The lack of health care resources is the most obvious barrier for developing countries to reach TB control targets. However, there is a strong association between poverty and TB, say researchers from Belgium's Institute of Tropical Medicine. The number of tuberculosis cases continues to rise worldwide and only a minority of people has access to high quality tuberculosis services. Tuberculosis control cannot reach its targets without investing in an adequate network of accessible, effective and comprehensive health services, say the researchers. However, only a small proportion of all TB patients in the world are detected and many are diagnosed and treated late. The researchers identify many problems in the way in which care and support are delivered. These include insufficient and rundown health facilities, lack of trained and motivated staff, shortages of drugs and medical supplies, poor supervision of health personnel and difficult communication and transport. In many regions, the private health sector is growing rapidly while the regulatory system remains poor.
Resource allocation and health financing
This report examines the evidence for and against foreign aid, and finds that, while there is much room for improvement, good quality 21st century aid not only saves lives, but is indispensable in unlocking poor countries’ and people’s ability to work their own way out of poverty. It makes a number of recommendations. Countries and stakeholders should ensure aid is channelled to help support active citizens, build effective states as a pathway to reducing poverty and inequality, and support diverse forms of financing to contribute to development. They should deliver aid through a mix of models, including increasing budget support wherever possible, and ensure that a percentage of aid flows are channelled to civil society organisations, to enable people to better hold their governments to account. Also, there is a need to dramatically improve the predictability of aid, by increasing the proportion of aid that is general budget support where possible and by sector support where general budget support is not an option, and limit conditions attached to aid to mutually agreed poverty indicators. Rich countries should give at least 0.7% of their national income in aid, and set out how this target will be reached, with legally binding timetables. Furthermore, the global community should reject a culture of corruption, uphold human rights standards, and act in ways which are transparent and open to scrutiny. It should also provide legal environments in which civil society organisations monitoring government activities can flourish and respect the independence of non-government bodies like audit offices and the judiciary.
Uganda has increased its allocation to the health sector from Ush1.8 trillion ( US $470.6 million) in the 2017/18 financial year to Ush2.3 trillion ($595.6 million), in what the author indicates that some see as an a response to a backlash in 2017 from external funders when the government reduced the nominal value of Ministry of Health’s funding by Ush6 billion ($1.5 million). Officials at the ministry note the increased allocation aims to support the country on a journey to universal health coverage and reduce dependence on external funding. In the 2018/19 financial year, Dr Sarah Byakika, the acting planning commissioner in the Ministry of Health, said the increased allocation will among other things target universal health coverage, recruit community health workers, cover recurrent expenditures at specific hospitals and for the national blood bank. Money is also being provided to avert the perennial strikes of interns and for the drafting of regulations for a new national health insurance law, with national health insurance seen as key for improved domestic financing.
In early 2009, the Ugandan health ministry made an emergency appeal to the Global Fund for $8.9 million to purchase ARVs for three months as an advance on $70 million awarded in Round Seven of its grants, but the world body could only offer $4.25 million in June 2009. The Global Fund was forced to cut funding by 10% in 2008. A recent World Bank report advised nations heavily reliant on foreign aid to prepare for any impending cash and drug shortages by implementing early warning systems, and work to avoid treatment interruptions as far as possible. Health minister, Stephen Mallinga, said it would be virtually impossible to expand ARV programmes. ‘We would rather sustain those that have started the treatment ... because the ramifications ... [of not accessing drugs] are grave, including resistance to drugs and therefore a requirement to change the combination ... which will lead to an increase in our treatment bill, which we cannot afford,’ he said. AIDS activists are concerned that funding woes will make it impossible for Uganda to achieve universal access to treatment, in other words, giving drugs to at least 80% of people who need them.
The Ugandan government's draft 2013/2014 budget allocates US$38.5 million to enrol a further 100,000 people living with HIV on life-prolonging antiretroviral (ARV) drugs. But activists say the money, while welcome in a country still largely dependent on external funds for its HIV programmes, is not sufficient to meet treatment needs. According to Alex Ario, programme manager at the health ministry's AIDS control programme, the financial gap in the public sector for 2013/2014 is about $29 million. The country enrolled an estimated 65,493 new HIV patients on ARVs in 2012, bringing to 356,056 the number of those on ARV therapy (ART), according to Uganda AIDS Commission statistics. However, this figure represents less than 70% of those in need of treatment. The government has set a target of reaching 80% of HIV-positive people with ARVs by 2015. Ugandan civil society is calling on the government to substantially increase its investment in ART for financial year 2013/14 in order to save lives, slash rates of new infections, and begin to end the AIDS epidemic.
European envoys in the Ugandan capital, Kampala, have asked the government to take "expeditious" action against individuals, including senior politicians, accused of mismanaging HIV/AIDS grants. The diplomats were further concerned at the slow implementation of the judicial commission of inquiry report.
The Ugandan Health Ministry has cut its budget to refund about Shs2 billion on behalf of individuals who stole Global Fund money for immunisation of children and financing the health facilities in the country. The directive followed failure by the government to recover the billions stolen from the Global Alliance for Vaccine and Immunisation (GAVI) from the suspects. About Shs1.6 billion was misappropriated in 2006. However, the amount rose to about Shs2 billion due to the exchange rate. But Ministry of Health officials told the Auditor General in his latest report that they acted on cabinet instructions. Mr Samuel Ssenyonga, the Permanent Secretary in the ministry, said that paying back the stolen funds from the public kitty was meant to allow for more funding from GAVI to be released to the country and more time for government to run after the suspects. He also stated that efforts were being made to get those implicated to refund the cash.
Most Ugandans cannot readily access the medicines they need due to the high prices charged. To understand more about what people pay for medicines in Uganda, the Ministry of Health in collaboration with the World Health Organization (WHO) and Health Action International (HAI) Africa conducted a countrywide survey on medicine prices in 2004, and recommended a medicine price monitoring system for surveys to be conducted quarterly. This is the first price monitoring report, presenting the survey results for the October-December 2006 quarter.
The Global Fund to Fight AIDS, Tuberculosis and Malaria and the UK Department of International Development have agreed to appoint a Health and HIV/AIDS Adviser to step up advice, monitoring and liaison between DFID, the Global Fund and Mozambican health authorities. The collaboration will ensure that the Global Fund, as a major financier of the health sector of Mozambique, is kept informed and can provide policy inputs whilst having no staff of its own present in the country. The article describes the work up to and components of the agreement.
Third World Network report a call for a World Social Bank funded by abolishing offshore tax havens. A letter from civil society, sent in advance of the April G20 summit, appeals to United Kingdom Prime Minster Gordon Brown and other world leaders to 'reform international finance in a way that provides a real boost to the growth of the third sector'. About £255bn is said to be lost each year to tax havens, and the funds couold be used for a World Social Bank that could stimulate social investment by developing the infrastructure for an international social investment market, working with private investors to grow this market and encouraging collaboration between different countries.