1. Approaches to service delivery and the implications for public administration
Dr. Vincent Bagambe (MoH-Global Fund, Uganda)

2. Presentation Overview
Global Statistics on HIV
Burden of HIV in Uganda
Drivers of the epidemic
Goals & Strategies for HIV Response
Achievements/response to the epidemic
Challenges
Priorities for the period

3. Summary of Global HIV/AIDS epidemic Statistics
Total
Adults (15+)
Children (<15 yrs)
Number of people living with HIV
35.0 million
31.8 million
(16M Women)
3.2 million
People newly infected
with HIV in 2013
2.1 million
1.9 million
AIDS deaths in 2013
1.5 million
1.3 million
Source: UINAIDS 2014

4. Summary of Global HIV/AIDS epidemic Trends
2001
2009
2013
Number of people living with HIV
30.7million
33.4 million
35.0 million
People newly infected
with HIV in 2013
3.4 million
2.5 million
2.1million
AIDS deaths in 2013
2.9 million
2.1 million
1.9 million
Access to ART -
5.2 million
12.9 million
Source: UINAIDS 2014

5. Uganda’s Response in the Regional and Global Context
There is a general trend of decreasing new HIV infections
Only Uganda experienced an increase in new HIV infections at the last AIDS Indicator Survey (2011)
Trends in new HIV infections for 10 top sub-Saharan African countries:
Source: UNAIDS 2013

6. Burden of HIV
Uganda has been affected by the HIV/AIDS epidemic since the early 1980’s
HIV prevalence among adults aged years is now 7.3%
Women disproportionately more affected than men (8.3% Vs 6.1%)
Estimated No. of people living with HIV (PLHIV) by 2015: 1,544,000
HIV prevalence ranges from 4.1% in Mid-Eastern region to 10.6% in Central region
Urban residents more infected (8.7%) than their rural counterparts (7%)
PLHIV estimated to increase to 1,783,508 by 2020

7. BURDEN OF DISEASE IN UGANDA: HIV/AIDS STATISTICS IN 2015
In 2015, there were 1.54 million Ugandans living with HIV. About 1,973,000 people were estimated to have died of AIDS related causes between 1990 and 2012.
About 383 Ugandans get infected with HIV on a daily basis while an additional 173 people die due to AIDS related causes everyday.
Source: Spectrum data ( 2015)

8. Drivers of HIV Transmission
 Behavioural factors
Multiple sexual partnerships,
Cross-generational, early and transactional sex
Alcohol and substance abuse
Structural/Policy related Factors comprise of:
Inequitable access to health services,
Governance, Accountability, Coordination, and
Stigma and discrimination.

9. Drivers of HIV Transmission
Socio-economic factors
Harmful socio-cultural practices e.g. polygamy & widow inheritance
Gender norms (women can’t negotiate for safer sex
Gender-based violence,
Violation of rights of women and girls,
Economy & mobility (migrant work, poverty and wealth)

10. Impact of HIV on Uganda AIDS Deaths:
About 1,973,000 people died of AIDS related causes between 1990 & 2012
Economic Impact
Reduced labor supply, by reducing population growth
Reduced productivity and investment due to morbidity
Increased spending on HIV/AIDS: from 0.6% of GDP in 2004 to 1.5% in 2007 & to 3.0% in 2012
Social Impact
Increased household poverty
increased OVC: 21% of Ugandan children are either orphaned or vulnerable (OVC)

11. Overall Goal and Sub-Goals

12. Key Achievements to date, towards HIV response
Uganda decreased HIV prevalence from a peak of 18% in 1992 to a low of 6.1% in 2002;
But got a resurgence to 6.3% in 2004/05 & to 7.4% in 2011
New infections increased from 95,000 in 2002 to 160,000 in 2011
Strengthened delivery systems
72% individuals within 5 kms of a health facility
HIV testing taken beyond health facilities to outreaches
Strategic information management has improved
DHIS2 and Open MRS system
Aids Indicator Surveys regularly done

13. Key Achievements to date, towards HIV response
Access to HCT services Increased from 24% in 2006 to 50% in 2011 (5M people)
Increased SMCs from 400,000 in 2012, to 1,023,357 (at 1295 sites) in 2014
Increased ART facilities from 475 in 2011 to 1,603 by June 2014
Improvements in lab infrastructure: 100 regional hubs and Early Infant Diagnosis testing centres established

14. TREATMENT – UGANDANS ACCESSING ART
Coverage improved: Access points for ART increased to 100% hospitals, 100% HCIVs and 63% HCIIIs now providing ARTs;
BUT Eligible PLHIV increased: to 821,721 (2014 at CD4-350) and +1.3m (2015 at CD4-500)
Uganda has increased the number of access points for ART with 100% hospitals, 100% HCIVs and 63% HCIIIs now providing ARTs;
There has been a dramatic increase in lives saved as the number of PLHIV that were put on treatment increased from 17,000 in 2003 to 566,000 in 2013, and to 834,931 in 2015
By June 2013 the percentage individuals eligible and accessing ART was 76.5% (i.e. 8% children and 76.5% are adults); However, this percentage fell back to 61% in 2015 due to change in WHO treatment guidelines
Eligible children accessing drugs is only 41%
Source: MoH (2013)

15. Challenges
Inadequate budgetary provision to support critical HIV services (e.g. WHO guidelines)
Poor infrastructure with mostly dilapidated buildings
Inadequate staffing especially for the rural based health facilities
Poor supply chain management, hence stock outs/expiries of drugs &essential commodities
Inaccessible laboratory monitoring services
Weak M&E systems,
Services mostly donor supported

16. HEALTH FINANCING REMAINS INADEQUATE : 2007/08-2010/11 & 2011/12-2014/15
WHO Recommendations
Per capita public expenditure on health has continued to decline from $11.1 in 2009/10 to $9 in 2012/13; this falls short of the WHO recommended amount of $40
GoU Health Budget as % of Total Budget has also declined from 9.6% in 2009/10 to 7.9% in ; this is far less that the 15% traget in the Abuja declaration.
Abuja Declarations
Source: UAC (2011)

17. Prioritization period 2015-2025
Scale up ART to reach 80% coverage with treatment for the MARPs, irrespective of CD4 count;
Expand eMTCT coverage with ARVs to 95% among HIV infected pregnant women
Promote SMC to attain 80% coverage by 2025
Increase accessibility to and use of condoms in high-risk sexual encounters (80%);
Scale up HTC to 50% of eligible population annually;
Promote BCC focusing on sex workers, MSM, fishing communities, truckers and uniformed personnel as well as young people in and out of school