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<div><font size="4">Hello,</font></div><div><font size="4">I am re-submitting my article for posting.</font></div><div><font size="4">Regards,</font></div><div><font size="4">Michael.</font></div><div><font size="4"><br></font></div><div><font size="4"><br></font></div><div><font size="4"><span style="font-family:"romans",serif"><span></span></span></font></div><div><font size="4">
</font><p class="MsoNormal" style="text-align:justify;margin:0in 0in 8pt;line-height:107%"><b><font size="4"><span style="font-family:garamond,serif"><span style="line-height:107%">The
Italian Investor Proposed USD 379.7 Million Lubowa Hospital Construction Project
In Uganda: Disconnections And Disruptions In The Health Sector Expenditure
Priorities<span></span></span><span style="line-height:107%"><span> </span><span></span></span></span></font></b>
</p><p class="MsoNormal" style="text-align:justify;margin:0in 0in 8pt;line-height:107%"><b><font size="4"><span style="font-family:garamond,serif"><span style="line-height:107%"><br></span></span></font></b></p><p class="MsoNormal" style="text-align:justify;margin:0in 0in 8pt;line-height:107%"><b><font size="4"><span style="font-family:garamond,serif"><span style="line-height:107%">Presented
By Michael Ssemakula and Denis Bukenya</span><i><span style="line-height:107%"> </span></i></span></font></b><font size="4"><span style="font-family:garamond,serif"><i><span style="line-height:107%">f</span></i><i><span style="line-height:107%">rom</span></i><span style="line-height:107%"> </span></span></font><b><font size="4"><span style="font-family:garamond,serif"><span style="line-height:107%"> People’s Health Movement – Uganda <span></span></span></span></font></b></p><font size="4"><span style="font-family:garamond,serif">
</span></font><p class="MsoNormal" style="margin:0in 0in 0.0001pt;text-align:justify;line-height:normal"><font size="4"><span style="font-family:garamond,serif"><span>------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------</span></span></font></p><p class="MsoNormal" style="margin:0in 0in 0.0001pt;text-align:justify;line-height:normal"><font size="4"><span style="font-family:garamond,serif"><span></span><span>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 <span> </span>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.<span></span></span></span></font></p><font size="4"><span style="font-family:garamond,serif">
</span></font><p class="MsoNormal" style="margin:0in 0in 0.0001pt;text-align:justify;line-height:normal"><font size="4"><span style="font-family:garamond,serif"><span><span> </span></span></span></font></p><font size="4"><span style="font-family:garamond,serif">
</span></font><p class="MsoNormal" style="margin:0in 0in 0.0001pt;text-align:justify;line-height:normal"><font size="4"><span style="font-family:garamond,serif"><span>In a paper by<span id="gmail-m_3753034985749147701gmail--157457380"><span><span> </span>(Denis
Bukenya, 2019)</span></span>,
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</span><span> simultaneous backwash </span><span>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? <span></span></span></span><span style="font-family:garamond,serif"></span><span style="font-family:garamond,serif"><span><span><br></span></span></span></font></p><p class="MsoNormal" style="margin:0in 0in 0.0001pt;text-align:justify;line-height:normal"><font size="4"><span style="font-family:garamond,serif"><span><span></span></span></span><span style="font-family:garamond,serif"><span><br></span></span></font></p><p style="margin:0in 0in 0.0001pt;text-align:justify;background:white none repeat scroll 0% 0%"><font size="4"><span style="font-family:garamond,serif"><span>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.<span></span></span></span><span style="font-family:garamond,serif"></span><span style="font-family:garamond,serif">
</span><span style="font-family:garamond,serif"></span><span style="font-family:garamond,serif"><span><span></span></span><span style="color:rgb(31,31,31)"><br></span></span></font></p><p style="margin:0in 0in 0.0001pt;text-align:justify;background:white none repeat scroll 0% 0%"><font size="4"><span style="font-family:garamond,serif"><span style="color:rgb(31,31,31)"><br></span></span></font></p><p style="margin:0in 0in 0.0001pt;text-align:justify;background:white none repeat scroll 0% 0%"><font size="4"><span style="font-family:garamond,serif"><span style="color:rgb(31,31,31)">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.</span></span><span style="font-family:garamond,serif"></span><span style="font-family:garamond,serif"><span style="color:rgb(31,31,31)"><br></span></span></font></p><p style="margin:0in 0in 0.0001pt;text-align:justify;background:white none repeat scroll 0% 0%"><font size="4"><span style="font-family:garamond,serif"><span style="color:rgb(31,31,31)"><br></span></span></font></p><p style="margin:0in 0in 0.0001pt;text-align:justify;background:white none repeat scroll 0% 0%"><font size="4"><span style="font-family:garamond,serif"><span style="color:rgb(31,31,31)">Besides the government of Uganda insensitively
spending over $48 million on a private presidential jet by 2014, <span id="gmail-m_3753034985749147701gmail--226613485"><span>(Tomori, 2014)</span></span>, in February, 2019 a
hardcore, egocentric, ruthless and<span>
</span>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.<span> </span>On </span>12<sup>th</sup> 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 <span id="gmail-m_3753034985749147701gmail-313616799"><span>(Okello, 2019)</span></span> and <span id="gmail-m_3753034985749147701gmail--1528325030"><span>(Independent, 2019)</span></span>, 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.<span></span></span><span style="font-family:garamond,serif"></span><span style="font-family:garamond,serif"></span><span style="font-family:garamond,serif"><br></span></font></p><p style="margin:0in 0in 0.0001pt;text-align:justify;background:white none repeat scroll 0% 0%"><font size="4"><span style="font-family:garamond,serif"><br></span></font></p><p style="margin:0in 0in 0.0001pt;text-align:justify;background:white none repeat scroll 0% 0%"><font size="4"><span style="font-family:garamond,serif"></span><span style="font-family:garamond,serif">The report by <span id="gmail-m_3753034985749147701gmail-4721052"><span>(Network, 2019)</span></span> 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 <span class="gmail-m_3753034985749147701gmail-invisible"><u><span style="color:blue"><a href="https://t.co/L395m1eBej" title="https://finasi.com/" target="_blank"><span style="color:blue">https://</span><span class="gmail-m_3753034985749147701gmail-js-display-url"><span style="color:blue;text-decoration:none">finasi.com</span></span><span style="color:blue">/ </span></a></span></u></span>, 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.<span></span></span><span style="font-family:garamond,serif"></span><span style="font-family:garamond,serif">
</span></font></p><p style="margin:0in 0in 0.0001pt;text-align:justify;background:white none repeat scroll 0% 0%"><font size="4"><span style="font-family:garamond,serif">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. <span></span></span></font></p><font size="4"><span style="font-family:garamond,serif">
</span></font><p style="margin:0in 0in 0.0001pt;text-align:justify;background:white none repeat scroll 0% 0%"><font size="4"><span style="font-family:garamond,serif"><span style="color:rgb(31,31,31)"><span> </span></span></span></font></p><font size="4"><span style="font-family:garamond,serif">
</span></font><p style="margin:0in 0in 0.0001pt;text-align:justify;background:white none repeat scroll 0% 0%"><font size="4"><span style="font-family:garamond,serif"><span style="color:rgb(31,31,31)">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?<span></span></span></span></font></p><font size="4"><span style="font-family:garamond,serif">
</span></font><p style="margin:0in 0in 0.0001pt;text-align:justify;background:white none repeat scroll 0% 0%"><font size="4"><span style="font-family:garamond,serif"><span style="color:rgb(31,31,31)"><span> </span></span></span></font></p><font size="4"><span style="font-family:garamond,serif">
</span></font><p style="margin:0in 0in 0.0001pt;text-align:justify;background:white none repeat scroll 0% 0%;font-family:"Times New Roman",serif"><font size="2"><font size="4"><span style="font-family:garamond,serif"><span style="color:rgb(31,31,31);background:white none repeat scroll 0% 0%">The question
of inadequacies in the Uganda’s health governance is an outrageous dark-fortune
that still stand vividly</span><span style="color:rgb(31,31,31)">. The enabling arm through the
decision powers of the independent</span><span style="color:black"> 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,</span> <span style="color:black">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</span>
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</span></font><span style="font-family:"romans",serif;color:black"><font size="4"><span style="font-family:garamond,serif"> social responsibility through community
engagement and increase in investments for health development through participatory
processes.</span></font><span></span></span></font></p>
<p style="margin-top:0in;text-align:justify;background:white none repeat scroll 0% 0%;margin-right:0in;margin-left:0in;font-family:"Times New Roman",serif"><font size="2"><span style="font-family:"romans",serif;color:black"><span> </span><span></span></span></font></p>
<font size="2"><span id="gmail-m_3753034985749147701gmail--366451000">
<h1 style="margin:12pt 0in 0.0001pt;line-height:107%;break-after:avoid;font-family:"Calibri Light",sans-serif;color:rgb(46,116,181)"><span style="line-height:107%;font-family:"romans",serif">References<span></span></span><span style="line-height:107%;font-family:"romans",serif;color:windowtext"><span></span></span></h1>
<span id="gmail-m_3753034985749147701gmail--573587230">
<p class="gmail-m_3753034985749147701gmail-MsoBibliography" style="margin:0in 0in 8pt 0.5in;line-height:107%;font-family:"Calibri",sans-serif"><i><span>Denis
Bukenya, &. Michael Ssemakula. (2019). <span>The Rhetoric In Achieving The Universal Health Coverage Under
Public-Private Partnerships In Uganda.</span> Geneva: PEAH.</span></i><i><span style="line-height:107%"><span></span></span></i><span style="line-height:107%"><span></span></span></p>
<p class="gmail-m_3753034985749147701gmail-MsoBibliography" style="margin:0in 0in 8pt 0.5in;line-height:107%;font-family:"Calibri",sans-serif"><i><span>Financing,
D. o. (2012). <span>Health Systems
Governance for Universal Health Coverage.</span> Geneva: World Health
Organization.<span></span></span></i></p>
<p class="gmail-m_3753034985749147701gmail-MsoBibliography" style="margin:0in 0in 8pt 0.5in;line-height:107%;font-family:"Calibri",sans-serif"><i><span>Independent,
T. (2019, February 13). MPs query $379M Gov’t support to Lubowa hospital
investor. Kampala, Central, Uganda.<span></span></span></i></p>
<p class="gmail-m_3753034985749147701gmail-MsoBibliography" style="margin:0in 0in 8pt 0.5in;line-height:107%;font-family:"Calibri",sans-serif"><i><span>Kickbusch,
I. (2014). A new governance space for health. <span>Global Health Action</span>, Issue 6.<span></span></span></i></p>
<p class="gmail-m_3753034985749147701gmail-MsoBibliography" style="margin:0in 0in 8pt 0.5in;line-height:107%;font-family:"Calibri",sans-serif"><i><span>Network, U.
D. (2019, March 20). Here is what Ugandans need to know about FINASI.
Kampala, Central, Uganda.<span></span></span></i></p>
<p class="gmail-m_3753034985749147701gmail-MsoBibliography" style="margin:0in 0in 8pt 0.5in;line-height:107%;font-family:"Calibri",sans-serif"><i><span>Okello, G.
(2019, March 12). Parliament approves UGX1.3 trillion loan for Lubowa
hospital amid land dispute with royal family. Kampala, Central, Uganda.<span></span></span></i></p>
<p class="gmail-m_3753034985749147701gmail-MsoBibliography" style="margin:0in 0in 8pt 0.5in;line-height:107%;font-family:"Calibri",sans-serif"><i><span>Tomori, O.
(2014). <span>Health in Africa: Corruption
and misplaced priorities.</span> Kampala: Bulletin Daily.</span></i></p></span></span></font></div>
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