17 October 2013

Uganda: We Need Teamwork to Boost Drugs Access


Access to medical drugs or the lack thereof has been an ongoing debate in Uganda for the past decades.

Since 1985, Uganda has grappled with the challenge of ensuring availability of essential medicines and health supplies, with 60 per cent of the health facilities consistently registering stock-outs of essential medicines over the past 10 years and the average availability of the 40 essential medicines being 59 per cent in the government facilities compared with 78 per cent in the non-for-profit facilities.

As a result, the government has put together a formidable supplies team whose ultimate goal is to ensure that medicines are made continuously available and affordable at public or private health facilities or medicine outlets that are within one hour's walk from the homes of the population.

Over the past decades, this team has evolved in response to emerging challenges as well as structural and policy reforms.

Currently it includes the National Drug Authority (NDA) whose role is to regulate drugs in the country, National Medical Stores (NMS), whose role is to ensure continuous distribution of pharmaceutical products in a financially-viable and sustainable manner, National Drug Policy (NDP), and most recently the Medicines and Health Service Delivery Monitoring Unit (MHSDM) whose role is to improve the surveillance of medicines and health care service delivery.

The above team is supported by the ministry of Health whose mandate includes policy formulation, budgeting, strategic planning capacity building, monitoring and evaluation of the overall sector performance.

Several donors have also provided substantial input to the team through procurement of medicines and supplies or through pharmaceutical sector support programmes such as Supply Chain Management Systems (SCMS), DELIVER and strengthening pharmaceutical systems programmes and capacity building at district and facility level.

Using the analogy of football, the opponents to the team comprise issues of inadequate financing, poor coordination, irrational drug use and pilferage, etc which continue to pose an insurmountable challenge since they keep stepping up their game geared to defeat the good team.

Unfortunately, while each of the players in the health team is striving to deliver a solution to issues relating to medicines prices, quality, availability, promotion, transparency and accountability as well as partnerships, they seem to be united in being unwilling to play as a team!

The policy options analysis for Uganda's pharmaceutical supply system agrees with this observation noting that with a multiplicity of independent stakeholders in the medicines supply sector, coordination within and across players remains a challenge. Procurement is often not well-coordinated among private sector entities, procurement agencies, and the public sector.

Weak quantification, forecasting, and demand management have resulted in overlaps of efforts and parallel supply chains. Without an overview of available stock, crises with stock-out or even overstocking have often resulted into waste of limited resources. These scenarios only perpetuate an environment that allows mismanagement, inefficiency, corruption and pilferage.

Whereas addressing the medicines supply sector problems cannot be done in isolation, the players in this team seem rather convinced that each of them can deliver a solution independent of the other. Each team member brings with them strengths which other team players cannot afford to ignore or lose!

It is, indeed, high time a holistic approach, systems thinking and inter-linkages among sector entities was embraced and emphatically cultivated if Uganda is to register improvement in this sector.

The sooner the authorities sort out the dynamics of who plays which role in the team (quantification, procurement, storage, distribution, monitoring and the logistics management information system), the faster Uganda will avoid the shame of failing to qualify for the World Cup... oh sorry... achieve universal access to medicines.

The writer is a Makerere school of Public Health-CDC fellow.

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