Record Funding for Epidemic Preparedness in Uganda
The Challenge
Uganda’s position in the tropical belt of the Congo basin makes it particularly vulnerable to pandemic diseases— including, over the past four years, outbreaks of COVID-19, Marburg, Congo Crimean hemorrhagic fever, Ebola and anthrax. Meanwhile, like many low- and middle-income countries, Uganda has been historically reliant on donor aid. Currently, for instance, 84% of its total health expenditures come from households and external development partners. On top of these challenges, a key institution in pandemic preparedness and response, the National Institute of Public Health (NIPH), lacked the legislative authority to access even the limited public funds that were available. An analysis conducted by the Global Health Advocacy Incubator (GHAI) determined that Uganda’s ability to respond to epidemics was dependent on donor grants –an unsustainable situation.
GHAI’S Response
Analysis
In 2023, Resolve to Save Lives provided financial support for GHAI to participate in Uganda’s national self-assessment and Joint External Evaluation, a process to evaluate a countries’ ability to prevent, detect and rapidly respond to public health risks and prepare for epidemics. GHAI also conducted a detailed political, stakeholder and media landscape analysis to identify needs and opportunities for strengthening domestic epidemic preparedness and response capabilities. One of the findings of this analysis was that advocacy for domestic health security financing was nearly nonexistent.
Collaboration
GHAI partnered with the Uganda National Health Consumers Organization (UNHCO) to develop an advocacy strategy for domestic epidemic preparedness funding. Guided by GHAI’s Budget Advocacy Toolkit for Epidemic Preparedness, GHAI and UNHCO identified and quantified budget deficits, mapped the budget process and identified potential obstacles and opportunities. The stakeholder analysis identified the public health architecture of the country, in relation to financing epidemic preparedness. This architecture includes an established and functional Public Health Emergency Operation Centre (PHEOC), and a robust Integrated Disease Surveillance and Response (IDSR) mechanism that operates under the National One Health Platform and is composed of key ministries, departments and agencies such as Ministry of Health (MOH) Ministry of Agriculture, Animal Industries and Fisheries (MAAIF), Ministry of Water and Environment and the Uganda Wildlife Authority - coordinated by the Office of the Prime Minister , (NIPH) – with the support of the U.S. Center for Disease Control provides technical and logistical support to the PHEOC.
Advocacy
The Coalition adopted three lines of action to advocate for sustainable domestic financing for epidemic preparedness and health security:
- Building a critical mass of CSOs.
- Conducting budget analysis and developing position papers and policy briefs.
- Engaging and enlisting key stakeholders across the legislative and executive branches of government in the push for funding for the PHEOC in the 2024-25 financial year.
Results
In a significant victory for public health, the Coalition’s collaborative efforts culminated in the Ugandan government’s approval of 57.8 billion Uganda shillings (approximately US$ 15.4 million) for epidemic preparedness in the 2024-25 fiscal year. This groundbreaking decision signals a pivotal moment in Uganda’s commitment to safeguarding its citizens from the threat of epidemics.
The critical challenge ahead now is for the implementation of a comprehensive workplan building off the new National Action Plan for Health Security and robust accountability framework to translate this financial commitment into tangible outcomes that protect the health and well-being of Ugandans.
Lessons Learned
- Global learning: Sharing experiences from other countries through GHAI’s international network, especially those with similar political landscapes such as Nigeria and Ghana, helped advocates develop effective strategies that could be tailored to their political context.
- A CSO coalition: The Coalition on Health Security provided a platform for the members to come together with one voice, which played a key role in ensuring a budget was created for epidemic preparedness. The expertise, resources and convening power of the Coalition was invaluable.
- Respect for officials: Government officials expressed appreciation for clear meeting agendas. Hosting meetings in convenient venues and showing respect for officials’ time reinforced the importance of the discussions and made them feel valued.
- Active listening: Prioritizing listening over demands, particularly by allowing officials to share their challenges, created a more collaborative atmosphere and avoided the pitfalls of single-issue advocacy.
- Strategic negotiations: Effective policy change comes from letting officials feel ownership of solutions rather than feeling pressured. This approach also strengthens the perception of participation, collaboration and mutuality in problem-solving.
- Understanding stakeholders: Understanding the roles and interests of key players in the one health platform, particularly MAAIF, MOH and the Ministry of Finance, supported inclusive strategies that addressed varying perspectives.
- Local leadership: Emphasizing the locally-driven nature of initiatives, with thought leadership from a national think tank and government engagement by the civil society coalition, helped address common concerns about external influence.
- Broad support for the Ministry: Offering support to the Ministry in other relevant areas, such as pandemic treaty negotiations, helped build trust.
- Engaging all levels: Involving technical officers, who often prepare critical documents, was key to influencing decisions.
- Personal credibility: Building trust through personal credibility was essential for successful advocacy.
