Ethical Challenges In Big Data In The Developing World

Third party sale of big data for commercial reason is more common than actually believed and many times without patient’s knowledge and consent. These challenges are compounded when the literacy rates are suboptimal in LMICs where questions of understanding informed consent have risen. There is an ongoing debate in the developed world on how to establish national and international standards and policies. Lacks of uniform definition of big data along with its blurred geographical boundaries thus have a destabilizing effect on existing bioethical norms

By Nighat Khan

Fertility and Gynecology Center, Karachi Pakistan

nighat.khan.13@ucl.ac.uk

Ethical Challenges In Big Data In The Developing World 

 

Introduction

Exponential global growth of information and communication technology has been witnessed recently in every day and in health care. Global cellular penetration is approaching 96% (Lower middle income countries -LMICs’ penetration 89%), and mobile users have reached over 7 billion according to International Telecommunications Union (ITU)  and at the end of 2018, 51.2 per cent of the global population, or 3.9 billion people, were using the Internet (1) [Fig 1].

Health care challenges like resource shortages and patient safety concerns demand a quick access and exchange of medical information amongst the practitioners with an increasing involvement of patients empowering them with a more dominant role in their care (2). In the developed world, the technology-driven exchange of information has diverse and ubiquitous sources ranging from health care industry generated like electronic medical records to patient generated personal health information through social media domains. These massive data sets or big data have the potential to improve quality of healthcare delivery in a cost effective manner by supporting wide spread health benefits such as disease surveillance, decision support and public health management (3).

Fig 1: Global information and communication technology (ICT) developments according to a recent ITU report (1)

 

Big data

Microsoft defines it as “Big data is the term increasingly used to describe the process of applying serious computing power – the latest in machine learning and artificial intelligence – to seriously massive and of- ten highly complex sets of information” (4). Other definitions describe big data as a term describing the storage and analysis of large and or complex data sets using a series of techniques including, but not limited to: NoSQL, Map Reduce and machine learning (5).

Although there is a lack of uniformity in defining big data, its attributes throw some light on its meaningful interpretation. These characteristics (6 Vs) are: Volume: the data comes in large amounts.  Variety: the data (structured and unstructured) have different sources. Velocity: the data has a real-time and continuous nature. Veracity: the data can be triangulated from multiple sources. Validity: the data reflects primary sources of collection, and, Volatility: the data is available over time.  Another important attribute, the seventh V concerns data’s value (6). A McKinsey report has predicted that big data, fueled by “disruptive” technologies (e.g., mobile Internet, Internet of things, the cloud, advanced robotics, genomics, and social media, will significantly increase by 2025 (7).

Sources of big data

Big data in healthcare is overwhelming not only because of its volume but also because of the diversity of data types and the speed at which it must be managed (8). It includes clinical data, such as from physician’s written notes, prescriptions, medical imaging, laboratory, pharmacy, insurance, and other administrative data); patient data in electronic patient records; machine generated/sensor data, such as from monitoring vital signs; social media posts, including Twitter feeds, blogs, LinkedIn status updates on Facebook and other platforms, and health related web pages (Facebook 2.07 billion  and Twitter: 330 million monthly active users); patient-specific information, including emergency care data, news feeds, and articles in medical journals; patient generated (Fitness app, social media Smart watch/fitness apps (Fitbit 23.6 million unique U.S. users) (9); big transaction data: health care claims and other billing records increasingly available in semi-structured and unstructured formats; biometric data, such as finger prints, genetics, handwriting, retinal scans, x-ray and other medical images, blood pressure, pulse and pulse-oximetry readings, and other similar types of data (10).

Data generated by US health systems alone has reached 150 exabytes a decade ago and may reach the zettabyte scale. Kaiser Permanente with over 9 million members has over 40 petabytes of data from electronic health records (11).

Opportunities of big data

In the developed world the data scientists and analysts view existence of these data sets as huge opportunity. By analysing  associations, patterns and trends there is a potential to improve quality of care in a cost effective manner. These patterns provide insights to disease epidemiology, better diagnosis and treatment as well as predict disease outcomes. They proactively identify patients who can benefit from preventive strategies by influencing the care provider behaviour such as diabetes, hypertension and other lifestyle diseases (12). Using these data sets trends in treatment can be computed and predicted. This can be achieved by combing and analysing a variety of structured and unstructured data from: electronic health records (EHR) or electronic medical records (EMR); financial and operational data; and more recently genomic data to match treatments with outcomes. Thus enabling the data scientists to predict patients at risk for disease or readmission and provide more efficient care (13).

McKinsey estimates that big data analytics can enable more than $300 billion in savings per year in U.S. healthcare, two thirds of that through reductions of approximately 8% in national healthcare expenditures. McKinsey believes big data could help reduce waste and inefficiency in many areas such as (14):

Clinical operations:  By determining more clinically relevant and cost-effective ways to diagnose and treat patients with the help of available data.

Research and development:  By predictive modeling to lower attrition and produce a leaner, faster, more targeted R&D pipeline in drugs and devices; statistical tools and algorithms to improve clinical trial design and patient recruitment to better match treatments to individual patients. This can lead to reduction in trial failures and might speed up new treatments to market. Analysis of clinical trials and patient data can identify follow on indications and discover adverse effects before products reach the market.  These two areas alone can potentially save $165 billion and $108 billion in waste respectively.

Public health: By analyzing disease patterns and tracking disease outbreaks and transmission to improve public health surveillance and speed response; Faster development of more accurately targeted vaccines, e.g., choosing the annual influenza strains; and, turning large amounts of data into actionable information that can be used to identify needs, provide services, and predict and prevent crises, especially for the benefit of populations.

Genomic analytics: By executing gene sequencing more efficiently and cost effectively and make genomic analysis a part of the regular medical care decision process and the growing patient medical record.

In public health challenges in LMICs arising from epidemics (e.g., Ebola, Zika), natural disasters (e.g., earthquakes, storms), and humanitarian crises (e.g., migration, conflict, security) ICTs will be a key resource, and big data undoubtedly comes with huge potential to aid in this quest (15).

Ethical issues in big data

Compared to traditional methods of healthcare, digital data has no geopolitical boundaries; hence clients can seek services or sell services across international and local borders. Laws on medical licences, client privacy, advertisement & marketing of services, vary in different places, therefore a law that is internationally applicable is a subject of debate and deliberation. Third party sale of big data for commercial reason is more common than actually believed and many times without patient’s knowledge and consent. These challenges are compounded when the literacy rates are suboptimal in LMICs where questions of understanding informed consent have risen. There is an ongoing debate in the developed world on how to establish national and international standards and policies. Lacks of uniform definition of big data along with its blurred geographical boundaries thus have a destabilizing effect on existing bioethical norms (16, 17).

Keys areas of ethical concern in big data exchange are

  • Data privacy and security issues by hackers and malware
  • Respect for patient privacy
  • Third party use of data
  • Quality of patient generated data
  • Data ownership
  • Respect of patient dignity in terms of continuous home monitoring
  • Genomic data access by employers and health insurance
  • Digital divide and aging population
  • Global transfer of medical information and interoperability issues
  • Informed consent or lack of informed consent in LMICs
  • Data colonization specially with data generated from LMICs
  • Lack of uniformed standards and policies across the globe
  • Difficulty in contextualization of data from the perspective of LMICs.

Global laws on data protection

The last five points of above paragraph are in context with the regions where data protection acts are weak or nonexistent. Figure 2 provides a bird’s eye view of data protection laws across the globe (18). There are diverse types of data protection laws. On 25 May 2018, the European Union (EU) regulation 2016/679 on data protection, also known as the General Data Protection Regulation (GDPR) took an effect. The GDPR, repealed previous European legislation on data protection (Directive 95/46/EC) (1), is bound to have major effects on biomedical research and digital health technologies, in Europe and beyond, given the global reach of EU-based research and the prominence of international research networks requiring interoperability of standards (19). The European Commission has so far recognized AndorraArgentinaCanada (commercial organisations), Faroe IslandsGuernseyIsraelIsle of ManJapanJerseyNew ZealandSwitzerlandUruguay and the United States of America (limited to the Privacy Shield framework) as providing adequate protection. Adequacy talks are ongoing with South Korea (19).

Fig.2: Global data protection (18)

 

Data protection laws in the developing countries

A recent UN conference on trade and development (UNCTD, 2016) summarized that the number of national data protection laws has grown rapidly, but major gaps persist. Some countries have no laws in this area, some have partial laws, and some have laws that are outdated and require amendments (20). The present regulatory environment on protection of data is far from ideal. In fact, some countries do not have rules at all. In other cases, the various pieces of legislation introduced are incompatible with each other. Increased reliance on cloud-computing solutions also raise questions about what jurisdictions apply in specific cases. Such lack of clarity creates uncertainty for consumers and businesses, limits the scope for cross-border exchange and stifles growth (UNCTD).

South East Asian countries like Pakistan have a vibrant and robust information technology (IT) workforce, however data protection and privacy laws have yet to be enacted. Data Protection Act (DPA) was drafted more than a decade ago in 2005, however it has not been promulgated into law.  Despite the availability of cheaper smart phones and tablets the government has failed to implement the DPA-2005 (21, 22). This data protection act is similar to UK Data Protection act in legal terms, however in absence of its enactment it remains a document.  Moreover, broadband internet services such as 3G and 4G are provided low cost package by mobile network operators (MNOs) thus further popularizing its use among lower to middle income masses.

Massive amounts of personal consumer information is collected, exchanged and stored without the consent and knowledge.  In absence of any legal protection this equates to data theft. This is violation of privacy under the Article 12 of UN International declaration of Human Rights 1948. Telecom operators collect vital information like address, telephone numbers and the National Identity Cards (NICs) along with the biometrics. Concerns are raised about third party sharing of this data. Digital scientists in Pakistan have been voicing their concerns at the lethargic approach to enactment of DPA and since this draft formation 12 years ago. Moreover, the technology has progressed and many clauses may need revision and updating.

 

References

  1. https://www.itu.int/en/ITU-D/Statistics/Pages/stat/default.aspx (Accessed 10th April, 2019).
  2. Haluza, D. and Jungwirth, D., 2015. ICT and the future of health care: aspects of health promotion. International journal of medical informatics84(1), pp.48-57.
  3. pdf (Accessed 10th April, 2019).
  4. Big Data Definition – MIKE2.0, the open source methodology for Information Development. http://mike2.openmethodology.org/wiki/Big Data Definition
  5. Ward, J.S. and Barker, A., 2013. Undefined by data: a survey of big data definitions. arXiv preprint arXiv:1309.5821.
  6. Gandomi, A. and Haider, M., 2015. Beyond the hype: Big data concepts, methods, and analytics. International journal of information management, 35(2), pp.137-144.
  7. Groves, P., Kayyali, B., Knott, D. and Kuiken, S.V., 2016. The ‘big data ‘revolution in healthcare: Accelerating value and innovation.
  8. Manyika J M, Chui B, Bughin R, Dobbs C, Roxburgh A. 2011. Big data. The next frontier for innovation, competition and productivity. Washington DC; McKinsey Global institute.
  9. Raghupathi and Raghupathi Health Information Science and Systems 2014, 2:3 http://www.hissjournal.com/content/2/1/3 (Accessed 10th April, 2019).
  10. Paul, A., Ahmad, A., Rathore, M.M. and Jabbar, S., 2016. Smart buddy: defining human behaviors using big data analytics in social internet of things. IEEE Wireless communications23(5), pp.68-74.
  11. Ratha, N.K., Connell, J.H. and Pankanti, S., 2015. Big Data approach to biometric-based identity analytics. IBM Journal of Research and Development59(2/3), pp.4-1.
  12. Wang, Y., Kung, L. and Byrd, T.A., 2018. Big data analytics: Understanding its capabilities and potential benefits for healthcare organizations. Technological Forecasting and Social Change126, pp.3-13.
  13. Hemingway, H., Asselbergs, F.W., Danesh, J., Dobson, R., Maniadakis, N., Maggioni, A., Van Thiel, G.J., Cronin, M., Brobert, G., Vardas, P. and Anker, S.D., 2017. Big data from electronic health records for early and late translational cardiovascular research: challenges and potential. European heart journal39(16), pp.1481-1495.
  14. Pramanik, M.I., Lau, R.Y., Demirkan, H. and Azad, M.A.K., 2017. Smart health: Big data enabled health paradigm within smart cities. Expert Systems with Applications87, pp.370-383.
  15. Sahay, S., 2016. Big Data and Public Health: Challenges and Opportunities for Low and Middle Income Countries. CAIS39, p.20.
  16. Taylor, L., 2016. No place to hide? The ethics and analytics of tracking mobility using mobile phone data. Environment and Planning D: Society and Space, 34(2), pp.319-336.
  17. Nickel, P.J., 2019. The ethics of uncertainty for data subjects. In The Ethics of Medical Data Donation(pp. 55-74). Springer, Cham.
  18. https://idpc.org.mt/en/Pages/dp/transfers/internationaladequacy.aspx (Accessed 7th April, 2019).
  19. https://ec.europa.eu/info/law/law-topic/data-protection/data-transfers-outside-eu/adequacy-protection-personal-data-non-eu-countries_en (Accessed 7th April, 2019).
  20. https://unctad.org/en/PublicationsLibrary/dtlstict2016d1_en.pdf (Accessed 7th April, 2019).
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Health Breaking News 330

Health Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Health Breaking News 330

 

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Why Public Health Care is Better

Viva Salud is a Belgian NGO that supports movements for health in the Philippines, Palestine and DR Congo. Recently, they launched the paper Why Public Health Care is Better  with the aim to debunk long lasting myths concerning the commercialisation of health care

 By Julie Steendam

Policy Officer on Health, Viva Salud

Brussels, Belgium

 Why Public Health Care is Better

 

This article is a summary of the paper
 Why Public Health Care is Better
 We hope that this paper can be a support for those social movements standing up for social justice

 

 The majority of countries in the world agreed to take all possible measures to fulfil the right to accessible and qualitative health care for their population. However, year 2019, this is far from achieved. Even worse, many national governments and international institutions direct health policies along a market-led approach. Privatisations have been brought up as the solution to national health systems’ funding shortages. But numerous case studies and comprehensive research show that health outcomes get worse when the pursuit of profit comes in:

Privatisation triggers higher inequality in access to care
Private hospitals have to make a profit, so they focus mainly on people who can afford it. This creates the risk of a health system at two speeds. On the one hand, high-tech and specialised care for the rich and, on the other hand, simple public health care for the less well-off. This despite the fact that it is the duty of public service providers to provide care to everyone, without distinction.

Privatisation is often more expensive in the long run
Unexpected costs, such as rising interest rates or expensive energy prices, are usually passed on to the government or the patient in private hospitals. An Oxfam study calculated that a public-private hospital in Lesotho costs the government three times more than the public hospital it replaced. Under some contracts, the company can even sue the state for costs related to protests of employees.

Privatisation isn’t more efficient
Public systems are more efficient because they ensure economies of scale in the purchasing, supply and distribution of drugs and equipment.
By contrast, in the United Kingdom, the number of managers in the National Health Service tripled since the introduction of a market logic. In the Netherlands, private health insurers spend 500 million euros per year on advertising campaigns.

Privatisation doesn’t lead to better quality
In today’s market logic, private institutions will focus on the treatments that are financially interesting, instead of those that benefit the patient the most. In Peru, private hospitals are much more likely to choose a more risky caesarean section than a natural birth, because the doctor can charge more.

Privatisation leads to less public control
Negotiations between private players often take place under strict rules of confidentiality. Public control is therefore very difficult, which makes the risk of corruption increase. Engaging funds from the private sector opens the way for corporate involvement in policy shaping.

Privatisation leads to a lower availability of health workers and deteriorating working conditions for them
Commercial companies take the scarce resources, such as health workers, away from the public sector. This so-called “brain drain” leads to shortages in the public sector and in more remote areas. Moreover, the drive for ever higher profit margins often leads to poorer working conditions, unpaid overtime and higher work pressure. Burn-out and stress symptoms are very common in the health sector.

The alternative exists

This paper starts from the positive side. All over the world, social movements and governments make efforts to change their health care system for the benefit of the population.

Universal access to quality health care is a feasible political choice

Countries that prioritise people’s well-being and choose to invest in making health care accessible to all achieve better health outcomes. Even countries with low expenditure on health have been able to build strong health systems.

Need, not wealth

The only proven route to realise this is cancelling all fees for health care and essential medicines, and increasing public investments in well-trained staff, nearby health facilities, and prevention and health promotion programs. A unified public system does not have the disadvantageous contradictions brought by the fragmentation and competition that characterises mixed private-public health systems.

What the international community can do

Reinforcing countries financial capacities to cope with a potential budget increase should also be a focus of the international community and international institutions, for example by

– stepping away from imposed budget restrictions in public services

– regulating pharmaceutical companies’ monopoly positions

– cancelling debt

– fighting large-scale tax evasion

– excluding health services from trade and investment agreements.

Due to globalisation, the vast majority of people in the world are subjected to very similar economic realities, forces and dynamics: environmental degradation, the global competition of workers, attacks to and exclusion from social protection schemes and a growing inequality between social classes to name but a few.[i]

This global emergency situation represents an unprecedented challenge for humanity. Since health and other societal challenges are very interconnected, the struggle for health can function as a major unifying factor in the mobilisations required to address these issues.

——————————

[i] The Struggle for Health, 2018, p.2

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Health Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

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Health Breaking News 328

Health Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

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AFEW Creates Space for Public Health Within EU-Russia Civil Society Forum

PEAH is pleased to help circulate a message by partner organisation AFEW International regarding the newly initiated Working Group (WG) on Public and Inclusive Health within the EU-Russia Civil Society Forum. Those organisations that are interested in joining AFEW’s WG can get in touch with AFEW’s director of programs and WG’s coordinator Janine Wildschut at janine_wildschut@afew.nl

By Valeria Fulga

AFEW International

AFEW Creates Space for Public Health Within EU-Russia Civil Society Forum

 

AFEW International initiates the Working Group (WG) on Public and Inclusive Health within the EU-Russia Civil Society Forum. AFEW is doing it together with the following organisations: Active Citizenship, Stichting Skosh, Centre for Social Support “Navigator”, FOCUS-MEDIA Foundation, Humanitarian Action, Humanitarian Project, Kovcheg Anti-AIDS. AFEW felt the need of introducing a completely new topic to the Forum after participating in various General Assembly meetings of the Forum.

Having a healthy society stands at the very base of any nation. Health related issues arise not only within health-related policies, but also at various other levels.

AFEW International sees deteriorations in Romania, Bulgaria and Russia when it comes to the freedom of speech and implementation of social justice work in the light of health field. Working in solidarity with European Union and Russia Civil Society Organisations towards inclusiveness, particularly when it comes to health is what AFEW aims for in this WG.

“More precisely, the present WG aims to learn from other Civil Society Organisations what methods worked for them and we – the members of the WG – would like to use it as an exchange platform and understand how other countries are working on an inclusive health agenda and how they are resilient in difficult times.” says Janine Wildschut, coordinator of the WG.

AFEW International has already gathered a group of active community-led civil society organisations in the WG. These organisations have a background in HIV or key populations fields. During the General Assembly which will take place in Bratislava in May 2019, several meetings will be organised. These meetings will have two different objectives: discussing the path for the WG and opening the WG for other interested parties.

Those organisations that are interested in joining AFEW’s WG can get in touch with AFEW’s director of programs and WG’s coordinator Janine Wildschut at janine_wildschut@afew.nl

 

The Italian Investor Proposed USD 379.7 Million Lubowa Hospital Construction Project in Uganda

Uganda needs only USD 9.6 million to put its Mulago national referral hospital to an internationally recommended standard, the proposed USD 379.7 million can construct five state-of-art cancer hospitals with 1000 bed capacity each. But why would the government instead opt for a USD 379.7 million deluxe hospital that has a bed capacity of only 264 which will benefit a handful?! Is this the best approach to set our line-of-preferences at the cost of other numerous districts without a single public hospital?

 By Michael Ssemakula

and Denis Bukenya

Health Rights Advocates

Human Rights Research Documentation Center (HURIC), and PHM-Network, Uganda

The Italian Investor Proposed USD 379.7 Million Lubowa Hospital Construction Project in Uganda

Disconnections and Disruptions in the Health Sector Expenditure Priorities

Disclaimer: PEAH disclaims and refuses any responsibility for the views expressed in this article which are solely those of the authors and do not engage Policies for Equitable Access to Health

 

Uganda has increasingly incorporated the neoliberal capitalistic forces in providing, financing and developing state health infrastructure and service delivery through public–private synergies. Justifications for this commitment are diverse stretching from levitation of finance for maintaining and operating public health to assistance for the high-end investment functions and scaling-up support for ever growing GDP expenditure to lessen the budgetary gap. Though Public Private Partnerships (PPPs) are a magnetization  propulsion to an enormous segment of the civil corporate powers and diverse stratified clusters of stakeholders in state possessed and managed entities in Uganda, over two decades ago, there is still absentia of a sturdy thrust impulsion of a mechanism to draw and incorporate well streamlined and rationalized strategic policy charters in the health management in which state and non-state nexus in health service provision is well regulated to effectively improve healthcare delivery even in the marginalized and impoverished settings.

In a paper by (Denis Bukenya, 2019), the elementaristic and contemporary forces of governance for health have superseded the humanlike social-progressive provision of state centric health services with the mixed hegemony of capitalistic health service provision through which the competitive commodified health system has emanated. There is limited significance, conceptualization and in-depth investigation about the PPP phenomenon’s implications on the Uganda’s health sector among the resource apportioning powers— which has culminated into a simultaneous backwash quantum of adversely skewed anthropologic socio-economic inequality space, eccentric complex aligned health priorities, negligent privatization of the fundamental public services and one-sided investment trade agreements predominantly through the multi-national business conglomerates’ treaties. But is this a sustainable roadmap to attain the UHC commitments?

Achieving universal health care (UHC) is a health priority entrenched in the Sustainable Development Goals. Though there is no one-size fits all model for universal health care in all settings, the ultimate health system approach would be one that is people-centered, rights-based, integrated, non-biased, and broadly-inclusive in all its processes and priority setting to build an egalitarian mechanism of healthcare delivery.

The power arm, policy orchestras and policy enhancing actors in the government quite often blame the insufficient public health funding on poverty. But the actual culprits are inappropriate misplaced priorities and corruption —few state managers in Uganda prioritize health over private actors’ big businesses and civil corporate elite interests. Bettering the lives of the privileged affluent classes and devoting exorbitant sums of money towards frivolous expenditures to political party financing is now a genealogistic and an indirectly legalized abnormally normalized health rights violation in Uganda. A common practice that is undermining health. This is unsympathetically intensified by the pseudo “public” white elephant projects, laced first in the scale of the ostentatious and flamboyant priorities at the expense of adequate health, education, and other services that would improve the social-economic welfare of the citizenry.

Besides the government of Uganda insensitively spending over USD 48 million on a private presidential jet by 2014, (Tomori, 2014), in February 2019 a hardcore, egocentric, ruthless and  merciless bunch-of-crooked mafias of the governing body, shamelessly came up with another worse than ever anti-humancentric mockery to Ugandans through another over-and-above excessively inflated unscrupulous multi-million dollar Italian investor hospital project, an attack on the poor country’s ever hemorrhaging empty coffers.   On 12th of March 2019, the parliament and the National Economy Committee approved a promissory note of USD 379.7 million which will be given to an Italian private investor. Through a loan request, the government seeks to borrow USD 379.7million (UGX 1.3 trillion, which is more than half the Uganda’s projected health expenditure for the Financial Year 2019/2020) that will be given to this little-known investor to construct the hospital that government says will be for the treatment of Non-Communicable Diseases (NCDs). In reports by (Okello, 2019) and (Independent, 2019), the documents that were submitted by the Ministry of Finance and Economic Development, the total project cost breakdown is USD249.9 million excluding tax payment component. However, the financing for which government is seeking the Legislatorial approval is USD379.7 Million thus an increment of USD 129.83 million, which is 52% of the original projected cost.

The report by (Network, 2019) shows that the Parliament doesn’t know the investor-in-question to be assigned this work. The hospital is to be constructed under a corporation between FINASI and ROKO Construction Ltd. Ugandans know ROKO and its operations in Uganda, but greater majority are not in the know of FINASI. FINASI was registered in Italy in 1993 but on their website https://finasi.com/ , FINASI was established and started its operations in the 1969. The company was founded as a 360° Importer/Exporter and a primary goods trader in the Middle East and far as Africa. FINASI is basically an import/export company in mineral ores, quarried stone, furniture, clothing and footwear, paper, chemicals, industrial machinery, agricultural machinery, toilet systems and so on. The company has diverse activities it deals with but has no phone numbers on its website which conclusively make us suspicious of this, an eminent scam danger. Apart from a mention of surgical equipment and instruments; hygiene and sterilization equipment for medical and surgical use, there is no indication that FINASI has any experience or footprints in establishing a hospital. The company type is registered as a head office! This is unquestionably a fraud trouble Ugandans are likely to befall, the 1989 year of establishment contradicts with the year 1969 in which it claims to have been registered. CF (Codice Fiscale): 01139180937 Registration No.: PN 45691. All companies in European Union are required by law to submit the total financial annual returns and there is no information about FINASI past 2015. In Europe, no bank or government can guarantee companies like FINASI without a transparent annual audited return filed with the Italian government in this case. The company turnover is 2-5 million Euros from 2013-2015 which sounds phony, and a total deception because the companies in Europe submit total financial annual returns and there is no information about FINASI past 2015. There are no records for the financial years 2016, 2017, 2018. Enrica Maria Aristidina Pinetti, is the CEO – Chief Executive Officer (Ceo – Amministratore Delegato). There are no any other staff or vice president listed. The company is listed to have nine staff and yet it claims to have operations in Italy, far as east, Russia, Middle East and sub-Saharan Africa.

Worse still there is no secured land for this above-life health facility, the land on which the project is to be allocated is under dispute by a Buganda Royal family. This implies that the said land’s legal status is still unsettled, therefore we risk litigation and we might be subjected to another drama of a multi-million dollar humiliating frenzy-of-penalization after the investment kick-start.

Despite of the efforts to fight the disease in Uganda to achieve the SDGs’ 2030 agenda, and also meet the universal commitments enshrined in the global guiding instruments such as the Article 25 of UDHR, 1978 Alma Ata declaration, the 2001 Abuja declaration and the 2018 Astana declaration, Uganda still faces a horrific nightmare of poor misguided and non-inclusive priority setting processes in the health sector. Uganda needs only USD 9.6 million to put its Mulago national referral hospital to an internationally recommended standard, the proposed USD 379.7 million can construct five state-of-art cancer hospitals with 1000 bed capacity each. But why would the government instead opt for a USD 379.7 million deluxe hospital that has a bed capacity of only 264 which will benefit a handful?! Is this the best approach to set our line-of-preferences at the cost of other numerous districts without a single public hospital?

The question of inadequacies in the Uganda’s health governance is an outrageous dark-fortune that still stand vividly. The enabling arm through the decision powers of the independent institutions is unwaveringly being emasculated through one decision enhancer, the president and the common jargon of ‘orders-from-above!’ Governance for health in this sense in regards to oversight, control, transparency, responsiveness, equity, effectiveness, efficiency, regulatory quality, accountability, consensus orientation and participatory priority setting process in-line with objectives, and interests of institution’s management and public health strategies has lost its course. Therefore to prevent wasteful expenditures, we must have well streamlined, rationalized and efficient health strategies that clearly describe and guide the procedures within institutions (notably government) and define priorities and the parameters for action in response to the public health needs and available resources. This should be properly incorporated with inclusive approaches which embrace social responsibility through community engagement and increase in investments for health development through participatory processes.

 

References

Denis Bukenya, &. Michael Ssemakula. (2019). The Rhetoric In Achieving The Universal Health Coverage Under Public-Private Partnerships In Uganda. PEAH.

Financing, D. o. (2012). Health Systems Governance for Universal Health Coverage. Geneva: World Health Organization.

Independent, T. (2019, February 13). MPs query $379M Gov’t support to Lubowa hospital investor. Kampala, Central, Uganda.

Kickbusch, I. (2014). A new governance space for health. Global Health Action, Issue 6.

Network, U. D. (2019, March 20). Here is what Ugandans need to know about FINASI. Kampala, Central, Uganda.

Okello, G. (2019, March 12). Parliament approves UGX1.3 trillion loan for Lubowa hospital amid land dispute with royal family. Kampala, Central, Uganda.

Tomori, O. (2014). Health in Africa: Corruption and misplaced priorities. Kampala: Bulletin Daily.