The suspension of Dr Baterana Byarugaba has taken on a new belligerent tone as the under-fire executive director of Mulago national referral hospital begins a court fight to retain his job.

Infighting and self-generated financial crises have made the past months of Baterana’s term turbulent. He has weathered past concerted and vocal parliamentary inquiries into his financial management style but can he fend off the State House Health Monitoring Unit (HMU) onslaught?

On March 1, 2022, Dr Baterana Byarugaba was arrested by the State House Health Monitoring Unit (HMU) for alleged embezzlement, fraudulent accounting, abuse of office, and causing financial loss to the government. Baterana, who doubles as the accounting officer of the hospital, was detained with the hospital’s principal administrator, engineer, head of accounts, senior accountant, and an accounts assistant.

In April 2021, HMU launched an investigation into Mulago hospital’s management of essential medicines and health supplies, human resources for health and finance, covering four financial years. The total unaccounted-for or misappropriated funds during the period under investigation amounted to Shs 28.8 billion.

Dr Baterana has always been under scrutiny over the misappropriation of funds at the nation’s referral hospital. In August 2014, MPs on the parliamentary Public Accounts Committee (PAC) quizzed Baterana for making advance payments of Shs 228 million to individual accounts.

Baterana paid money directly into accounts of individuals who managed medical camps, surgical camps, International Nurses day, and International Midwives day instead of paying it to service providers as mandated.

Baterana was asked to explain why he overlooked the treasury accounting instructions. He apologized and assured MPs that he wouldn’t do it again.

In June 2019 while appearing before the Public Accounts Committee chaired by Nathan Nandala-Mafabi, Baterana was put on the spot to account for Shs 245 million, which was not traceable on the hospital’s bank accounts.

According to the auditor general’s report for the financial years 2016/2017 and 2017/2018, Mulago hospital collected Shs 2.45 billion in the financial year 2017/2018 but only remitted Shs 2.31 billion. The balance of Shs 145 million couldn’t be traced.

There was also another Shs 98 million, which had not been spent during the same financial year but was not reflected in the hospital’s bank statements and could not be traced on the hospital’s bank accounts.

OPERATION OF PRIVATE PHARMACIES IN MULAGO

While appearing before the parliamentary Health Committee in January 2022, MPs asked Baterana to explain why private pharmacies were operating inside Mulago hospital. The committee vice chairperson Joel Ssebikali demanded to know the owners of these pharmacies and how they came to access the hospital premises.

Baterana told MPs that the two pharmacies are legally operating inside the hospital premises after undergoing a competitive procurement process. He said they signed a memoranda of understanding with Mulago to supply drugs that cannot be obtained from the National Medical Stores (NMS).

“There is a shortage of specialized drugs and that is why we sought the services of these private pharmacies to supply them. Some patients come looking for particular brands of drugs which can only be provided by private pharmacies,” Baterana said.

The two private pharmacies inside Mulago hospital are Ecopharm and First Pharmacy, which Baterana said pay Shs 3 million each in monthly rent to the hospital.

However, according to the State House Health Monitoring Unit investigation, Mulago hospital management headed by the executive director on February 7, 2018 signed off 10-year memoranda of understanding (MOU) and tenancy agreement allowing Ecopharm and First Pharmacy to operate within the hospital premises.

The unit, however, says that the said memorandum and tenancy agreements between Mulago hospital and the private pharmacies were irregularly executed without clearance from the relevant government authorities and that the pharmacies are operating illegally without National Drug Authority licenses.

Due to these irregularly executed MoUs and tenancy agreements, both Ecopharm and First Pharmacy had defaulted on paying rent to the tune of Shs 135 million for Ecopharm and Shs 67.5 million for First Pharmacy by November 4, 2021.

These pharmacies were also accused of involvement in suspicious procurement of medicines and other medical supplies. The investigation team conducted an extensive verification of supplies allegedly procured from First Pharmacy by the hospital.

The verification was triggered by IFMS payment statements obtained from the Accountant General, which showed that during the period under investigation, Mulago hospital paid First Pharmacy Shs 1.4 billion for medicines procured and supplied under emergency orders presumably after running out of NMS supplied stock.

Verifications conducted at the Burns Unit store at Kiruddu hospital (under Mulago hospital) established that only a small quantity of the purported deliveries made by First Pharmacy was received. Most of the other delivery notes from the pharmacy that showed deliveries were made to the Burns Unit store were denied by Kiruddu hospital.

During verifications at the bulk/central stores, it was established that funds worth Shs 754 billion were paid out to First Pharmacy in 14 different transactions between December 2017 and May 2020 for untraceable supplies.

The investigating team also found that most items on the First Pharmacy delivery notes supplied to the bulk store were the same NMS delivers to the hospital and dispenses to the public at no cost.

A total amount of Shs 40.5 million was also paid by Mulago hospital to the First Pharmacy purportedly for the purchase of medical supplies but an analysis of documents so far reveals that the said medical supplies were not delivered to the hospital.

Though in 2019 President Museveni ordered the National Drug Authority to cancel the licenses of the said pharmacies operating inside Mulago hospital, Baterana in January this year said that the directive was temporarily stayed following legal advice from the Attorney General.

Dr Baterana Byarugaba became the executive director of Mulago hospital in 2010 after the sacking of his immediate boss, the late Dr Edward Ddumba.

According to URN, Dr Ddumba was sacked because of mismanagement of funds, meant to buy essential drugs for the treatment of special diseases such as diabetes, heart, and cancer.

The then minister of state for Primary Health Care, James Kakooza said Ddumba had been fired because of poor management, ghost workers, mismanagement of funds, and outright cases of corruption and failure to supervise work at the hospital.

Baterana came in with promises of improving services at Mulago hospital and fighting corruption that had perennially bedeviled the institution.

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