The news from around the country is not good; in some places we are hearing of people with access to anti-retroviral treatment succumbing to the Aids condition because they do not have food to eat (healthy eating is an essential factor in managing the condition), while in other places HIV/Aids sufferers with food do not have access to therapy partly because the high incidence of infection, has outstripped the financial resources currently available to make ARV's available.

However, in a few weeks, an agreement between the Uganda government and a local drugs producer, Quality Chemicals (QC) will be complete. The agreement will specify what nature of life-saving HIV/Aids drugs the company will provide for the 300,000 or so Ugandans infected with the HIV virus and require treatment.

It is what health managers and experts in Uganda's checkered fight against the pandemic hope the future will look like. Locally procured medicines with Ugandan taxpayer's money to replace a long, and some say dangerous addiction to donor-funded procurement.

The government has set aside some Shs60 billion to procure locally manufactured ARV's from QC - a business with suspected strong connections to the higher-ups of the ruling National Resistance Movement party. Until this point, the country's HIV/Aids response plan has been "rented house" for donor countries and NGO's providing virtually all Anti-Retroviral Treatment. This has bred a situation which some say has made Uganda a hostage to the agenda set by big Western-based pharmaceuticals who benefit from the millions of dollars spent by Western countries supporting the treatment of Ugandan patients.

Regardless of the truth or not of such views- what is factual is that there are major contradictions in strategy - led by the concern that the national response is tied too tightly to the rules governing the money outsiders provide.

That's the part that the Ugandan authorities have no control over. A glance at the plethora of organisations involved in HIV/Aids management and the mangled distribution network for drugs cannot qualify the success of treatment programmes nationally.

It's to the broken health care system that some point for most of the problems that Uganda is facing. One observer pointed out that in one district like Kabale there are multiple organisations all providing ARV's including The Aids Support Organisation (TASO), the Joint Clinical Research Centre and the Ministry of Health itself. There could be more. And this scenario is replicated around the country.

Ideally information about all patients and their needs are tracked and fed into a nationally coordinated plan but experts say far from it - and despite the hype about Uganda's successes in the past - there are huge gaps in information - HIV/Aids treatment is in a mess. It's a statistical nightmare as many varied figures are churned out and no consensus exists on the correct number of patients, infections and trends.

The Aids Information Centre (AIC) should know but says it does not. "MoH does not have a complete list or general number of patients (although it claims it does)" says Dr Raymond Byaruhanga of the AIC who says most organisations report centrally to the Ministry of Health.

With a reported rise in new infections, confirmed two months ago with much alarm by Uganda Aids Commission chief, Dr Kihumuro Apuuli, there is also a moral and medical dilemma as patients old and fresh are suddenly left without drugs for months. And it goes something like this.

In light of the financial crisis, accusations of corruption such as the Global Fund saga, money for Aids treatment is dwindling leaving patients reeling as stock-outs are reported. There are unconfirmed reports of deaths of patients unable to get their regular dose at government-mandated clinics, says Dr Byaruhanga.

"There are too many players and little coordination between them," he says, adding that in fact Uganda has no reliable numbers of HIV-infected persons or those on treatment. "We have poor statistics which means we plan badly," he adds.

Fortunately, despite that poor planning there are pockets TASO where patients are guaranteed regular supply because unlike other players it is in charge of its entire chain including procurement of drugs. "The solution is twofold. Uganda can produce its own drugs and supply to its patients or pay for treatment of patients directly [as opposed to donor funds.] I pay taxes why should I not get treated by the government?" asks TASO director Robert Ochai, who recognises the dependency but says patients must come first.

TASO and other organisations reflect the schisms in the patchwork of HIV/Aids treatment. "The donors run a parallel process," explains a senior Ministry of Finance official who tracks health care spending. "Government has little control over what they do".

The official who could not be named because they were not authorised to speak to the media on the matter told Sunday Monitor that the National Medical Stores - the official drug repository - only distributes donor drugs to accredited distribution centres. This means that NMS can only distribute what has been delivered to it and to whom it is instructed to. Currently, the body has Aids drugs to last five months (this is matched to pre-existing programmes not new ones) in stock.

"We receive ARVs on behalf of the government and distribute them according to instructions from the Ministry of Health. Currently there are two Ministry of Health staff at NMS helping in translating orders from treatment centres and drawing up allocation lists" said NMS publicist Hamis Kaheru in an emailed response to Sunday Monitor.

"It is against those orders and allocation lists that ARVs are picked and packed in our stores and then delivered to treatment clinics. Therefore it is true that we don't control how much ARVs we stock and distribute. However there are indications that this will change soon because we have been informed that NMS may start handling supplies from Quality Chemical Industries Limited (QCIL) for which government pays QCIL directly. Therefore we shall be dealing with QCIL directly" he adds.

The involvement of the Ministry of Health suggests that the government has some say in procurement and distribution but according to Dr Byaruhanga there remains an unequal relationship between the state and donors.

He argues that this explains the bizarre situation where tonnes of drugs are procured for non-existing patients which then expire on NMS shelves. He adds that donors still have a bigger say on where to procure the drugs leading to delays especially when there is disagreement with government.

"For example PEPFAR (the American-funded Aids support and treatment programme) objected to procurement of drugs before including from Quality Chemicals. Where the donor pays, he calls the tune" he said.

The head of planning at the MoH, Dr Francis Runumi, in a phone interview on the sidelines of a health conference in Kigali however said the relationship between the ministry and donors is governed by a Procurement and Supply Plan (PSP) which acts as an agreement of sorts as well as a roadmap. It details the quantity and type of HIV/Aids drugs that are required. It's based upon this agreement that procurement on a competitive basis is initiated.

Health officials say that a lot of Uganda's Aids drugs are procured this way and suppliers of both generic drugs like India's Cipla (a partner in QC) and well known global pharmaceuticals compete on even ground. However, the PSP governs mainly procurement out of the Global Fund for HIV/Aids, Tuberculosis and Malaria.

Other organisations that procure for themselves including PEPFAR which runs one of the biggest budgets determine their own suppliers.

According to Lynne McDermott, the PEPFAR communications officer based at the American Embassy in Kampala - the programme will continue to spend $280 million annually on HIV/Aids through 2013.

"There are indeed problems with the supply of ARV's in the national programme" she acknowledges and adds that even with PEPFAR's funding "there is a gap between national treatment needs and funds available to provide treatment".

PEPFAR funding accounts for the largest percentage [61%] of off budget money for health care in Uganda according to an August 2008 study. The US embassy notes that American money alone is two thirds of HIV/Aids response in Uganda.

A major distortion in Ugandan government spending on health care is precisely because it is a minority stakeholder.

Of the close to $800 million planned for spending on healthcare in the financial year 2009/10 half is donor money. It is however unclear if the government would be better organised had its own funds been sufficient. Organisational weaknesses clearly exacerbate the problem of making the best use of the money available. A study by the World Bank for example found that nearly 90% of all drugs at NMS did not reach their intended recipients - let alone the leakages in the public health sector blamed for the waste that goes on. Former health minister Mike Mukula says inconsistencies in the fight against HIV/Aids is entrenching the disease.

"The way you make babies is the way you get HIV. Uganda's population is rising and the politics of procurement must be put aside. No single African country can meet the bill of costs for treatment. Aids should be de-politicised nationally and internationally so that all hands are on deck in this fight," he said.

After two decades in the trenches it will take more than speeches to turn the page.