Gaps and opportunities in sustainable medicines use in resource limited settings: A situational analysis of Uganda

Kamba, Pakoyo Fadhiru; Nambatya, Winnie; Aguma, Herbert Bush; Charani, Esmita; Rajab, Kalidi

doi:10.1111/bcp.15324

Cited by 2 publications

(1 citation statement)

References 61 publications

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“…Local production is encouraged by a) pharmaceutical producing companies being made exempt of paying duty tax on 80% of their imports [41] and b) PFSA giving preferential treatment to local manufacturers [41]. These initiatives aim to promote sustainable medicine use, and similar policies have been adopted in other countries on the continent [42,43]. However, there are ongoing challenges with local production.…”

Section: Discussionmentioning

confidence: 99%

Striving towards access to essential medicines for human and animal health; a situational analysis of access to and use of antifungal medications for histoplasmosis in Ethiopia

Abera¹,

Wood

Deressa³

et al. 2023

PLoS ONE

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Antifungal medications are vital in combatting fungal diseases that affect over a billion people annually. Antifungal medications for people and equids are scarce in Ethiopia, where lack of resources to treat fungal infection, in particular histoplasmosis, is a major health challenge. Histoplasmosis is endemic within the equine population in Ethiopia, where it is estimated that one in five horses are infected. This disease has far reaching impacts on equine welfare and the socio-economic wellbeing of families. The burden of histoplasmosis in people in Ethiopia is currently unknown, representing a blind spot in public health surveillance. Previous research has identified contact with wildlife, and domestic animal species as possible transmission pathways for histoplasmosis however, questions remain about the role of equids in human histoplasmosis. Given the close proximity of people and animals in this setting, the high level of endemic disease among equids, and the common sources of anti-fungals in Ethiopia, our study adopted a One-Health approach to examine how systemic issues affect access to, and use of antifungals to treat histoplasmosis among people and equids. A qualitative study was conducted in 6 urban regions of Oromia, Ethiopia in December 2018, incorporating semi-structured face-to-face interviews and focus group discussions. Twenty-seven individual interviews were held with doctors (n = 7), pharmacists (n = 12), veterinarians (n = 5), para-veterinarians (n = 2) and an equid owner (n = 1). Eleven focus groups were conducted with equid owners (n = 42), 3 with veterinarians (n = 6), 1 with para-veterinarians (n = 2) and 1 with pharmacists (n = 2). Transcripts were analysed using thematic analysis, and dimensions of key themes conceptualised and compared. Two overarching themes namely, ‘Structural’, and ‘Human factors’, summarised the main limitations to access to antifungal medications. ‘Structural factors’ included the national reliance on importation of medicines or pharmaceutical ingredients, inaccurate demand forecasting due to poor recording of the shortfall within the pharmaceutical supply chain, deficiencies in diagnostic capacity for fungal disease and, a healthcare system funded with a significant component of out-of-pocket expenditure. ‘Human factors’ that influenced access to antifungals included the perception of the expense of antifungals compared with competing needs such as food and education, the social stigma attached to histoplasmosis that could lead to delays in treatment seeking and, readily available home remedies or alternative treatment options. Furthermore, it was reported that trust in healthcare and veterinary provisions was undermined by a perceived lack of efficacious medications. Access to antifungals remains an urgent public health and animal welfare concern in Ethiopia. Key points within the supply and distribution chain that affect access to anti-fungals are identified, and policies that facilitate anti-fungal procurement and distribution should be reviewed. This paper highlights the structural, socio-economic and cultural factors influencing the management of infection with histoplasmosis, including how it is understood, identified and treated. This study identifies areas where further cross-sectorial work is needed to address these factors to improve disease control and clinical outcomes observed in human and animal histoplasmosis within Ethiopia.

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Section: Discussionmentioning

confidence: 99%

Striving towards access to essential medicines for human and animal health; a situational analysis of access to and use of antifungal medications for histoplasmosis in Ethiopia

Abera¹,

Wood

Deressa³

et al. 2023

PLoS ONE

View full text Add to dashboard Cite

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Labor markets for health supply chain management in Rwanda: a qualitative study of stakeholder perspectives

Meier,

Brown,

McHenry

et al. 2023

BMC Health Serv Res

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Background Effective supply chains for health products require an adequate, skilled workforce for supply chain management (SCM). Rwanda faces challenges in human resources for SCM, including limited capacity for SCM at different levels. Understanding of the factors influencing the supply of and demand for SCM professionals in Rwanda is necessary to ensure the labor market contains an adequate workforce. This study identifies the perspectives of key stakeholders in the supply chain management sector about the factors influencing the supply of and demand for SCM professionals. Methods Data were collected in semi-structured group and one-on-one interviews with 39 key stakeholders involved in the supply chain management labor market between March and April 2019. Interviewees were categorized according to their role in the labor market as system actors, functional actors involved in the supply of SCM workers, and functional actors involved in the demand for SCM workers. Interviewees were asked open-ended questions about factors influencing the demand for and the supply of SCM workers, and recommendations for improvement. Interviews were analyzed thematically. One validation focus group was held and the results were also reviewed by the Ministry of Health in Rwanda. Results Stakeholders agreed that skills mismatch between SCM workers’ skills and the competencies jobs require impacts the supply of workers. A lack of career structure for SCM, lack of professional definitions for health supply chain management, and SCM curricula that do not match the needs of the workplace contribute to this gap. The demand for SCM professionals is poorly defined in terms of the numbers of professionals needed and the skills workers require. Financial limitations hinder demand for health SCM professionals. Conclusions This study adds to the understanding of factors influencing the SCM labor market in Rwanda by documenting perspectives from government ministries, professional organizations, universities, and employers from SCM organizations. Improving the SCM labor market in Rwanda and the availability of the skilled cadres required for the effective management of health supply chains in Rwanda requires a coordinated effort by the Ministry of Health in Rwanda, private SCM companies, professional associations, education sector, and policy makers.

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Gaps and opportunities in sustainable medicines use in resource limited settings: A situational analysis of Uganda

Cited by 2 publications

References 61 publications

Striving towards access to essential medicines for human and animal health; a situational analysis of access to and use of antifungal medications for histoplasmosis in Ethiopia

Striving towards access to essential medicines for human and animal health; a situational analysis of access to and use of antifungal medications for histoplasmosis in Ethiopia

Labor markets for health supply chain management in Rwanda: a qualitative study of stakeholder perspectives

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