In the 1990s Uganda was typically considered to be one of the success stories in the management of the AIDS epidemic in SSA. However, as is shown below, since the early 2000s Uganda has significantly lagged its regional peers (Kenya and Tanzania) in the fight against HIV/AIDS. New infections are declining in Kenya and Tanzania but increasing in Uganda. HIV prevalence also appears to be increasing in Uganda, while either declining or keeping steady in Tanzania and Kenya. Lastly, of the three countries, the rate of decline in AIDS-related deaths has been slowest in Uganda.
It’s not clear to me why the HIV/AIDS situation has deteriorated in Uganda since the late 1990s relative to its neighbors. After all, the three countries have been receiving cash from PEPFAR since 2004 (which explains the decline in AIDS related mortality in the mid-2000s after the use of ARTs became widespread).
My hunch is that this is a reflection of Yoweri Museveni’s gradual loss of control of the state institutions that he has worked hard to build since 1986. It is also probably related to the manner in which Museveni chose to deal with the advent of competitive politics in Uganda after the end of the no-party “movement” era. His strategy has come to be defined by a willingness to basically buy off anyone and everyone — at the expense of state institutions and specific government agencies.
The OIG auditors identified stock-outs of key medicines, particularly those to treat HIV, in 70% of 50 health facilities visited which could result in treatment disruption for patients. Furthermore, 54% of the health facilities visited had accumulated expired medicines. 68% of facilities reported stock-outs of anti-malaria medicines and test kits and 64% of the facilities reported stock-outs of tuberculosis medicines of between one week and three months.
The OIG concluded that the supply chain system does not effectively distribute and account for medicines financed by the Global Fund. There were reported cases of theft, including 40 cartons of artemisinin-based combination therapies; an unexplained difference of US$21.4 million between recorded and actual stocks at the central warehouse; and a difference of US$1.9 million between commodities received and actually dispensed to patients from January 2014 to June 2015 in eight high-volume facilities visited by the auditors.
Uganda’s post civil war economic recovery may have been impressive (see graph), but it should no longer be something for Museveni to hang his hat on. It is clear that the longer Museveni stays in office, the more he is going to undo his very own achievements in the earlier years of his three-decade rule.
There is more good news in the area of public health. A couple of days ago I posted on the decline of human mortality rates in the tropics. Now the UN agency for HIV/AIDS, UNAIDS, reports that HIV infection rates, especially of the mother-to-child variety, are on a downward trend.
New infections with H.I.V. have dropped by half in the past decade in 25 poor and middle-income countries, many of them in Africa, the continent hardest hit by AIDS, the United Nations said Tuesday.
The greatest success has been in preventing mothers from infecting their babies, but focusing testing and treatment on high-risk groups like gay men, prostitutes and drug addicts has also paid dividends, said Michel Sidibé, the executive director of the agency U.N.AIDS.
Some regions, like Southern Africa and the Caribbean, are doing particularly well, while others, like Eastern Europe, Central Asia and the Middle East, are not. Globally, new infections are down 22 percent from 2001, when there were 3.2 million. Among newborns, they fell 40 percent, to 330,000 from 550,000.
The life expectancy of a Kenyan has increased to 64 years up from 55 two years ago, a report released on Sunday shows.
The data compiled by the University of Nairobi in partnership with 12 other universities worldwide notes that the life of Kenyans has improved substantially and they can expect to live longer.
The report, State Of The Tropics, further says that Zimbabwe is the only nation in the world that recorded a decline in life expectancy at 47 years.
Madagascar reported the largest improvement in life expectancy to 65.8 years, with large reductions in infant and adult mortality rates.
…. In regional terms, Zimbabwe has a low infant mortality rate, but a very high adult mortality rate (the highest in the world)
Overall, there has been massive improvement in life expectancy in the tropics since the fifties:
…. life expectancy in the tropics has increased by 22.8 years to 64.4 years between 1950 and 2010 and the gap between the life expectancy of women and men has widened in favour of women over the same period.
I guess this calls for an investigation of the real causes of the drop (if the data hold up) in mortality rates (especially infant mortality). Is it better healthcare, diet or just a natural secular trend? Or could it be better economic prospects (since the mid-1990s) that inspire greater investment in healthcare? Also, has the AIDS epidemic peaked in the tropics? Over to you, epidemiologists.
It is a bit odd that a country like Zimbabwe has a low infant mortality rate but a high adult mortality rate – why has the total collapse of state institutions disproportionately affected health provision to adults?