Wednesday, October 31, 2012

One HIV Pill a Day: Is supply assured ?

By Esther Nakkazi

The once-a-day pill approved recently for HIV medication may reduce costs and improve compliance to life-prolonging medicines, HIV advocates in Uganda say.

Last month, the US Food and Drug Administration or FDA, approved a new combination pill, Stribild, to treat HIV infection effective for only adults who have never been treated for HIV infection.

One of the biggest problems with HIV treatment in Uganda and sub-Sahara at large is drug adherence, which is deepened by the pill burden on a daily basis.

But even though some anti-retroviral therapy users say they are not worried about the price, Uganda's  drug regulatory body, National Drug Authority (NDA) says unless they are confident about supply, the drug will never be introduced here. 

US based Big Pharma, Gilead Sciences is the only global manufacturer so far. The pill infused with four different drugs costs about $75 per day.

“The innovator might not be able to rapidly produce enough quantities. Yet for ARVs we cannot start patients on any drug without assured continuity or its lifetime availability,” said Gordon Katende Sematiko the Executive Secretary NDA.

For any new drugs to get onto the Ugandan market the Ministry of Health would first develop a policy to introduce them and alert development partners to accept to fund it. There should also be a local applicant to register it.

About 95 percent of all anti-HIV drugs distributed in Uganda are funded by development partners and these cater for only 60 percent of the people who need them. So universal access is still a big issue. 

But while the first reaction for development partners was price and they would probably not pay the bill, some Ugandans with deep pockets feel they could for the sake of adherence and convenience pay the price. 

Stribild is estimated to cost about $75 per day, more than 100 percent increase from the $10 for the cheapest regimen on the market today in East Africa. The AIDS Healthcare Foundation that supports many HIV people around the world, reacted by calling the price ‘shockingly irresponsible and unsustainable.’

“I take two pills at night, one pill in the morning and 1 Septrin everyday. But it is difficult not to miss a dose- so a single dose is very conducive. The chances of missing this will be minimal,” said Flavia Kyomukama the national coordinator Global Coalition of Women against AIDS in Uganda. 

On average, an HIV patient on medication takes at least four pills per day if they do not have any opportunistic infections. If one is infected with tuberculosis the pill number triples.

“Approving the once-a-day pill for HIV is very good news - the cost notwithstanding for now,” said Robert Nakibumba a Community Health Research Consultant.

We know that with advocacy the cost will collapse drastically. In fact, as we push for research into the cure, we want scientists to get a drug with a longer shelf-life like a week if possible, said Nakibumba.

According to a press release from FDA, the safety and effectiveness of Stribild was evaluated in 1,408 adult patients not previously treated for HIV in two double blind clinical trials.

Patients were randomly assigned to receive Stribild or Atripla, an HIV drug that contains two HIV drug compounds- Truvada and Efavirenz, once daily in the first trial. In the second trial the new drug Stribild or the anti-HIV drug Truvada with compounds- Atazanavir and Ritonavir were given once daily.

Results showed between 88 percent and 90 percent of patients treated with Stribild had an undetectable amount of HIV in their blood, compared with 84 percent treated with Atripla and 87 percent treated with Truvada plus atazanavir and ritonavir.

The studies were designed to measure the percentage of patients who had an undetectable amount of HIV in their blood at 48 weeks. “The cost of producing new drugs is exorbitant. Uganda can afford to pay for that pill, it is merely a question of leadership and commitment,” said Kyomukama.


State of River Nile Basin Report Launched in Uganda

By Esther Nakkazi

Policy makers based in the River Nile Basin, now have a monitoring tool to support their decisions and present expert analyses with factual data to communities for better stewardship of the common Nile waters and environmental resources.

A report on the state of the Nile basin- which, will be issued every three years- was launched by Betty Bigombe, the Minister of State for Water and prepared by the Nile Basin Initiative (NBI), an inter-governmental regional organization for the River Nile recently in Kampala.

The State of the River Nile Basin Report 2012 was prepared by NBI staff and funded by the German government through GIZ, is also expected to generate discussion, trigger common policy interventions and convergence.

“The report takes stock of past actions, present challenges and future opportunities for improving the stewardship of the Nile, and defines a list of indicators for monitoring the health of the basin,” said Stanislas Kamanzi, the minister of Natural resources, Rwanda.

Kamanzi also the chairperson of Nile Council of Water Ministers said the report, now a flagship knowledge product of the NBI countries, would promote cooperation amongst Nile riparian states for successful management of the basin.

In Europe, it has been established that creation of common basin monitoring tools for transboundary river basins can contribute to mutual trust and joint policy-making. 

As a common planning tool for the River Nile basin, this report is expected to contribute to the building of trust and confidence amongst Nile riparian countries, said Dr Nicholas Azza, a water policy specialist with the NBI who is one of the lead researchers.

And with time it will discern trends into the future facilitate the understanding of complex issues and will draw attention to emerging critical happenings, said Dr. Azza. 

One of the critical issues about the 4,100-mile River Nile is access to the waters by upstream countries Ethiopia, Uganda, Kenya, Tanzania, Congo, Burundi, and Rwanda which felt unfairly treated by the agreements signed by the British in 1920 that favoured downstream countries Egypt and Sudan.  

The upstream countries have been demanding for more access to the Nile waters and a series of meetings have been held to have a new agreement, the Cooperative Framework Agreement, which would regulate the water use by different countries. 

“It is comprehensive and important for planning for all those who will read it. We shall use it to create awareness in our communities using its accurate information,” said Fekahmed Negash, the Head of the Nile Basin Administration Directorate.

Negash said in the past they have been presented with uncoordinated and biased information depending on the source and their interests but this factual information will now ease that problem.

But it is not your traditional report with a lot of research, rather many facts were pulled together and policy briefs generated by NBI staff who carried it out. It has many photos and graphs for easy readability.

The Nile is the longest river in the world and has a drainage area exceeding 3 million square kilometers, shared by eleven countries.

“It is a credible source of information we can rely on and keep updating. It is a chance to have a better judgment for the good of our people who share the Nile basin,” said Dr. Sherif M. EL Sayed the head of Information Central Directorate, Ministry of Water resources and Irrigation in Egypt.

The 256-page report, and the first ever, however points to the quality of the Nile waters which has generally deteriorated because of increases in population, intensification of agricultural activities, industrial development and accelerating in soil erosion.

It is only in the sparsely populated areas along the Nile water in countries like Uganda, Tanzania, and Rwanda where the quality is still within the standards of the riparian countries and the World Health Organization (WHO).

The launch ceremony was witnessed by members of the Nile Technical Advisory Committee (Nile-TAC) representing the ten NBI Member States of Burundi, DR Congo, Egypt, Kenya, Rwanda, South Sudan, Sudan, Tanzania and Uganda as well as NBI Development Partners, representatives of the Nile Basin Discourse as well as staff of NBI.


Monday, October 29, 2012

No water at Jesus baptism place; must be climate change!

By Esther Nakkazi

The journey to Jordan, the baptism place of Jesus by John the Baptist, started aboard Egypt Air. We arrived at 19.15 hours in Amman to find a long, winding queue through immigration, which could have lasted for more than three hours since we got visas on arrival.

My mission was to witness the graduation of 60 science journalists from Africa and the Arab world, who had been trained for two years by the World Federation of Science Journalists (WFSJ) in the SjCOOP, a peer-to-peer mentoring at a distance project, which aimed to help journalists make a career in reporting complex and science related issues.

The good news is that, the graduation at Madaba city, ‘The City of Mosaics’ was fantastic. We did not see much of anything on the two-hour ride from the Dead Sea Spa hotel where we were residing to the restaurant in Madaba, because the country is essentially a desert and dark, but at least we were in the comfort of knowing that underneath almost every house here, lies a fine Byzantine mosaic.

The interesting news was that we got to go see the place where Jesus was baptized but it was as dry as climate change could dry it. 

Not a drop of water. 

Not even water that can be pumped to the site -River Jordan- because Jordan imports almost 70 percent of its water and recycles 60 percent of this for the 6 million people.

Getting into Amman was not that exciting to me, but residing at the Dead Sea Spa hotel, in proximity to the Dead Sea - the said lowest point on earth- was the catch because it meant that for the first time in my life I would float on water. 

Many ask if you can walk on it. No, you cannot walk on the Dead Sea. It’s essentially dead with no living life in it but you can't sink.

Diligently, for a week every morning, I would wake up at 6.00 o’clock, to float on the sea for half an hour after doing the dead sea mud-smear, which is known for improving skin's natural processes, easing rheumatic pains, relaxing muscles and providing inner calmness.
The Dead Sea mud smear
I would scoop mud from the bottom, which is really swallow at that point and then smear it and wait for 30 minutes. It felt so good for the first time, but I made now mistake, I splashed water on my face and in the next 3 minutes I could not see. My eyes hurt.

But the comfort was that my face felt smooth and was glowing every day until I heard the shocking news in one of the conference sessions. 

"Jordan was in a $10 billion plan, ‘Two Seas Canal Project’ to desalinate the Dead Sea. The idea was to use reverse osmosis technology or hyper filtration, which reduces salts and other impurities to give high quality tasting water."

According to reports the Dead Sea water would be mixed with the Red Sea water using this technology, but the results of the mix were unknown, and although a reaction was anticipated, as both seas have chemicals and minerals, Jordan wanted to take the risk as had Israel.

This was a water security project for Jordan, shelved for a while still awaiting results from a feasibility study and Environmental Impact Assessment (EIA) supported initially by the World Bank.

“It is the best solution for us and we do not have an alternative solution. It is a humanitarian and economic mission,” said Mr. Khaled Irani, President of Royal Society for the Conservation of Nature. Jordan imports both water and oil, items, which throw its budget over the roof. 

The alternative would be to use the River Jordan waters to desalinate the Dead Sea but much of its waters have been grabbed by Israel, which has built a dam and also has a desalination project while Syria has built reservoirs.

The skeptics of the ‘Two seas canal project’ said it could not happen, unless Israel concurs with it, but environmentally it would be a catastrophe, said Dr. Samir Mahmoud, a mentor in the SjCOOP project and a media expert in Egypt.

This was the historical Jordan, which in the bible is a scene of many miracles, had priests carrying the Ark of the covenant of the Lord stopped in its middle, it parted, and his people crossed it on dry ground, (Joshua 3; 15-17). Elisha healed Naaman, a commander of the army, of leprosy, by having him bathe in its waters, but its almost gone.

Reports showed that its flow had declined from more than 1.3 billion cubic meters to 30 million cubic meters per year. Mr. Batir Wardam, an environment expert thinks the project would improve water security and revive the biodiversity in the region.

As journalists, River Jordan was also one of our ambitious site visits.When African journalists attending a conference in a country like Jordan, dig into their pockets and organize for a visit, you know how important it is to them.
So was this excursion to see the Baptism place of Jesus. 

Maybe the gravity of the damage to the River, explained earlier in the session, was underestimated but each of us, all from Africa boarded into two Matatu-like vans and proceeded to the baptism place.

We all had empty mineral water bottles. I had forgotten my big one on the conference table and I run back, break-neck speed to pick it. Each one of us paid 10 Jordanian dinars, which exchange for exactly 10 British pounds.

In the van, we could see Jericho, very near but on the Israelite side, which Biblically, fell flat on the ground, after men in the command of prophet Joshua, marched around it for six days blowing trumpets and carrying the Ark.

It was exciting but we were in high spirits for the Jordan. Walking along the track that Jesus and many prophets had walked was even more thrilling. However, along the way the van stopped. The tour guide pointed to River Jordan.

Disappointment, disbelief, doubts is what I saw on people's faces. In front of us was River Jordan, the water was with a lime greenish, brownish color and was still, the bank of the river ground was cracked and the vegetation along it was bamboo like. You could walk across it in 3 minutes.
The River Jordan banks (the highest point of our disappointment on the trip.
The guide advised that we continue on the track. Everybody was quite, emotional and I choose to tap into people's feelings.  These were some of the words I heard; spiritual disappointed, it feels dry’, historical, spiritual. “There is no feeling-oooo”, Leocadia Bongben from Cameroon said angrily. 

The next site was the real place. There was a wooden shelter; significant of the three early churches of Basilica built by John the Baptist. Below it were three blocks of steps in descending order.
At this point also the heavens opened twice; Elijah was taken to heaven and again the heavens opened and a voice recognized Jesus as his beloved son, Matthew 3.17.
The first block and then the second and third, which leads to lower ground and shapes like a cross, which is the supposed real place, where Jesus was baptized by John the Baptist. It is also aligned with the city of Jericho, which is symbolic. But there was not a drop of water.
The Baptism place of Jesus in Jordan
Water once did flow here but the Jordan changed its course or flow, and in a country with nine months of intensive heat, evaporation levels are high. 

But about 5 minutes away, from this site is the Jordan again, separating two nations, Jordan and Israel.

It is here that that empty water bottles we carried were filled.

“I will use the water to wash my kids faces’, ‘I will keep it for 10 years in a special bottle’, ‘I will give it to my Pastor to use it on the sick for healing’, were the many uses echoed out. “I will give it to my mum, she is a Reverend,” said Violet Otindo, a television producer and reporter with Citizen TV. My own bottle did not carry back any water from River Jordan.


Tuesday, October 9, 2012

Health Sector in Uganda after 50 years; Is there progress?

By Esther Nakkazi

When the Organisation of African Unity (OAU) was held in Kampala in 1975, delegates of the meeting were taken to tour the Uganda Cancer Institute at Mulago referral hospital.

It was a showcase of an effectively and efficiently run Uganda institution with enough equipment, human resource and research that made a break through on liver cancer treatment to the world.

Dr. Charles Olweny, who was heading the UCI at the time, says the place was ‘booming’ so whenever there were guests in Kampala, they were taken to tour the Institute.

“It was hectic but enjoyable. The Institute made its name and we followed up on every patient and knew everything about every one of them.”

Mulago Hospital in the 1960’s was a centre of excellence in East and possibly central Africa, serving as the teaching hospital for the East African Medical School and high-level research centre in cancers, kidney conditions, and malnutrition in children, malaria and heart diseases.

In the health system that the colonialists left in place was centralized; all health workers were interviewed at one central point and then transferred to health centres across the country.

This ensured high staffing levels and the World Health Organisation (WHO) minimum target of 23 health workers per 10,000 population was met.

Each of the 22 districts in Uganda had a hospital and was linked to a place of worship and school in the same neighbourhood offering a total package. The faith-based health facilities were upbeat and committed.

The life expectancy, 50 years ago, in Uganda was 74 years and by 1962 the population was only 7.3 million people growing at 2.4 percent. The age structure was biggest for the age group 15-64 years with 50 percent of the total population.

The population of Uganda was about 7.3 million and Uganda had one of the best health services systems in Sub-Saharan Africa. The health infrastructure was excellent and was regularly maintained.

“Public health services were adequately provided, immunization programmes were active and health workers were well motivated, disciplined and proud to be members of the distinguished health sector,” said Dr. Lawrence Kaggwa a Senior Consultant Surgeon and Consultant in Heath Systems, Clinical services and Health management.

Dr. Kaggwa who was a young doctor in the 60’s and 70’s says the health sector was bed rocked on objective planning, commitment, enforcement of the Public Health Act, dedicated health workers, appropriate budgeting for health with active professional councils.

Ten years after independence, the political turmoil that followed in the late 1970’s and 1980’s led to the collapse of all sectors including health, leading to a brain drain of professionals including health experts that left for dear life or better pay.

But the doctors never came back. Instead it was been an exodus of health workers not only from Uganda but Africa to developed countries looking for better pay.

The infrastructure and equipment broke down with minimal attempts at repair. Planning was quite low and the coping strategy with the health technological development was minimal resulting in a serious lag in catching up with the novel trends then.

Dr. Kaggwa summarized the health sector for over 20 years from 1966-1986, as with a rapid population growth which is not in keeping with the planned health faculties, demoralized health workers and poor culture for repair and maintenance of the infrastructure and equipment.

When he came to power in 1986, President Yoweri Museveni was eager to improve the conditions of scientists and has been promising them better money that would keep them home.

A young scientist at the time, Dr. Fina Opio now the programme manager, staple crops at ASERECA, remembers how after taking over power the President visited Kawanda Agricultural Research Institute (KARI) and spent the whole day listening to them. At the end of the day he raised their pay.

Rehabilitation and recovery of the entire socio-economic sector started in earnest and despite competition for the limited national funds, the health sector received its share and with enthusiasm embarked on a protracted recovery course, but it is now constrained by a bottleneck of rapid population growth 3.3 percent and high fertility rate of 6.7 percent.

The population seems to be doubling every 22 years, for in 1984 it was 14 million and in 2007 it was 29.6 million, which requires appropriate planning for the national income, rate of employment, status of living conditions and sustenance of economic growth. Now the nation has one of the youngest and most rapidly growing populations in the world, half of the 36 million people are youngsters below 15 years. And districts keep being added.

“This is making efficient and effective management of health facilities and planning very difficult, if not impossible,” said Francis Runumi, the commissioner of health services in charge of planning at the Ministry of Health.

The health workforce is also beset with problems low job satisfaction and working conditions. And these are linked to inappropriate deployment, low salaries, inadequate supervision, excessive workloads and poor job security.

The government expenditure on health as a percent of total government expenditure has remained around 9 percent, as it has been for the last decade, well off from the Abuja target of 15 percent. Health workers serve only 12 percent of the population and rural areas are widely neglected.

But there is hope. The salaries and allowances for the doctors at the lower level were increased recently and will be increased even more in the future, as promised by President Museveni in his Jubilee celebration speech to Ugandans.

Immunization has been quite successful. At the moment the health sector performance indices are improving except the Maternal Mortality Rate. The infant Mortality has improved from 76/1000 to 54/1000, the Under-five Mortality from 137/1000 to 90/1000. However, Maternal Mortality remains around 438/100,000 live births, which calls for serious interventions so that births remain as sacrosanct as God willed.

Health has been one of our priority areas in the NRM, said Museveni.


Wednesday, October 3, 2012


I congratulate all of you on the attainment of the 50 years of independence.  I wish all of you a happy future.

Before I talk about the last 50 years, let me first talk about Uganda.  There is a wrong but pervasive idea that Uganda was created by the British in 1894.  Even some official documents propagate this lie.  I have tried several times, in the past, to dispel this lie.  Let me try again.

Before the emergence of the present dynasties (the Kabakas, the Bahinda, the Bashambo, the Babiito, etc), Uganda had become one kingdom when Ruyonga and Ishaza formed an alliance, through the marriage of the former’s daughter called Nyamate, to the latter.  Ishaza and Nyamate produced Isimbwa (Simbwa among the Baganda).  Isimbwa succeeded Ruyonga and his capital was in Bigo bya Mugyenyi in the present day Sembabule district.  Isimbwa, eventually went to Bunyoro and produced a boy child with Nyinamwiru, Bukuku’s daughter.  The boy was the famous Ndahura (Ndawula in Luganda).  Isimbwa went to Bukiri (Lango and Acholi).  He, later, abdicated to his son Ndahura.  By this time, Ankore, Buganda, Bunyoro, Bukiri were one kingdom, under Ndahura.  One of the Bachwezi, Kyomya, had children with a Mukiri woman called Nyatwooro, daughter of Rabongo.  The children were: Nyarwa, Isingoma, Mpuga Rukidi, Kato Kimera, Kintu and Kiiza.  These legends may not be exact in terms of details.  They, however, give a general outline of the linkages of our peoples.  The shared Bachwezi names say it all: Isimbwa, Ndahura (Ndawula), Kagoro, Mukasa (Mugasha), Kyomya, Wamara, Mugyenyi, etc.  Archaeology confirms this history.  The excavations at Bigo and Ntutsi confirm that there were huge settlements at those sites by 1350 AD and 900 AD, respectively.  There were huge cities there (Endembo).  Who were the kings there?  Certainly they were not the present dynasties of Buganda, Bunyoro or Ankore.  Who, then, were they? 

When we restored the traditional leaders, it was our expectation that the cultural institutions would delve into these obvious linkages among our peoples instead of promoting tribal chauvinism.

It was not just that the kingdoms and the chiefdoms of Uganda had linkages among themselves, it is also true that what is now Uganda had close and organic links with the Coast of East Africa, with Congo and with South Sudan.  As I have pointed out some time back, the excavations at Ntutsi and Bigo retrieved cowrie shells (ensimbi) and glass beads (enkwanzi).  Cowrie shells could only come from the ocean and there is no ocean in Uganda.  Where, then, did the cowrie shells come from?  Obviously, it was from the ocean.  Which ocean?  The Indian Ocean, because, at that time, the route to the Atlantic ocean, through Congo, was not open.  It is Stanley who opened that route in 1874.  Uganda was not manufacturing glass beads.  Where did they come from?  They were coming from India as well as from the Middle East and passing through Zanzibar.  The oneness and linkages of the African peoples in this Region is further illustrated by the dialects, the languages, the clan system and other aspects of culture.

On this occasion, let me just mention something on the clans, dialects and languages.  Take my Basiita sub-clan.  I call it sub-clan because it belongs to the bigger cluster of clans known as Abagahe.  All these clans have a totem of the striped cows ─ black stripes against a background of a brown skin.  Such a cow is known as Ngoobe in Runyankore and Lubombwe in Luganda.  My sub-clan, the Basiita, is found in Kigezi (especially Rukungiri), Ankore, Tooro, Bunyoro, in Tanzania (Karagwe, Buhaya, Bujinja, etc.) and in Rwanda.  In Bukonjo, the Basiita are called Baswaaga.  In Buganda, they are called Ab’ ente, with the same totem ─ the striped cow.  In Sironko, there is a whole parish, known as Busiita.  Dr. Wabudeya belongs to this clan.  The late Rev. Engola Etwai of Lango belonged to the cow clan.  In Tanzania, there is a Minister in the present Government, Dr. Anna Tibaijuka.  She belongs to this clan as did the late Cardinal Rugambwa.  The former President of Burundi, Batista Bagaza, apparently, belongs to the Basingo clan, the clan of the Rt. Hon. Eriya Kategaya.  The Basiita clan, of course, also is found in the DRC, the Bunia area.  There is the Bahinda clan, their totem is a monkey.  They became the ruling clan in Ankore, in Tanzania (in the areas of Karagwe, Buhaya, Bujinja, Busuubi and Buha in Kigoma) after the collapse of the Bachwezi Dynasty.  That is why you find a number of Ruhindas in Tanzania.

Coming to the dialects and languages, you hear a lot of untruths on this subject.  You hear that Uganda has got “a lot” of languages.  Where are these “many” languages?  In fact, there are only four languages in Uganda: the Bantu dialects; Luo; Karimojong-Ateso; and Lugbara-Madi.  This is why I never use translators in most of the Bantu speaking areas.  Somebody speaking Rukiga, Runyoro, Rutooro, Luganda, Lusoga, Luruuli, Lunyala, Lugweere, Runyambo, Ruhaya, Rujinja, Lunyole or Ruhema of Congo is, actually, speaking Runyankore in a certain way, slightly different from the way I speak Runyankore, but perfectly intelligible to me.  With Kinyarwanda-Kirundi, mutual intelligibility is about 50%.  With Lumasaaba- Lusamya and Rukonjo ─ most of the words are the same but pronounced differently or sometimes used differently.  Take the word ─ enyena.  In most of the Bantu dialects of this area, the word, enyena, is used to mean ─ a calf or young cow that has not produced a baby cow.  However, in Lumasaaba, it is also used to mean a dog puppy.  This makes it so funny to a Runyankore speaker.  The Bagisu call a puppy ─ inyana yimbwa.  The Banyankore call a puppy ─ ekibwaana and use the word enyena to apply only to a pre-mothering cow.  The Bagisu also use the word hugona (kugona in Runyankore) to mean to sleep just like the Nyakyusa of South Western Tanzania.  In Runyankore, kugona means to snore.  In the same way there are similarities among the Bantu dialects, there are also similarities among the Luo dialects (Acholi, Langi, Alur, Japadhola, Luo of Kenya, Labwor, Anuak of Ethiopia, etc); Karimajong-Ateso, the Ateker group, which also includes the Turkana of Kenya, the Rendille of Ethiopia, the Kakwa and the Bari of South Sudan; and the Lugbara-Madi which include some of the dialects of South Sudan which I have not studied except for the Lugbaras and Madis who are found in Congo and South Sudan.

Apart from the similarities among the Bantu dialects, there are also linkages between Bantu languages and the Luo, Lugbara-Madi and Karimojong-Ateso.  The Oyima clan of Lango, the clan of the late President Obote, means the Bahima clan.  The Bahima are the cattle keeping portion of the populations of Karagwe, Ankore, Bunyoro, Tooro, parts of Congo, etc.  The word Lubaala means anthem in Acholi.  In Luganda, the word Omubala means clan anthem.  The word Wankachi used to describe one of the gates in the Kabaka’s palace is known as Wang-kac in Luo meaning the main gate.  The word: Oyaa in Lugbara means syphilis.  In Runyankore, syphilis is known as: ebihooya.  The word nyaara in Luo means daughter.  The Bantu speakers know what that word means.

My question, then, is: if you say that Uganda was created by the British in 1894, did the British create these similarities and linkages?  The answer is, obviously a big “no”.  The people of this area are either similar or linked.  At some stage, according to the oral history, a big chunk of them were even governed together as I already said.  In any case, they were always trading together ─ all the way to the River Congo in the West and to the Indian Ocean in the East.  The kingdoms that colonialism found in the area, were, sometimes, fighting each other but, sometimes, co-operating with one another.

Indeed, on page 300 of Hannington Speke’s Book: The Discovery of the Source of the Nile, Kamurasi made the following comments to Speke:
“After arriving there, and going through the usual salutations, Kamurasi asked us from what stock of people we came, explaining his meaning by saying, “as we, Rumanika, Mtesa, and the rest of us (enumerating the kings), are Wawitu (or Princes), Uwitu (the country of the Princes) being to the east”. 

Kamurasi was referring to Rumanyika of Karagwe, Tanzania, as his brother and Mutesa as his son.  Therefore, all these were fraternal kingdoms that at some stage were governed together.  However, even at this stage, following the disintegration of the old kingdom, Bunyoro was still a very large kingdom, covering an area that could not be smaller than the present day Uganda.

On page 277 of the same book, Speke was trying to intimidate Kamurasi’s official known as Kijwiiga, mis-pronounced as ‘Kidgwiga’, by saying that if the latter did not open the way for them to Gani, they would combine with Mutesa (Mtesa) and the latter’s rebellious brothers such as Ruyonga and fight him.  Kijwiiga answered as follows:
“Nonsense! Kamrasi is the chief of all the countries around here ─ Usoga, Kidi, Chopi, Gani, Ulega, everywhere; he has only to hold up his hand and thousands would come to his assistance”. 
Gani must either be West Nile or South-Sudan and Ulega (Bulega) is Congo.  Bukiri is the traditional name the Banyankore, Baganda, Banyoro and Basoga people give Lango and Acholi region. In the foregoing quotation, Bukiri was mispronounced as Kidi.  In the colonial times when the Banyankore cattle keepers were going to those areas to work after tse-tse flies had killed their cattle in Ankore, we would say: “Bakaza Bukiri – they went to Bukiri.  Therefore, this idea that Uganda did not exist until the British came it, is nonsense.  In fact, colonialism interfered with the wider Commonwealth of these kingdoms and chiefdoms, from the River Congo, Ituri forest and the swamps of South Sudan to the Indian Ocean Coast at Zanzibar.  The only problem was the greed and narrow mindedness of the kings and the chiefs.  Moreover, we are even luckier that our people at the Coast distilled a non-tribal dialect from these many dialects known as Swahili.  Swahili is a Bantu dialect that is non-tribal and was enriched by words from Arabic, Portuguese, etc.

The fact that such untruths can persist and be propagated even in schools and universities not to mention newspapers, media houses, churches, the traditional institutions which were resurrected at great sacrifice to our lives and time, etc, shows the first problem that afflicted independent Uganda.  This was the problem of ideological disorientation. 

Was the economic, social and political space created by Uganda good or bad for the producers of Uganda?  During the launch of the patriotic clubs in 2009, I answered this question.  My prosperity as a Munyankore is not just because of the Banyankore; it is, mainly, because of the people of Kampala (Ugandan or otherwise) that buy my milk, my beef and my matooke. Actually, most Banyankore do not buy my milk because they also produce milk except the ones living in the towns.  The Banyankore only help me to generate enough volumes of milk for ease of marketing and processing.  It is only the parasitic interests that are not engaged in production that do not appreciate the importance of Uganda.  Also the uninformed may not see the importance of Uganda.  Most of the problems Uganda has had since independence in 1962 were springing from the pushing of these parasitic interests.  There was also the issue of the poor or no sensitization of the masses so that the parasites are isolated.  The ideological disorientation of so many actors was, therefore, problem number one of Uganda.

This ideological disorientation led to problem number two ─ the inability to restructure the colonial state to the chagrin of Ugandans.  Without a nationalist ideology, it was impossible to, for instance, build a national Army.  Sectarianism that was being manipulated by colonialism could not produce a national Army.  The Governments that took over after independence, trying to rely on these sectarian Armies that had little or no education, created a dangerous booby-trap for our country.  In time, that booby-trap exploded with tragic consequences for our people.  Since Independence, about 800,000 Ugandans have died on account of political violence, mainly, in the form of extra-judicial killings by indisciplined Armies.  In Luwero, we have 32 mass graves, each with about 2,000 skulls and other skeleton parts.  That is why point number two (2) of the NRM Ten-Point Programme that was, finally, promulgated at Kanyaara in the Luwero Triangle talked of security of persons and property.  Extra-judicial killings, impunity on the part of security forces, poaching of animals in the National Parks, looting of people’s property, etc., were the order of the day.  The NRM addressed this by targeting and destroying the old colonial Army and replacing it with an Army that is based on patriotism which despises sectarianism.  Of course, it is also an Army that is led by educated people.  Hence, its heroic performance on the battle fields.  The UPDF has solved one strategic bottleneck ─ insecurity of persons and property. 

Apart from the two strategic bottlenecks above ─ ideological disorientation and a criminal state ─ there are eight (8) other strategic bottlenecks independent Uganda had to deal with.  These were:
     i.         attacking the private sector;

  ii.         an undeveloped human resource;

iii.         inadequate infrastructure that causes the costs of doing business in the economy to go up thereby rendering our products un competitive and undermines the profitability of investments by having the said high costs;

 iv.         a small internal market caused by the political balkanization of Africa;

    v.         lack of industrialization;

 vi.         an undeveloped services sector;

vii.         underdevelopment of agriculture; and

viii.         lack of democracy.

Attacking the private sector arose from a mistaken view among some of the leaders.  Some people thought that altruism was universally and equitably distributed.  They thought that everybody, inspired by altruism, was able to work diligently and devotedly even if he was working for the State.  They did not believe in the story of the ‘hired hand who runs away from the wolf when it comes to attack the sheep unlike the owner of the sheep that will defend them even at the cost of his own life’.  This is from the Gospel according to Saint John 10:12.  This was a failure to understand the nature of the majority of human beings.  What will make a human being work devotedly?  Can he/she work devotedly for the benefit of others as he/she would work for himself/herself?  This was a philosophical question.  Are all human beings Mother Terezas who can be motivated by altruism to work devotedly for the benefit of others?  Many of the NRM people are, indeed, like Mother Tereza.  That is why we could fight all these wars.  Who was paying us?  However, the majority of human beings are selfish and ego-centric.  They work best when they work for themselves.  When we are designing a plan for the entire society, it is better to utilize the ego-centrism of the human beings to build our economy and society.  It is not correct to be subjective and assume that because you are not selfish, the entirety of society is also selfless.  This is not objective but subjective.

It is better to recognize and utilize private initiative ─ the entrepreneurial spirit.  In the past, we used to talk of the three factors of production in economics.  These were: land, capital and labour.  It was later, realized that we needed to add a fourth factor, entrepreneurship ─ private initiative.  I hear that since my time of studying economics in the 1960s, a fifth factor has been added, knowledge.  As you know, entrepreneurship and knowledge are both private and personal capabilities.  Soon after Independence, influenced by the success of socialism in the Soviet Union, many African elite declared socialism of some form ─ ending up with interfering with the private sector.  Here in Uganda, we had bouts of that which culminated in the expulsion of the Ugandan Asians by Idi Amin in 1972.  This was a big disservice to Uganda.  That is one of the factors that led Uganda to join the rest of Africa in lagging far behind Malaysia, Singapore and South Korea, which were far much less endowed than the African countries, in rapid socio-economic transformation.  In Uganda, when our leaders were, in one way or another, attacking the private sector, in South Korea, General Park Chung Hee was empowering private groups such as Samsung, Daewoo, Hyundai, etc.  Chinese private groups have played big roles in building the economies of Malaysia, Singapore, Indonesia, etc.  Even today, bias against private enterprise by some political actors, corrupt public servants, etc interferes with the fast development of Uganda.  However, the NRM, under my leadership, has firmly stood behind the private sector.  I am a socialist by ideology.  However, I long ago realized what Mzee Deng Hsiao Ping of China realized and implemented since 1978 ─ to use capitalism to build socialism.  This is correct and those who inconvenience private entrepreneurship that is within the law are, knowingly or unknowingly, the new enemies of Uganda.  On account of our correct stand, by ensuring security of persons and property, as well as supporting private enterprises, the GDP of Uganda has been growing at the rate of 6.5 for the last 27 years, the problem of inadequate infrastructure, especially electricity, notwithstanding.  Now that we are solving the problem of electricity, the economy will roar at an even much faster rate.  I have no doubt about that.  However, inconveniencing legitimate private entrepreneurship is un-acceptable.

The next strategic bottleneck was a human resource that was underdeveloped on account of inadequate education and health care.  These two have been our priority. In 1986, there were a total of 936 Health facilities all over Uganda, of which 89 were Health Centre IIIs or their equivalent of that time, 104 were Health Centre IVs and only 81 were District Hospitals and above.  We now have 1,279 Health Centre IIIs, 193 Health Centre IVs and 152 Hospitals (i.e. 135 General Hospitals, previously called District Hospitals, 17 Referral Hospitals). The private ones are 342 Health Centre IIIs, 23 Health Centre IVs and 88 Hospitals.  Our people, in their enthusiasm and without clearance from the Central Government, went ahead and built 3,549 Health Centre IIs at the parish.  In the recent debate within the Government and Parliament, our stand of consolidating health care at HC IIIs and IVs has been re-affirmed.  The salaries and allowances for the doctors at HC IVs have been increased and will be increased even more in the future.  Immunization has been quite successful.  That is why infant mortality rate has declined to 54 out of 1,000 live births from 120 out of 1000 live births in 1986. If only our people could add hygiene, nutrition and disciplined behavior in sexual matters, we would eliminate 80% of all sicknesses.

Increase in education has been phenomenal.  Enrolment in primary schools, is now 8,317,420 pupils compared to 2,203,824 pupils in 1986; in secondary schools, it is 1,225,326 compared to 123,479 students in 1986; in universities, it is 150,000 students compared to 5,390 students in 1986.  We are now working on skills and emphasizing science education.  The problem is now jobs for the schools and university graduates.  This is a problem but a good one.  We have had very good success in this area in spite of inadequate resources.  This strategic bottleneck of uneducated population is being addressed by emphasizing skilling of the youth.  We must quickly deal with the other strategic bottlenecks so that we create jobs for these youth.

Strategic bottleneck number five was undeveloped infrastructure.  By independence we had only 844 kms of tarmac roads (now we have 3,300 kms), 150 megawatts of electricity and very few towns with piped water, etc.  This minuscule infrastructure deteriorated during the time of Amin.  At least the post independence UPC Government had extended tarmac roads to new towns such as Mbarara-Kabale, Mbarara-Fort Portal, Kampala-Gulu-Lira, etc. This infrastructure, however, collapsed during Idi Amin’s time. 

By 1986, Jinja was producing only 60 megawatts.  The NRM, on account of depending on external funding up to 2005 for electricity, could not launch its own aggressive plan.  Using external funding, we had repaired the Nalubaale power station back to its original capacity of 150 megawatts and later up-graded it to 180 megawatts as well as built the Kiira power station to the East of the Nile with 200 megawatts if the water to run both is available.  That was the end of progress in that sector. External funders would use every pretext to block projects of electricity. Excuses like the environment, Egyptian objections and some Basoga spirits would all delay the construction of a dam.  It was only the creation of the Energy Fund that liberated us from that blackmail.  Uganda is now generating 810 MW.

With Karuma, which we are about to embark on, we shall be generating 1,885 MW.  By 2014, we shall start generating power using crude oil and gas before we start using Heavy Fuel Oil (HFO) from our oil.  Using the Energy Fund we have supported the following mini-hydro projects to get connected to the grid by supporting their inter-connection lines: Bugoye (13 MW), Buseruka (9 MW), Mpanga (18 MW) and Ishasha (6.5 MW).  We have also extended electricity lines to the following Districts:  Kibaale, Kyenjojo, Bundibugyo, Kanungu, Kaberamaido, Amolatar, Aleptong, Oyam, Dokolo, Nakapiripirit, Amudat, Moroto, Napak, Kyankwanzi in addition to the rural large industries like Tea Factories, Fish Processing Factories and Mining areas.  With reliable electricity, the economy will grow much faster.   Since the switching on of Bujagali in February 2012, several industries have been connected consuming about 36 MW and expected to grow to about 56 MW by the end of 2012. The following new businesses have been connected:
·      101 large and medium scale businesses;

·      458 commercial enterprises;

·      34,600 domestic users;

·      Since June 2012, about 40 large existing businesses have significantly increased their consumption e.g. Roofings, Hima cement, Tororo cement, Tembo steel, etc;

·      The number of domestic users is also increasing.
With reliable electricity, the economy will grow much faster.  The real march forward has begun.

Strategic bottleneck number six was the small market created by colonialism.  While British colonialism had seen the wisdom of re-assembling the East Africa common market which had been fragmented by the competing colonial interests – German, British, etc, that effort did not include Congo, Rwanda, Burundi or South Sudan which were part of our old system.  Without a big market, you cannot sustainably produce.  Somebody must buy what you produce.  Big markets are stimulants for production.  Working with our partners, we have revived the East African Community (EAC) and also created COMESA.  Besides, we have negotiated market access, tariff free and quota free, with USA, EU, Japan, India and China.  The markets are there.  Let us produce for them.  The GDP of Uganda was USD 1.55 billion in 1986.  It is now USD 20 billion.  The size of the economy has grown by 13 times since 1986.  If we succeed in adding value to our coffee, our cotton, our bananas, our fruits and to our minerals (copper, gold, cement, iron-ore and phosphates, the size of GDP would jump to USD 155 billion which would be bigger than South African’s economy by 1994 when Nelson Mandela took over.  Now that we are beginning to solve the problem of electricity, this is what we are targeting.  Therefore, lack of industrialization has been strategic bottleneck number seven (7).  The cure for this is industrialization.   Adding value to our coffee, for instance, would push the value of our coffee to go up by, at least, ten times – from USD 400 million to USD 4 billion.

Strategic bottleneck number eight (8) has been the underdevelopment of services.  In 1963, I drove (kufunya) a bull on behalf of Mr. Kaguta, my father, from Kikyenkye (Ibanda) to Katebe (10 miles from Mbarara).  I was assisted by another slightly older person.  I was 19 years old at that time.  Although we had money, we could not get anything to buy on the way.  We could not even buy a soda from the few shops on the way (e. g. Rubindi) because we had no ‘empties’ – empty bottles.  Yet, we did not have time to stand in the shops so as to drink the soda and finish it in order to hand back the bottle.  We even offered to put 50 cents down as an extra charge to cover the soda bottle but the shopkeepers would not agree.   In the end, we quartered for the night at Rweibare, gave money to a mutembuuzi (somebody starting a fresh garden) to go and buy a bunch of banana from a nearby village, cooked for us bananas with mere salt so that we could have a sort of breakfast, supper for the previous night, lunch for the previous day and lunch for that day in that one meal.  Services were poor if not non-existent at all.  Services have now increased but there is a lot to be done.  With the underground and the under sea cables, telephones are much easier; public transport is more plentiful; hotels and trading centres are more plentiful today than in 1986 and before.

At independence, there was one capital city, Kampala.  There were 13 municipal councils, 27 town councils and a few trading centres.  What is the situation now?  There is still one city, Kampala – Although Jinja, Mbale, Mbarara, Fort Portal, etc., are clamouring for city status.  There are 22 municipalities, 174 town councils, 197 town boards and very many trading centers which are not gazatted.

If you take the example of the Kazo-Nyabushozi  area that I know well, there were only two shops at Burunga in 1966 about three shops at Kiruhuura, three shops at Rushere, etc.  There are now big trading centres at Burunga, Rwemikoma, Kijuma, Mugore, Nshweere,  Rushere, Katongore, Bijubwe, Rushoga, Kyakabunga, etc.  All these contain services – shops, eating houses, telephone agents, etc.

Strategic bottleneck number nine has been the underdeveloped agriculture.  The British had promoted coffee, cotton, tea and tobacco – crops that were of interest to the colonial system.  Beyond that, they had no interest in bananas, cattle, maize, millet, sorghum, irish potatoes, sweet potatoes, cassava, etc.  In order to modernize agriculture, we have to undertake the following measures:  improved seeds and breeding stock; improved agro-practices; organic and inorganic fertilizers; as well as irrigation and water conservation in the soil.  We have made some good progress in the area of seeds and breeding stock – there are products with high yields e.g. clonal coffee, improved breeds, etc.  What we need is the multiplication of these seeds.  Let us take coffee.  There are about 6 million homesteads in Uganda.  If four million of them were to grow one acre of coffee each, when each acre requires 450 trees, that would mean that we could require 1.8 billion seedlings.  When they would mature in 18 months, Uganda would harvest 18 million bags of 60 kg each.   It would be number two or three in the whole world in the production of coffee depending on the coffee production in Vietnam which currently produces 17-19 million bags.  Four million acres of land represent only 10% of the whole acreage of arable land in Uganda, 40 million acres. 

Some years ago, we put out plans of 4 acres per family of small holders planted as follows:  One acre of clonal coffee; one acre of fruits (oranges, mangoes or pineapples); one acre of bananas; and an acre of pasture (elephant grass) for 6 cattle in the shed (zero-gazing).  To this, add poultry, piggery and improved goats in the backyard of the home.  A combination of all these enterprises would bring in much in excess of the 20 million shillings per annum we set as a minimum.  In the non-coffee growing areas, we can use fruits.  Where possible, e.g.  Busoga, Teso, Lango, some parts of Buganda, some parts of Ankore, fish ponds should be promoted as well as apiary.  In some areas, I am promoting silk rearing.  With the above mentioned enterprises, we are talking about small holders.  The big farmers and the plantation owners have different options: ranching, cotton growing, tea growing, sugarcane, palm oil, cocoa, etc.

Strategic bottleneck number ten, was lack of democracy.  We have achieved democracy.  However, some people want to turn our democracy into anarchy, using populism and opportunism.    This is injurious, especially if it creates a feeling of paralysis and crisis.  We need disciplined democracy.

You recall the panic that was generated last year when inflation climbed to 30%.  You remember, that I told you that that inflation was good because it showed that there was high demand for food and other products.  I called on Ugandans to produce more in order to feed these bigger markets.  As we speak today, inflation is only 5.4%.  Shame is on whom – the charlatans or ourselves?

We have identified the above mentioned ten (10) strategic bottlenecks that Uganda has had to face in the last 50 years.  To recapitulate, these are:

     i.         ideological disorientation;

  ii.         a state, especially the Army, that needed restructuring;

iii.         the suppression of the private sector;

 iv.         the underdevelopment of the human resource;

    v.         the underdevelopment of the infrastructure (the railways, the roads, the electricity, the telephones, piped water, etc);

 vi.         a small market;

vii.         lack of industrialization;

viii.         the underdevelopment of the services sector (hotels, banking, transport, insurance, etc);

 ix.         the underdevelopment of agriculture; and

   x.         the attack on democracy.

The NRM has long identified all these bottlenecks and is in the process of addressing each of them.  The process of addressing each one of them has gone some distance.  Some still have a long way to go.  On the ideological plane, we still have groups that are still trying to push sectarianism and chauvinism.  This matter needs to be concluded.  No group should be allowed to continue on this false path.  The NRM stands for four principles:
·      nationalism,
·      Pan-Africanism,
·      Socio-economic transformation, and
·      democracy.

On the human resource development, we have gone a long way.  What is needed is more skilling and adequate remuneration of the crucial cadres such as scientists, judges, teachers, soldiers not to foeget other security personnel as well as managers.

As far as infrastructure is concerned, this is a crucial frontline.  It is good that we have now began to focus and have gained some progress on electricity.  We are not going to relax on this point. We are aiming at 3,500 megawatts in the short-run.  Uganda, however, needs something in the range of about 20,000 megawatts which is the level of electricity a country like Japan consumes minus what they need for winter or hot summers which Uganda, fortunately, does not have.  Fortunately, Uganda has the resources ─ hydro-power, fresh water bodies, good agricultural land, petroleum and gas and other minerals etc.  National Planning Authority (NPA) has found out that we need about US$ 13 billion to push Uganda to a middle income status.  In the last 27 years, the total amount of aid and loans from outside, from all sources, only amounts to approximately US$ 17 billion in total.  If we are earning US$ 5 billion per annum from petroleum and gas, we only need three years to raise the money we need to invest to convert Uganda into a middle income country.

By dealing with infrastructure, it will be easier for us to industrialize Uganda.  Good and adequate infrastructure, means low costs of doing business in Uganda.  This means more business coming to Uganda.  This is the key to industrialization and the modernization of the services.

The plan for modernization of agriculture is, partially, addressed with our research institutions developing improved seeds and breeding stock.  We need to multiply these products to meet our planting and stocking needs.  With our oil money, we shall deal with the issues of irrigation and, if the private sector has not shown up, we shall build the fertilizer factory at Tororo by using Government funds. 

However, we need to protect our environment to ensure the durable productivity of our good land and to maintain reliable rain patterns.  We need to protect the rivers and the lakes from silting as well as the wetlands because they help us with transpiration that gives 40% of our rain.  The other 60% comes from the oceans (the Pacific).  That is why West Nile and Acholi have more rain than Karamoja although they are on the same latitude.  West Nile and Acholi get moisture from the swamps of South Sudan and the forest of Ituri (Congo).

Although we emancipated the private sector through liberalization, that sector is still inconvenienced by corruption of the public servants as well as some elements of the political class and also the arrogance and the myopia of some elements of the political class.  This corruption must stop.  As you have seen, the Criminal Investigation Department (CID) is hot on the trail of the suspected thieves in various sectors.

In restructuring the State, the NRM mainly dealt with the Army.  Recently, we have been dealing with the Police and URA.  We need to deal with the whole civil service and judiciary so that we eliminate corruption and anti-private sector attitudes.  In my address to the nation recently, I told you that, in modern economies, apart from peace and security that are provided by the State, there are two sovereign actors:  the investor and the consumer.  Without these two, there will be no sustainable production or wealth creation.  The investor encapsulates savings or ability to borrow, entrepreneurial skills that enable one to identify opportunities to create wealth and has the ability to deploy the appropriate technology to make quality and price-wise competitive products.  All wise countries need to attract but not to mishandle these actors – the investor and the consumer.

Uganda is going to become a first world country in the next 50 years.  We shall become a middle income country in the next few years.  Our GDP per capita is today US$ 580.  With value addition to our oil, our coffee, our cotton, our fruits, our maize, our leather, our beef, etc., this GDP per capita would rise to US$ 2,700 even at the present level of raw-material production.  To become a middle income economy, you need to have a GDP per capita of at least US$ 1,000. This we can quickly achieve now that we are solving the problem of electricity.  Therefore, in the next 50 years, if we follow the NRM line, Uganda will become both a middle income country and a first world country.  We have, since some time now, identified the strategic mistakes.  They can be solved.  This Century is Uganda’s Century, it is Africa’s Century.  It will be the first time, ever since the conquest of ancient Egypt by the Persians in the year 525 B.C., that Uganda and Black Africa will be, in terms of development, at par, or even ahead, of the most prosperous countries in the world.  We have the means, we now know what was lacking and we have always had the intention to fundamentally transform Uganda.

Long Live Uganda, Long Live Africa.

I thank you all.