Uganda needs only USD 9.6 million to put its Mulago national referral hospital to an internationally recommended standard, the proposed USD 379.7 million can construct five state-of-art cancer hospitals with 1000 bed capacity each. But why would the government instead opt for a USD 379.7 million deluxe hospital that has a bed capacity of only 264 which will benefit a handful?! Is this the best approach to set our line-of-preferences at the cost of other numerous districts without a single public hospital?
By Michael Ssemakula
and Denis Bukenya
Health Rights Advocates
Human Rights Research Documentation Center (HURIC), and PHM-Network, Uganda
The Italian Investor Proposed USD 379.7 Million Lubowa Hospital Construction Project in Uganda
Disconnections and Disruptions in the Health Sector Expenditure Priorities
Disclaimer: PEAH disclaims and refuses any responsibility for the views expressed in this article which are solely those of the authors and do not engage Policies for Equitable Access to Health
Uganda has increasingly incorporated the neoliberal capitalistic forces in providing, financing and developing state health infrastructure and service delivery through public–private synergies. Justifications for this commitment are diverse stretching from levitation of finance for maintaining and operating public health to assistance for the high-end investment functions and scaling-up support for ever growing GDP expenditure to lessen the budgetary gap. Though Public Private Partnerships (PPPs) are a magnetization propulsion to an enormous segment of the civil corporate powers and diverse stratified clusters of stakeholders in state possessed and managed entities in Uganda, over two decades ago, there is still absentia of a sturdy thrust impulsion of a mechanism to draw and incorporate well streamlined and rationalized strategic policy charters in the health management in which state and non-state nexus in health service provision is well regulated to effectively improve healthcare delivery even in the marginalized and impoverished settings.
In a paper by (Denis Bukenya, 2019), the elementaristic and contemporary forces of governance for health have superseded the humanlike social-progressive provision of state centric health services with the mixed hegemony of capitalistic health service provision through which the competitive commodified health system has emanated. There is limited significance, conceptualization and in-depth investigation about the PPP phenomenon’s implications on the Uganda’s health sector among the resource apportioning powers— which has culminated into a simultaneous backwash quantum of adversely skewed anthropologic socio-economic inequality space, eccentric complex aligned health priorities, negligent privatization of the fundamental public services and one-sided investment trade agreements predominantly through the multi-national business conglomerates’ treaties. But is this a sustainable roadmap to attain the UHC commitments?
Achieving universal health care (UHC) is a health priority entrenched in the Sustainable Development Goals. Though there is no one-size fits all model for universal health care in all settings, the ultimate health system approach would be one that is people-centered, rights-based, integrated, non-biased, and broadly-inclusive in all its processes and priority setting to build an egalitarian mechanism of healthcare delivery.
The power arm, policy orchestras and policy enhancing actors in the government quite often blame the insufficient public health funding on poverty. But the actual culprits are inappropriate misplaced priorities and corruption —few state managers in Uganda prioritize health over private actors’ big businesses and civil corporate elite interests. Bettering the lives of the privileged affluent classes and devoting exorbitant sums of money towards frivolous expenditures to political party financing is now a genealogistic and an indirectly legalized abnormally normalized health rights violation in Uganda. A common practice that is undermining health. This is unsympathetically intensified by the pseudo “public” white elephant projects, laced first in the scale of the ostentatious and flamboyant priorities at the expense of adequate health, education, and other services that would improve the social-economic welfare of the citizenry.
Besides the government of Uganda insensitively spending over USD 48 million on a private presidential jet by 2014, (Tomori, 2014), in February 2019 a hardcore, egocentric, ruthless and merciless bunch-of-crooked mafias of the governing body, shamelessly came up with another worse than ever anti-humancentric mockery to Ugandans through another over-and-above excessively inflated unscrupulous multi-million dollar Italian investor hospital project, an attack on the poor country’s ever hemorrhaging empty coffers. On 12th of March 2019, the parliament and the National Economy Committee approved a promissory note of USD 379.7 million which will be given to an Italian private investor. Through a loan request, the government seeks to borrow USD 379.7million (UGX 1.3 trillion, which is more than half the Uganda’s projected health expenditure for the Financial Year 2019/2020) that will be given to this little-known investor to construct the hospital that government says will be for the treatment of Non-Communicable Diseases (NCDs). In reports by (Okello, 2019) and (Independent, 2019), the documents that were submitted by the Ministry of Finance and Economic Development, the total project cost breakdown is USD249.9 million excluding tax payment component. However, the financing for which government is seeking the Legislatorial approval is USD379.7 Million thus an increment of USD 129.83 million, which is 52% of the original projected cost.
The report by (Network, 2019) shows that the Parliament doesn’t know the investor-in-question to be assigned this work. The hospital is to be constructed under a corporation between FINASI and ROKO Construction Ltd. Ugandans know ROKO and its operations in Uganda, but greater majority are not in the know of FINASI. FINASI was registered in Italy in 1993 but on their website https://finasi.com/ , FINASI was established and started its operations in the 1969. The company was founded as a 360° Importer/Exporter and a primary goods trader in the Middle East and far as Africa. FINASI is basically an import/export company in mineral ores, quarried stone, furniture, clothing and footwear, paper, chemicals, industrial machinery, agricultural machinery, toilet systems and so on. The company has diverse activities it deals with but has no phone numbers on its website which conclusively make us suspicious of this, an eminent scam danger. Apart from a mention of surgical equipment and instruments; hygiene and sterilization equipment for medical and surgical use, there is no indication that FINASI has any experience or footprints in establishing a hospital. The company type is registered as a head office! This is unquestionably a fraud trouble Ugandans are likely to befall, the 1989 year of establishment contradicts with the year 1969 in which it claims to have been registered. CF (Codice Fiscale): 01139180937 Registration No.: PN 45691. All companies in European Union are required by law to submit the total financial annual returns and there is no information about FINASI past 2015. In Europe, no bank or government can guarantee companies like FINASI without a transparent annual audited return filed with the Italian government in this case. The company turnover is 2-5 million Euros from 2013-2015 which sounds phony, and a total deception because the companies in Europe submit total financial annual returns and there is no information about FINASI past 2015. There are no records for the financial years 2016, 2017, 2018. Enrica Maria Aristidina Pinetti, is the CEO – Chief Executive Officer (Ceo – Amministratore Delegato). There are no any other staff or vice president listed. The company is listed to have nine staff and yet it claims to have operations in Italy, far as east, Russia, Middle East and sub-Saharan Africa.
Worse still there is no secured land for this above-life health facility, the land on which the project is to be allocated is under dispute by a Buganda Royal family. This implies that the said land’s legal status is still unsettled, therefore we risk litigation and we might be subjected to another drama of a multi-million dollar humiliating frenzy-of-penalization after the investment kick-start.
Despite of the efforts to fight the disease in Uganda to achieve the SDGs’ 2030 agenda, and also meet the universal commitments enshrined in the global guiding instruments such as the Article 25 of UDHR, 1978 Alma Ata declaration, the 2001 Abuja declaration and the 2018 Astana declaration, Uganda still faces a horrific nightmare of poor misguided and non-inclusive priority setting processes in the health sector. Uganda needs only USD 9.6 million to put its Mulago national referral hospital to an internationally recommended standard, the proposed USD 379.7 million can construct five state-of-art cancer hospitals with 1000 bed capacity each. But why would the government instead opt for a USD 379.7 million deluxe hospital that has a bed capacity of only 264 which will benefit a handful?! Is this the best approach to set our line-of-preferences at the cost of other numerous districts without a single public hospital?
The question of inadequacies in the Uganda’s health governance is an outrageous dark-fortune that still stand vividly. The enabling arm through the decision powers of the independent institutions is unwaveringly being emasculated through one decision enhancer, the president and the common jargon of ‘orders-from-above!’ Governance for health in this sense in regards to oversight, control, transparency, responsiveness, equity, effectiveness, efficiency, regulatory quality, accountability, consensus orientation and participatory priority setting process in-line with objectives, and interests of institution’s management and public health strategies has lost its course. Therefore to prevent wasteful expenditures, we must have well streamlined, rationalized and efficient health strategies that clearly describe and guide the procedures within institutions (notably government) and define priorities and the parameters for action in response to the public health needs and available resources. This should be properly incorporated with inclusive approaches which embrace social responsibility through community engagement and increase in investments for health development through participatory processes.
References
Denis Bukenya, &. Michael Ssemakula. (2019). The Rhetoric In Achieving The Universal Health Coverage Under Public-Private Partnerships In Uganda. PEAH.
Financing, D. o. (2012). Health Systems Governance for Universal Health Coverage. Geneva: World Health Organization.
Independent, T. (2019, February 13). MPs query $379M Gov’t support to Lubowa hospital investor. Kampala, Central, Uganda.
Kickbusch, I. (2014). A new governance space for health. Global Health Action, Issue 6.
Network, U. D. (2019, March 20). Here is what Ugandans need to know about FINASI. Kampala, Central, Uganda.
Okello, G. (2019, March 12). Parliament approves UGX1.3 trillion loan for Lubowa hospital amid land dispute with royal family. Kampala, Central, Uganda.
Tomori, O. (2014). Health in Africa: Corruption and misplaced priorities. Kampala: Bulletin Daily.