After weeks of on-the-ground visits to health facilities in the central, east, north and western Uganda, MPs filed a report last week that found a much-unprepared and frail healthcare system almost one and half years after the pandemic broke out.
The report shines a harsh spotlight on the shortcomings of Uganda’s health system managers and a pitiable failure by the ministry of Health to account for all monies so far spent on the Covid-19 mitigation efforts.
The 174-page report written by the Parliamentary task force on the National Covid-19 Response found that government has provided Shs 4,034.11 billion to finance Covid-19-related interventions since its onset in March 2020.
Out of Shs 4,034.11 billion, Shs 314 bn (7.8%) was provided in the financial year (FY) 2019/20, Shs 2,787.23bn (69.1%) was released for the FY 2020-21 and Shs 932.58 bn (23.1%) released in the FY 2021-22.
A total of Shs 1,139.98bn (28.3%) was provided to finance interventions related to the provision of direct health services, Shs 116.38bn (2.9%) was directed towards social protection specific interventions (SAGE and funds to the vulnerable populations within cities and municipalities) and another Shs 2,665.87bn (68.9%) was to support interventions implemented under the economic stimulus package.
Lack of transparency
According to the report, by bankrolling various economic stimulus packages, government intended to minimize the negative impact of Covid-19 on the social and economic welfare of the economy.
Focus was placed on household economic welfare, firms to survive the crisis and maintenance of financial stability to avoid the potential collapse of the economy.
Interventions such as re-capitalization of Uganda Development Bank (UDB), support to SACCOs through the Microfinance Support Centre, Emyooga and the Youth Funds, Uganda Women Entrepreneurship Programme (UWEP) and provision of inputs and support for the e-Voucher systems were well intentioned to boost the private sector, protect economic resilience, and provide some certainty for business.
However, they were affected by a lack of a transparent mechanism to ensure that the resources trickle down to the intended beneficiaries. But, many small and medium enterprises (SMEs), women and youths have continued to suffer from the economic impacts of Covid-19 unabated, the report found.
“Government through the Finance ministry should submit to parliament full accountability backed by an authentic list of beneficiaries of the funds appropriated in respect to recapitalization of Uganda Development Bank totaling to Shs 558.18bn and the additional allocation to support SACCOs under the Microfinance Support Centre totaling to Shs 77.72bn meant to enable small and medium enterprises (SMEs) access quick and affordable credit to turn around their businesses that were on the verge of collapsing,” the report partly reads.
The MPs demanded that government provides to parliament full accountabilities showing the beneficiaries of the funds appropriated under the Youth Fund totaling to Shs 130bn, UWEP under gender ministry totaling Shs 29.51bn and Emyooga through the Micro Support Centre totaling to Shs 260bn.
According to the report, future interventions like the Youth Fund should be appropriated under the rightful ministries that ordinarily are mandated to perform such functions to avoid duplication and uncoordination.
“In addition, the taskforce recommends that government should halt further provision of any form of economic stimulus until the auditor general conducts a forensic audit on all funds that have been appropriated for the Covid-19 response,” the MPs noted.
High cost of enforcement of Covid- 19 SOPs
The task force further noted that whereas there is still a deficit in the budgetary allocation towards the procurement of the much-needed vaccines to the tune of Shs 365.9bn, government is still spending huge sums of money on Covid-19 containment measures at the expense of mass vaccination.
Since the onset of Covid-I9 in the financial year 2019-20, a total of Shs 142.23bn has so far been spent on enforcement of Covid-19 lockdown directives.
During the FY2019/20, Parliament appropriated a total of Shs 22.18bn to support the establishment of 20 Isolation Centers in each district and to undertake surveillance as a means of slowing down disease transmission.
“However, teams established that in most of these districts, not a single isolation centre ever existed. Government should submit detailed accountability to Parliament for Shs 22.18bn appropriated to establish 20 isolation centres per district indicating the location in each district where such facilities were established,” the report read.
Discrepancy in Covid- 19 expenditure
Parliament appropriated Shs 94.188bn under a supplementary budget to the ministry of Health but the ministry told the Task Force that by the end of FY 2019-20, a total of Shs 92.431bn had been spent, leaving a balance Shs 1.757bn unspent.
The balance is reported to have been returned to the Consolidated Funds (CF). A review of the actual expenditures submitted to the task force revealed Shs 99.069bn was spent instead of the reported Shs 92.431bn. MPs demand that the health ministry explains the additional expenditure amounting to Shs 4.881bn.
“The task force noted that this amount is over and above the amount appropriated by Shs4.881bn. The source of the additional funds totaling to Shs 4.881bn remains unknown. lt is not possible to spend more than what was appropriated,” the report said.
Discrepancy in purchase, distribution of masks
As a condition for lifting the lockdown in May 2020, cabinet directed the ministry of Health to provide 34,109,085 non-medical and reusable face masks to all persons above six years of age. In addition, as a prerequisite to the reopening of schools, cabinet further directed that all learners should be provided with fabric masks.
Therefore, this necessitated procurement of an additional 2,592,963 masks for finalists in candidate classes. Consequently, a total of 36,702,048 masks at a cost of Shs 2,400 per mask were procured and distributed to 135 districts and to all finalist learners in candidate classes across the country.
At a cost of Shs 2,400 per fabric mask, the total cost for 36,702,048 masks comes to Shs 88,084,915,200.
“However, a review of the accountability of government Covid-19 funding to the Health ministry for the period March 2020 to June 2021 revealed that a total of Shs 90,999,000,000 was spent in respect to procurement of fabric masks for the communities totaling to 35,323,287 and finalist learners totaling to 2,592,963. This brings the total number of community masks to 37,916,250,” the report indicates.
Consequently, the analysis of the task force revealed a discrepancy in both the reported number of fabric masks procured and distributed by 1,214,202 and the amount of money spent on the procurement of the fabric masks by Shs 2,914,084,800.
“The Health minister should explain the observed discrepancy arising from her report titled: ‘Update to parliament taskforce on Covid- 19 in Uganda’ dated July 7, 2021 and the one titled: Accountability for Uganda Covid- 19 funding to the health ministry March 2020 to June 2021.”
External funding
The ministry of Health reported that Shs 389.13bn was received as external financing for the period March 2019 to June 2021. Out of this, Shs 215. 19bn was from the Global Fund, Shs 56.24bn from the World Bank –the Uganda Covid-19 Response and Emergency Preparedness Project (UCREPP), Shs 55.5bn was from the World Bank’s Contingency Emergency Response Component (CERC), Shs 51.02bn from the lslamic Development Bank (lsDB), while Shs 10.4bn and Shs 0.78bn was from GAVI and Uganda Sanitation Fund (USF) respectively.
The Contingency Emergency Response funds were spent on coordination, risk communication, ICT innovations, case management, mental health and psychosocial support, surveillance and laboratory operations as well as logistics (related to testing, PPEs, ambulances, motorcycles), among others.
On the other hand, UCREPP funds were spent on staff salaries, training of health personnel and other office operations. The Global Fund cash was mainly spent on purchase of test kits, surveillance support supervision and purchase of oxygen cylinders, among others.
A review of the external financing accountabilities submitted by the Health ministry revealed that most of the items that were funded were similar in nature and purpose as those funded using the government budget. According to the report, it was not possible to establish whether there was no duplication and, therefore, multiple accountabilities.
“The auditor general should institute a forensic audit into all Covid-19 expenditures to ascertain value for money spent,” the report indicated.
Donations towards Covid-19 responses
According to the report, the task force was informed that government, through the national and district task forces, received both cash and donations in-kind. The donations in-kind included vehicles, mattresses, beds and beddings, sanitizers, test kits, PPEs and food items, among others.
“The task force commends all persons and organizations that made a contribution for their support at such a critical time. However, the task force noted that there were inadequacies in the accountability of donations received. Indeed, this is also confirmed in the Auditor General’s thematic Audit Report on Covid-I9 Pandemic Government Interventions dated February 2021,” the report indicated.
“This report provides findings of the Auditor General in respect to the Management of Covid-19 interventions for the FY 2019/2020. At an appropriate time, the Accountability task forces of Parliament shall review it and make recommendations for the appropriate resolutions.”
The report indicates further that when the task force reviewed the submission of the Health ministry on accountability of Covid-19 government funding, it established that Shs 29.6bn is reported as having been collected as cash donations towards Covid-19 response. And Shs 23.9bn of which was spent on procurement of 282 pickup vehicles, Shs 3.3bn was spent on the construction of a blood bank in Soroti while Shs 2.4bn was earmarked and spent on construction of border post health units at Vurra and Cyanika.
“By the time of writing this report, a total of 121 vehicles had been imported into the country and were still awaiting clearance of the import taxes amounting to Shs 9bn by Uganda Revenues Authority (URA). The taskforce was informed that the Health ministry did not have Shs 9b to clear the import taxes and as a result the vehicles are still parked in URA Customs bonded warehouses awaiting clearance,” the report indicated.
lt has been established that these vehicles started arriving in June 2021 and as a result the demurrage costs keep piling plus other clearance fees. Whereas the ministry of Health had written to the Finance ministry requesting for a tax waiver, Finance insisted that the tax obligation had to be paid. This process was causing undue delays and the vehicles could not be deployed as required.
“The taskforce noted that there was poor planning and disjointed coordination amongst the two ministries on procurement of these vehicles. It is ill conceivable for government to imagine that funds donated by well-wishers would be used to clear government tax obligations.”
“lt is a disappointment on the part of government towards the public generosity. Why wouldn’t government provide counterpart funding to clear the taxes or provide an undertaking to clear the taxes with URA so as to deploy these vehicles urgently to facilitate the much-constrained logistical activities,” the report says.
“Government should urgently resolve this impasse by either availing the funds required to clear the due taxes or settle for a tax waiver altogether with a view of having the vehicles cleared and deployed to serve the deserving population without any further delay. The decision taken should as well apply to the remaining batch of 161 vehicles yet to be received in the country.”
The taskforce recommended that in such an emergency, imported vehicles should be precleared before arrival so as to deploy them quickly and avoid unnecessary costs. Further still, such vehicles can still be warehoused in government-gazetted facilities as they wait clearance from URA to avoid unnecessary demurrage costs.
The MPs in their report said all procurements undertaken during the Covid-19 response were of emergency nature and, therefore, couldn’t have followed the procurement process.
“In the circumstances, a forensic audit should be conducted within two months to ascertain whether there was value for money,” the report indicated.
Covid- 19 resurgence plan
According to the report, the total budget for the Covid-19 resurgence Plan from July 202l to June 2022 is Shs 1,763.8bn. Of this, Shs 445.9bn (25%) is earmarked for the procurement of the much-needed Covid- 19 vaccines while Shs 808.4b will go to logistics.
The taskforce was informed that within the first quarter of FY2021-22, a total of Shs 206.3bn has been earmarked. Specifically, these funds will be used to cater for oxygen requirements, surveillance, allowances, case management and management of ambulances, among others.
In addition, Shs 255.4bn has been reported as committed. That is, NMS (Shs 80bn), UCREPP (Shs 46.2bn) and GFTAM (Shs 129.2bn). This brings the total amount available towards the budget for Covid-19 resurgence plan to Shs 461.7bn (Shs 206.3bn plus Shs 255.4bn) leaving a funding gap of Shs 1,302. 1bn.
The report found that when the taskforce met with the Finance minister Matia Kasaija, he indicated that there were resources from the World Bank amounting to Shs 480.8bn and this money was already in the Health ministry budget for FY 2021-22. In addition, an allocation of Shs 80bn was approved under National Medical Stores for FY 2021-22.
“These resources, together with a supplementary budget of Shs 206.3bn approved by cabinet, total to the budget available to the health ministry of Shs 767.14bn. Therefore, going by Finance, the deficit in financing the budget for the Covid-19 resurgence plan is Shs 996.66bn (Shs 1,763.8bn less Shs 767.14bn) contrary to what is indicted by the health minister of Shs 1,302.1 bn.”
“It is not clear which of the two figures is the true deficit in financing the budget for the Covid-19 resurgence plan. With this apparent discrepancy between the funding gaps indicated by the two ministries, it is difficult to ascertain the exact deficit in the budget for Covid-19 resurgence plan for July 2021 to June 2022,” the MPs said.
The MPs recommended that government should undertake realistic and hamonised planning with a view of ascertaining the optimal level of financing required for the resurgence plan taking into account critical interventions that should be implemented to contain the transmission of Covid-19.
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