WASHINGTON — A $90 million loan from the World Bank to Uganda should be allowed to proceed so long as the government issues guidelines protecting LGBT patients and healthcare workers, recommends a team of consultants hired by the bank according to a source familiar with their report.
The World Bank put the loan on hold the day before it was due for final approval from the bank's board in February because of concerns that the Anti-Homosexuality Act could impede access for LGBT patients and endanger health care workers. The act, which Ugandan President Yoweri Museveni signed into law on Feb. 24, not only imposes up to a lifetime prison sentence for homosexuality, but also potentially exposes health care workers who treat LGBT people to arrest under a provision criminalizing "aiding and abetting homosexuality." The bank's official explanation at the time was that it wanted to "ensure that the development objectives" of the loan, which was primarily aimed at maternal health but also subsidized the renovation of health care centers, "would not be adversely affected by the enactment of this new law."
"None of the options [recommended by the review team] included suspension of the funds," said the source familiar with the report, which was submitted to the bank on April 22. But the team will call for "stringent conditions" as "prerequisites for disbursement of the fund," including government guidelines clarifying that health care workers could not be prosecuted for serving LGBT patients. The team also recommends a real-time monitoring system for abuses under the law and prohibitions on disclosing patient information that could lead LGBT people to be identified to police by health care workers. The report will now be reviewed by the bank's leadership, which must release the funds by the end of June or the grant will be canceled under the bank's budgeting rules.
Bank spokesman David Theis declined to comment on the review, saying in an email, "The Bank continues to review the postponed US $90 million health project for Uganda and has not yet made a final decision."
The worst fears of advocates who warned that the law could interfere with health services were confirmed just before the team of consultants began its work earlier this month. On April 3, Ugandan police raided an HIV center run by the U.S. Military HIV Project in collaboration with Makerere University. Undercover police officers had been investigating the clinic for weeks before the arrests were made after receiving a report that the center "was carrying out recruitment and training of young males in unnatural sexual acts." Police arrested one employee of the clinic and reportedly photographed several patients who were there at the time of the raid.
The arrests undermined assurances that Ugandan Health Minister Ruhakana Rugunda had given to the World Bank following the loan's suspension. On March 7, Rugunda appealed for the release of the funds to the World Bank's Uganda director, writing: "Public health facilities deliver services to all segments of society without discrimination in accordance with Uganda's constitution and National Health Policy.... The Act will not adversely impact on the provision of health services by any program financed by the World Bank. Rugunda also promised to "prepare and issue guidelines for health workers in handling cases of LGBT."
But a document obtained by BuzzFeed entitled "Draft Guidelines for Health Workers Regarding Services for Homosexuals," which was prepared by Rugunda's ministry in March, does little to put to rest concerns about the ministry's ability to ensure access for LGBT patients. While the draft states, "Health care providers shall continue to provide services with equal opportunity of access to all clients including clients with homosexual orientation," it also says the "responsibilities" of "clients with homosexual orientation while seeking medical care" include "disclosing their sexual orientation." Additionally, the draft says health workers "may disclose information about his/her homosexual client/patient ... when required by law or a court order" or in cases where "such information is vital for the protection of the health status of others," wide caveats in a political climate where homosexuality has been framed as a threat to Ugandans' way of life.
Asia Russell, the Uganda-based director of international policy for the American HIV advocacy organization Health Gap blasted the proposed guidelines. "Claims that the law 'won't affect access to health services' are, quite frankly, spin--and these extremely weak draft guidelines reveal that government is not providing the clear assurances Ugandans--patients and health workers alike--urgently require," she said by email
Final guidelines for implementing the Anti-Homosexuality Act have not yet been issued by the Ugandan government.
The delayed loan has put the bank's president, Jim Yong Kim, in a difficult position. After publishing a strong op-ed in the Washington Post slamming anti-LGBT laws as counter to development when the loan was delayed, he appeared to get cold feet over incorporating LGBT rights into lending policies and abruptly withdrew from a panel on the "Economic Cost of Homophobia" that he was scheduled to chair in March. Then, in the midst of the World Bank's annual meeting in Washington this month, the loan delay was the subject of a scathing editorial from The Economist magazine, which wrote that the loan deferral seemed "capricious" and that "Setting up gay rights as a test of its lending decisions is likely to make the bank less effective at what Mr Kim himself has emphasised is its core job: tackling extreme poverty."