Fahamu (Oxford)

13 December 2012

Africa: Tackling HIV and Aids Through Taxation in Uganda

Photo: Emily Dugan/Merlin
Merlin community workers with sex workers on the Ugandan border, South Sudan.

analysis

A new tax on goods and services is being proposed in Uganda to fund HIV and AIDS prevention and protection programmes. But the idea has sparked a debate about government performance in managing funds

In the early 1980's Uganda had an extremely high rate of HIV and AIDS infection that was a serious social problem. President Yoweri Museveni, in power since 1986, has been applauded for his pro-active approach to HIV and AIDS and for being a leader in Africa on prevention methods. He spearheaded a mass education campaign promoting a three-pronged 'ABC' HIV and AIDS prevention message: Abstinence from sexual activity until marriage; Be faithful within marriage; and Condoms as a last resort.

He was ably assisted by significant foreign aid; most notably the United States President's Emergency Plan for AIDS Relief (PEPFAR). From 2004-2011, for example, Uganda received US$1.8 billion in direct funding.

Despite the continuation of this financial support, since 2007 HIV and AIDS infection rates have stagnated and even show a small increase from 6.4 to 7.3 percent.

Is a fresh, more sustainable approach, now needed? And what might this look like?

WHAT IS BEING PROPOSED

A working paper released in September 2012, Justification for Increased and Sustainable Financing for HIV in Uganda, proposes the creation of a fund specifically designated to assist projects for HIV and AIDS prevention and protection.

The fund will generate cash through levies on bank transactions and interest, air tickets, beer, soft drinks and cigarettes, as well as taxes on goods and services traded within Uganda. In addition a small tax will be added to telephone calls and to each kilowatt of electricity consumed (equivalent to 1 Ugandan Shilling (0.025pence) per phone call).

The revenue generated is expected to be spent on condom distribution, reducing cases of sexually transmitted infections and in the prevention of mother to child transmission.

In discussing the thinking behind the strategy David Apuuli Kihumuro, director general of the Uganda AIDS Commission outlined the need for Uganda to fund its approach to HIV and AIDS without such heavy reliance on international support:

"[Currently] 68 percent of Uganda's HIV funding comes from donors, and 20 percent from HIV-positive people and their families, while only 11 percent comes from the government and 1 percent from the private sector."

REACTIONS TO THE TAX

The reactions from ordinary Ugandans have not been particularly favourable. It's not been so much about the idea of a HIV and AIDS tax being proposed that is drawing dissent, but it is more revealing of the absence of faith held in the government not to pocket the funds.

The current scandal at the Office of the Prime Minister discovered in October by the country's auditor general- the theft of €12 million committed by workers based at the Office of the Prime Minister, taken from joint donor funds from Ireland, Norway, Denmark and Sweden that was ear-marked for peace and development programmes in Northern Uganda - is still fresh in the memory and has led to several international organisations and governments withholding or suspending aid.

These kinds of breaches of trust felt by Ugandans and donors provide the backdrop to nearly all political debates in Uganda. Although people I have spoken to do not necessarily think the HIV and AIDS tax idea is a bad one, there are still those who don't support it based on "official" Uganda's recent record. Most people believe that the practices of managing and enforcing the tax would fail to achieve the results it sets out to in the first place. Two of the most repeated questions I have heard again and again were:

Who would be in charge of dispersing the funds?

And how would accountability for the funds be created?

Citizens are also asking why the current funding, which remains high, around $400 million in 2010-11, is not preventing an increase in the rate of infection.

Three issues remain problematic:

1) There is a failure to properly engage with the root causes of the problem in rural areas. Knowledge levels of prevention methods remain at just 33%.

2) The key driver of infections in adults is complacency, both amongst citizens themselves and the government lessening it as a policy priority.

3) Lack of trained public health officials with the outreach and equipment to have an impact.

Questions therefore need to be asked as to whether it is a shortfall in funds that is the problem or the attitude and approach to tackling the issue which needs re-thinking.

WHAT'S HAPPENING IN NEIGHBOURING COUNTRIES?

Other African countries have also trialled or are considering similar measures and so this debate is not just taking place in Uganda.

In Kenya the National Aids Control Council (NACC) is proposing that the government enforce a 2 percent tax on mobile phone airtime, to raise $153 million over five years. It has even been reported that the country's largest mobile phone network has expressed a willingness and support to participate in such a programme.

Kenya is already part of an air ticket funding scheme, whereby a small levy on airline tickets and cargo goes towards HIV and AIDS programmes. The money raised is specifically used to buy anti- retroviral drugs.

Meanwhile Zimbabwe has also a strategy which raises funds for HIV and AIDS prevention through taxation at 3 percent. This was a policy forced on them in 1999 by declining donor support brought about by political developments in the country. Low salaries and weak state structures have made collecting this difficult. Recent years have seen revenues of $20.5 million collected from this scheme but while it is undoubtedly an improvement more is needed to tackle the HIV and AIDS problem in Zimbabwe.

FINAL COMMENTS

The idea of levying a small tax on everyday goods such as petrol and phone tariffs is an innovative, bold solution and one that, at least in theory, has merits for ensuring sustainable funding that isn't dependent on international support.

Ugandan scepticism-at-large about the transparency of parliament and the air of resignation about official corruption held by the public and by government officials are at the core of why meaningful debates about a HIV and AIDS health tax are being held back.

Is this method of collecting revenues the right solution for Uganda?

How can the money be best spent to get Uganda reducing its HIV and AIDs infection rates?

These are just some of the questions that should be driving the debate, and hopefully will. An announcement of a renewed commitment to tackling HIV AIDS by the government on 3 December 2012 may be a start but there is a need to involve all Ugandans in a national debate. HIV and AIDS affects a huge percentage of the population, directly and indirectly, and their views cannot, and should not be ignored.

Opinions about how to tackle HIV and AIDS may differ but the ideal of a society free of the illness is a vision shared by all.

Jamie Hitchen currently lives and works in Kampala, Uganda. Having obtained a Masters in African Politics from the School of Oriental and African Studies (SOAS) he now works for the Human Rights Centre Uganda (www.hrcug.org).

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