Barriers to Accessing Internationally Controlled Essential Medicines in Uganda: A Qualitative Study

Abstract

Context. Access to internationally controlled essential medicines is a problem worldwide. More than five billion people cannot access opioids for pain and palliative care or do not have access to surgical care or anesthetics, 25 million people living with epilepsy do not have access to their medicines, and 120,000 women die annually owing to postpartum hemorrhage. In Uganda, access to controlled medicines is also problematic, but a lack of data on factors that influence access exists.Objectives. The objective of this study was to identify the social, cultural, and regulatory barriers that influence access to internationally controlled essential medicines in Uganda.Methods. Semistructured interviews with 15 key stakeholders with knowledge on controlled medicines from relevant institutions in Uganda. Interviews were transcribed verbatim and analyzed using the Access to Medicines from a Health System Perspective framework.Results. Barriers in accessing controlled medicines were experienced owing to lack of prioritization, difficulties in finding the balance between access and control, deficiencies in the workings of the estimate and distribution system, lack of knowledge, inadequate human resources, expenses related to use and access, and stigma. It was believed that some abuse of specific controlled medicines occurred.Conclusion. The findings of this research indicate that to improve access to internationally controlled essential medicines in Uganda, health system strengthening is needed on multiple fronts. Active engagement and concerted efforts are needed from all stakeholders to ensure access and prevent abuse.

Progress Update: Palliative Care Development Between 2017 and 2020 in Five African Countries

“…Steps were taken to ensure that the 2016 Narcotic Drugs and Psychotropic Substances (Control) Act, which did not initially allow nurses and clinical officers to prescribe morphine, would not interfere with palliative care delivery. 40,41 The first training course on palliative care for public institutions was developed, as were postgraduate and MSc programs in palliative care. 42 Palliative care indicators were integrated into the national health information system, strengthening monitoring and evaluation efforts.…”

Implementing essential diagnostics-learning from essential medicines: A scoping review

“…The barriers for the implementation of the EML are similar to the EDL barriers reported above, and the main barriers were poor financial access 39,48,78,79,83,[86][87][88][89]104,110,136,[140][141][142][143][144][145][146][147][148][149] , poor geographical access 36,65,74,82,104,143,146,150 and health facility access 73,74,106,[150][151][152] .…”

“…Similar and other related barriers were also cited in the EML implementation. The main barriers unique to the EML included inefficient procurement processes 34, 47, 49, 63, 65, 69, 70, 82, 157 , poor stock management practices 39, 49, 50, 53, 94, 105, 107, 140, 158, 159 , and inefficient distribution systems 40, 49, 75, 94, 111, 131, 146, 160, 161 .…”

“…Barriers to the EML implementation included market ideologies where generic medicines enter the market without a review process 142 , and political ideologies where facilities are built for political and economic purposes and without the involvement of the communities 73 and a disconnect between insurance drug list and drug prescription guidelines 41 . Community beliefs and attitudes negatively influenced the use of internationally controlled essential medicines (ICEMs) by patients with end-stage diseases 146 .…”

Drug shortages in low- and middle-income countries: Colombia as a case study

“…There has been support for improving medicine access globally, and one key dimension is availability of drug products [ 12 ]. However, while barriers to access have been studied at local levels [ 13 – 15 ], there are few country-level studies of drug availability and shortage in LMICs; studies that do exist focus on Asian and African countries [ 3 ]. In Colombia, as well as in other Latin American countries, an overview of country-level drug shortages is not available in English.…”