Access to medicine or the lack thereof has been an ongoing debate in Uganda for long. Since 1985, Uganda has grappled with the challenge of ensuring availability of Essential Medicines and Health Supplies (EMHS) with 60 per cent of the health facilities consistently registering stock-outs of essential medicines over the past 10 years. The average availability of the 40 essential medicines is 59 per cent in government facilities compared with 78 per cent in the non-for-profit facilities.
As a result, the Ugandan government has put together a formidable EMHS 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 (1993) whose role is to regulate drugs in the country, National Medical Stores (1995) whose role is to ensure continuous distribution of pharmaceutical products in a financially viable and sustainable manner, National Drug Policy (2002), and most recently, the Medicines and Health Service Delivery Monitoring Unit (2009) whose role is to improve the surveillance of medicines and healthcare 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 EMHS team through procurement of medicines and supplies or through pharmaceutical sector support programmes such as Supply Chain Management Systems, DELIVER and Strengthening Pharmaceutical Systems programmes, capacity building at district and facility level, and funding of EMHS.
Using the analogy of football, the opponents to the EMHS team comprise of; issues of inadequate financing, poor coordination, irrational drug use, pilferage, etc., which continue to pose an insurmountable challenge since they keep stepping up their game to defeat the good team. Unfortunately, while each of the players in the formidable EMHS 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 unwilling to play as a team!
The policy options analysis for Uganda’s pharmaceutical supply system report 2010, agrees with this observation, noting that with a multiplicity of independent stakeholders in the EMHS 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 over stocking have often resulted into waste of limited resources. These scenarios only perpetuate an environment that allows mismanagement, inefficiency, corruption and pilferage.
Whereas addressing the EMHS 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 high time a holistic approach and interlinkage among sector entities are embraced and emphatically cultivated if Uganda is to register improvement in this sector, let alone achieve target 8 of the MDGs - “...in cooperation with pharmaceutical companies, provide access to affordable essential medicines in developing countries.”
The sooner the authorities sort out the dynamics of who plays which role in the EMHS team (quantification, procurement, storage, distribution, monitoring and the logistics management information system), the faster Uganda will achieve universal access to medicines.
Mr Walugembe is a Makerere School of Public Health-CDC Fellow.