Variation in the Availability and Cost of Essential Medicines for Non-Communicable Diseases in Uganda: a descriptive time series analysis

Armstrong-Hough, Mari; Sharma, Srish; Kishore, Sandeep P.; Akiteng, Ann R.; Schwartz, Jeremy I.

doi:10.1101/2020.02.21.20026393

Cited by 4 publications

(5 citation statements)

References 15 publications

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“…Recent studies have shown different levels of availability of EMHS across health facilities in Uganda. A study by [2] showed higher levels of availability of essential medicines at across all levels of care than those observed in this study. However, the results are from a sample of 23 health facilities.…”

Section: Discussioncontrasting

confidence: 62%

Health supply chain system in Uganda: assessment of status and of performance of health facilities

Lugada¹,

Ochola²,

Kirunda³

et al. 2022

J of Pharm Policy and Pract

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Background Health supply chain systems are essential for effective and efficient healthcare system by ensuring availability of quality essential medicines and health supplies. While several interventions have been made to ensure the availability of quality essential medicines and health supplies, health facilities continue to report stockouts in Uganda. Objectives This study aimed to assess the status and performance of the supply chain system across all levels of care in health facilities in Uganda. Methods This was a cross-sectional study conducted in 128 public and private-not-for-profit health facilities across 48 districts in Uganda. These facilities included all levels of care from Health Centres II, III, IV, general and referral hospitals, and national referral hospitals. Data were collected using desk reviews, health facility surveys, and key informant interviews with key personnel. Stock registers were reviewed to assess the availability of a basket of essential medicines based on the essential medicines list of the Ministry of Health. Results Less than half (42%) of health facilities had computer hardware. Most (84%) of health facilities were using a form of Logistics Management Information System with only (6%) were using the Electronic Logistics Management Information System. Just under a third (33%) of health information officers and (51%) of public health officers’ positions were filled in the health facilities. Nearly (66%) of health facilities used supply chain data to support decision-making. Most (84%) of health facilities reported stockouts of Essential Medicines and Health Supplies in the past 6 months. The main reasons for stockouts were (59%) a sudden increase in demand (40%) delivery gaps/delayed deliveries and (35%) discrepancies in orders and deliveries. Health facilities responded to stockouts through various means including (75%) redistribution (43%) purchased from a distributor, and (30%) placing emergency orders. Conclusions The findings from this study show that the performance of health facilities in different supply chain processes and functions was defective. To improve the supply chain performance of health facilities, it is important to invest in infrastructure development, provide computer hardware and internet connection and strengthen the capacity key personnel. This is key for ensuring full functionality of the supply chain and availability of quality medicines and health supplies to the end-user.

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Section: Discussioncontrasting

confidence: 62%

Health supply chain system in Uganda: assessment of status and of performance of health facilities

Lugada¹,

Ochola²,

Kirunda³

et al. 2022

J of Pharm Policy and Pract

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“…Other EDL barriers were poor geographical access contributing to limited access to essential in vitro diagnostics in rural areas 96 , and limited health facility access: availability of essential in vitro diagnostics at referral hospitals but not primary health care facilities 96 and public facilities 98 , and poorly resourced health facilities 97 . 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, 86–89, 104, 110, 136, 140–149 , poor geographical access 36, 65, 74, 82, 104, 143, 146, 150 and health facility access 73, 74, 106, 150–152 .…”

Section: Resultssupporting

confidence: 54%

“…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 .…”

Section: Resultsmentioning

confidence: 99%

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

Nyanchoka

Mulaku

Nyagol

et al. 2022

Preprint

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Background The World Health Organization (WHO) model list of Essential In vitro Diagnostic (EDL) introduced in 2018 complements the established Essential Medicines List (EML) and improves its impact on advancing universal health coverage and better health outcomes. We conducted a scoping review of the literature on the implementation of the WHO essential lists in Africa to inform the implementation of the recently introduced EDL. Methods We searched eight electronic databases for studies reporting on the implementation of the WHO EDL and EML in Africa. Two authors independently conducted study selection and data extraction, with disagreements resolved through discussion. We used the Supporting the Use of Research Evidence (SURE) framework to extract themes and synthesized findings using thematic content analysis. We used the Mixed Method Appraisal Tool (MMAT) version 2018 to assess the quality of included studies where applicable. Results We included 172 studies reporting on EDL and EML after screening 3,813 articles titles and abstracts and 1,545 full-text papers. Most (75%, n=129) included studies were purely quantitative in design comprising descriptive cross-sectional designs (60%, n=104), 15% (n=26) were purely qualitative, and 10% (n=17) had mixed-methods approaches. There were no qualitative or randomised experimental studies about the EDL. The main barrier facing the EML and EDL was poorly equipped health facilities - including unavailability or stock-outs of essential in vitro diagnostics and medicines and inadequate infrastructure to enable health service delivery. Financial and non-financial incentives to health facilities and workers were a key enabler to the implementation of the EML however, their impact differed from one context to another. Fifty-six (33%) of the included studies were of high quality. Conclusions The EDL implementation at the national level can learn from health system interventions to improve the availability and supply of essential medicines such as financial and non-financial incentives in different contexts.

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“…A large population and inadequate pharmaceutical budgets have perpetually combined with human resource and technological inadequacies in medicines management to simultaneously exacerbate the frequent stock-out of essential medicines. 39,40 Stock-outs of medicines and limited health commodities are a primer to AMR because they perpetuate missed, incomplete and inappropriate doses, as well as depriving prescribers of diagnostic tools, leading to an overreliance on empirical diagnoses and management of infections. Additionally, stock-outs drive patients from public sector health services to the private health market, where profit-motivated practices compromise adherence to treatment guidelines and appropriate medicines use.…”

Section: Threats To Sustainable Medicines Usementioning

confidence: 99%

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

Kamba

Nambatya

Aguma

et al. 2022

Brit J Clinical Pharma

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Resource constraints and widespread poverty among populations undermine disease prevention in low‐ and middle‐income countries (LMICs) and ensure that these countries carry a disproportionate share of the global disease burden. Lack of access to efficacious medicines in LMICs further exacerbates this inequity. Addressing inequitable access to medicines and assuring their sustainable use is critical to the well‐being of these populations. Whilst inadequate access to medicines in LMICs has drawn much attention, less is known about the sustainable use of available medicines, particularly to ensure their efficacy and mitigate harm to the population and the environment. Uganda has adopted various measures to ensure sustainable medicines use, including a national medicines policy, essential medicines list, medicines regulation framework and promotion of domestic medicines production. Despite progress, challenges remain to achieving sustainable medicines use in the country, including fragmented access, inappropriate use, poor quality and inappropriate disposal. There is a need to consolidate the globally embraced One Health approach (fostering collaboration between human, animal and environmental health sectors) to addressing these challenges as espoused in the country's One Health strategic plan. Medicines supply chain management in public sector health facilities needs to be strengthened to minimize inventory shortages (stock‐outs). A strategy for universal health insurance can minimize economic barriers to medicines access. Enhanced professional and medicines regulation in the private health market needs to be implemented. There are opportunities to build further capacity in Uganda, particularly infrastructure for regulation of its healthcare systems, policy and governance, workforce capacity building, and population action and engagement.

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Variation in the Availability and Cost of Essential Medicines for Non-Communicable Diseases in Uganda: a descriptive time series analysis

Cited by 4 publications

References 15 publications

Health supply chain system in Uganda: assessment of status and of performance of health facilities

Health supply chain system in Uganda: assessment of status and of performance of health facilities

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

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

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