GOOD NEWS AND BAD NEWS AS THE GLOBAL FUND RETURNS TO

UNCLAS SECTION 01 OF 02 KAMPALA 000523 C O R R E C T E D COPY///ADDING SENSITIVE CAPTION/// DEPARTMENT PASS TO MCC (CHAKA) DEPARTMENT FOR S/GAC DOJ FOR ICITAP (TREVILLIAN, RODERICK, BARR, AND RAUCH) SENSITIVE SIPDIS E.O. 12958: N/A TAGS: PGOV PHUM EAID KCOR KHIV UG SUBJECT: GOOD NEWS AND BAD NEWS AS THE GLOBAL FUND RETURNS TO UGANDA Ref: Kampala 444 KAMPALA 00000523 001.2 OF 002 ¶1. (SBU) Summary: The Global Fund to Fight AIDS, Tuberculosis and Malaria is poised to resume disbursement of funding for previously approved grants in Uganda that for the most part have been on a three-year hiatus caused by the illegal diversion of Global Fund monies in 2005. The resumption of funding comes at a good time in that Uganda is facing, yet again, a potentially disastrous stock-out of life-saving drugs, including anti-retrovirals to treat HIV/AIDS. At the same time, we are deeply concerned about the Government of Uganda's passivity and inability to take the lead in fighting HIV/AIDS. As donors continue to willingly shoulder most of the resource burden and repeatedly come to the rescue when the Government mismanages, we are perpetuating donor dependence and perversely undermining good governance and accountability in Uganda. End summary. - - - - - - - - - - - - - - - - - - - - - - - - - - Background: Global Fund's Long Hiatus from Uganda - - - - - - - - - - - - - - - - - - - - - - - - - - ¶2. (SBU) The Global Fund to Fight AIDS, Tuberculosis and Malaria ceased disbursing funds in Uganda in late 2005 after revelations that various Government of Uganda (GOU) agencies and civil society organizations may have diverted $1.5 million of Global Fund monies, either for personal gain or to finance partisan efforts to win approval of the referendum the previous year that eliminated presidential term limits. In response, Ugandan President Yoweri Museveni established a Commission of Inquiry, which conducted a ten-month investigation into the scandal. Although the inquiry was presented to President Museveni in May 2006, the Government White Paper on the Judicial Commission of Inquiry into the Alleged Mismanagement of the Global Fund was not issued until November of that year. It stated that the Ministers of Health and Finance would not be held accountable, only technicians and it requested that funds be made available to the Criminal Investigation Department (CID) and Department of Public Prosecution (DPP) to investigate and prosecute. However, the GOU did not make funds available for investigations until nearly two years after the inquiry was submitted to President Museveni, seriously diminishing the chances for good investigation and successful prosecution. Nearly three years after the scandal broke, police investigations began, culminating in the recent successful prosecution of two minor figures in the scandal (see reftel). Under pressure from donors, the Global Fund also appointed its own Inspector General (IG) to carry out an investigation. Although the Global Fund created the IG position in 2005, the person appointed, John Parsons, did not visit Uganda until 2008. ¶3. (U) IG Parsons is reportedly almost ready to submit his final report to the Global Fund Board on the response of the GOU to the scandal and on the adequacy of the so-called Long Term Institutional Arrangements (LTIA),a complex set of interagency fiduciary procedures put in place after the scandal to protect the integrity of donor-provided funds in the health sector. - - - - - - - - - - - - - - - - - - - - - - - Uganda Faces Life-Threatening Drug Shortages - - - - - - - - - - - - - - - - - - - - - - - ¶4. (SBU) In a separate-but-related development, Uganda again faces imminent shortages of life-saving anti-retroviral and other drugs. The GOU has known since the end of 2008 that a potential stock-out of antiretroviral drugs was imminent. This was reaffirmed at the end of January. The GOU response has been at best piecemeal and we are unable to verify whether the Ministry of Health has sufficient safeguards in place to ensure a continuous supply of drugs to those currently enrolled. The Ambassador and Charge d'Affaires (CDA) have written to the Minister of Health twice, in April and May, to convey the message that the USG, through PEPFAR, is no longer in a position to bail out GOU programs facing stock-outs given our own budget constraints and the need to maintain the integrity of PEPFAR programs and the health of their clients. We further emphasized our concern about the GOU's management of ARVs in Uganda. As it is now, PEPFAR funds 80% of the total effort to fight HIV/AIDS in Uganda, and pays for the ARVs of 95,000 of the 175,000 Ugandans who now receive them. - - - - - - - - - - - - - Global Fund: We're Back! - - - - - - - - - - - - - ¶5. (U) In this context, the CDA met May 13 with a Global Fund team led by Fareed Abdullah, Global Fund Director for Africa. Abdullah's team met separately in the week with the PEPFAR Coordinator and the Director of Improved Human Capacity at USAID/Uganda. Abdullah told KAMPALA 00000523 002.2 OF 002 the CDA and other donor Chiefs of Mission that there would be no final official decision until after his visit, but that Global Fund would very likely resume funding to Uganda "within weeks, not months." The IG's report into the scandal is still pending completion of an ancillary report in the readiness of the LTIA to manage Global Fund monies. Abdullah made it clear, however, that it was the Global Fund Secretariat's prerogative to resume funding or not, independent of the IG's final conclusions. He said the Secretariat believes that it is time to move on, put the scandal behind it, and begin to alter the perception that the Global Fund is unwilling to provide funding to Uganda. ¶6. (SBU) Abdullah said that there will be renewed vigor and vigilance on the part of the Global Fund in overseeing its programs in Uganda and that it will continue to press the GOU hard for recoveries and prosecutions. Abdullah was sanguine on preventing future theft, noting that a large-scale diversion of funds at the central level in the future is unlikely because the issues are isolated and are more likely to occur at the decentralized level. The expectation is that the Long-Term Institutional Arrangements will be used in the next disbursement of Round 7 resources; however, the IG report on the LTIA is still pending. Given the GOU's poor track record in managing many of the existing systems and structures, it is not clear how successful the LTIA will be. ¶7. (SBU) In terms of funding, the Global Fund will turn on three different spigots in Uganda in the coming weeks: -- Round 6 for Tuberculosis; this is an ongoing grant, the third disbursement request is being planned; however, there are outstanding reporting issues on activities performed to date. -- Round 4 for malaria; was renewed and signed two weeks ago for $71 million; Global Fund is waiting for Uganda to submit a disbursement request. -- Round 7 for HIV/AIDS and malaria; the first tranche of Round 7 funding will amount to $23 million for ARVs, according to Abdullah. This will be disbursed quickly in light of the dire shortage of ARVs in Uganda. To hasten disbursement, the Global Fund plans to waive its requirement for the appointment of a new procurement agent, and instead use a procurement agent used in earlier procurements. Note: Round 3 for HIV/AIDS ended in December 2008 with remaining unspent funds. The Global Fund decided not to sign a Continuation of Services agreement, an emergency procedure to deliver life-saving services, since the previously-signed Round 7 will accomplish the same function. - - - - - - - - - - - - - - - Good News or Bad News? Both - - - - - - - - - - - - - - - ¶8. (SBU) Other donor representative in attendance on May 13 spoke at length about corruption and the need to follow-up prosecutions and recoveries in the Global Fund scandal. The CDA touched on the broader issue of ownership, noting that while the U.S. is relieved that the Global Fund will be able to address the ARV stock-out in the short-run, we are also very concerned about the GOU's longer-term inability and unwillingness to lead on the issues of proper management of donor funds, and more broadly, successful planning and implementation of the GOU's own strategy to fight the HIV/AIDS pandemic. The GOU's recent actions (or lack thereof),he noted, indicate the GOU is irresponsibly ceding responsibility for fighting HIV/AIDS to donors like the U.S., the Global Fund, and others. - - - - - - - - - - - - - - - - - Comment: Caught in Our Own Trap - - - - - - - - - - - - - - - - - ¶9. (SBU) In theory, the Global Fund's return to Uganda is good news, both in the short-term because money is needed now to buy life-saving drugs, and in the long-term because our own programs like PEPFAR cannot indefinitely carry the burden of fighting HIV/AIDS in Uganda. We need the Global Fund as a partner and our efforts are complementary. At the same time, we remain deeply concerned over the lack of political will and initiative on the part of the GOU to lead the way and contribute meaningfully in an area that is so clearly a public responsibility. In this and other areas, years of steadily growing donor inflows appear to be having a perverse impact by diminishing the need for Uganda's leadership to govern well and provide essential services to its citizen. HOOVER