Uganda’s Ministry of Health (MoH) has offered a detailed defence of the expenditure of funds released for Covid19 after a report by the Budget Monitoring and Accountability Unit (Bmau) of the Ministry of Finance Planning and Economic Development.
In the following response, the ministry gives its account of what funds it has received, what has been delivered and what is outstanding:
The Ministry of Health would like to respond and set the record straight on a report titled “Covid19 Interventions Report Financial Year 2019/20” authored by a team of the Budget Monitoring and Accountability Unit of Ministry of Finance, Planning and Economic Development (MoFPED).
The monitoring team raised a number of issues which have since become a subject of seemingly planned and malicious attacks against the Ministry of Health in mainstream and social media.
While we acknowledge that this is a Government report and we don’t want to be contradicting each other, it is important that the distortions are clarified for record purposes.
Therefore, the Ministry of Health would like to respond to as follows:
Budgetary allocation and Expenditure as of June 2020:
The report states that MOH received Shs766.7bn which was committed to the Covid19 prevention and response.
It further states that by end of June 2020, MOH had received and spent Shs264bn from both Government and donors; Sgs119bn from GOU, Shs55bn for Government World Bank’s Uganda contingency Response Component and Shs10bn from GAVI, the Vaccine Alliance. Another amount totaling Shs94.9bn was in the pipeline.
Ministry of Health would like to clarify that the Shs51Bn from Islamic Development Bank loan, MOH would like to state that these funds are still with the bank.
National Medical Stores, Uganda is procuring medical supplies for the Response and funds will be expended as soon as supplies are delivered.
It is therefore not true that MOH received and spent the Shs51bn from Islamic Development Bank.
Out of the Shs55bn from the World Bank, MOH had spent Shs13bn as of June 2020. This was largely spent on Health workers allowances and Medical Supplies.
The Global Fund initially committed to support the Covid19 Response by providing SHS 28 billion in-kind. This meant that they would NOT provide money, instead, they would procure commodities and deliver them to Uganda.
By end of Sept 2020, Global Fund delivered all these commodities to Ministry of Health. An additional grant of Shs69.6bn was approved in July 2020 for procurement of PPE and test kits by Global Fund. This funding is still in pipeline. It is important to note that this money is not meant to come to MOH directly.
The support from GAVI was disbursed to UNICEF & WHO.Of the Shs10bn released by GAVI in June 2020, Shs6.5bn was disbursed to UNICEF to procure medical supplies while Shs3.5bn to WHO for test kits and others. It is clear that by end of June 2020 the Shs10bn had not yet been spent.
It is therefore pertinent to note that the total resources disbursed to MOH is SHS 174billion (SHS 119 billion from Government of Uganda and Shs55bn from World Bank) while the rest of the funding stated in the report did not come to MOH.
It is also worth noting that the other monies cited are either off-budget expenditure or future commitments. It should not be portrayed that all the entire money was disbursed by the Ministry of Health.
The Ministry of Health would like to state that the contract to supply the megaphones was worth Shs2.9bn, (i.e. a total of 10,863 megaphones, 43,450 rechargeable and dry cell batteries) were procured.
This is contrary to the number of 108,863 megaphones quoted by the monitoring team in their report, which implied that Government would have spent approximately Shs25.47bn on the megaphones and batteries.
The monitoring took place at the time when the distribution of the megaphones was ongoing. The megaphones were delivered to the Ministry on the September 21, 2020. It is unfortunate that the sampled districts had not yet received the megaphones at the time.
So far, all districts except 10 districts have received the megaphones. The 10 districts include: Amudat, Bushenyi, Butaleja, Kaabong, Kamwenge, Kalangala, Karenga, Lwengo, Mitooma and Napak.
The Ministry of Health did not have funds to distribute the megaphones country wide. Therefore, it relied on using every opportunity that was available; either for the districts to pick them or to take advantage of any available means to deliver them to the respective districts.
EMERGENCY AMBULANCES AND BOATS
The Ministry of Health would like to clarify that 33 type B ambulances have since been received at the Ministry and another 5 ambulances (3 water boat intensive care ambulances and two type C road intensive care ambulances) are going through the Customs clearing at the Kenya Port of Mombasa.
It is also important to note that the presumed delay in delivery of the ambulances was due to the customized manufacturing process of the ambulances as per the contract specifications and due to the global movement restrictions which also affected shipping of equipment and other commodities.
BEDS AND MATTRESSES
The report alleges that Ministry of Health signed three contracts with Joint Medical Stores worth Shs1.3bn to supply 1,000 beds and mattresses, 2,000 blankets and 2,000 bed sheets.
However, during verification, the team only verified delivery of 331 beds and mattresses. The report further adds that ‘although 300 beds were moved from Namboole to Mulago, the latter acknowledged receipt of 290 instead of 300 beds. Mulago also received 108 mattresses which does not commensurate to the beds provided. Three of the beds were already broken and left at Namboole.’
The Ministry would like to categorically state that a total of 1,000 beds, 1,000 mattresses and 1,000 blankets were delivered to Mandela Auxiliary treatment Center in Namboole. Out of which, 700 beds were fixed in Mandela Auxiliary treatment Centre while 300 were re-located to Mulago National Referral Hospital and are being utilized by Covid19 patients.
The items are available for verification at both sites. It is unfortunate that the monitoring team did not physically enter the hospital to view the aforementioned items at the hospital. Reason has it that since the team feared to enter COVID19treatment centers of Mulago and Namboole, the team ought to have trusted what our medical that provided information , rather than assuming that beds had disappeared, or they were not available.
SPECIALIZED MACHINERY AND EQUIPMENT PROCURED
From the start of the pandemic, MOH carried out assessment of ICUs in all our hospitals. Currently, 143 ICU beds complete with ventilators, patient monitors and high flow oxygen therapy apparatus have been procured and distributed to the various facilities across the country.
Although the plan and budget captured refurbishing of some ICUs in some hospitals before installation, it is important to note that funds to undertake this activity are yet to be obtained. Therefore, some of the equipment in some hospitals will be installed once refurbishing is done.
You may wish to note that the Ministry is expanding space to ensure that ICU equipment is installed at the earliest possible time.
At the onset of Covid19 Pandemic in Uganda, the Ministry of Health undertook a needs-assessment, revised specifications and procured 7 oxygen plants, 450 oxygen cylinders, 5 filling stations and other accessories.
Four (4) of the seven plants have been installed at Mulago National Referral Hospital while the two (2) have been installed at Entebbe Grade B and Mbarara Regional Referral Hospital. One (1) has been allocated to Kayunga Regional Referral Hospital.
These are high tech, high volume, high flow and high purity oxygen plants procured to ensure continuous supply of oxygen to patients, which is critical in the management of COVID-19, as we are now experiencing more patients progress from moderate to severe conditions.
The report highlights that the contract was signed in May 2020 and deliveries and installations had not commenced by September 2020. While the Ministry acknowledges that the contract was signed in May 2020, it is important to find out why the delivery and installations had not commenced in the agreed timeline.
The general public and the authors of this report are aware that Uganda went into a total lockdown in March 2020 and this greatly affected logistics among others.
However, contrary to what the report stated ‘deliveries and installations had not commenced by September 2020’, the plants were delivered in August 2020. The four oxygen plants that were procured for Mulago required additional space, prompting the Ministry to quickly create space for them, hence, the additional required time.
As a result, the installation and commissioning processes were finalized early October 2020. Suffice it to note that Mulago National Referral Hospital uses pure piped oxygen (99 -100%).
The report states that 20 Sleeper Tents worth Shs3.8bn were procured from M/s Lumious Uganda Limited.
The report further adds that ‘although the contract stipulated 20 tents, only 13 were signed and installed at Namboole by the time of monitoring in September 2020.
The authors alleged that ‘all the tents procured failed and could not be used to accommodate patients as earlier anticipated due to their weak specifications and capacity.’
The Ministry would like to categorically state that the tents could not be erected in Namboole Auxiliary COVID19 Treatment Centre as this would damage the turf at the premises.
Therefore, in order to expand capacity for Covid19 treatment at district level, the tents were reallocated to the Regional Referral Hospitals (RRHs).
All the 20 tents have since been delivered, erected and are under use at the Regional Referral Hospitals across the country. For purposes of clarification, all the tents supplied meet the required specification.
MOBILE HEALTH FACILITIES ESTABLISHED AT BORDER POINTS OF ENTRY
On the above mentioned, the report noted that confirmation of land availability was not done prior to contract signature leading to resource overruns. ‘Equipment and human resource to run these facilities was also not planned’ the report added.
However, this is not true. Following the decision by Cabinet and the Covid19 National Task Force to ease port health testing because of the long queues of truck drivers, the Ministry of Health contacted Uganda Revenue Authority (URA) and the respective local governments at the various points of entry who agreed to avail land.
The truth is that the local governments delayed to identify land for the development. Although, they had earlier indicated willingness to provide land.
Additionally, the contractor had fabricated 50% of the buildings by the end of June 2020 but land allocation delayed completion.
ACCOMMODATION HIRED TO QUARANTINE ABROAD RETURNEES AND COVID19 SUSPECTS
The Government of Uganda instituted mandatory institutional quarantine for all returning travelers on March 17th 2020.
In the same vein, Cabinet resolved to meet the costs of all the returning travelers until the airport was closed on March 22nd 2020 at designated Government quarantine sites.
However, when repatriation of Ugandans stranded abroad resumed, it was communicated that all returnees would meet their costs at the designated quarantine sites.
The report questions the engagement of Kirigime Guest House in Kabale District and further asks why the same measures were not undertaken in other points of entry.
The Ministry of Health would like to clarify that this is because unlike other borders, 86 Ugandans were stranded abroad were dropped off at the border in Kabale District.
It was more economical to quickly set up an institutional quarantine site rather than transport all of them to Kampala.
The process of identifying a hotel (Kirigme Guest House) was done by the Kabale District Taskforce to urgently accommodate the stranded nationals who returned through the Uganda-Rwanda border point at Katuna.
The Ministry of Health worked with the Ministry of Tourism to identify hotels that agreed to accommodate the COVID19suspected travelers.
MEALS PROVIDED FOR QUARANTINED INDIVIDUALS, COVID19SUSPECTS AND PATIENTS:
On the cost of meals for persons who were under quarantine, the BMAU report states that a unit cost of food (plate of food) at one of the hotels in Kampala cost Shs105,000.
This is not true.
The Ministry of Health would like to clarify that the quoted cost of Shs105,000 was for full-board accommodation at the designated quarantine facility.
It included the cost of accommodation and all meals (breakfast, lunch and dinner) and not only ‘a meal’ as quoted in the report.
The Ministry of Health released funds to Regional Referral Hospitals and Local governments for meals for patients under isolation and persons who underwent quarantine. It therefore did not participate in selecting the suppliers.
PERSONAL PROTECTIVE EQUIPMENT (PPE) PROCURED AND DISTRIBUTED:
The report states that one of the suppliers for PPEs delivered 3,200 surgical masks expensively at Shs4,946 each.
The Ministry of Health would like to clarify to the public that there are different types of masks i.e. surgical masks, N95 and non-medical masks which are all priced differently.
It is therefore disturbing that the report did not clarify the type of masks that were referred to. For avoidance of doubt, the average market price for N95 is Shs5000. The Ministry of Health purchased it at Shs4,946 lower than the market price.
This price is much cheaper than what the global market offers at Shs10,000 for the same mask. All masks supplied met the stands according to the Regulatory Authorities.
If the supplied masks were substandard as the authors state, one wonders how the authors established the quality of the masks when they are not experts in this area, and why the medical personnel who were using these masks in the ICUs were effectively protected from Covid19. This makes one believe that this was mere hearsay and an inaccurate statement.
To-date, a total of nearly 29 million masks have been delivered to 91 districts in the country. This includes: community and student masks. The variation of the price from Shs1,000 to Shs2,400 was as result of the suppliers complaining that the initial price of Shs1,000 was not enough to cover their costs. This matter was subsequently discussed in Cabinet and Cabinet approved the variation to Shs2,400.
The question of quality does not arise, since UNBS was involved and certified the specifications for the Masks.
Even during procurement, any samples that were found not to be meeting the required standards, were always rejected.
On the issue of whether the masks were necessary, the Ministry of Health would like to state that this was necessary, since the use of Masks has been scientifically proven to have a preventive effect in the transmission of Covid19.
Lastly, the delay to complete the procurement and distribution of the masks was due to insufficient funds to undertake these activities.
In conclusion, the Ministry of Health calls upon MoFPED and its other agencies for maximum support in the fight against the ongoing Covid19 pandemic.
The Ministry of Health believes in transparency and accountability for the all the funds disbursed to it for the various programs and activities from both government and development partners.
In the same vein, accountability will be made available to the responsible bodies as constitutionally mandated.