This paper examines the vast gap in access to essential drugs in Uganda and highlights the many circumstances of the drug stock-outs culminating into the high premiums on medicines hence frustrating access to medicines and many a time sprouting drug resistance illnesses
By Denis Bukenya
and Michael Ssemakula
Human Rights Research Documentation Center (HURIC), Kampala, Uganda
Accessibility to Medicines in Uganda
The Polygonal Lateral Disease Resistance
The five fundamental questions of What, How, Who, Where and When to improve medicine accessibility, is still a heavy quarry assemblage of unreciprocated answers to improve medicine availability and accessibility in Uganda. Due to the shifts introduced by the new health system management embraced by the government of Uganda, there has been the introduction of a neoliberal Public Private Partnerships in the drug procurement and management process. This process has caused untold pain due to drug-stock outs. The scourge of stock-outs inherits terrible dynamics of worsened plights of disease from critical to chronic levels especially among the susceptible HIV/AIDs and Non Communicable Disease (NCDs) patients.
Over the years, the vacuity in access to medicines especially those for NCDs has been worsened by the commercialization of the health sector which has become an integral center of worry to the citizenry and turning health into a private good as opposed to a social good provided by the state as a prerogative service. In a report on access to medicines by Hazel Bradley and Richard Laing (2015), 33% of the expenditures on NCDs drugs are out-of-pocket expenditures, implying that those who cannot afford will either opt for cheaper medication which is counterfeit and ineffective causing disease resistance, continue to struggle with the illnesses and hope for a spiritual miracle or befall the preventive death sentences due to the medicine stock-outs and the state ineptness in the protection of the right to health.
This paper examines the vast gap in access to essential drugs in Uganda and highlights the many circumstances of the drug stock-outs culminating into the high premiums on medicines hence frustrating access to medicines and many a time sprouting drug resistance illnesses.
The heavyweight burden of disease in Uganda has continued its vicious existence due to the vacuum in access to medicines especially the essential drugs. The deficiencies of essential medicines in public health facilities is a major issue. Despite the increasing attention to this predicament (plentiful reform attempts and creativities in the last ten-years have been used in assessment and evaluation of health facilities, State medicine provision and health human resources), the general population still experiences scarcities of medicines. When patients are unable to get the affordable care needed from the public sector (government hospitals, clinics and government drug authorities in charge), they turn to the atrocious private sector which includes the pharmacies, clinics and nonconformist state of the art private hospitals for profit owned by the politicians in the third world countries which charge them exorbitant prices in accessing medical care. This in effect increases the out of pocket expenditure on access to health putting the citizens at risk of deteriorating into poverty as an after effect to ill-health. This has aligned many defects in the health systems in Africa including counterfeited drugs, the sale of expired drugs and turning to herbal unregulated medications which may harm the general populations.
Considering the inner-city populations in the foregoing, one would literary argue that paying surcharge premiums for essential medicines that should be available at no cost from the public health sector creates poverty in the economy, robs the citizenry of their fundamental right to attainable standards of health and breaks the SDGs slogan of leave no one behind. The rural poor populations due to the scarcity of functional public and private health facilities, suffer the consequences of long distance treks to access health care which many a time conclude in avoidable deaths and reduce the percentages of lives for the people living in the rural poor areas.
Looking at essential drugs like trastuzumab whose 440mg of the original drug’s brand version costs Shs 9m whereas its generic costs Shs 4.1m as evidenced by the Uganda Cancer Institute, makes the case that the influence of unaffordable premiums charged on the patented cosmopolitan medicines puts health in a dire state especially for Non-Communicable Diseases (NCDs).
This in Uganda is worsened by the scourge of counterfeit products, medicines in this regard. These are plentiful on the market hence the reason why people in the country are dying from manageable ailments where presumably the medication is readily available in circulation. The management of these counterfeits in Uganda is said to be failing at an unimaginably high rate due to the crippling corruption in the country which makes the cost of curbing, enforcement and regulation of counterfeit medication impossibly high.
There is also a gap on the stock-outs in Uganda due to the institutional inefficiency in the Ministry of health and a link-gap in the information flow between the procurement pharmacy departments and National Medical Stores (NMS) in documenting the status on the drug stocks. Crossing over to the HIV/AIDS drugs, malaria and other preventable and treatable diseases including the Sexual Reproductive Health Commodities, people survive by a two-faced chance. Since May 2018 reports show how the medicine stores in Uganda started going empty.
Further, the recent research survey carried out on 6th and 7th August 2018 by the Uganda Coalition on Access to Essential Medicines (UCAEM) a Civil Society Coalition in which Human Rights Research Documentation Center (HURIC) and PHM-UGANDA bear membership, revealed gory stories of gaps in the availability of essential medicines, family planning and Sexual reproductive health commodities across the eight-health centers in Lira and Pallisa districts. This survey reflected the absence of the following drugs, septrin (Cotrimoxazole), emergency contraceptive pills, Combined Oral Contraceptive pills (like microgynon), Progestin, HCG kits, Combined injectable Contraceptives, Sino Implants, Implanon Classic, ibrogfen tabs, Depo-provera, IUCD, Moon beads, Norigynon, Microrute, Jade NXT, IUD and a national-wide stock-out crisis in Anti-TB drugs, ARVs, Vaccines and malaria diagnosis equipment. The drug prices and medicine stock-outs have significantly widened the medicine availability and acquirability in Uganda. Upon realizing that there are no drugs in public health centres, patients have resorted to private health facilities and pharmacies which sell the medicines at a cost way above the affordability line of the patients, with some drugs being counterfeits especially the cancer drugs and cardiovascular disease drugs.
In the recent past, reports from World Health Organization warned Uganda’s authorities (the Uganda National Medical Stores) on the procurement of fake copies of the Roche’s Avastin and Pfizer’s Sutent used to treat cancer (WHO, 2017). These had hit the medicine market through pharmacies and scamming patients through the fake generic drugs thus becoming one of the interlopes to end disease in Uganda as a result of the institutions’ inefficiencies and a gap in the ethical values.
The incompetent drug tracking system and inconsistences in the procurement plans in the pharmacy department and the National Medical Stores as the national entrusted bodies mandated to procure medicines and store them, is another key prime cause of medicine inaccessibility in Uganda that increase fluctuations. The gist here is that the dilemma of medicine inaccessibility in Uganda is not only about the tight resource constraints and technical gaps, but also a sequence of poor political rationalities that permit and reinforce temporary makeshift policy-implementation that results in weak oversight and a gap in meaningful accountability. The ramifications for this inadequacies are translated into preventable deaths due drug resistance and reduced DALY years of the general population.
With such paucities in our health system, commercialization drive has been inevitable through importation of expensive medicines by private pharmaceutical companies. Which makes the poor strata to suffer severely.
It is therefore recommended that appropriate drug tracking systems are put in place together with training of properly qualified health professionals in the health procurement departments to improve their stock taking capacities and narrow the gap in the information flow between the health workers at grass roots like the store managers, procurement and finance departments. Such skills training is needed for the health professionals in health centers’ inventory management systems to learn the new technologies involved in drug implementation tracking processes as a tool to better the practice of reconciling the medicines stock-gaps to minimize shortages, human errors and streamline ardently the inventory management procedures.
Also a need for right supportive political rationalities is necessary. This will permit and strengthen policy-implementation on strategic plans for medicine provision with strong oversight and meaningful accountability.
Finally the need to negotiate for parallel importation from the medicine patent holders and originators of the medicines is essential. This is because parallel importation allows the country to procure medicines from a cheaper source where the originator or patent holder sells his drugs at a lower premium than the actual price cost from the patent holder of the medicines. This reduces the cost incurred in purchasing the medicines thereby increasing their affordability and accessibility to all patients regardless of social status.