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kampala Uganda hopes Fund will bring long-term progress
DISPATCH
Uganda hopes Fund will bring long-term progress
he Global Fund to fight AIDS, Tuberculosis, and Malaria is expected to release US$52 million to Uganda for programmes to tackle HIV/AIDS, while grants for malaria and tuberculosis are yet to be approved. Some of this money will be spent by various government departments and the rest will go to civil society organisations such as groups representing AIDS patients. But before the money is released, the Fund’s technical review committee has tabled several queries about Uganda’s spending plans. One of the issues raised by the committee was how Uganda will subsidise antiretroviral drugs prices for poor people. On April 22–24 the Global Fund handed out the first round of grants for 40 projects in 31 countries (see Lancet 2002; 359: 1581–82). Although Ugandan health ministry officials who attended the meeting returned from New York technically empty handed, officials were hopeful that it was only a matter of time before they received the money. Although this delay has caused some anxiety, government officials have other concerns. While grateful to the Fund for this money, officials acknowledge that the money is far less than what is required to meet the funding gaps in their fight against HIV/AIDS. Furthermore, even though HIV infection rates in Uganda have actually declined since the mid 1990s there are still huge clinical challenges. During the past 20 years 800 000 people have died from AIDS out of a total population of about 22 million people. More than 1·7 million children have been orphaned after their parents died of AIDS. Today 1·1 million Ugandans are living with HIV and only 1–2% of these people have access to antiretroviral drugs. This is perhaps not surprising in a country where the average annual income per person is just enough to buy one months supply of triple therapy antiretrovirals. And where the annual per capita expenditure on health is only about US$8. Against this background, Uganda warmly welcomed the establishment of the Fund. When the international organisation was first announced, in a show of support Uganda immediately pledged $2 million to the fund. Thus Uganda became the first African country to pledge a contribution to the fund, which has now
T
66
raised more than $2 billion, mostly from developed countries. When announcing the first batch of grants in April the chairman of the fund, Cryspus Kiyonga, called for additional resources. “This is a successful start but the fund needs far
The Global Fund
KAMPALA
Cryspus Kiyonga
more resources to fight AIDS, TB, and malaria—millions of lives are at stake”, said Kiyonga, a former Ugandan health minister. Uganda’s AIDS Control Programme Manager, Elizabeth Madra, emphasised that the money will not be used to substitute other sources of funding. It is only meant to fill the funding gap. That is, to cover important activities that have so far not received sufficient funding from other sources. Unfortunately this funding gap is so wide that it can not be covered by the Fund’s grant. The Ministry of Health estimates that they need $150million for AIDS alone every year. However the stark truth is that to date they have never managed to raise more than $100 million in a single year. Uganda’s anti-HIV/AIDS programmes have been dominated by activities to prevent further spread of the virus. A number of projects involve caring for the sick but still their efforts have not been sufficient because there is not enough capacity to take in the vast number of patients. On a positive note, Uganda’s infection rates are declining, AIDS awareness is high, and stigma has been reduced. But what about those who already have the infection? Though accurate figures are difficult to calculate, a significant proportion of people who die of HIV/AIDS would live longer if they had at least treatment for opportunistic infections. They die earlier due partly to
poverty and under funding of the national health service. Although much attention and time is spent on raising funds for antiretrovirals, drugs for opportunistic infections are also needed. For instance a typical Ugandan HIV patient who contracts toxoplasmosis or cryptococcal meningitis will most likely die, because they can not afford the treatment. The lack of funds across the national health service means that health facilities often lack equipment to do even simple tests that could detect opportunistic infections or the toxicity caused by antiretrovirals. For example, patients consider themselves lucky if they can find a district hospital that can do liver function tests. Uganda hopes to reverse this desperate situation by carefully investing the money from the fund by improving the health system and purchasing an initial stock of antiretroviral drugs for regional treatment centres. Some of this money will also be spent on training medical personnel, installing medical equipment, and improving management systems. Ugandans hope that the money will yield results quickly. Until early last year only a few health facilities, all of them located in the capital city, had the appropriate facilities and training to administer antiretroviral therapy. The few patients from upcountry who could afford the treatment had to travel to Kampala, a trip that usually takes nearly a whole day by bus. Only late last year did the Ministry of Health establish ten regional centres for antiretroviral treatments. But currently these centres do not have enough antiretrovirals for patients. Patients are forced to take their prescriptions to Kampala. Health officials hope that stocking the regional treatment centres would save patients the burden of travelling to the capital city and bring an immediate improvement to their lives. Whereas Uganda is quietly confident that it will be able to meet the Fund’s queries, observers hope that the money will bring about sustainable improvements. The donations may not last forever but Ugandans hope that any progress in their health services in the coming months will last for many years to come. Charles Wendo
THE LANCET • Vol 360 • July 6, 2002 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.
Uganda hopes Fund will bring long-term progress
he Global Fund to fight AIDS, Tuberculosis, and Malaria is expected to release US$52 million to Uganda for programmes to tackle HIV/AIDS, while grants for malaria and tuberculosis are yet to be approved. Some of this money will be spent by various government departments and the rest will go to civil society organisations such as groups representing AIDS patients. But before the money is released, the Fund’s technical review committee has tabled several queries about Uganda’s spending plans. One of the issues raised by the committee was how Uganda will subsidise antiretroviral drugs prices for poor people. On April 22–24 the Global Fund handed out the first round of grants for 40 projects in 31 countries (see Lancet 2002; 359: 1581–82). Although Ugandan health ministry officials who attended the meeting returned from New York technically empty handed, officials were hopeful that it was only a matter of time before they received the money. Although this delay has caused some anxiety, government officials have other concerns. While grateful to the Fund for this money, officials acknowledge that the money is far less than what is required to meet the funding gaps in their fight against HIV/AIDS. Furthermore, even though HIV infection rates in Uganda have actually declined since the mid 1990s there are still huge clinical challenges. During the past 20 years 800 000 people have died from AIDS out of a total population of about 22 million people. More than 1·7 million children have been orphaned after their parents died of AIDS. Today 1·1 million Ugandans are living with HIV and only 1–2% of these people have access to antiretroviral drugs. This is perhaps not surprising in a country where the average annual income per person is just enough to buy one months supply of triple therapy antiretrovirals. And where the annual per capita expenditure on health is only about US$8. Against this background, Uganda warmly welcomed the establishment of the Fund. When the international organisation was first announced, in a show of support Uganda immediately pledged $2 million to the fund. Thus Uganda became the first African country to pledge a contribution to the fund, which has now
T
66
raised more than $2 billion, mostly from developed countries. When announcing the first batch of grants in April the chairman of the fund, Cryspus Kiyonga, called for additional resources. “This is a successful start but the fund needs far
The Global Fund
KAMPALA
Cryspus Kiyonga
more resources to fight AIDS, TB, and malaria—millions of lives are at stake”, said Kiyonga, a former Ugandan health minister. Uganda’s AIDS Control Programme Manager, Elizabeth Madra, emphasised that the money will not be used to substitute other sources of funding. It is only meant to fill the funding gap. That is, to cover important activities that have so far not received sufficient funding from other sources. Unfortunately this funding gap is so wide that it can not be covered by the Fund’s grant. The Ministry of Health estimates that they need $150million for AIDS alone every year. However the stark truth is that to date they have never managed to raise more than $100 million in a single year. Uganda’s anti-HIV/AIDS programmes have been dominated by activities to prevent further spread of the virus. A number of projects involve caring for the sick but still their efforts have not been sufficient because there is not enough capacity to take in the vast number of patients. On a positive note, Uganda’s infection rates are declining, AIDS awareness is high, and stigma has been reduced. But what about those who already have the infection? Though accurate figures are difficult to calculate, a significant proportion of people who die of HIV/AIDS would live longer if they had at least treatment for opportunistic infections. They die earlier due partly to
poverty and under funding of the national health service. Although much attention and time is spent on raising funds for antiretrovirals, drugs for opportunistic infections are also needed. For instance a typical Ugandan HIV patient who contracts toxoplasmosis or cryptococcal meningitis will most likely die, because they can not afford the treatment. The lack of funds across the national health service means that health facilities often lack equipment to do even simple tests that could detect opportunistic infections or the toxicity caused by antiretrovirals. For example, patients consider themselves lucky if they can find a district hospital that can do liver function tests. Uganda hopes to reverse this desperate situation by carefully investing the money from the fund by improving the health system and purchasing an initial stock of antiretroviral drugs for regional treatment centres. Some of this money will also be spent on training medical personnel, installing medical equipment, and improving management systems. Ugandans hope that the money will yield results quickly. Until early last year only a few health facilities, all of them located in the capital city, had the appropriate facilities and training to administer antiretroviral therapy. The few patients from upcountry who could afford the treatment had to travel to Kampala, a trip that usually takes nearly a whole day by bus. Only late last year did the Ministry of Health establish ten regional centres for antiretroviral treatments. But currently these centres do not have enough antiretrovirals for patients. Patients are forced to take their prescriptions to Kampala. Health officials hope that stocking the regional treatment centres would save patients the burden of travelling to the capital city and bring an immediate improvement to their lives. Whereas Uganda is quietly confident that it will be able to meet the Fund’s queries, observers hope that the money will bring about sustainable improvements. The donations may not last forever but Ugandans hope that any progress in their health services in the coming months will last for many years to come. Charles Wendo
THE LANCET • Vol 360 • July 6, 2002 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.