Building Local Capacity to Support Medicines Supply in Uganda
Securing Ugandans' Right to Essential Medicines (Uganda SURE), a five-year project that began in 2009, expands access to essential medicines and health commodities through reforming and harmonizing the national supply system and building local capacity to manage that system.
MSH spoke with Chief of Party Birna Trap about how the USAID-funded program, led by MSH, is addressing pharmaceutical challenges in Uganda.
What was the pharmaceutical supply situation in Uganda before SURE began? And what is the situation today?
Despite years of technical support in pharmaceutical management from various projects sponsored by organizations like USAID, Danida, and the World Bank, Uganda continues to face basic problems in supply-chain management for essential medicines and health supplies. These problems include lack of and/or poor use of stock cards and other records, stock-outs, wastage, and inappropriate use of medicines. Appropriate information to guide pharmaceutical decisions and priorities is low at all levels. Awareness of financial need and financial management is also low at all levels. The predominant management style has been one of crisis management, which quickly degrades morale among health care workers.
After analyzing the situation, SURE identified several strategies to optimize Uganda's use of resources and increase the availability of pharmaceuticals while decreasing the amount of wasted pharmaceuticals. Among the efforts SURE has undertaken are building the capacity of health care workers at the facility level, increasing the availability of information to managers at all levels so that they can make evidence-based decisions, establishing better tracking systems for finances and commodities, and establishing national advisory and planning bodies. SURE is supporting medicine supply organizations across all sectors, including the National Medical Stores, which serves public facilities, and the Joint Medical Stores, which serves private facilities.
One of the most innovative aspects of SURE's work in Uganda is the Supervision, Performance Assessment & Reward Strategy, which builds the capacity of facility-level health care workers through on-the-job training and recognition of good performance. The program carefully selects, trains, and supports district Medicine Management Supervisors (MMS) who periodically assess performance at health facilities and provide coaching, mentoring, and oversight at those facilities. Preliminary results show marked improvement in stock and storage management, dispensing, appropriate use and ordering, and reporting at the 1,500 facilities in the project area, which covers 45 districts.
Uganda SURE has also increased the availability of six major medicines being tracked by the MMS -- two drugs to treat malaria, a treatment for dehydration caused by diarrhea, a measles vaccine, an injectable contraceptive, and an infection treatment that also is prescribed to prevent mother to child transmission when the mother is confirmed or suspected to be HIV positive -- and the amount of funds available for essential medicines and health supplies.
What have been the primary challenges for SURE? How has it handled those challenges?
SURE has had some difficulty integrating its work with the activities of the Ugandan Ministry of Health.
Some stakeholders were initially slow in uptake of technical assistance and others were reluctant to share information. But SURE's strong results have helped the ministry's pharmacy division accept our work and we are now able to collaborate closely. The ministry is currently working with partners to expand SURE's capacity-building program mentioned above to all 116 districts in the country. It has also adopted several of SURE's proposed management information systems (Financial and Commodity Tracking System (FACTS) and Pharmaceutical Information Portal (PIP)) as part of its national strategy.
How has MSH empowered the people of Uganda through SURE?
By gaining its trust and close collaboration, SURE has enabled the Ugandan Ministry of Health to fully own the results of the SURE program. The ministry's leaders are now more open to applying new ideas to old problems. In addition, SURE has trained nearly 150 medicines managers at health facilities to be leaders in the field and sustain the program's work.
How does SURE ensure the sustainability of its work?
In addition to empowering the ministry of health and medicines managers, SURE aims to adapt its successful strategies for all health care programs in the country, thereby harmonizing the entire medicines system and integrating that system with all other health care interventions. Strengthening the entire health system in this way will contribute to the program's sustainability.
SURE has also established a program to include supply chain management in pre-service training of all health care workers. Additionally, we are collaborating with Uganda's Makerere University to transfer our training activities to the university by the beginning of 2012.