Office of the Inspector General

Message from the Executive Director: Global Fund Grants in Uganda

11 December 2023

Uganda has been for many years an effective and strategic partner of the Global Fund in the fight against HIV, tuberculosis (TB) and malaria. The significant progress that has been achieved in fighting the three diseases and in building resilient and sustainable systems for health in Uganda results from our strong collaboration with partners such as the Ministry of Finance, Planning and Economic Development, the Ministry of Health, as well as The AIDS Support Organization (TASO).

An Office of the Inspector General (OIG) audit of Global Fund grants in Uganda concluded that the performance of Global Fund grants for HIV and malaria needs significant improvement. However, combining the assessment of the performance of the different disease programs obscures important differences. Uganda’s HIV programs are performing well and have achieved a remarkable impact.  By contrast, Uganda’s malaria programs have fallen short of targets and need improvement.

On HIV, Uganda has made significant strides, with new infections reduced by 40% since 2010. The country is making remarkable progress towards the UNAIDS 95-95-95 HIV  targets (95% of people living with HIV know their HIV status; 95% of people who know their status are on treatment; and 95% of people on treatment have suppressed viral loads), having achieved 90%-94%-94%.

The OIG audit highlights that while Uganda has made significant progress in the fight against HIV, the country still faces challenges in treatment linkage and patient retention, as well as in the implementation and scale-up of HIV prevention interventions for key and vulnerable populations.

As the report also notes, there is a risk that restrictive laws and policies, including the recently enacted Anti-Homosexuality Act, could threaten this progress. Progress has also been registered in the fight against TB, with reductions in incidence and TB-related deaths by 1.6% and 43% respectively between 2015 and 2021.

On malaria, the OIG audit found that programs to fight malaria in Uganda face a range of implementation challenges and have fallen short of achieving the desired impact. The Grant Cycle 6 (2021-2023) malaria grant did not meet the goals of reducing malaria infection and morbidity by 50% and malaria-related mortality by 75% relative to 2019 levels.

Uganda has faced challenges in malaria control and has experienced an upsurge in malaria cases and deaths. The audit found that gaps in prevention, treatment, and data quality are hampering Uganda’s progress towards malaria targets. There have been significant delays in the planning and execution of key interventions, including mass campaigns to roll out long-lasting insecticidal nets, indoor residual spraying, and preventive treatment of malaria during pregnancy. Additionally, the audit identified suboptimal effectiveness of procurement and supply chain management and called for significant improvements in that area.

Related to the malaria findings, the OIG audit identified challenges with sub-recipient management and gaps in the financial management of grant funds. The audit showed that contracting and disbursement to sub-recipients were significantly delayed, hindering the timely implementation of program activities. There were also delays in the accountability of funds disbursed to sub-recipients, including to the local governments.

We take these findings seriously and are committed to addressing them together with our partners in Uganda. Building on the lessons and evidence generated during the 2021-2023 grant implementation period, we will seek to reverse this recent trend of increasing malaria cases and accelerate and sustain efforts to reduce Uganda’s malaria burden. Any backslide in the fight against malaria in Uganda will also have implications across the region.

Together with all our partners, we will work to improve vector control measures, expand and reinforce malaria case management, and enhance data quality. We will strengthen financial management and reporting systems, including assurance mechanisms, reporting, monitoring and oversight for sub-recipients. We will also improve the management of health commodities and their timely distribution to the last mile.

We thank the OIG for this audit report. The work of the OIG complements the active grant management and risk oversight and controls put in place by the Secretariat and supports our emphasis on transparency and accountability of grant performance. The Uganda audit report highlights the challenges and successes on which we can build in the future. The Global Fund is committed to continuing our investments in Uganda, working in partnership with the country as we seek to accelerate progress toward ending HIV, TB and malaria as public health threats, and building stronger and more resilient systems of health, better able to respond to both existing and new health threats.