for HIV Drug Resistance

As part of the celebrations, a regional reference laboratory for monitoring HIV drug resistance was commissioned by Uganda’s Vice President, Dr. Gilbert Bukenya. This facility further cements MRC/UVRI’s role as a leader in HIV research, equipped with cutting-edge infrastructure and collaborative networks that transcend borders.

Looking Ahead

The MRC/UVRI partnership has set a gold standard for translating research into actionable policy. With robust funding, groundbreaking studies, and a focus on real-world impact, the future of HIV research looks promising. For me, this milestone anniversary isn’t just a celebration of the past—it’s an inspiration for the stories yet to be told. Next time Walgate calls, I’ll have plenty to write about.


The lab commissioned at the MRC/UVRI 20th anniversary
Ends.

Monday, January 18, 2010

BEANS AND WOMEN IN RWANDA

Esther Nakkazi in Rwanda

The journey to Kigali started off on the Rwanda Air twin-engine propeller Dash-100, a small 37-seater plane. It was on short notice by Centre for International Tropical Agriculture (CIAT), but it was worth the journey on the earsplitting, rickety plane and heavy rains as we landed at the airport in Kigali.

The good news was that on January 15, 2010, Rwanda scientists at the Institut de Sciences Agronomiques du Rwanda (ISAR) released 15 new bean varieties that are going to benefit thousands of farmers in the central and east African region.

Rwanda and Beans:
For this beans field-learning trip, I think I have learned so much about climbing beans, I am contemplating becoming a bean farmer or changing my name to Ms. Esther Bean.

But seriously, here are some facts about Rwanda and beans, particularly climbing beans, which fascinated me so much, and interestingly, I had never seen them grow in the field.

Rwanda is one of Africa’s most densely populated nations. It relies on beans as the main staple food, source of protein and calories as such beans are consumed on a daily basis by almost everybody. The very poor can eat them alone. 

Luckily, beans described as a ‘poor mans’ meat’ and a second-class protein can be the sole source of protein with very little or no first class protein (animal) supplement. 

That is why Rwandans, who reportedly are the highest consumers of beans in the world at 50-60kgs kgs per capita (per person per year), grow strong and healthy by eating only beans as a source of protein.

They eat the leaf, as a vegetable, the grain at major meal times- lunch, dinner, and kids eat beans for breakfast with tea before going to school. In other countries when one eats a meal like Irish or sweet potatoes than beans, the other food is the bigger portion but in Rwanda, the beans per meal are more than the other food.

Rwanda has one of the highest diversity of beans in Africa. It has so much variety in terms of color, types-bush beans and climbing beans as well as Rwanda farmers have immense knowledge on beans.


The new bean varieties released by ISAR on 15th January. 

















For instance according to Augustine Musoni, a bean breeder with ISAR, since the year 2000-2010, Rwanda in partnership with CIAT has developed 35 beans varieties. They have thus, managed to get high yielding, disease resistant and climate change tolerant beans that can easily grow elsewhere in the region.

Rwanda also has the mandate to breed for climbing beans in the region under CIAT. In Rwanda, beans are grown in especially the northern region. 

For our tour, we visited Ruhengere, a 2 hours ride from Kigali, and also Kirambo and Musanze in Bulera district. I must say that Rwanda is a beautiful country with many hills. I can describe it as a high rising brown cake, decorated with green icing sugar with thick chocolate (brown dirty water) flowing along its hills.

With its high population and declining land size, climbing beans allow maximum use of limited land and are comparable to having skyscrapers in cities in terms of space utilization.

Women and Beans:
Beans are described as a woman’s crop. Women in Rwanda plant, cultivate, harvest, store, sell, cook the beans and they are very much involved in the selection of bean varieties developed by plant breeders. 

The farmers’ experience in growing beans is excellent, actually, Rwandan women could be the most experienced about growing beans in the world, with a lot of knowledge the ladies are said to know their beans very well.

They can tell which beans can grow in a particular type of soil and season. Hence, Rwanda bean breeders, have a deep connection with Rwandan women via beans. The breeders cannot release a variety until they get confirmation from women who touch, cook and taste them in the participatory variety bean selection.

“When we are breeding we get women to select the varieties. They have the traditional expertise, they will look at the seed in their hands and just say this variety cannot be grown here or it will not do well,” said Musoni.

A woman farmer in Rwanda tending to her climbing beans.
Women also give beans names in Rwanda. The beans bear scientific names but are also given local names.

One of the varieties released on January 15th was CAB 2 – scientific name, Gasirida, local name after a woman farmer Cansilde Gasirinda.

The women also name some beans after what they look like in terms of colors, shape- ‘red kidney’, or other characteristics like weight, ‘coltan’ because they are heavy and fetch more money just as the mineral coltan.

Jacqueline Mujawamariya, 31 years old has spent many years growing, tending, eating and selling beans. She eats beans with Irish potatoes and posho and does not remember that many days when she had a meal with no beans.

As a bean farmer and trader, she has bought a calf from her beans proceeds. She described the climbing beans –as ‘sweet’ compared to bush beans. But also the climbing beans technology –is comparable to the 'Jack and the Beanstalk', which is extremely useful where land pressure is soaring and the need for higher yields is very intense.

CIAT and Beans:

The partnership between the Centre for International Tropical Agriculture (CIAT), the Pan-Africa Bean Research Alliance (PABRA) and Rwanda’s ISAR has developed improved climbing beans that slink up stakes two meters high- tripling, and even quadrupling yields.

These beans require stakes and relatively more labor, but they give back assisting in soil nitrogen fixing, as well as reduction of soil erosion in sloping areas that experience heavy rain. 

In Rwanda, the immediate pay off from the high yields of climbing types has catalyzed farmers’ adoption of soil fertility improvements, such as organic amendments and the use of agroforestry. This has led to better soil conservation and more sustainable agro-ecosystems for areas.

According to Dr. Robin Buruchara, Africa regional Coordinator CIAT, the national programmes like ISAR in Rwanda, or Kawanda Agricultural Research Institute (KARI) in Uganda, are given lines for breeding that they make adaptable to the needs of the country.

For instance, the ‘marker assistance selection’, which is basically conventional technology is used to breed varieties that are selected by farmers. CIAT, the custodian of beans varieties, however, does not allow the varieties to be sold after being bred even after the country program adds value because they are a ‘public good’.

That hopefully, is knowledge enough for you to become Mr/Ms. Bean like I would like to become  a bean farmer like the Rwandan women.
Ends-

Tuesday, December 15, 2009

Uganda will participate in HIV Prevention Microbicide Trials again

The gel used in the trial increased sexual pleasure and it also opened a lot of sexual talk between women and their partners in Uganda.

By Esther Nakkazi

Uganda is ready to participate in another microbicide trial, the results of the failed largest international clinical trial on HIV prevention microbicide not withstanding, said Stephen Malinga, the minister of health at a press conference in Serena hotel.

After a full explanation and knowledge that there is no danger from using the gel, we shall explain this to our participants and urge them to participate again in any other microbicide trials, said Malinga.

At the trial site in Masaka, women who participated in the trials were crest fallen, even if they knew that the gel might not work, they also had very high hopes that it would work.

“The women are disappointed just as we are but they are very appreciative that we have gone back to inform them on the outcomes of the research just as we had promised to do,” said Anatoli Kamali, the Principle Investigator at the Uganda site.

The women were instructed to insert the gel an hour before sex and not to wash after sex. In Uganda all those recruited were potentially high-risk women.

It is disappointing that the gel did not give HIV prevention a chance; the Abstinence Be faithful Condom use (ABC) strategy and female condoms remain the only option for HIV prevention for women.

Kamali says Uganda will participate in HIV prevention microbicide trials again because huge infrastructure was built and women in Uganda and their partners have demonstrated that they used and very much liked the gel during sex. The gel increased sexual pleasure and it also opened a lot of sexual talk between men and women in Uganda.

“The general concept is that women are willing to use the gel. The next trial that comes around in two years time will be with ARVs and we shall have full participation,” said Kamali.

In Uganda 840 women participated in the trial at the Medical Research Council/Uganda virus Research institute (MRC/UVRI) in Masaka site. The largest international clinical trial to date into a preventive HIV gel found no evidence that the vaginal microbicide, PRO 2000 reduces the risk of HIV infection in women, scientists announced today.

“We need an arsenal of intervention. The failure of this candidate does not mean that we shall stop participation in HIV prevention microbicide trials,” said Dr. David Kihumuro Apuuli, the director general Uganda Aids Commission (UAC).

Tuesday, December 8, 2009

The Politics of the Global Fund in Uganda

By Esther Nakkazi

Five months ago officials from the Global Fund came to Uganda and at a press conference at the media centre, announced the disbursement of $4.2 million the next month, to avert a treatment crisis in the country at the time.
To date the money has never been disbursed and Uganda has failed to qualify for Round 9 of the Global Fund causing a $20 million funding gap in HIV and early deaths due to treatment interruptions.
HIV/AIDS financing delays and cuts by development partners are now causing rationing of anti-retroviral drugs and most medical institutions are turning away new patients, unable to enroll them for the life-prolonging drugs. The latest has been a cut from the US President Emergency Plan for AIDS Relief (PEPFAR) funding for paediatric HIV, which will cut at least $1million next year.
Prof Addy Kekitiinwa the executive director Baylor Uganda Children’s Foundation during the annual paediatric conference said – ‘As I speak now, I have a letter from PEPFAR asking me to stop enrolling children. Even if all factors remain constant we still need the government to help or we shall not achieve universal access.
Starting April next year PEPFAR the biggest funder of HIV programmes in Uganda will cut up to $1million from the $7million annual contribution it was making to the paediatric HIV programme. Also the Global Fund money although available is not yet accessible.
Officials from the ministry of Health say that the Global Fund money has been disbursed from New York to Uganda’s central bank account, but there are administrative problems that are hindering its use.
Dr. Francis Runumi the commissioner Planning and Development at the ministry of Health says although the money is on the account but the Global Fund at first disbursed it to the wrong account and later when the signatory to that account was changed, it caused a further delay. In the meantime patients are dying due to ARV stock outs.
The signatory to the account at the central bank was Mary Nannono, the former permanent secretary in the ministry of Health who was interdicted and replaced by Dr. Sam Zaramba acting in the position.
Officials from the ministry of Health who want to keep this out of the media say, they thought it would be automatic for the process to accept a new signatory but as it turned out, due to the high sensitivity by the bank, a lot of technicalities need to be dealt with before the unanticipated long delay is sorted out.

Does the Global Fund have Bad Will for Uganda?
The $4.2 million, which was supposed to be a stopgap measure, in March 2009 is now expected to be disbursed early 2010. But in this entire saga, some officials accuse the Global Fund of having bad will for Uganda.
They say this could be due to the strained relationship, which was created when in 2005, serious mismanagement of $1.6 million was discovered leading to the suspension of financing to Uganda.
However, other sources attribute Uganda’s problems with the Global Fund, to its failure to change its management system. While the Global Fund insists that Uganda should change and operate under the project mode, the government still wants the money to go into budget support.
But Ugandan officials say that even if the Global Fund does not say it explicitly they do not want their money to go to budget support. They want Uganda to go into project mode where they can monitor money, can have a say about the expenditure and most importantly where the Global Fund prominence is proclaimed.
Some say it has a stereotyped way of working, which is too limited in its approach. For instance when Uganda mismanaged only $1.6million they rushed to arrest the culprits, that was not bad at all given the corruption in Uganda but again there was no mechanism for redress.
According to records, at least 70 percent of the people who had not accounted for the funds have already been cleared, recovering at least $1 million from institutions and individuals implicated in the misappropriation.
But even then the funds that could be assessed in Round 7 and Round 3 are not yet available although the two parties had earlier this year committed to resolve all outstanding issues so that the intended beneficiaries are not affected.
The weaknesses that the two sides had were identified and rectified. We shall ensure that the bad past is left behind, said Dr. Richard Nduhura the state minister for Health during a Press conference held to announce the stop gap measure earlier in the year.
This signified a renewed commitment from the Uganda Government to address past weaknesses and strengthen health systems in the long term.
But ministry of health officials say that all other conditions that were required by Uganda like improvement of the procurement and supply chain and a third party agent have now been fullfilled. But there is no money yet.
“If we could access the $254 million for the two rounds, it would be enough to take us through the next two years. We have lost Round 9 but it was rated fit for resubmission,” said Jim Arinaitwe the Global Fund coordinator at Uganda Aids Commission (UAC).
The country deliberately missed out on Round 8 of the Global Fund last year but had approval for two proposals under round 3 and 7, which were supposed to provide enough funds for running HIV programmes. But funds did not come in on time, which has in the long run affected treatment programmes.
The Global Fund has pumped nearly $52 billion in fighting the ravages of the HIV pandemic. Over the next year, the Global Fund will be another $2 billion short to meet its goals for funding new programmes.
To Uganda health officials the Global Fund remains an enigma -on one hand there is a lot of flexible but on the other hand there is no flexibility. It says something can be done but when it is suggested and presented on paper it is denied!

Monday, November 30, 2009

Baylor Uganda Children demand Rights

By Esther Nakkazi

“We have a right, the right of living; we have a hope, for the future; we need care; we need love; we have to grow, its a generation!” sang children swinging their hands and dancing away to the drum beat.
Child labor, defilement, child sacrifice, we need our rights! recited an HIV positive young girl, a member of the Baylor Uganda children choir at the 3rd annual national paediatric HIV&AIDS with a theme ‘accelerating access to HIV prevention, care and treatment for all children,’ conference held in Kampala 26-27th November.
The conference this time emphasized the need for indiscriminate universal rights to counseling, treatment, paediatric care and rights to all, irrespective of age, gender, race and geographical location.
“Children’s rights continue to be violated by their parents and care takers. They refuse to bring the children for testing and treatment and some of them even take them away,” said Prof. Addy Kekitiinwa the executive director Baylor Uganda Children’s Foundation.
This years World Aids Day slogan is ‘Access my Right, Testing my responsibility’ which has been coined from the global theme of ‘Universal Access and Human Rights.’
In Uganda, health officials say many parents deny their children treatment or drop it and opt for spiritual healing- just because the children cannot make their own decisions. But this should not mean they be denied treatment.
In Uganda 120,000-150,000 children aged less than 15 years are estimated to be living with HIV/AIDS of which 50,000 have advanced HIV disease and need anti retroviral therapy (ART).
HIV is one of the major killers of children in Uganda, one in six deaths in children is as a result of HIV infection, 30 percent of HIV infected children will die by one year of age and 50 percent before the age of two unless they are identified and treated early.
One of the Baylor choir children said some parents have become a menace and do not want to look after their HIV positive children. Some parents sell the children’s items, others are drunkards and some even chase the children away from the homes when they establish that they are HIV positive. But these children like all other children and have simple basic needs.
The Government has come up to assure that it will ensure scale-up of access to services for Early Infant HIV testing and treatment, and for care and support for all children that are rejected and affected by HIV.
But although enrollment of children into HIV care has improved over the past one year, it is still very low compared to that of adults. Of the 193,000 people accessing ART by the end of June 2009, only 16,500 (8.5%) were children aged less than 15 years of age.
Children in rural settings do not have easy access to ART as compared to those in urban settings, over 60 percent of children on ART of children are treated in urban settings.
One of the major problems is that the unique and dissimilar issues of children infected and affected by HIV&AIDS are often lumped-up together with those of adults, giving children’s issues less attention than required or no attention at all.
Aids where did you come from, we are stigmatized in school, even in church; defilement, child sacrifice we need our rights! Aids where did you come from, parents so discriminative! the Baylor youngsters danced away as they exited from the conference hall.
Ends-