Special Reports

Long Read: Dr Atwiine’s War: How Plans to Rob Billions from Health Ministry were Foiled

On one chilly morning, the Health Permanent Secretary Dr Diana Atwiine was on her desk sipping on a cup of hot tea. Being an early riser, Atwiine, according to staff, is always in office before 7:00am.

This gives Atwiine, who previously headed an investigative desk that probed theft of drugs from public health facilities, time to hold early morning meetings ahead of his normal official duties.

On her table was a report on the Bills of Quantities (BOQ) for the Intergovernmental Fiscal Transfer (UgIFT) Program for Results (P4R).

The World Bank-supported project is intended to improve the adequacy and equity of fiscal transfers and improve fiscal management of resources by Local Governments for health and education services.

The cost of BOQ was Shs 1.5bn per Health Centre II to be upgraded to Health Centre III.

“This can’t be,” Atwiine, who was appointed Health Ministry Permanent Secretary in 2016, told technocrats at her office.

“Isn’t it possible to revise the figure downwards?” she challenged her staff.

The Project Management Unit (PMU) would later revise the BoQs to Shs 800m from Shs 1.5bn per health facility – with improved designs.

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This increased the number of health facilities that could be upgraded from 285 to 297 facilities.

This, to Atwiine, was an eye-opener to something bigger –the cost of services rendered by external service providers was hugely inflated.

To some extent, staff at the Ministry were complicit in reaping off the taxpayer.

If the costs were revised, the taxpayer would be saved billions of shillings.

Under UgIFT, the PMU intervened in the design, procurement, monitoring and supervision of the program. This was achieved because of strict supervision and ensuring value for money.

This intervention resulted to savings worth Shs 7.0bn in the first year.

Kawolo

An attempt to siphon funds was visible at Kawolo General Hospital. It’s here that most casualties of road accidents along Jinja road highway are taken. The hospital had gone to the dogs and efforts were underway to bring it back to life.

PMU brought forward the completion date of Kawolo General Hospital to April 26, 2019 saving the Ministry, USD 110,142 in consultant fees. This was achieved by reducing the projected time extension due to delays from 6 months to 3.5 months.

The completed Casualty Block to Handle Accidents and Emergencies at Kawolo General Hospital
The previous state of Kawolo hospital

“This increased the level of supervision introduced in contract execution of Kawolo Hospital and limited unnecessary variations to the project. This resulted in the project saving USD 353, 500,” said Dr Atwiine in her report sent to Parliament which ChimpReports has seen.

These funds have since been redirected to construct a perimeter wall.

Lyantonde Hospital

As if this was not interesting enough, a team of Engineers were tasked to assess the scope of work for the proposed reconstruction of the maternity ward at Lyantonde General Hospital.

The Bills of Quantities were revised and a saving of Shs 124,777,418 was realized.

Atwiine and fellow technocrats agreed to use this money to construct a six stance VIP latrine and a foundation for the mortuary.

Additionally, a team of Engineers (PMU) carried out a cost and performance appraisal of the works for the refurbishment of Radiotherapy Department (Cancer Bunker) at Uganda Cancer Institute.

The Contract signed was of Shs 1,016,630,434. The appraisal revealed that the work carried out was worth Shs 707,633,529 in spite of the contractor’s claim of Shs 1,407,962,011. The intervention caused a saving of Shs 700,328,482.

The Auditor General has previously castigated government bodies over poor management of contracts. Billions of shillings are lost annually due to gross neglect of duty, incompetence, fraud, collusion and corruption.

When Dr Atwiine took charge, the Health Ministry was grappling with a crisis of confidence of development partners.

Winning them back to support the sector especially UNICEF which had stopped disbursing funds for two years earlier because of lack of accountability, corruption and inflated contracts was a daunting task.

In 2014, prior to Atwiine’s coming, Uganda Health Systems Strengthening Project (UHSSP), a World Bank Funded project constructed 20 Maternity wards of 222.4 square meters at an average cost of Shs 1.2bn (excluding general conditions, preliminaries, contingencies and VAT).

In 2018, Uganda Inter-Governmental Fiscal Transfer Program Constructed 124 Maternity/General Ward of 338 square metres at an average cost of Shs 500m.

MoH PS Diana Atwiine engaging the media during a field exercise

GAVI had likewise suspended support because of lack of accountability and misuse of funds.

Restoring donor trust required recovery of misused funds and building stronger accountability systems.

Atwiine and some staff members worked hard to recover funds from staff who had misused it both from headquarters and through Local Governments. This was a precondition for donors’ recommitment to fund the sector.

The first two years of her office was a daunting task to find resources within the limited budget to refund GAVI, UNICEF, WHO and Global Fund that had threatened to pull out their support.

Atwiine recently told Parliament that she was happy to note that donor confidence was restored.

“These partners have not only supported us, but have committed more resources than ever before because of the commitment of the Ministry of Health to account for the resources through the financial reforms I had instituted in Ministry of Health,” she said in a report to Parliament.

Accountability was a big challenge as un-accounted for funds were in billions for the previous years.

Currently, individuals and Local Governments are not only adhere to strict financial management but to refund where they fail to account.

This is still a big task as the Ministry struggles to inculcate the culture of results, value for money and proper and timely accountability through mindset change.

Karamoja

Under Karamoja Infrastructure Development Project, 68 Staff Houses were constructed in Karamoja at UGX 428,206,000 (excluding general conditions, preliminaries, contingencies and VAT)

In 2019, PMU prepared an Engineering cost, according to market survey, in preparation for construction under UgIFT. The same staff houses under the UgIFT program will cost Shs 103 Million for each of the 343 facilities.

This Intervention has saved the government approximately Shs 112,574,658,000.

In 2014, prior to Atwiine’s arrival, Uganda Health Systems Strengthening Project (UHSSP), a World Bank Funded project constructed 20 Maternity wards of 222.4 square meters at an average cost of Shs 1.2bnn (excluding general conditions, preliminaries, contingencies and VAT).

Later on in 2018, Uganda Inter-Governmental Fiscal Transfer Program Constructed 124 Maternity/General Ward of 338 square metres at an average cost of Shs 500 Million.

With the support from PMU, the cost of construction in MoH has been brought down by 50 percent yet maintaining excellent Quality.

As Atwiine started to bite, technocrats who were reaping from corruption windfalls put up resistance.

Whistleblower reports were sent to the Inspectorate of Government and President’s office.

A source, who spoke to us on condition of anonymity, said Atwiine regularly briefed the president about her operations. This made it difficult to rally Museveni against Atwiine.

Solar scandal

Under the Global fund, 149 health centres benefited in receiving a complete package of Solar system for Information systems.

After assessing the works by PMU Engineers, several items which included Lightening arrestors, earthing and all associated switching gears in addition to supplying sub-standard batteries all totaling to Shs 211,770,000 that had been paid for but were not included in the installation were unearthed.

This was brought to the attention of the Contractor and all the missing items were installed.

With keen supervision, the trend of providing substandard goods was reversed.

A power bank system for the Ministry of Health initially priced at Shs 164,963,705 for batteries with a lifespan of two years, was reduced to Shs 114,963,705 with batteries that had a lifespan of at least 5 years.

Better quality batteries were procured that had an advantage of extra 3 years and at a lower cost.

These details underscore the extent of corruption that had taken root at the Ministry and spread to different parts of the country.

According to a low-ranking official who spoke to us on condition of anonymity, contractors had created inexistent maintenance centres for solar installations thus stealing large sums of money.

Between the months of April – June 2019, invoices totaling to Shs 168m had been submitted for payment.

“PMU Engineers with support from PS discussed with contractors about this and resolved not to pay the money as there was no value,” recalled an official at the Ministry.

Service providers for local area network installations for level 3 block B at Ministry of Health were initially priced at Shs 140,683,107 (USD 38,020), saving Shs 78m.

Some of the equipment supplied to the Ministry were found to be defective

PMU technical assistance reviewed the BOQs and evaluated the work before reducing the cost Shs 61,853,902 (USD 16,700).

And recently, uninstalled solar energy packages in several districts amounting to Shs 450m for contracts done in 2011 were found on site, while others could not be accounted for.

An official told us that PS Atwiine was livid.

She insisted on specific performance of these contracts. The contractors have been compelled to correct the anomaly.

Maintenance of non-existent solar installations have been registering annual cost of not less than Shs 600 million. Non verification in the past led to payments for both incomplete and inexistent work.  Invoices totaling to Shs 445,000,000 had been submitted between the months of November and December 2018 for annual maintenance costs.

Upon verification only Shs 108,000,000 was paid, realising a saving of Shs 337,000,000.

Under ERT III running Contract, solar installations in the 329 Health Centres faced a huge challenge.

Fake earthing materials costing Shs 108,000,000 had been shipped into the country to be used in these Health Centres.

The Contractor was asked to re-order the correct materials.

Under ERT III running Contract, Solar installations in the 329 HCs, the contractor had been scheduled to be paid Shs 187,500,000 in excess of the solar packages to be installed. The number of packages to be installed were less compared to the actual number that is in the contract.

Additionally, the procurement of ERT III vehicle in May 2019 saw the cost inflated to USD 70,000. After Atwiine protested, the same vehicle was procured at USD 50,000.

However, the annual health sector report released recently indicated the Ministry has a long way to go.

By the Financial Year 2018/19, the health sector was able to achieve the annual performance targets for only 8 out of the 41 (19.5 percent) Health Sector Development Plan (HSDP) indicators and remarkable progress was realized in another 8 (19.5 percent) indicators although the annual HSDP targets were not met.

The report also indicated that there was “minimal, no progress or decline in performance in 25 (61 percent) of the indicators and these indicators are still far from the HSDP target.

“There is need to identify appropriate interventions to address the bottlenecks achieving the HSDP targets,” the report concluded.

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