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President Trump’s suspension of all aid to Uganda is the latest contingency that the country failed to foresee and make provision for. Landslides, drought and famine happen so frequently one would have thought they would be part of the budget cycle by now but the Ministry for Disaster Preparedness seems always to be caught unawares. 

Following the famine of 2017 in which 10.9 million people experienced acute food insecurity, the auditor general reported that, in violation of the Public Finance Management Act, the government had not set up a contingency fund. The locust invasion of 2020 affected the same region of the country, Karamoja. At the height of the crisis, the Ministry of Agriculture could not get immediate access to locust control equipment from the Desert Locust Control Organization because of unpaid membership dues amounting to USh11 billion. The COVID pandemic found the Ministry of Health scrambling to repair 94 grounded ambulances.

It seems like a long time since I wrote about aid dependency and the possibility that donor country goals could change, leaving Uganda unprepared. It was clear then that, under Donald Trump’s first presidency, there was a very real likelihood that the US would withdraw funding from United Nations organs as he had pledged to do. It has come to pass; America’s agenda has changed. With the exception of Israel and Ukraine, US aid to all countries has been suspended. America has also announced its intention to withdraw from membership of international NGOs such as the World Health Organisation.

Under the Structural Adjustment Programme, priorities were set that were deemed to be important (but not important enough for local capacity to be built around them). These projects were farmed out to donors and consultants from their countries. International NGOs took up outstanding projects. For example, few African governments are wholly responsible for routinely vaccinating their children. UNICEF (to which the United States is the largest individual donor), the Global Fund (to which President Biden pledged US$6 billion in 2022) and other international NGOs carry the bulk of the burden. The World Health Organisation (WHO) covers much of Uganda’s healthcare; its main contributor is the United States, which donated $1.28 billion in 2022/23. That funding is scheduled to stop by executive order of President Trump.

The World Bank used to track the percentage of the costs of vaccination covered by aid recipients. For the past few years, this dataset has not been available on the World Bank website. What is known is that WHO funds used to fall short of budgetary expectations even before the suspension of aid.

More than half of Uganda’s health sector budget is donor-funded. Few districts receive all the external assistance (donor funds) they optimistically put in their budgets. As a result, health services are underfunded. For some years now, the auditor general has been reporting on local government revenue performance, including the performance of the external assistance budget for each district. Where programmes are not implemented, the most common reason given by district officials is a shortage of funds. In the case of donor funds, the refrain from Abim to Zombo is, “This was caused by the fact that the donors send money at their discretion.”

Services curtailed by the shortfalls include immunisation, treatment of tuberculosis and malaria, construction of school facilities, and rehabilitation of boreholes, which in turn affects education services and the supply of safe water. 

In 2022/23, the United States provided, among other assistance, over 1.3 million insecticide-treated bed nets for mothers visiting health clinics for antenatal care; indoor residual spraying providing malaria protection for over 3.8 million Ugandans in 10 districts; 1.32 million doses of malaria medications; and 1.25 million rapid diagnostic tests. 

Shortfalls in external assistance are a regular occurrence. A few examples of shortfalls in expected donor funds follow in the table below:

External Assistance (Grants) expected and received

DistrictBudgetTotal ReceiptsShortfall% Received
Abim (2021)6,271,311,918 335,542,488 5,935,769,430 5.4
Adjumani (2022)        5,788,894,200     2,785,858,268   3,003,035,932         48.12 
Amudat (2022)      3,602,240,295       986,257,442   2,615,982,853 27.4
Bududa (2021)702,009,000196,289,300505,719,70028.0
Buikwe (2021)16,085,930,3452,564,615,91813,684,646,11014.9
Gulu District (2022)3,015,683,214451,067,2962,564,615,91815.0
Isingiro (2023)28,448,014,826028,448,014,8260.0
Sources: Local government audit reports for the years indicated

Overall, in 2022, USh197,395,695,925 in local government grants was expected from donors. The total received was USh71,542,080,541, leaving a shortfall of USh125,853,615,384. Only 36 per cent of expected donor funds were received. The auditor general’s polite guidance to local governments to “prepare budgets in consultation with donors to ensure realistic and attainable revenue estimates” only emphasises the fact that Uganda’s development goals do not necessarily align with donor goals, and the further fact that the foreign agenda takes precedence. The rest of the advice ̶ “LGs should further ensure compliance with donor requirements to avoid penalties and unnecessary delays.” ̶ raises the issue of competence. The government’s inability to use received funds – USh703,665,173,939 in 2022 – is a matter for another discussion.

In response to the looming development aid budget cuts, the permanent secretary for health has explained that her ministry is currently reviewing donor funding with a view to identifying essential services (the funding for which could potentially to be reinstated). What is disingenuous about that statement is that even before the threatened Trump cuts, the health sector and most other sectors were woefully underfunded. While the government boasts about numbers of pupils enrolled, it is reticent about how many have chairs or desks and how many sit on bricks and rocks. Furthermore, despite the availability of human development statistics from the UNDP, the government of Uganda does not discuss the high primary school drop-out rate of 40 per cent, caused in part by overcrowding, lack of books and hunger (eleven per cent of Ugandans have one meal a day), and dwindling enrolment.

In the 1990s, there was an agreement between the World Bank/IMF and the government of Uganda that “priority programme areas” would be fully funded regardless of what happened in other programmes. To my recollection, this ring-fence was breached when Uganda invaded the Democratic Republic of Congo. Then, 25 per cent of the budget of each sector was shaved off to finance the military adventure.

Despite profligate, wrong-headed and frankly self-serving expenditure, donors including the United States continued to give without requiring value for money. Districts that could not cover the cost of rehabilitating boreholes at the cost of under USh200,000 million, are represented by three members of parliament, each of whom government has gifted USh200,000,000 to buy themselves vehicles. The ministries of health and education are not on record arguing that the funds would be better used for immunisation, or to meet the USh16 billion shortfall in the emergency ambulance service budget, or to expand safe water coverage from 62 per cent to 100 per cent of the population. On the contrary, plans to put up a health centre and secondary school in every sub-county were quietly shelved in 2024.

Still, the IMF insists there is no cause for alarm. In 2016 it issued a Debt Sustainability Analysis stating, “Government finances remain on a sound footing, though expenditure composition can be of concern.” It has not identified aid cuts as a risk factor in debt sustainability.

None of this matters to Trump, however. His agenda is to spend his taxpayers’ money on advancing America’s interests. Soft power, influence acquired through funding developing countries, is no longer important to the United States.

We had a good run, USAID funded a broad range of programmes including in 2022 alone; 140,279 households connected to the national electricity grid (while the government reached only 7 per cent of its target); 180,000 people benefited from USAID-supported energy-saving stoves, water-harvesting tanks and other resilience activities; 384 community members received beehives to protect them from wildlife invasions; US$871,084 (USh3.3 billion) was given to support agricultural cooperatives, off-grid energy and women-led agribusinesses, and US$462,436 (USh1.7 billion) went to support communities and the private sector for nature-based business start-ups improving stewardship of natural resources.

With such basic needs (essential to each recipient), it is astounding that the government continues to indulge in wasteful expenditure. State House spends USh2 billion per day and parliament sends a team to the annual East African Parliamentary Games at the cost of USh6 billion (US$1,624,550).

The question is, if made permanent to a significant degree, what impact will the cuts have on governance? Ugandans may expect a greater sensitivity to human development deficits in their leaders. Leaders who had become accustomed to abandoning human development – healthcare, education and access to water – to donors, and hiding behind the appearance of providing critical services, however rudimentary, will find that even that basic level of service is not available to take credit for. What will happen when, as p’Bitek said, “The buffalos of poverty knock the people down,” when drug stock-outs increase, and immunisation and TB treatment programmes grind to a halt, and long-term ARVs, Maama Kits, and nutrition programmes are in shorter supply than usual? Possibly there will be an increase in social unrest and a review of debt payments.

The voting public may become more focused on holding their leaders to account. They may question how it is that at public expense their leaders enjoy lifestyles rivalling those of leaders in industrialised countries while the majority of their constituents still live in semi-permanent structures and continue to carry water long distances from water sources (some safe, some not) to their homes. 

Entire districts receive between just USh350,000 and USh1.5 million per year under the Uganda Road Fund to grade the access roads so essential to market gardeners. Even then, they often experience budget shortfalls, resulting in impassable roads. It is cynical if not criminal for leaders to waste the limited resources available on self-indulgence, but far worse is the lack of any real challenge from the electorate. For instance, leaders continue to receive medical treatment abroad, and are visited in hospital there by parties of parliamentarians each drawing enough in per diems to replace the bricks and rocks in a primary school classroom with actual furniture.

Again, President Trump is not making a moral argument; he simply isn’t interested. We do not add value to anything he is trying to accomplish. The moral of the story was articulated by Thomas Sankara: He who feeds you controls you. Slavish support of American policy goals, including getting deeper into debt, and remaining silent during the Gaza genocide, in order to remain on the right side of their donors has not secured American aid. If anything, negotiating the reinstatement of the funds will require further surrender, such as cold-shouldering China as required.