Uganda’s been in the news a lot lately:
- An outbreak of deadly Ebola (now declared over).
- The country’s celebration of its 50th anniversary of gaining independence from Britain (along with the perhaps less-celebrated 26th anniversary of President Yoweri Museveni’s refusal to relinquish power).
- The next phase of the bizarre “social-mediated” hunt for Ugandan warlord Joseph Kony.
- Uganda’s crackdown on the ‘crime of homosexuality.’
- An update on the corruption probe, started in 2009, of the country’s mismanagement of foreign money donated to fight AIDS, tuberculosis and malaria.
So, you can imagine, I had a lot of questions for Uganda’s Minister of Health Christine Ondoa, a pediatrician and pastor, and one of her traveling companions, Ugandan Parliamentarian Tim Lwanga. Ondoa has been in Seattle for the last few days to meet with a number of local organizations, talking about collaborating on projects aimed at improving health in the poor East African nation.
“The main challenges are the infectious and communicable diseases, especially malaria,” said Ondoa, who while in town met with folks at Gates Foundation, PATH, World Vision and also at the Fred Hutchinson Cancer Research Center to discuss the Seattle cancer center’s ongoing project with the Uganda Cancer Institute in Kampala.
(I suspect the Fred Hutch folks might chafe at the claim malaria is Uganda’s biggest health problem. The cancer community is part of a broader campaign out there contending non-communicable diseases like cancer deserve equal attention in Uganda. As my friend and local journalist colleague Joanne Silberner has reported, cancer kills more people than HIV, TB and malaria combined.)
Uganda has all of the typical health problems of a poor African country, but Ondoa says malaria does deserve special attention
“We have been able to make progress controlling HIV, though lately the prevalence has risen slightly,” she said. Uganda has been celebrated (and, of course, also condemned by some) for its aggressive anti-HIV efforts that emphasized, among other things, sexual abstinence and Christian moral values and which succeeded in reducing infection rates by two-thirds (down to a prevalence of about 7 percent today).
HIV-AIDS is still a major concern but it is malaria, Ondoa said, that is today one of Uganda’s biggest killers and social burdens. Part of this is due to the country being an excellent geographic location for mosquitoes.
“Malaria is endemic in 95 percent of the country, killing anywhere from 200 to 300 people a day,” she said. “But it is not just a question of mortality. Studies have shown that the average household spends 25 percent of its income dealing with malaria (in terms of health care costs, time lost to work, etc).”
Finding a more effective way to fight malaria is the main reason Ondoa came to Seattle. Her visit was sponsored by a relatively new and little-known local humanitarian organization Pilgrim Africa. Started by Kevin and Dorothy Ochodu in Uganda in 2001 first aimed at doing refugee relief, it has expanded its portfolio to try to bring a more ‘holistic’ and community-based approach to doing malaria control efforts in select communities.
There are literally hundreds of such organizations based in the Seattle area alone, religious or non-religious, doing these kinds of projects. And there’s a raging debate within the aid and development community about whether or not they are actually effective or just heart-warming efforts that help raise donations without making much of a lasting impact against disease or poverty.
I’m not going to go into all that. It’s too complicated. We’ll talk briefly about why Ondoa likes the approach taken by Pilgrim Africa and than ask her and the gregarious top Ugandan politician with her on this visit, Tim Lwanga, to give us some perspective on the many news stories out of Uganda lately.
Q What is the reason malaria is so big a burden for Uganda?
CA: Part of it is lack of access to treatment but also to lack of rapid diagnosis. A two- or three-day delay in diagnosis can make the difference between life and death for children infected with malaria…. We need to have a comprehensive approach.
Q What is the advantage to the government in collaborating with Pilgrim Africa to reduce malaria?
CA: In 2008, we partnered with them in one community, Kakatwi. We screened everyone in the community and treated all of those infected, sprayed all the households and distributed nets … The results were incredible. The infection rates were reduced by more than 92 percent. Medicines are now available in most clinics and we are using these kind of partnerships already to distribute 20 million bed nets…. We want to work with partners to scale up this approach to more than 80 percent of the country.
Q Has suspension of Global Fund money to Uganda due to allegations of mismanagement impacted health?
CA: We’ve made tremendous strides thanks to the Global Fund, especially in HIV prevention. For HIV, about 70 percent of our resources come from outsiders so (the suspension) has had an impact, yes. But not as much because of our multi-pronged approach. We have greatly strengthened our internal controls.
Tim Lwanga: Yes, there was mismanagement of funds, in 2009 (before Ondoa was minister of health). There have been investigations. people have taken responsibility and recently some arrests were made. Since then, we have also made significant improvements in financial accountability.
Q As an American, I am unfamiliar with government corruption (everyone laughs). How do either of you respond to the stereotype that so many of these aid projects in Africa fail or are seriously undermined by chronic corruption?
Lwanga: Today, it must be recognized that 75 percent of Uganda’s budget (much of it from oil revenue) is local funding. Donor funding is only 25 percent. My problem with a lot of NGOs is that they come in, fund their own work and don’t collaborate with local officials or the central government. Many of these problems come from lack of collaboration and working with the community. The approach of Pilgrim Africa begins with collaboration at the community level. That is the difference.
Q Speaking of the risk of corruption, how is the oil boom in Uganda being handled to avoid the ‘oil curse’ or natural resource curse that has afflicted other countries like Nigeria?
(Lwanga fielded this question also. He has been involved in a number of anti-corruption efforts by the Ugandan government.)
Lwanga: I was in the government cabinet when oil was first discovered. I was in charge of ethics and integrity. The challenge we have is to make sure the revenue is distributed equitably and efficiently. We have worked out a number of transparent profit-sharing measures, modeled along the Norway model. Ghana is doing something fairly similar. I would say that 72-80 percent of the oil revenue profits remain in Uganda and are spent on infrastructure improvements….
I would encourage Americans to recognize that there are many forms of corruption, and sometimes it comes in from international players. There are three players in most kinds of corruption – the organizer, the giver and the taker. The taker, the recipient in Africa, is normally the one pointed to. The giver and sometimes the organizer are often international organizations, donors, agencies or corporations. You must always look at the entire picture if you want to understand corruption.
Ondoa: We often see these multinationals or NGOs come in, receive aid funding, buy expensive cars and housing, paying themselves without even working with us in the government, or the local communities. But that is not considered corruption. It is legal (she smiles).
Q Does Uganda’s law against homosexuality hurt anti-AIDS efforts?
CA: As Africans, we have our own cultural norms. I am a married woman but it is not acceptable for me to kiss my husband in public, to speak openly about sexuality. For people to openly say they are gay in our culture, it is an abomination … As minister of health, my goal is to reach everyone. Recently, a clinic was opened up for the LGBT community in Kampala, a private clinic. I dialogue with them to figure out how to do this properly and within the law.
That’s all I had time to run by Ondoa and Lwanga. I didn’t get to ask about the Stop Kony campaign (which launched in Uganda and was reportedly not too well-received).