There was a Ugandan currency

I wish to borrow today from that recently departed Nigerian enigma, Chinua Achebe. I wish to borrow the title of his last work. 'There was a country'. The Ugandan shilling is suffering an enduring pounding from the US dollar. It has reached an all time low of 3,000 Uganda shillings for one US dollar. We are told its an external matter.The the US economy is rebounding strongly and that all major currencies are affected. ''It is beyond our control'' the new Uganda Finance Minister has gone on to allege. But most economic problems are actually local. And what we are not getting much appreciation of is the connection with Uganda forthcoming presidential polls in 2016. The press is awash with reports of election-associated cash bonanzas. Ugandans have not forgotten the economic melt down that followed the presidential elections in 2011. Many friends I know have converted their few coins into US dollars. And surely this must be a part of the problem. But the truth is the first casualty in war.

Why Uganda must wake up to the cancers and heart disease epidemics

This year is set to be a land mark year. In 2015, the UN will converge on New York to set new millenium development goals(MDGs) for the next 15 years. Reducing extreme poverty and maternal deaths were some of lofty goals set in the past 15 years. In all likelihood, Non-communicable diseases(NCDs) will form part of the next set of MDGs. Uganda has been slow in aligning its development agenda towards the budgeoning cases of cancers, heart diseases and diabetes. The World Bank and World Health Organization (WHO)have separately published major reports which come to the same conclusion. NCDs such as cancers and heart diseases will be the leading cause of death by 2030 in low and middle income countries such as Uganda. And yes they are projected to outstrip HIV,malaria and Tuberculosis. That is just 15 years from now. To be sure, infectious diseases such as HIV are still of emergency importance and in many ways we have a double-trouble situation where infectious and non-infectious epidemics are co-occurances. In some instances they are even interacting. Take the case of HIV-associated cancers such as skin cancers which have been on the rise at the Uganda Cancer Institute. Reading the reported causes of death of the majority of middle class Ugandans in the press in the last five years, one cant escape two facts. The majority of these deaths have been reported to be as a result of NCDs. The majority of the deaths have occured before the 70 year mark.When I was growing up in the 1980s and 1990s, people, on average, died much later in life. Last year I spent two months in South Africa and I believe what is happening there is instructive for Uganda. Universities have re-focussed alot of their research towards NCDs particularly diabetes and heart diseases. I attended several PhD research seminars and was astonished at how much research attention NCDs are getting. Remember South Africa has a much higher HIV burden and we were told in some rural villages, HIV prevalance is as high as 40% but they have not taken their eye off the ball regardless. Prof Shane Norris of Witwatersrand University talked about exciting research they are doing in Soweto which shows that newly born babies who gain weight in the first week after birth have been shown to have a higher risk of diabetes later in life. We were told that a study on sugary soft drinks done at Wits found that an ordinary bottle of soda contained 8 spoons of sugar. But there some challenges at the global level.The global health lobby is still largely focused on infectious diseases. The US has officially declared that combating HIV is in their national interest. Academia, researchers and 'big pharma' are all heavily invested in HIV and other infectious diseases even when the terrain is changing. Of course South Africa is a middle income country and Uganda is not but there is lots we can do. One of the problems we have is that there is not much national-level data on NCDs in Uganda and most NCDs dont give off symptoms until one has a really advanced condition. Most Ugandans with NCDs dont even know it. We need to strengthen the NCDs office in the Ministry of Health led by the dedicated Dr Gerald Mutungi. Health workers need to probe for NCDs when patients visit health facilities. NCDs prevention is a much more cost-effective approach when compared to treatment which in most cases is life-long and prohibitively expensive as many Ugandans who flock to India already know. Dr Joseph Babigumira of Washington university told us that Nigeria spends a billion dollars on treating its citizens abroad every year. Measures aimed at life style changes such as reducing salt and sugar-intake, raising tobacco taxes and increased physical activity are critical. On a policy and planning level, small incremental steps such as integrating NCDs in current infectious diseases programs such as HIV would be advisable.

Blaise Compoare and the African spring

After 27 years, the people of Burkina Faso have had enough. And so handsome Blaise was bundled out in an unceremonious exit he hardly hoped for. Generations of Burkinabes had only known one leader. Parliament was set to rubber stamp his quest for a constitutional change to pave way for another term in office and certain victory in the joke that is African presidential polls especially when they involve incumbents. We have been told that Africans (south of the sahara) are incapable of what we saw in Egypt, Tunisia,Libya, Syria-the so called' Arab Spring'.But the people of Burkina Faso have now spoken. We have had enough. Thank you very much. The message is now all too clear to all African presidents who have been in power for over two decades 'winning' sham elections, one after the other. It is amazing how electoral democracy in Africa has been subverted and gone against the very spirit in which it was intended by western civilization.

Of Uganda's 'arrested' development and vested interests

I was recently invited to Nairobi by Partnership for Governance Research (PASGAR) to attend a political economy analysis symposium which attracted thirty participants from across Africa, courtesy of the British government. Why do development programs and interventions in poor countries like Uganda not succeed? There has been tonnes and tonnes of studies on this very subject with explanations ranging from geography to work ethic.It turns out we were blind to the potency of political economy analysis tools. This has began to change among western donors who have wisened up over the past few decades. They now acknowledge that the best-laid development plans and programs in poor countries will not necessarily get a red-carpet welcome. In a word, 'politics matters'!. That a sophisticated understanding of the context and mechanisms that maintain poverty or some other status quo is instructive. To over simplify, some quarters of society benefit from the way things are and may not be too keen on new 'interventions' which may turn them into 'losers'. The symposium was ably facilitated by Dr Tim Kelsall, an ex-Oxford don and our own Dr Fred Golooba-Mutebi. It is early 2013. You work as Chief Technical Advisor for an aid agency, lets call it JICA. Your brief is to support Uganda construct the Mukono-Katosi Road.You base all your plans for succeeding on sound planning and technical expertise. We now all know how that ended and which determinants impacted on implementation. And the scenarios are numerous. Britain's DfID actually commissioned a political economy analysis of road works procurement in Uganda that makes compelling reading. Imagine here what interests are ranged against an efficient passenger railway network across Uganda. What economic interests would you displace? Or picture this. You want to distribute free bed-nets in a malaria-endemic district of Uganda but the District chairman owns the largest shop in that district selling bed-nets. A few years ago,I was part of a team evaluating a foreign-funded effort to support a local government in Uganda provide HIV treatment at its lower health centres. I was told that before the project could even get off the ground, some 'good will' fees were demanded before the local government could allow to be supported to provide HIV treatment! The British,Dutch and Swiss international development arms ,and even The World Bank, now conduct political economy analyses that seek to anticipate impediments to their sponsored development interventions. When I was an impressionable fresh graduate, I imagined that the best development intentions would deliver Africa from what Paul Collier calls 'the bottom billion'. But as one makes their way through the world, one begins to see how complex the world is and how 'arrested' development can be. I have witnessed first hand how vested interests fail or stall development. From Uganda passing a sub-optimal law impacting on access to generic HIV drugs to Uganda taking more than 5 years to legislate a tobacco control law when Kenya took less than half that time. Indeed,it is worthwhile to analyze the key actors, interests and 'institutions' that facilitate or impede development programs. We were also told that when engaging with public offices, we may need to to look beyond people in formal positions and that key actors may be 'outsiders' who are actually in the 'inner circle'.It reminded me of Charles Rwomushana when he commented on a recent squabble in a most pinnacle office in the land. He opined that people in that office were not taken seriously depending on their official titles but on their perceived closeness to the 'principal'. Political economy analysis is not an imperative for western donors alone but for government programs as well. Why, for instance, hasn't NAADS succeeded despite its clearly noble goals? It was an opportune moment to brush up on my mid-1990s undergraduate political economy 101 and revel in the new importance attached to a discipline which had long been stigmatized because of its 'incorrect' roots.

Interrogating access to generic HIV drugs: Political Economy analysis matters

Uganda is one of the countries most affected by the global HIV/AIDS pandemic. According to a recent UN report, Uganda is only one of eleven countries where HIV prevalence rates are actually going up. In 2012, a national survey revealed that national HIV prevalence rates had increased from 6.4% in 2005 to 7.3% in 2011 pointing to an increase of the population in need of HIV treatment. Annual new HIV infections more than double those who are being enrolled on treatment. WHO enrollment eligibility criteria has been revised three times in past few years requiring that HIV treatment be initiated earlier than initially recommended further compounding the unmet need (WHO, 2013). Currently, more than half a million Ugandans are enrolled on HIV treatment in a population of 1.2 million who are HIV positive. According to PEPFAR-Uganda, over 97% of Ugandans currently enrolled on HIV treatment depend on Indian generic antiretroviral drugs (ARVs) for treatment. Generic drugs are identical, albeit un-authorized, copies of drugs originally developed by innovator pharmaceutical companies most of which are based in western Europe and North America. Because of the excessively high cost of research involved in developing new drugs, often in hundreds of millions of dollars, these pharmaceutical innovators are granted patents or exclusive right of use and distribution of typically 20 years under international trade law relating to intellectual property rights. PATENT BARRIERS These patents imply that the HIV drugs originally developed by western pharmaceutical innovators are not to be copied by another manufacturer, in Uganda’s case, an Indian one. Brand drugs are often quoted in prices tailored to western markets, yet a quarter of Ugandans live below the poverty line and Indian generics, which go for about a tenth of the price of brand drugs, is all they can afford. Because of these patent and international trade law barriers to access to essential medicines, poor countries met in Doha, Qatar in 2001 and made the Doha declaration which provided relief for poor countries to overcome these patent barriers by domesticating its provisions in their laws allowing poor countries to disregard these pharmaceutical patents on account of public health emergencies such as HIV/AIDS. The grace period for manufacturing generic pharmaceuticals however expires on January 1, 2016.The prospect is that generic HIV drugs may become illegal under Uganda law and western pharmaceutical giants would successfully enforce patents for HIV drugs in Ugandan courts. Low-income countries have however not taken advantage of the Doha declaration which provides for ‘flexibilities’ ,consented to by the World Trade Organization(WTO) in 2005, to circumvent patent barriers to access to HIV drugs. Continued access to generic HIV drugs is therefore a major determinant of long-term HIV program sustainability as are any efforts aimed at treatment scale-up including by western donor countries. Therefore, it’s imperative that analytical frameworks unearth the impediments to continued access to generic HIV drugs which low-income countries will need for generations to come owing to their development status. Doing this will require understanding the complex relationships that impinge on access to generic drugs from within Uganda but also from an external perspective. These analyses would also be relevant to the nascent Ugandan pharmaceutical industry such as the Quality Chemicals which began production of generic HIV and malaria drugs about six years ago. The global pharmaceutical industry has been seen to use international trade law and national laws in Uganda such as the Uganda industrial properties act and anti-counterfeit bill to protect their intellectual property rights beyond the recommended minimum international IP regime agreed between industry and global health lobbies. ACCESS TO HIV TREATMENT AN MDG. Universal access to antiretroviral therapy (ART) is Millennium Development Goal (MDG) six (b). The WHO, UNDP and UNAIDS in March 2011, issued a joint statement over their concern on the unsecured long-term sustainability of access to affordable HIV treatment. In Uganda, universal access to HIV treatment is a goal in the National Development Plan (NDP) 2010/2011-2014. The Uganda National Strategic Plan (NSP) sets universal access to HIV care and treatment as a goal, specifically, ensuring that 80% have coverage by 2015. WHY POLITICAL ECONOMY? As an analysis tool, this framework explains how population health and outcomes are shaped by economic and political determinants in a complex interaction from a national and international perspective. Unequal distribution of resources gives rise to the contest for pharmaceutical resources by low-income ARV users seeking life-saving treatment on the one hand and the capitalist industrial class and owners of means of production represented here by ‘big pharma’, on the other. On another level, the dichotomy can be extended to the competition for power and the struggle for scarce resources between low-income and high-income countries. From a human rights–based perspective, the fundamental right to life and health and intellectual property rights constitute competing rights. This classic contest of dichotomies finds a conceptual home within a political economy analytical framework. Understanding the complex relationships that impact on access to HIV in Uganda including the power play by multinationals to secure their commercial interests through using national and trans-national legal regimes is well suited to the rigour of political economy analysis. Pharmaceutical companies are known to lobby their home governments to adopt an IPRs enforcement agenda in low -income countries including at multilateral institutions that set international policy and legal frameworks. In 2012, the US Department of Trade scheduled an intellectual property rights enforcement conference in Cape Town, South Africa which was later called off after civil society protests. ‘Big pharma’‘s sphere of influence extends to African governments and legislatures which are often prevailed upon not to act in the public interest of their own people. An in-depth assessment of the interests and influence of innovator pharmaceutical companies and how their power is exercised is critical to efforts to secure long term access to HIV treatment in the developing world. A stakeholder analysis would inform any measures aimed at securing long-term access to generic drugs including attempts at finding a balance between pharmaceutical industry interests and public health interests in Uganda. Political economy therefore offers a set of methodological tools and contextual analysis particularly suited to understanding the complexities of access to generic HIV drugs in Uganda and the appropriate policy responses and remedial measures needed to secure HIV treatment in the long-term.

The political economy of Ebola drugs and an inconvenient ethical question

Two US missionary health workers contract Ebola in West Africa. Days later, they are on a specially-designed CDC plane to the US. A Spanish catholic priest contracts Ebola in West Africa and is soon flown on an especially-equipped plane to the Spanish capital. Tragically for the cleric, this doesn't end well. A Briton catches Ebola in West Africa and is soon dispatched back to the United Kingdom. With the exception of the elderly Spanish priest, they are all recovering well. In fact, the first US missionary doctor to be flown in was discharged from hospital in the US a few days ago. As for the rest of the dying West African Ebola patients, to bad you hold the wrong passport. And then there are pharmaceutical-related questions to be asked here. Why are the US patients doing well even when there is no approved anti-Ebola drug on the market? We know of course that for 'Big Pharma, this Ebola thing is a no-brainer. It's simple business logic. Why spend millions of dollars developing a new anti-Ebola drug for a handful of African patients- who cant even pay for it anyway? And how often does Ebola strike? When was the last outbreak? Shareholders wont be rewarded. And ethical questions arise here. Why is it morally acceptable for people anywhere in the world die from Ebola when an experimental drugs as practically cured all Western patients it has been treated with? But the West Africans can do better for themselves surely. If Liberia, Sierra Leone and Guinea were to put up a $ 15 million to fast track the Ebola experimental drug with some goodwill support, couldn't that work? And why should African countries continue to expect the west to underwrite the health of its citizens? Credit goes to the Canadians for putting up some funding for the trial Ebola drug. The truth is that investing millions of dollars in research on drugs in treating poor mens' diseases is not going to happen anytime soon. There is need for a basket fund for developing drugs for neglected diseases. After all, we all in this together. A virus or bacteria dont need passports at airports and the world as it is today is intertwined.

Of Putin and press coverage of the Gaza conflict

TIME magazine calls it ''Cold War II''. Any avid follower of international politics already knows what to make of that headline. You would be forgiven for thinking that the Cold War ended in 1991 with the spectacular collapse of the Soviet Union. Who would have predicted that in 2014, Russia would be the most prominent threat to western hegemony? With the tragic downing of MH17 in Ukraine, Snowden and the Ukraine separatists and yes, Syria, it appears Russia is back from the dead to reclaim its old adversorial role in the world. What a difference one individual can make at the helm of a country. Vladmir Putin. Previous Russian president like Boris Yelstin were so mired in the very survival of Russia out of the Soviet ashes that no one imagined that Russia would every be a foe of note post-cold war end. I used to have complete and utter faith in CNN. Watching the current press coverage of the Gaza conflict has revealed how blind I have been. Can CNN ever make an attempt to balance its coverage of the warring parties? I was told Journalists should aim for balance. I am not sure CNN has made a decent effort in this regard to Gaza. And for that matter, should western media be trusted to report international news objectively? My undergraduate classes in political economy tell me that would be an illusion.