Uganda Data Protection and Privacy Law Still Ambiguous

By Esther Nakkazi

Ugandan citizens’ personal data may be at risk of misuse if the Uganda Data protection and Privacy Bill (2014) to be tabled before parliament is passed in its current form.

Currently, large entities like telecommunications service providers, insurers, hospitals and even schools retain the information of millions of citizens who remain unaware of how secure their information is, especially as more of it becomes digitized.

In an effort to incorporate citizens concerns comments to the Bill were solicited from the public in 2014 but little progress was made on it over the course of 2015. According to Gloria Katuuku from the Ministry of ICT, the comments received have now been incorporated into a revised bill. 

“We brought this Bill before the public so that we get conclusive remarks. The bill has been gazetted and will be tabled in parliament, meaning at this time we shall just compile the concerns,” said Katuuku. 

She was speaking at a workshop convened by the Collaboration on International ICT Policy for East and Southern Africa (CIPESA) where Ugandan parliamentary journalists discussed data protection and privacy with reference to the bill.

CIPESA Policy Officer being interviewed by journalists

The workshop was organized in conjunction with the Uganda Parliamentary Press Association (UPPA) and aimed to create awareness among parliament journalists about clauses in the proposed law that contravene citizens’ rights, including to privacy. 

Few journalists were aware that government had drafted the law and called for robust media engagement with Members of Parliament so as to generate debate on data protection and privacy issues.

The former Chairman of parliament’s ICT Committee, Edward Baliddawa, said the data protection law should have been the basis for other cyber laws in Uganda. He added that as the country edges towards e-commerce, such as business process outsourcing, there is a need to regulate data controllers.

“This Bill is good for our safety and privacy as individuals and to become an e-commerce country,” he said. Baliddawa also called for continuous engagement with all stakeholders across the lifespan of the bill – drafting, tabling to parliament and any eventual amendments.

Although existing laws such the Electronic Signatures Act, 2011, the Computer Misuse Act, 2011, the Regulation of Interception of Communications Act 2010 and the Communications Commission Act 2013 cover aspects of data protection and privacy, they contain contradictions and potentially expose users’ information to unwarranted access and misuse by authorities. 

Lillian Nalwoga, CIPESA’s Policy Officer, said of the laws: “These laws have broad terminologies that should be amended to repeal contradictory provisions and this can be done within the Data protection and Privacy Bill, 2014 in the contexts of data users and collectors, and to prevent abuse.”

See this Overview of How ICT Policies Infringe on Online Privacy and Data Protection in Uganda

But the proposed data protection and privacy law that is meant to address privacy of citizens’ communications and data still has ambiguous terminologies, unclear definitions and arbitration issues that will negate its purpose.

According to CIPESA officials, the drafting phrase should further engage with and seek consultations with different stakeholders including civil society, the private sector, the media and academia for an extended period prior to tabling it before parliament. This would ensure that the law passed “is inclusive, accommodative and addresses the concerns raised by all the stockholders,” said Wakabi Wairagala, the head of CIPESA.

At the workshop, CIPESA officials referred journalists to various areas of concern in the draft bill including some of its ambiguous terminologies, such as Section 4 (2) which states that personal data may be collected or processed where necessary for ’national security’ or for the ‘proper performance’ of a public duty’ by a public body.

However, these words can be misinterpreted and leave room for the access to and abuse of citizens’ information.

Meanwhile, Section 7 (2) says data can be collected from another person, source or public body in certain circumstances without the consent of the owner. The length of time that the collected personal data can be retained is also not indicated.

Section 14 (1) states that the data cannot be held for a period longer than is necessary and says it will be retained for national security purposes.

Overall, the bill does not explicitly state what constitutes a ‘privacy infringement’, thereby leaving users’ data open to abuse by data collectors and processors. It also does not state the procedures for citizens to access their data. 

See CIPESA’s review of the Bill: Reflections on the Draft Data Protection and Privacy Bill

This has also been published here http://www.cipesa.org/2016/01/cipesa-convenes-journalists-to-discuss-ugandas-data-protection-bill/

About 30% Uganda Students Drop Out in Primary One

By Esther Nakkazi

Back in the day, the Uganda education system and its graduates were celebrated around the world. Lately, although some still feel the quality of Uganda’s education is still good, and it still exports professionals around the world. Others feel Uganda’s education has deteriorated below desired levels.

This happened last year. I was attending the first symposium for higher education held in Uganda on 16th March 2015 and the debate on the quality of Uganda’s higher education was intense.

In a room filled with gurus at the higher education level, Professors and heads of different Universities, answers were varied; the teacher is the core, you cannot expect the best if your teacher is the worst. We do not supervise our teachers proficiently that is the problem, one professor suggested.

Uganda has quality education but its not uniform; the content may be irrelevant; we are doing assessment for learning rather than assessment of learning-it should be continuos assessment; maybe Uganda put its education assessment indicators so high. We need to redefine the performance indicators they are so high, they went on and on.

Until one stunning statistic was revealed by Vincent A. Ssembatya, the Director, Quality Assurance Makerere University.

In one of his recent research, he found that of the 1.8 million children who get into school annually in Uganda, 500,000 drop out in primary one. After a year. It was a defining moment for the higher education experts because of all of them simultaneously asked, why? Maybe not verbally but more so on their faces. Ssembatya had no answer.

One Professor, Eriabu Lugujjo, an electric engineer who spent over 30 years teaching engineering at Makerere University, and prides himself in disciplining, for never in his class did any student enter class after him, offered his understanding of the situation.

Lugujjo also the current vice Chancellor of Ndejje University, amused us all, when he narrated how he used to walk for many miles to his primary school, but that was not a problem, and he used to carry with him food, left over from dinner, for his school lunch.

He said Uganda’s curriculum has not changed but the learner has changed. Hilariously, he suggested that the children drop out because they go hungry. Others thought the kids just got bored. In primary one? How does a five year old get bored with school. Boredom! Or the parents abdicate their responsibilities.

But Karrine Sanders, Programme manager, Association of Commonwealth Universities, UK insisted that as a mother, she thought parents would only do something in the best interest of their children. I think so too.

Its important though, to research on why so many kids drop out of school so early. Ssembatya went on to say that Uganda’s higher education quality has gone down because the system has failed to link up the UNESCO ‘education for all goals’ 1 to 6.

Six internationally agreed education goals aim to meet the learning needs of all children, youth and adults by 2015.

While goal 1 looks at expanding and improving early childhood education, goal number 6 looks at improving quality education and ensuring excellence mostly at the higher level.

The two fall far apart in Uganda. The educationists concurred that if they clean up the base there will be quality at the higher level.

Joseph Oonyu, head of School of eduction, Makerere University, said the quality in the lower section would influence the quality in the higher section. But if they received bad quality students at the lower level, don’t expect miracles at the higher level.

So Uganda needs to prioritise early childhood education, which is the basis of quality for higher education.


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Should Sanitary Pads for Ugandan Girls be Entirely Free?

By Esther Nakkazi

On his forth leg of the campaign trail, which took him to Lango region in Northern Uganda, candidate Yoweri Museveni also the incumbent, said if the people vote him back into power all school going girls will get free sanitary pads.

It is only the girls who are under the Universal Primary and Secondary Education (UPE/USE) programs that were started by the National Resistance Movement (NRM) that has been in power since 1986 who will get the free sanitary pads.

He explained that girls who lack pads skip school when that time of the month comes. “Girls should not have to run away from school because they are ashamed. We will get them what to use,” assured Museveni. But this is the second time that candidate Museveni has promised free sanitary pads.

Elections are due in February 2016 but if the niceties the eight candidates promise the voters come to pass, all Ugandans would indeed live in paradise thereafter.

But let us focus on this promise by candidate Museveni particularly because sanitary pads are a reproductive health commodity and access and financing of sexual and reproductive health commodities is such a big issue in Uganda.

It is true that girls' performance is lower, absenteeism and drop out rates higher in school because of this menstrual hygiene problem. 

So why not celebrate with civil society who have at last managed to put menstrual hygiene on top of the development agenda?

When I met officials from the Sexual and Reproductive Health Unit at the Ministry of Health at the monthly science café, which focussed on Sexual Reproductive Health Rights (SRHR) for adolescents and youth sponsored by Uganda Network of AIDS Service Organisations (UNASO) I put it to them.

Olivia Kiconco from the Ministry of Health who was quick to clarify that it was her own opinion and not related to her work place expressed fears of the repercussions of giving out free things. She said she would rather they get an investor to set up a factory here so that they are cheaper.

Wilberforce Mugumya, the reproductive health coordinator at the Ministry of Health was of the view that this should be looked at more comprehensively, in terms of menstrual hygiene and dysmenorrhea to improve the girl child education.

“At the Ministry we look at the policy implications. We shall need to unpackage the President’s commitment. Doing it is a process and takes time,” said Mugumya. He reminded us that with making this statement candidate Museveni started with ‘If you vote for me….”

In my own opinion I think this is definitely a good and commendable thing to do by the government but I have my own fears for free things. What has happened to free mosquito nets?

Bed nets may be used at the front line of fighting malaria and they have proven to be effective but look at the misuse, or multiple uses if you are optimistic; from use as nets in football posts, to fishing nets, wedding veils. And this is inspite of the education and awareness attached to them.

I am imagining creatively using sanitary pads that are handed out for free for stuffing pillow cases, mattresses, using the polythene cover for making crafts or not giving them to the girls in UPE And USE schools and misappropriating them because they are expensive. Currently, sanitary pads (a pack of seven) costs 3,000 Uganda shillings or ($9).  

So I would rather a small fee is attached to them or that the government removes taxes on sanitary pads so that they are cheaper for those who do not qualify to get them for free and promotes local innovators like the manufacturers of MakaPads, which are made from papyrus and waste paper.

But also this is the second time free sanitary pads are coming up in Museveni's campaigns so we should definitely question if it will work this time round.

We discussed all this at the ninth science café organised by the Health Journalists Network in Uganda (HEJNU). 

Speakers were Primah Kwagala from CEHURD; Bakshi Asuman from REACH a Hand; Patrick Mwesigye, Founder and Chief Executive Officer at Uganda Youth and Adolescents Health Forum; Godfrey Walakira from Straight talk Uganda; and Olivia Kiconco and Wilberforce Mugumya from the Sexual and Reproductive Health Unit at the Ministry of Health.

They exchanged views with journalists about Post Abortion Care (PAC), gender justice, family planning, youth friendly services in health facilities, diversity in HIV, dating violence, Pre-exposure prophylaxis (PrEP) in HIV and human rights issues for youth and adolescents on sexual and reproductive health. It was a good afternoon well spent!

ends

Uganda Celebrates 10 years of Community Research

In November, we (I am a volunteer of the Community Advisory Board at the Makerere University Walter Reed Project) celebrated ten years of cross CAB at the 10th annual Cross-CAB network Forum. The cross CAB is when all the CABs of the different institutions meet togather. Thsi was the tenth anniversary, a milestone achievement really.

Dr. Emmanuel Mugisha outlined the why the Cross CAB annual meetings were started, saying it was because the community was inquisitive about research. At the time that they were started the concept was not understood by the high level researchers but there was a common ground which was the community and that is how all the stakeholders started talking.

It was hard to get people to buy into the concept. In Nov 2005, the first Cross CAB meeting was held, ten years later in the same month, November, we held a Cross CAB meeting, thus its sustainable.

He emphasised that research should empower the communities to have power over their health. Research findings should also move to influence public health policies and implementation.

The CAB is an important platform in making people understand that they have to participate in research. He emphasised that participation in research is voluntary.

Dr. Francis Kiweewa: Highlights of his talk: “Stop being consumers of the science but be part of the science.”

• Many studies fail to take place in Africa because people do not want to participate in research maybe because they are not aware, are ignorant or they are confused.
• Taking part in clinical trials is very important.
• Africans need to stop being consumers of science but also contribute to the making of science. He said “many times people ask me has this vaccine been tested on Americans yet?” Dr. Kiweewa said Africans should know that the virus is less in those areas.

Dr. Joseph Ochieng; Highlights of his talk-

A: The first IRB in Uganda was established in 1986. But research ethics has been active for the last 13 years.

• The last revision of research ethics guidelines was last year by Uganda National Council for Science and Technology (UNCST).
• The ethical review guidelines keep changing and being updated. The world over research ethics is new and we are trying to make it a discipline.

B: Role of community representatives; they should be drawn from the community to help the IRB appreciate the proposed research.
They are expected to represent the cultural and moral values of a community.

C: Consent forms; In our community many people do not want to read so consent forms should be short.

• The Uganda culture is a listening culture. The community representatives should advise the IRB to have few pages.
• People should be able to understand the risks in a consent form. Are the risks clearly stated? Adequate informed consent is key. The benefits can come in later.
• The community representatives should be able to bring out the salient aspects of the research to volunteers.
• You cannot eliminate all risks but the best way is put on the table all the harms that the volunteers would be going through when they undergo the research.
• If you do research that does not go to theIRB, there are few journals that will accept it. If the science is bad then the research is bad.
• In research accountability is having a publication.

Adeodata Kekitiinwa: Highlights of her talk:

• Adolescents have the highest mortality rate for HIV in Uganda. Majority do not fear HIV they fear pregnancy most.
• There is a lot of sexual exploitation of adolescents by adults.
• There is a lot of exploitation by the adults because even if you are giving transport refund you are closing one eye for the adolescents.
• The global trend in HIV is declining but among the adolescents it is increasing and they need to be included in research. There is an urgent need to research about HIV in adolescents.
• There is a lot of alcohol and substance abuse among them. It is not because they have HIV that abuse these but because they are adolescents.

A: Informed Consent for adolescents in research;

• Informed consent must be given and should be taken home so that they do not make a rush decision. (24 hours) those with low mental capacity should be given a chance to take longer to consent.
• As we talk about research we have to tell adolescents about the benefits, -tell them about any intervention without mincing words.

B: Rights of Adolescents in research;

• Some adolescents head households but they will decide about which family member will be able to involved in that process. Health workers go wrong when they make their decisions on which family member to participate with adoloscents in the research.
• An adult judgement cannot override the decision of an adolescents- that does not sound African.
• There are some adolescents that head households but legally they are not allowed to consent on their own.
• Research should not be done among adolescents with a low mental state- if they had nutrition issues when young.
• Many adolescents would participate in research just to have the transport refund. In the process the researchers are jeopardising the rights of the adolescents.
• We have issues of adolescents being abused by family members.
• Adolescents even if they head households are not legally acceptable to make that decision to participate in research.

C: Ambience for research venue;

• Institutions doing research among adolescents must be able to have the sensitivity and privacy. The venues were they do research should have the ambience.
• Long waiting time - not conducive for adolescents
• We have started study visits on phone so that they may be able to miss school.
• Mandatory parental escorts in research for adolescents.
• Who deals with them in research must be taken care of, shared confidentiality is shared with the care taker.
• If the adolescent says NO you stop there - do not force them concluded Dr. Kenkiinwa.

HIV DRUG STOCK OUTS IN UGANDA

CABINET INFORMATION PAPER

1.0 Title: ADDRESSING CRITICAL FUNDING GAPS FOR HIV AND AIDS DRUGS FOR THE PUBLIC HEALTH RESPONSE TO THE HIV AND AIDS EPIDEMIC IN UGANDA

2.0 Author: THE HONOURABLE MINISTER OF HEALTH

3.0 Purpose: To Leverage additional Domestic Finances to support Procurement of HIV and AIDS drugs for the National Response

3.1 Objectives of the Memo

This cabinet information paper is intended to;

Provide information to Cabinet on the current funding gaps for HIV and AIDS drugs for the Public Health response to HIV/AIDS in Uganda.

Provide Information to Cabinet on the progress in the implementation of the Public Health Response to HIV/AIDS Epidemic in Uganda.

Seek for support from Cabinet for mobilization of additional domestic resources to support the funding gap for HIV and AIDS drugs for the implementation of priority interventions for the HIV and AIDS response in Uganda.

4.0 Epidemiology (Burden) of the HIV/AIDS Epidemic in Uganda

Uganda has been grappling with a severe generalized HIV/AIDS epidemic for over three decades. The 2011 AIDS Indicator Survey (AIS) revealed an increase in HIV prevalence among adults aged 15-49 years, from 6.4% in 2004/05 to 7.3% in 2011. This increase is attributed to incident HIV infections and improved survival due to increased access to HIV care and treatment services including antiretroviral therapy (ART).

The increase in prevalence was noted in several regions with doubling of prevalence in some regions such as West Nile. The HIV burden (number of people in the country living with HIV was estimated at 1,486,642 (Adults 1,339, 248 and pediatric 143, 312) in 2014 and will be 1,544,315 (1,406,789 adults and 137,526 children) at the end of 2015.

The data for Uganda indicate geographic and socio-demographic heterogeneities. Women are disproportionately more affected than men with an overall HIV prevalence of 8.3% among women compared with 6.1% among men. 

By geography, HIV prevalence ranges from 4.1% in Mid-Eastern region to 10.6% in Central 1 region. Mid-Eastern Uganda, with the highest population coverage of circumcision (53%) had the lowest HIV prevalence at 4.1% and registered a modest decline from 5.3% in 2004/05 . HIV prevalence was higher among uncircumcised men (6.7%) compared to circumcised men (4.5%).

Urban residents are more likely to be infected (8.7%) than their rural counterparts (7%); this picture is prominent among women with HIV prevalence among urban women estimated at 10.7% compared to 7.7% among rural women while the rates for urban and rural men are the same (6.1%). In the younger age groups 15-24 years, HIV prevalence is estimated at 3.7%; the female HIV prevalence for the age groups 20-24 is two to three fold that of males within the same age category.

The country continues to experience a high rate of new HIV infections. The number of new HIV infections was consistently higher than that of individuals initiated on treatment until 2013 when the tipping point was reached (ratio of new HIV infections to the net increase in ART was <1). It is estimated that approximately 99,000 new HIV infections occurred in 2014 - falling from 137,000 in 2013, 140,000 in 2012 and 147,000 in 2011. (MoH- Estimates and Projections, 2014).

Data from the MoH also indicates that high-risk behaviors remain prevalent in Uganda. Reported condom use in high-risk encounters is low. Comprehensive knowledge combining several knowledge measures remains low. In 2011, only 36% of women and 43% of men aged 15-49 had comprehensive knowledge about HIV/AIDS, with very modest increases from 2004/05 (less than 10% for both men and women). 

Overall, 25% of the men reported having two or more sexual partners in the previous year, compared with 3% of the women. Condom use among those engaging in higher risk sex declined from 47% in 2004/05 to 29% in 2011 among women and from 53% to 38% among men.

5.0 The Public Health Response to HIV/AIDS in Uganda

The Government of Uganda has been addressing the HIV/AIDS epidemic through the implementation of the National Prevention Strategy, the National Strategic plan and the Health Sector Strategic and Investment Plan. In July 2014, these documents were re-inforced with the development of the HIV Investment Case which identified National core HIV/AIDS priorities. The response is premised on structural, behavioral and bio-medical interventions.

The priority interventions in the Feasible Maximum HIV Investment Case Scenario for Uganda will be scaled up over the first three years between 2015 and 2018 and thereafter maintained at the targeted levels through 2025. 

These priorities include the rapid scale up of ART coverage to 80%, with test and treat for MARPS, eMTCT coverage to 95%, annual HCT coverage of 50% of 15-49 years population, coverage of condoms use to 80%, coverage of SMC to 80% and expansion of BCC services to achieve a reduction in the number of sexual partners by 25%. The National Strategic Plan and Health Sector Strategic and Investment plan will also focus on the identified priorities in the HIV Investment Case.

It is envisaged that with the implementation of the priorities in the Investment Case, the country could avert 2,160,000 new HIV infections and 570,000 AIDS-related deaths between 2015 and 2025. Other integrated adjunctive interventions such as isoniazid preventive therapy, early detection of TB in HIV infected persons, and expanding ART coverage to all co-infected persons will be implemented because of their implications for the incidence, prevalence and mortality from the related TB epidemic.

6.0 Progress in the Public Health Response

The Ministry of health has a Health Sector HIV Strategic Plan (HSHASP 2010/11-2014/15) to guide the Public Health response to the HIV and AIDS epidemic. The health sector public health response focuses mainly on behavioral and bio-medical interventions. 

These include; BCC, Condom programming, HCT, STI management, Safe Male Circumcision, eMTCT, Care & Treatment and Strategic Information. The implementation of these interventions is tailored to focus on geographic and socio-demographic groups that are disproportionately affected by the epidemic. For the core programs that have been prioritized in the public health response, the following progress has been made;

6.1 Behavior change communication

Data from the NSP Mid Term Review indicate that many achievements have been registered in behavior interventions. These include the development of a BCC message book which was distributed to all districts; a pastoral letter distributed by the Inter-Religious Council of Uganda (IRCU); and interventions targeting cultural leaders. 

UAC also established a message clearing committee and launched a new campaign ‘Zip-up 256’. However, it is estimated that only 1,639,649 individuals were reached with BCC, representing 7.9% of the targeted number. Also, HIV risk behaviors persisted.

The Knowledge Management Communication- BCC review of 2013 indicates that consistent, targeted messages that are grounded in the realities of the communities, promoted by multiple sectors and multiple channels such as mass media and telecommunications are valuable but should be used strategically and targeted to communities. 

The review notes that the ABC campaign was previously successful but overlooked the influence of gender, coercion and socioeconomics of decision-making dynamics and did not target MARPs such as sex workers and fishermen as well as the risk compensation due to new technologies like SMC and ART . 

Inconsistencies in messages were also cited as a challenge (e.g. mixed messages around use and non-use of condoms). The current BCC models and messages are being adjusted to align with the current environment.

6.2 Condom Programs

The MoH is implementing a Comprehensive Condom Programming Strategy (CCPS) that is aimed at increasing demand for male and female condoms, improving access to and utilization of condoms, strengthening the condom supply chain management, and monitoring and evaluation. Both male and female condoms (FC2) are procured and distributed. 

The country has recently strengthened capacity for the Condom Post-shipment testing policy, and this has greatly improved the condom throughput. The number of condoms procured annually are significantly below the projected national need. 

 The Comprehensive Condom Programming strategy has been reviewed and a report is available. The review is the basis for the design of the next strategy that is being designed to refocus demand creation and condom distribution. 

With support from partners, a total of 172, 201,292 (56% of estimated national need) condoms were procured and distributed in the country in the last year. The capacity for post shipment testing at National Drug Authority (NDA) has continued to improve from 13 million in 2013 to 18 million per month in 2014. There is however a continued challenge of the lack of a budget line for this in the Ministry of Health budget.

6.3 HIV counseling and testing (HCT)

HIV Counseling and Testing is a critical entry point for HIV prevention and Care Programs. The number of people who tested for HIV in the last year was 10,273,927 out of a target of 7,421,024 people. Most of these tests were conducted in health facilities based on the Provider Initiated Testing and Counseling (PITC) approach. 

The population level proportion who know their HIV status were last determined in the 2011 AIS and was 45% for men and 66 % for women. The higher coverage among females is attributed to HCT opportunities during MCH and PMTCT services. 

HCT has expanded over the last three years with expansion of Provider Initiated Testing and Counseling (PITC), community models, and couples HIV counseling and testing. access to testing by some population groups (e.g. men) is still low. Couple testing is also low; only 5% of testers received couple HCT in 2014. A Population HIV Impact Assessment Survey will be conducted early next year and will help us determine the trend in this indicator.

6.4 Male circumcision

Data from UAIS 2011 indicate that the SMC prevalence was 26%. The annual target for the national SMC program is 1,001,875 circumcisions, to contribute to the NSP target of 4.2 million circumcisions by 2015. SMC scale-up was initially slow but has significantly increased due to improved capacity. 

The circumcision program has expanded and cumulatively a total of 2.4 million men have been circumcised since the program was initiated. In the last financial year, 688,313 men were circumcised. The program has developed a policy for tetanus immunization in response to the tetanus adverse events. In the new policy, there are proposals for booster immunization doses for target eligible males.

6.5 PMTCT and Early Infant Diagnosis (EID)

The implementation of the eMTCT program in Uganda is based on four prongs including:- 

a) Primary HIV prevention 

b) meeting the unmet need for family planning

c) lifelong ART-Option B+ and 

d) family centered treatment for children and adults infected with HIV. 

The new guidelines for Option B+ have been fully rolled out in the country and coverage of ART treatment to mothers receiving PMTCT in 2014-2015 was 112,909 (92%) against a need of 122,581 HIV infected pregnant women. The number of facilities implementing these new guidelines in the country has continued to increase and was 4,200 sites countrywide.

The PMTCT facility coverage has increased significantly over the past year; from 2,138 in 2013 to 3,248 facilities providing PMTCT services by June 2014. The proportion of pregnant women tested for HIV increased from 30% in 2008 to 95% in 2014. In 2013, EID facility coverage was 1,696 (76% of the facilities) including 100% of referral hospitals, 100% of district hospitals and 100% of HCIVs, 84% of HCIIIs, and 5.6% of HCIIs. 

Coverage of EID testing among infants (first DNA PCR) in 2013 was 60,437 (51%), a steady increase from 7% in 2007. However, the percentage of exposed infants who received the first PCR at two months has increased from 45.6% in 2011 to 59.8% by June 2014, against the NSP target of 50% by 2015. Prevalence of HIV among those tested was 9% in 2012 and 4.6% in 2013, a significant decline from 19% in 2007. Furthermore, data from MoH indicate that new pediatric infections reduced from 28,000 in 2009 to 15,000 in 2013 and were 9,500 in 2014

6.6 Care and Treatment

The objective of the Care and Treatment Program is to expand coverage so as to maximize individual patient benefit as well as the community prevention benefit. The Ministry of Health through the AIDS Control Program is implementing new guidelines for prevention and treatment that are focusing on enrolment of CD4<500 and test and treat for 

i) All TB/HIV and Hepatitis B/HIV co-infected individuals,

 ii) HIV infected children under 15 years, 

iii) HIV infected pregnant and lactating mothers, 

iv) All MARPS. This also includes a phased introduction of viral load monitoring of treatment in addition to the clinical and immunological markers.

The active ART enrollments grew by 28% during the 2014. The proportion of people who are on ARVs increased from 53% in 2009 to 750,896 (56%) by December 2014 of those in need (adults 694,627(58%) and children 56,269 (38%). 

ART enrollment increased to 823,050 (761,771 adults and 61,279 children) by September 2015. This coverage is based on the new HIV prevention and Treatment guidelines in which the number of people in need has gone up and is currently estimated at 1,345,872 (1,196,556 adults and 149,216 children) at the end of 2014 and is estimated to be 1,406,702 (1,269,176 adults and 137,526 children) by December 2015.

The total number of facilities providing ART in Uganda has increased from 1,552 at the end of 2013 to 1,658, of which 1,204 were concurrently providing ART to children by the end of 2014. These facilities include two national referral, 13 regional referral and 112 of 140 general/district hospitals (80%), 186 of 206 (90%) HCIVs, and 1084 out of 1309 (83%) HCIIIs, and 200 out of 2777 HCII as well as 31 specialized HIV clinics. The number of facilities providing pediatric ART increased from 869 in December 2013 to 1,204 sites (December 2014).

The Ministry of Health has introduced viral load monitoring through a centralized viral load laboratory at CPHL supported by the sample transport network. Since August 2014 to August 2015, a total of 132,000 viral load tests have been conducted. The Early Infant Diagnosis (EID) has continued to scale up services and last year over 98,000 tests were conducted and over 70,000 babies from 2239 health facilities.

7.0 Fundamental problem to be addressed in the Memo

In order to address the big challenge of the HIV/AIDS epidemic indicated in (4.0) and to sustain the achievements in (6.0) above, the MoH and Partners are implementing interventions that include the scaling up of priority behavioral and biomedical interventions in the National Strategic Plan, National Prevention Strategy, the Health Sector Strategic and Investment Plan and the HIV Investment Case. Other sectors are implementing Structural interventions and some behavioral interventions.

The Goal of the MoH and partners supporting the implementation of these interventions is to contribute to the following goals: (a) aversion of 2,160,000 new infections between 2015 and 2025- 77% reduction in new infections, (b) reduction of new infections in children from 14,200 to 4,040 between 2014 and 2025 (c) aversion of 570,000 deaths by 2025 and (d) saving lives of 42,620 children from AIDS related death by 2025.

The Care and Treatment program is an essential component of the interventions to achieve these targets. The Specific request in this Cabinet Memo therefore is for additional domestic financing to procure emergency drugs to fill out a critical public sector gap for the period November 2015 - June 206 and to request for the inclusion of additional resources in the budget for July 2015 - June 2016 to bridge a public Sector Funding gap. The ministry of Health aims to achieve the UNAIDS triple 90 targets in the scale up of the Care and Treatment program towards an AIDS Free generation.

8.0 Issues for Consideration by Cabinet

This Cabinet memorandum seeks to update Cabinet on the Status of the HIV and AIDS epidemic and to mobilize for funds to fill the gap for essential life saving ARVs. There are two major funding mechanisms in place for drugs: 

1) The Government of Uganda (GOU) budget support to the Health sector through the Ministry of Finance Planning and economic development; 

2) Support from AIDS Development partners; mainly PEPFAR and the Global Fund. The United States Government through PEPFAR supports the private sector ARV needs through the Joint Medical Stores and Medical Access Uganda Limited warehouses. The GOU and the Global Fund support the public Sector drug needs through the National Medical Stores (NMS).

The Government of Uganda has been increasing its contribution for public sector ARVS through NMS. There however remains a gap because the funds were insufficient for the patients currently enrolled on treatment, a situation which has been compounded by the depreciation of the shilling in recent months. 

There is therefore a stock out at the NMS and at the public health facilities. As a result of that, the Ministry of Health has asked the Global Fund to carry forward funds which were in their second year budget to fill the gap in the current first year. This therefore has a ripple effect in the second year which will also require to be offset to prevent a similar situation from recurring.

The focus for the resource mobilization in this memo therefore is to mobilize for funds for the procurement of anti-retroviral drugs to support the Care and Treatment Program in two categories namely; a) a subvention from the Ministry of Finance to the tune of USD 10,071, 638 for an emergency order for ARVs for November 2015 - June 2016 and b) funds to the tune of USD 92,281,641(excluding previous allocations to NMS budgets) for the July 2015 - June 2016 budget period.

9.0 Timing

This Cabinet Memorandum needs urgent action by Cabinet to bridge the Funding gap for essential drugs to ensure patients that are currently on treatment continue to receive essential life saving treatments. The Ministry of Health has notified AIDS Development partners including the Global Fund and the United States Government of Government of Uganda's intentions to increase domestic financing for the HIV and AIDS response and the processes it will take to mobilize them that includes the development of this Memorandum for Cabinet.

10.0 Policy analysis

The Ministry of Health concurs with the proposed procurement of essential life saving drugs to contribute to a reduction in new HIV infections and avert AIDS related deaths in a quest for an AIDS free generation. 

This will in turn save costs and contribute to socio-economic development. These interventions are in line with the Global UNAIDS triple 90 targets, the goal of the National Development Plan, the HIV Investment Case, the National HIV Prevention Strategy, the National Strategic Plan and the Health Sector Strategic and Investment Plan.

11.0 Implications of the Cabinet Memorandum

The Ministry of Health has conducted a Financial Gap analysis to determine the funds currently available from GoU and from AIDS Development Partners in order to determine the existing Funding Gap for essential drugs for the HIV and AIDS response. The focus for this Cabinet Memo will be on the procurement of essential life saving drugs for the Care and Treatment Program. 

Because of the current stock outs for ARVs in the Public Sector, the Ministry of health has requested the Global Fund to carry forward the funds in the 2nd year period of the HIV Grant that is currently being implemented to ameliorate the current deficit in drugs. The Global Fund have agreed to that request; that however will bridge but not completely close the first year gap. More importantly however, this front load will now result in a bigger public Sector Gap for the second year of the Global Fund Grant.

The request in this Memo is therefore for additional domestic funding for a) bridging the emergency requirements for ARVs for the period November 2015 - June 2016 for patients currently on treatment and b) bridging the gap for ARVs for the period July2016 - June 2017 Based on the programmatic and Financial gap analysis for the Care and Treatment Program for the public sector, the funding requirements for essential life saving drugs for the Emergency order for November 2015 - June 2016 and for the intermediate period July 2016 - June 2017 are summarized in table 1 and table 2 below.

This Cabinet Memo aims to mobilize for funds for the procurement of anti-retroviral drugs to support the Care and Treatment Program in two categories namely a) a subvention from Ministry of Finance to the tune of USD 10,071, 638 for an emergency order for ARVs for November 2015 - June 2016 and b) funds to the tune of USD 92,281,641(excluding what was previously in the NMS budget) for July 2015 - June 2016 budget period.

12.0 Recommendations

The Ministry of Health and Partners have proposed a plan to scale up the HIV and AIDS response that aims at an AIDS free generation by 2030. To implement that plan, there are significant resource gaps. The Ministry of Health proposes to Cabinet that GOU leverages for a subvention from Ministry of Finance for USD 10,071, 638 for an emergency order to support the procurement of essential life saving ARVs to support the current public sector gap at NMS. The Memo also seeks for USD 92,281,641 in the budget period July 2016- June 2017.

13.0 Conclusion

The implementation of the proposed priority interventions in the HIV Investment Case, the National HIV Strategic Plan, National Prevention Strategy and Health Sector Strategic and Investment Plan has the potential to significantly reduce the number of new HIV infections and AIDS related death in Uganda. Care and Treatment is an essential component in these plans. It is essential that Government prioritizes HIV and AIDS commodities particularly ARVs that will have impacts on the AIDS epidemic by cutting AIDS related deaths and contributing to a reduction in new infections. In the long term, this will also save costs of care and contribute to enhanced socio-economic development.

14.0 Attachments and References

This Memorandum needs a Certificate of Financial implication from Ministry of Finance Planning and Economic Development

15. Address of Author and Date of Initiation

THE HONORABLE MINISTER OF HEALTH

MINISTRY OF HEALTH, 6 LOURDEL ROAD, P.O. BOX 7272

KAMPALA, UGANDA

16th November, 2015.

Every Day is a Diabetes Day

By Esther Nakkazi

Next year, Merck, a leading science and technology company, in partnership with Uganda Ministry of Health aims to reach 30,000 Ugandans with free diabetes screening and education through its “Merck Uganda Diabetes Day” campaign which is dubbed “Every Day is a Diabetes Day”.

The move follows a Combined Diabetes and Cancer Campaign in Uganda as part of the Merck Cancer Control Program. The program is one of the initiatives of the Merck Capacity Advancement Program (CAP).

The CAP was launched by Merck in 2012 to expand healthcare capacity in the areas of research and development, supply-chain integrity and efficiency, pharmacovigilance, medical education, and community awareness in Africa and developing countries.

Through the combined community campaign, Merck aims to provide more than 2,000 Ugandans with free cancer education and diabetes screening and advice on how to lead healthier lives to enable them prevent the diseases.

According to World Health Organisation (WHO), by 2020 there are expected to be 16 million new cases of cancer every year, 70% of which will be in developing countries where governments are least prepared to address the growing cancer burden and where survival rates are often less than half those of more developed countries.

“Supporting healthy families, healthy communities, healthy economies - this is our over-all target we want to achieve”, said Kai Beckmann, Member of the Executive Board of Merck.

“We are convinced, that this initiative will make a great contribution to advance cancer and diabetes healthcare in Uganda. The close partnership with ministries of health and universities in Africa is a key for the success of the diabetes and cancer awareness campaign.”

At the campaign, Uganda’s Minister of State of Health, Sarah Opendi stated that most patients report to the health facility when the cancer is at an advanced stage which poses a challenge because nothing much can be done to save the patient’s life. “This is partly due to the nature of the cancers since they have no symptoms during the early stages but also due to our poor health seeking behaviours”

“According to the World Health Organization (WHO), over one third of cancer deaths are due to preventable causes such as a viral infection, poor nutrition and widespread tobacco use,” said Sarah Opendi.

“It is important to note that once diagnosed early cancer can be treated and cured. Uganda just like other developing countries faces a wide range of health system challenges and cancer is often not a priority in limited resource settings. Therefore the Ministry of Health appreciates private public partnerships with reputable companies like Merck to promote key health guidelines and raise awareness about cancer so that people learn how to detect and prevent it,” Opendi added.

Successful awareness campaigns on Diabetes in Uganda

“Merck previously partnered with the Ministry of Health, Makerere University and Uganda Diabetes Association to carry out medical camps and nationwide diabetes awareness through text messages via mobile phones (SMS) to healthcare providers and community members.” Rasha Kelej, Chief Social Officer for Merck Healthcare

“Today Merck addresses Cancer and Diabetes at the same campaign, which will help to target the common risk factors for non-communicable diseases (NCDs) such as tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity.” Kelej added.

Sarah Opendi emphasized: “Cancer awareness is very low in Africa, regardless of whether the patient is educated or not. For example even doctors, teachers and bank managers are late in responding to the disease, therefore our partnership with Merck to implement their Cancer Control Program is very important for Uganda since educating the public and healthcare providers about the signs and symptoms of cancer will help promote early detection and better survival outcomes.”

Merck has delivered healthcare services in Africa since 1897. With a population rising faster than in any other global market and a growing middle class, the company is increasingly tapping into the continent’s innovative spirit to create health awareness and help respond to unmet medical needs.

The Group’s Executive Board is visiting 10 African countries this week to underscore its commitment and rising importance of the continent. Among others, Merck seeks to start local production diabetes treatment Glucophage in Algeria, inaugurate an office in Nigeria and start the sale of its Muse® Auto CD4/CD4% System to detect HIV.

Uganda cannot eliminate Malaria like the Comoros

By Esther Nakkazi

Uganda launched the Uganda 2014-15 Uganda Malaria Indicator Survey (UMIS) officially on Friday, 6th November at Hotel Africana. Dr. Elioda Tumwesigye was the guest of honour at the launch and he was elated about the results.

Finally, Uganda made progress reducing malaria prevalence from 43% five years ago to now 19% . Treated insecticide bed net coverage now stands at 90% and net use over 70% thanks to non profit organisations like Malaria Consortium.

Dr Tumwesigye told us that he had been to South Africa for a conference recently and listened to a presentation from Comoros Island, where the presenter eloquently elaborated how they eliminated malaria. His wish now is that Uganda should emulate the Comoros and eliminate malaria.

Is the malaria parasite more intelligent than the people working on it, he asked the Ugandan scientists.

But before we have a delegation of Ugandan scientists jumping onto the plane headed for the Comoros to ‘study’ and emulate its example, here are the facts about why the Comoros malaria success story cannot happen to Uganda.

The Comoros is an island and in 2010 they gave almost an entire population anti-malarials in a three year programme to eliminate the parasite that causes malaria thereby preventing transmission of the disease.

In order to spread malaria, a mosquito has to feed off a human who is infected and then when it bites it injects the infectious sporozoites into another human.

So on an island where population movements can be controlled, if about 90 percent of the population swallows the anti-malarial drugs the mosquitoes can bite people who are not infected and hence not transmit malaria. With time if the infected are few the vector cannot spread the disease.

But in Uganda how can you limit people’s movements? Someone with malaria will come from Apac to visit a relative in Kampala and a mosquito will bite him and pass on malaria to the Kampala host. In other wards, you cannot restrict people’s movements even if we are land locked.

Secondly, if we grant Dr. Tumwesigye the benefit of doubt and Uganda eliminates malaria, that means an entire population’s immunity will be lost. In this scenario if someone visited from a neighbouring country and a Ugandan got infected they would die very fast because it would be a ‘new’ disease in the body. Uganda would also be prone to a malaria epidemic.

Also the 2012 Comoros Demographic Survey (DHS) showed that 6 in 10 households owned at least 1 mosquito treated net. The data from the Malaria Indicator Survey (MIS) conducted in 2011 showed that 8.9% of children under 5 tested positive for malaria. Compared to Uganda in 2009, malaria prevalence was 42% and in 2014-15 it is now 19%. Comoros is a low prevalence country in comparison to Uganda.

Finally, there is no magic bullet for the control of malaria just as there is no single example from a country that Uganda can emulate. Only let us continue to combine all the prevention methods, sleeping under a mosquito net, treatment, indoor residue spraying and a vaccine when it comes along.