Recently, Uganda joined the rest of the world to commemorate World Aids Day. This year’s theme: “National solidarity and a shared responsibility towards ending Aids,” calls us to address the bottlenecks hindering access to essential, life-saving medicines for people living with HIV/Aids.
Fresh in our minds are the disruptions Covid-19 has caused to HIV services and availability of medicines. Although Uganda came close to getting the HIV epidemic under control in 2019 - an achievement largely due to years of work of strengthening our supply chain - the country’s progress in meeting the UNAIDS 90-90-90 targets has stalled.
These targets - to have 90 per cent of all people living with HIV know their status, 90 percent of all people with HIV on treatment, and 90 percent of all people on treatment achieve viral suppression - have now been increased to 95-95-95 by 2025.
Meeting this new mandate will require continuous collaborations among governments, donors, the private sector, and civil society. Uganda’s ministry of Health and its partners, which include the Global Fund and the United States Government, the largest donor to Uganda’s health sector, have been working together to increase access to medicines.
The Ministry of Health regularly quantifies and analyses funding gaps for medicines and health supplies. The figures are shared with government and its partners to fill the gaps. Because of this coordinated effort, Uganda increased its funding for HIV medicines from Shs94b in 2016 to Shs140.3b in 2020. Uganda also secured $95.8m for HIV commodities between 2018 and 2020 through the U.S.
President’s Emergency Plan For AIDS Relief. This funding ensured sustained access to life-saving medicines for Ugandans living with HIV.
Working with the Ministry of Health, the USAID-funded Uganda Health Supply Chain Project and Uganda Strengthening Supply Chain Systems Activity, which are implemented by nonprofit organization Management Sciences for Health, developed a web-based system for health facilities to efficiently order HIV medicines.
This system facilitates real-time data that allows the Ministry to design and deliver health services promptly. The system will soon include all essential medicines for tuberculosis, malaria, reproductive, maternal, and child health.
To further enhance treatment success and to promote a client-centred care the Ministry of Health adopted a multi-month dispensing of HIV medicines. A stable person living with HIV now receives enough medicine to last up to three months. This, in turn, lessens the burden on health services.
The USAID activity constructed 26 medicine stores in 22 districts at high burdened health facilities. The medicine stores increased the storage space for the large volume of HIV commodities to support the multi-month dispensing.
Despite this progress, challenges remain: medicine shortages, inadequate human resource capacity, governance and accountability issues, and limited data for decision-making. If Uganda is to achieve Universal Health Coverage, those issues must be addressed.
The private sector is an often overlooked but essential partner in increasing access to medicines. The government and its partners should join forces with the private sector to develop or expand innovations, such as the home delivery of medicines or the availability of telemedicine during lockdowns.
We also need to engage people with chronic illnesses actively and consistently in designing and delivering solutions that expand access to medicines. Collaborations in the health sector that aim to optimize the benefits from technology will further enhance health services, save time, and minimize exposure to infectious diseases.
Whether we are working with people living with HIV or chronic diseases, there is no doubt that access to medicines is an integral part of a robust health system - a goal hard to achieve without strong multisectoral collaborations.
Dr Lugada is the Chief of Party with the USAID-funded and MSH-led Uganda Strengthening Supply Chain Systems Activity.