Lack of HIV test kits in Uganda – A risky challenge for women and babies

In Uganda health facilities are facing an ongoing crisis with a shortage of supplies which are putting unborn babies at risk of HIV and other infections.

A Ugandan government official who preferred not to be named said: “The HIV test kits have been in short supply ever since the withdrawal of partners in the supply of medical equipment. In some cases we just have to issue health facilities with a few HIV test kits with stern instructions that they should be preserved for pregnant women alone. It is an emergency that we have chosen to handle that way.”

Proscovia Kagoya is an HIV counsellor who is also living with HIV. She works at the Kyaligondo Health Centre III and runs a programme to prevent the transmission of HIV from mothers to their children, which is funded by ViiV Healthcare. She explains that test kits are vital for testing pregnant women and other clients to determine their HIV status and access treatment if needed. She is shocked by the ever diminishing number of kits at a time when they are needed most.

Why the shortage of HIV test kits?

Godfrey Kalyesubula, the HIV focal person in Luwero hints at the genesis of the shortage. He said: “The National Medical Store took over procurement of all medical equipment and other partners withdrew from this role. It waits for lists from the health facilities in order to supply equipment and health facilities face a recurring challenge to make requisitions.”

Proscovia said: “It is unfortunate there is sometimes a shortage of test kits. In some cases there are only a few reserved for pregnant women and the men do not have any. Even mama kits are not available. Women need these but it is only once in a while that we have them.” Mama kits contain basic materials to facilitate clean and safe delivery and reduce the risk of infection to mothers and newborn babies.

Jeniffer Gaberu, a team leader from Community Health Alliance Uganda who works on the prevention of mother to child transmission of HIV, said: “A number of the structural changes in procurement within the government affected delivery of mama kits. We have heard these complaints and they are genuine. But we are hoping that when our equipment is cleared, we can distribute to those in need.”

Preventing transmission of HIV from parent to child

There is huge interest by donors and the health community in preventing parent to child transmission of HIV as a strategy towards zero new HIV infections. Through the ‘networks model of intervention’ community members are trained to identify women who are pregnant and encourage them to go for HIV counselling and testing. When they find mothers who are HIV positive, they are referred to health facilities.

Recently, the first lady of Uganda Janet Kataha Museveni launched Option B+  a new version of prevention of mother to child transmission – but the chances of it succeeding amid a shortage of HIV test kits is unlikely.

Many questions need to be asked about this situation. Why would there be no HIV test kits in health centres and specifically centre IIIs that are most accessible to the community? Why would the Ugandan Government suspend donor purchase of equipment and medicines? Who is going to gain from the new approach?  

Donors stopped procuring equipment?

A government may recommend it takes charge to regulate and ensure substandard equipment is not used in diagnosing and treating patients. Or perhaps it is simply to assume control of supplies and therefore management of all resources involved. In this case, standards may not be a plausible argument to take, considering donors appear to have stricter measures for quality than the government of Uganda.

So the next question is; are health facilities suffering because of feuds that are targeting millions of dollars in the health ministry? It’s possible that by denying donors the space to procure and distribute medical equipment, they may channel such money to the national resource pool, where funds can be easily accessed by local politicians. The sector-wide approach to funding has already had its demerits under the office of the prime minister of Uganda, with billions of shillings being swindled.

At the moment, Asuman Lukwago, permanent secretary in the Ministry of Health, is being hunted by police. It is alleged he is being witch-hunted because he insists it is the technocrats at the Ministry of Health not politicians who should be in charge of all the vertical programmes carried out by the government. With the Ugandan government national budget allocation for health hovering between 7.8% and 8% ever since 2012, far below the Abuja recommendation of 15%, having non-technical people in charge would not ensure resources are efficiently used.

Political struggles over resources

In April, Sadab Kitatta Kaaya writing in Uganda’s observer newspaper identified two powerful forces in the Ugandan government trying to take control of a $22.8m integrated intelligent computer system project. One was the office of the Ugandan prime minister and the other was the health ministry which was meant to own the project to improve health service delivery.

The health ministry also faced a struggle with the office of the first lady of Uganda, who wanted changes in control of a $21m immunisation programme funded by the Global Alliance for Vaccines and Immunization.

Analysts believe the office of the first lady wanted supervision of activities to shift from the Uganda national expanded programme on immunisation (run by the Ministry of Health) to the National Medical Store, which is an autonomous government corporation where they can exert their influence more than they would with technocrats at the Ministry of Health. It is some of these factors that could have affected not only the availability of HIV test kits and other supplies, including antiretroviral drugs and blood.

When two elephants fight, it is the grass that suffers, but it appears that with the institutional power play and the need to dominate resources in Uganda, it is the people in need of antiretrovirals, mothers and HIV programmes that are feeling the pinch.