In Katine, a Coke is easy to buy. Medicine isn’t

Guardian.co.uk

Narrative Report – Stop the stock-outs campaign

Narrative Report
Stop the stock-outs campaign

Brief Background:

“Stop stock-outs” is a regional campaign in 6 countries in Africa including Kenya, Madagascar, Malawi, Uganda, Zambia and Zimbabwe to stop continued stock out of essential medicines in public health facilities. In Uganda, a consortium of 5 CSOs (HEPS Uganda, AGHA, AIDE, ACFODE, NAFOPAHU) is undertaking the one year campaign.

Through the campaign the CSOs want the government to:

• Ensure availability of essential medicines at all public health institutions.
• Ensure that there is sufficient funding for the medicines within the minimum healthcare package.
• Give representation of civil society on the board of the National Medical Stores.
• Enhance transparency in medicines supply management.
• Provide a dedicated budget line for essential medicines.
• Live up to their commitments to spend 15% of national budgets on health care.

The campaign in Uganda was launched with a week of activities which included:

narrative-report A visit to Kisenyi Health Centre IV on 17th March and Public launch:

Hon. Nabila Sempala, Woman Member of Parliament for Kampala District was the guest of honour and led the procession to the health centre. At the centre interviews of patients and health workers on stock out of medicines were done. The congregation was later joined by Artist Bobi Wine while marching back to Kisenyi Social Centre. This attracted many onlookers who joined the crowd.

Kizza Sebunya (Mariam Foundation) was master pf ceremonies. There were speeches from LC I and II of the area, Rosette Mutambi (ED-HEPS), George Kanyomozi (ACFODE), MP Nabila Sempala, Bobi Wine (also wooed the crowd with some singing). Diana Nekesa was asked to close the meeting a 1pm.

About 1000 residents of Kisenyi attended the function in addition to about 30 partners from the different organizations.

 Press conference and public forum on 19th March at the Green room of the National Theatre:

The press conference was held at 10am and was attended by over 50 journalists from various media houses. It was moderated by Ms. Beatrice Were, a renowned HIV/AIDS activist. There were 5 key resource people that included a cancer patient Allen, Rosette Mutambi (ED-HEPS Uganda), Sandra Kiapi (ED-AGHA Uganda), Denis Kibira (Campaign coordinator), Florence Nagawa (NAFOPHANU).
A public forum was held at 11:00am for 2 hours with about 70-100 participants to have an in-depth discussion of issues raised during the press conference. It was moderated by Rosette Mutambi.

 A Talk show on radio Simba a local Luganda station.
In this show the National Coordinator of the campaign, Denis Kibira highlighted the extent of medicine stock-out in Public health facilities.

Other activities:

1. Five planning meetings have been held at HEPS Uganda office.

2. Meetings were held with Ministry of Health Technical Working Group for Medicine Procurement and Management to introduce campaign. These were attended by the Executive Director of HEPS Uganda and Campaign Coordinator. Also meetings with MeTA (Medicine Transparency Alliance) Council were held.

3. The coalition facilitated a journalist to visit Karamoja region and investigate a killer disease, Leishmaniasis which has killed hundreds of nomads there. The findings were gruesome as medicines to treat this disease are not available in public health facilities and a dose costs up to U.Shs 400000/= ($ 200). The injections are extremely painful and as well toxic.

4. Pill check week 22nd -26th June: Spot check of medicine stock out in public health facilities was carried out in 11 districts in the country. The check was on 10 essential medicines and highlighted that stock outs especially of paediatric preparations are still a major problem I the health system.

5. 6th July 2009: Press conference to review the budget was held at AGHA Uganda. The coalition called upon the Government of Uganda to:

• Ensure that resources for the health sector are put to the right purpose–which is the delivery of healthcare and not the private enrichment of individuals. Money intended for health must be channelled for healthcare.

• Take a proactive role in strengthening the watchdog role of accountability mechanisms such as the Parliament, IGG, DPP, and Civil Society (CSOs) by meaningfully involving them in decision making and monitoring the delivery of health care and use of resources for health.

• Allocate resources based on needs and current data and not political decisions. Resources must be placed where the greatest need is which in experience has shown is EMHS, and strong mechanisms for monitoring resource use and fostering accountability

6. 14th august 2009: NAFOPANU (National Forum of PHA Networks in Uganda) together with other partners organised a Press Conference to highlight the ARV crisis in the country. A call was made to government and development partners to:

• While acknowledging that the world is faced with a financial crisis, development partners should sustain and increase funding levels that are sufficient to meet the desired level of responses against HIV and AIDS. This is because the situation, if left unabated is certainly going to reverse the gains that the country has achieved over the past five years.
• Global Fund should ensure timely and sustainable funding to ensure availability of HIV treatment and care to people already on treatment and enroll those that are eligible for treatment.
• Global Fund should resume Voluntary Pool Procurement of ARVs to save the millions of Ugandans who are initiated and those yet to be enrolled on ARVs
• The LFA should fast track the assessment of second PR for Uganda for the Global Fund to mitigate the current resource disbursement and operational constraints.
• Let GF release funds for Round 7 to support approved 66 CSOs, local governments and line ministries to alleviate most of the challenges facing both the infected and affected

Outcomes:

The public events were widely covered by the media:

1. Radios: CBS, Radio One, Kaboozi, Prime, Top, Sanyu, Simba

2. Televisions: UBC, WBS, NTV, NBS, Record, Top

3. Print media:
• New Vision 21st March 2009: Drug shortage hits Uganda
• New Vision 23rd March 2009: Shortage of TB Medicines
• New Vision 30th March 2009: Coartem dose for children is 6 tablets and adults12
• Weekly Observer 1st April 2009: Chronic drug shortage cripples health system.
• Weekly observer: Health activists half-hearted over new budget

4. National Medical Stores has come out strongly in the newspapers to explain the causes of stock-outs explaining its difficulties. They General Manager of the NMS also invited CSOs for a tour of the stores.

5. The campaign has awakened media and other stakeholder interest. There are frequent independent stories of medicine stock outs in public health facilities. Examples of the various follow up articles in the newspapers include:
• Monitor 3rd April 2009: City health units short of drugs
• New Vision 2nd April 2009: Hospitals cause drug shortage

6. Members of the Social Services Committee of Parliament made an unexpected visit to National Medical Stores to ascertain the level of stock-outs.

Action Group for Health, Human Rights and HIV/AIDS (AGHA) Uganda

agha_budget_press_statement-finalagha_budget_press_statement-final

Aids drugs tender given green light

Daily Nation

HIV AIDS FIGHT AND MEDICINES STOCK-OUTS

Read more

Aids funding crunch

Sunday Citizen Newspaper

Mobiles help put a stop to drug stock-outs

COMPUTERWORLD

Pill check in Livingstone

On 22^nd July, 2009 the Zambia country team Casco Mubanga From NZP+ Lusaka, Banza Chela from TALC Lusaka Hub and Claudio Midolo an Open Society Insitute fellow from New York City, visited the tourist capital Livingstone in southern province. The purpose of the trip was to a carryout a check on availability of essential medicines in the district , holding a focus group discussion as part of awareness of the essential medicine concept and the campaign, to carryout three interviews one with a pharmacist, a nurse and also with a patient who had experienced the stock-out.

Day one

Interview with Vivian, the district pharmacist

On the first day the team had a privilege of interview a district pharmacist. During the interview it came from the pharmacist that delivery are received from the central medical stores once in a month and there were no problems of stock outs in the district, all the requested drugs are received in the deliveries. The major challenge faced by the district pharmacy was transport to distribute medicines received to all the health facilities in the district. The lack of transport caused a lot of delays in delivery of medicines.

Interview with a Nurse Anne

This was very interesting interview, we were happy that our Nurse brought a lot of issues which really affect them, in the interview it came out that the problem of stock outs is a really problem in the public health facilities. Anne said a lot of essential medicines requested from the district pharmacy are not received ,they only received what packed from there not what they requested for, sometime they even receive drugs that have no use in their clinic like now they have a lot of drugs just packed for Buazare which they never request for. There also a great shortage of ARVs for PMTCT for women at the clinic and a serious shortage of septrin for people living with HIV. It also came out that some of the essential medicines such amoxicillin suspension are no longer stocked in clinics. Anne recommended that the old system where a pharmacist from the district following medicines and witnesses the packing of the drugs at medical stores was far much better than comparing to the new system where medical store delivery the medicines which usually have very essential medicines not included in the kits. It was also observed that the system used for ART program in clinic is very good and this system if adopted availability of essential medicines in public clinics can improve a lot.

Interview with Ida

Another interview was done with a grandmother who had taken the grandson for treatment to Libuyu clinic in Livingstone and they had experienced a stock out of amoxicillin suspension. Ida is a widow who stays in Libuyu looking after a grandchild, Ida said they went to the clinic seeking treatment and was only given a prescription of amoxicillin suspension of which she could not afford to buy the medicine. Ida said that recently there has been lack of access to medicines unlike in the old government were medicines were available in clinics.

Day two

On the next day a radio Talks show was held on Radio MOSI-O-TUNYA community Radio station which cover most parts of the province.

The panel was made up by Casco Mubanga a and Banza Chela both from the stop stock-outs country team members from Lusaka, Lloyd Bwalya the NZP+ Livingstone Coordinator while Claudio Midolo captured the event with photos and a video recording.

The Presenter Mr. Mwale asked Casco to give a background of the essential medicines concept, it was explained that the essential medicine concept was adopted by WHO member state 30 years ago which include Zambia, casco went into detail to explaining the whole concept, Mr. Banza explained the stop stock-outs campaign and the consequences of stock outs in patients while Lloyd Bwalya explained how they participated in the exit patient interviews called SMS check campaign.

In conclusion there serious stock outs of essential medicines in Livingstone and the province, programs such as PMTCT have been affected because of short supplies of some combinations of ARVs in most clinics in Livingstone. The list of stock outs include amoxicillin suspension for children, first line ARVs, Zinc 20mg tablet for children with Diarrhea others are benzathine Penicillin to mention a few.

Uganda investigates HIV patients’ deaths

mlive.com