PHM-Exch> Re-submitting Our Article

[michael ssemakula]

 Hello,
I am re-submitting my article for posting.
Regards,
Michael.


*The Italian Investor Proposed USD 379.7 Million Lubowa Hospital
Construction Project In Uganda: Disconnections And Disruptions In The
Health Sector Expenditure Priorities  *


*Presented By Michael Ssemakula and Denis Bukenya  **f**rom* * People’s
Health Movement – Uganda *

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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forces of governance for health have superseded the humanlike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 $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) show 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/  <https://t.co/L395m1eBej>*, 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) defines 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.
Geneva: 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.*
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