Uganda’s health ministry has released a statement explaining some of the issues raised by the Budgetary Monitoring and Accountability (BMAU) “COVID-19 INTERVENTIONS REPORT FINANCIAL YEAR 2019/20.”
In the statement issued on Wednesday, the ministry says BMAU hurriedly released “an incomplete and unsigned report in October 2020 to social media without receiving feedback from the Ministry of Health as it was expected.”
“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,” the statement says.
BELOW IS THE FULL RESPONSE
MINISTRY OF HEALTH RESPONSE TO A REPORT OF THE BUDGET MONITORING AND ACCOUNTABILITY UNIT (BMAU) TITLED “COVID-19 INTERVENTIONS REPORT FINANCIAL YEAR 2019/20”
The Ministry of Health would like to respond and set the record straight on the above-mentioned report authored by a team led by Ms. Annette Mutoni Kyakuwa of the Budget Monitoring and Accountability Unit of the Ministry of Finance, Planning and Economic Development. The Ministry of Health appreciates the support rendered by the Ministry of Finance, Planning and Economic Development (MoFPED) in the preparedness and response to the ongoing COVID-19 pandemic.
We acknowledge the positive comments on the efforts and achievements of the Ministry of Health in its response to the pandemic as contained in the aforementioned report.
However, the Ministry of Health would like to express its concern on the modus operandi of the Monitoring team that was assigned to undertake monitoring of the COVID-19 budget and accountability interventions. We would like to also note that BMAU hurriedly released an incomplete and unsigned report in October 2020 to social media without receiving feedback from the Ministry of Health as it was expected.
While the team states in its report that there was physical monitoring of the various interventions, most of their work was done over the phone and also promised to come at a later time to follow up. Even in areas where they did physical verification, information was obtained from junior officers who had little information to provide. The documentary review of the procurement files that was done lacked clarity from contract managers hence the distortions in the report.
Although monitors are not auditors it would have been courteous for them to share their report for complete feedback as expected. The Ministry of Health only noticed this report circulating on social media which the sector objected to in writing to MOFPED. Instead of sending the report formally, the Commissioner in charge of Planning at the Ministry of Health received an unsigned copy via email. However, to-date the Ministry of Health has never received an authentic and signed copy of this report.
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 BMAU report states that the Ministry of Health received UGX 766.7 billion which was committed to the COVID-19 prevention and response interventions. It further states that by end of June, 2020, the Ministry of Health had received and spent UGX 264 billion from both Government and donors; UGX 119 billion from GOU, UGX 55 billion for Government World Bank’s Uganda contingency Response Component and UGX10 billion from GAVI, the Vaccine Alliance. Another amount totaling UGX 94.9 Billion was in the pipeline. The Ministry of Health would like to clarify as follows:
Regarding the UGX 51billion from Islamic Development Bank loan, Ministry of Health would like to clarify that these funds are still with the bank. However, the National Medical Stores (NMS) is procuring medical supplies for the COVID-19 Response and the funds will be expended as soon as the supplies are delivered. It is therefore not true that the Ministry received and spent the UGX 51 Billion from the Islamic Development Bank.
Out of the UGX 55 billion from the World Bank, the Ministry of Health had spent UGX 13 billion as of June 2020. This was largely spent on Health workers allowances and Medical Supplies.
The Global Fund initially committed to support the COVID-19 Response by providing UGX 28 billion in-kind. This meant that they would NOT provide money, instead, they would procure commodities and deliver them to Uganda. As of the end of September 2020, Global Fund had delivered all these commodities to the Ministry of Health. An additional grant of UGX 69.6 billion was approved in July 2020 for the procurement of Personal
Protective Equipment (PPE) and test kits by the Global Fund (Geneva). This funding is still in the pipeline. It is worth noting that this money is not meant to come to the Ministry of Health directly.
The support from GAVI was disbursed to Multilateral agencies (UNICEF and WHO). Of the UGX 10 billion released by GAVI in June 2020, UGX 6.5 billion was disbursed to UNICEF to procure medical supplies while UGX 3.5 billion was disbursed to World Health Organization (WHO) for test kits and other activities. It is therefore clear that by end of June, 2020 that UGX 10 billion had not yet been spent.
It is therefore pertinent to note that the total resources disbursed to Ministry of Health is UGX 174billion (UGX 119 billion from Government of Uganda and UGX 55 billion from World Bank) while the rest of the funding stated in the report did not come to the Ministry of Health. 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.
Government funds sent directly to the Ministry that is quoted in the BMAU report
Procurement and Distribution of Megaphones
The report states that; “The contract for megaphones worth UGX 2.9 bn was signed on 11th May 2020.” The report further states that “MoH bought 108,863 megaphones at a unit cost of UGX 230,000 and 43,450 pieces of dry cells at UGX 10,000 each. These were expected to facilitate communication of COVID19 messages in all parishes across the country. The megaphones were delivered on 22nd June 2020, however, districts visited by the monitoring team in
July, August and September had not received these items. These included; Oyam, Omoro, Apac, Agago, Gomba and Butambala among others”
The Ministry of Health would like to state that the contract to supply the megaphones was worth UGX 2.9 Bn, (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 UGX 25.47 Bn on the megaphones and batteries. This is a gross misrepresentation of the facts regarding this procurement.
The monitoring took place at the time when the distribution of the megaphones was ongoing. The megaphones were delivered to the Ministry on the 21st September 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.
A sample of the megaphones procured by the Ministry of Health
A megaphone with its rechargeable batteries and other accessories
EMERGENCY AMBULANCES AND BOATS:
The report further states that: “38 ambulances were still under procurement.
M/s AutoZone Armor Processing Cars L.L.C through M/s City Ambulance
Limited was contracted to supply the ambulances at UGX 11bn. All funds (100%) were uploaded onto a letter of credit at Bank of Uganda by 30th June 2020. Actual payments to the service provider was done upon delivery. The initial delivery date was 30th July 2020, this was not achieved by September 2020 and extended to November 2020”.
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. Anyone who has procured such commodities would not say this was a delay at all.
BEDS AND MATTRESSES:
The report alleges that Ministry of Health signed 3 contracts with Joint Medical Stores worth UGX 1.3 Bn 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 COVID-19 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 COVID-19 treatment 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.
Oxygen Plants
At the onset of COVID-19 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%).
SLEEPER TENTS
The report states that 20 Sleeper Tents worth UGX 3.8Bn 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 COVID-19 treatment Centre as this would damage the turf at the premises. Therefore, in order to expand capacity for COVID-19 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 COVID-19 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 COVID-19 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 COVID-19 suspected travelers.
MEALS PROVIDED FOR QUARANTINED INDIVIDUALS, COVID-19 SUSPECTS 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 UGX.105,000. This is not true.
The Ministry of Health would like to clarify that the quoted cost of UGX.105,000 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 UGX 4,946 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 UGX 5000. The Ministry of Health purchased it at UGX 4,946 lower than the market price. This price is much cheaper than what the global market offers at UGX. 10,000 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 COVID-19. This makes one believe that this was mere hearsay and an inaccurate statement.
Non-medical masks
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 UGX 1,000 to UGX 2,400 was as result of the suppliers complaining that the initial price of UGX 1,000 was not enough to cover their costs. This matter was subsequently discussed in Cabinet and Cabinet approved the variation to UGX 2,400. 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 COVID-19.
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 COVID-19 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.
