Uganda: Our Impact

Chronic diseases account for about 28 percent of deaths in sub-Saharan Africa, and by 2030 they will kill nearly twice as many people in the region as they do today. In Uganda, screening for cancer, diabetes, cardiovascular disease, and other illnesses remains limited despite the availability of inexpensive and effective diagnostic techniques.

 {Photo credit: Rui Pires.}A woman receiving antenatal care undergoes an ultrasound at Mpigi Health Center IV in Uganda.Photo credit: Rui Pires.

Annette Mbwirahe didn’t know what was wrong—the pain in her lower abdomen wasn’t getting any better. Finally, unable to endure it, she decided to get help. Mbwirahe, 25, left Buyiwa village and went to Buwama Health Center III in the Mpigi district of Uganda where midwife Zura Kyotazaala examined her with an ultrasound scan. “I discovered that she was carrying a seven-week twin pregnancy,” Kyotazaala said.

 {Photo credit: Deus Lukoye/MSH.}Abraham Luutu after TB treatment.Photo credit: Deus Lukoye/MSH.

Tuberculosis (TB) is curable when detected and treated. But many people do not know they have TB. And patients who are diagnosed, often experience debilitating side effects from the medicine (such as nausea and loss of appetite) that lead to malnutrition, poor treatment adherence, and prolonged illness.

 {Photo credit: Rita Tumuhairwe/MSH.}Nile Breweries donated 36 cases of water to TRACK TB-supported hospitals. Purified water helps TB patients stay hydrated during treatment. Photo credit: Rita Tumuhairwe/MSH.

Nagayi Efrance became infected with tuberculosis (TB) in 2012. Although she attended local health facilities for treatment, the TB medicine did not heal her and often left her feeling nauseated and unable to eat. When Nagayi tried to take the TB medicine on an empty stomach, she felt even worse. Eventually, she stopped taking treatment and developed multidrug resistant TB (MDR-TB), a strain of TB that cannot be treated by first-line anti-TB medicines.

 {Photo credit: STAR-E staff/MSH}Lydia attends to a patient at Busia Health Center.Photo credit: STAR-E staff/MSH

Ms. Lydia Nakalyango is the only midwife on staff during the day at the Maternal and Child Health Department of Busia Health Center IV, which serves not just their own municipality, but clients from neighboring Kenya as well. Lydia takes care of antenatal clients while also paying attention to the labor ward for any mothers delivering. She is also on standby to care for new babies referred for early infant diagnosis.

Figure 1: Percentage of diarrhea cases that are appropriately treated

The MSH-led, USAID-funded Securing Ugandans’ Right to Essential Medicines (SURE) program registered significant improvements in rational prescriptions for diarrhea and cough after introducing on-the-job training to health workers. The training, which is a component of SURE’s supervision, performance assessment, and recognition strategy, was introduced in collaboration with the Ministry of Health to improve medicines availability, storage, and appropriate use.

 {Photo credit: MSH}Medicines management supervisors receive computer training for collecting, submitting, and analyzing SPARS data.Photo credit: MSH

Districts in Uganda faced many problems in managing medicines and health supplies. Health facilities often placed orders for medicines and health commodities without reviewing their consumption rate­—how much they had been using—which led to both the expiration and stock-out of vital medicines. Medicines were also prescribed without following treatment guidelines, which when coupled with inadequate information and instructions during dispensing,  left patients dangerously confused.

 {Photo credit: MSH}BEFORE: Drugs in boxes placed on the floor in Kisoro HospitalPhoto credit: MSH

Shelves may seem very basic and not particularly worthy of note. In fact, shelves can transform how medicines and supplies are organized by making it easier for a hospital to keep track of how many drugs it has and prevent wasteful expiry.  For nearly 16 years, all drugs and health supplies in Kisoro Hospital were stored on the floor, which was inefficient and a challenge for staff members who had to manage the stock. 

{Photo credit: MSH}Knud Rhyl was brought on board by SURE and NDA to help devise the new guidelines and inspection tool. Knud helped adapt international best practices to the Ugandan context. He is pictured presenting at the meeting with key wholesalers in Uganda.Photo credit: MSH

In Uganda, although wholesale and retail pharmacies are legally distinct, their practices are indistinguishable and their customer base overlaps. Wholesalers’ service should be business-to-business only, but they often sell to the public. This division of responsibility is crucial in assuring the quality and safety of drugs; without accountability, substandard and counterfeit medicines can too easily slip through the cracks.

 {Photo credit: MSH}District Inspector, Daniel Isabirye, inspecting Misima HC II in Jinja, while Esther Mugadya, the In-charge, helps find stock cards for review.Photo credit: MSH

The National Drug Authority (NDA) has minimum standards and inspects facilities to certify that they meet those standards. Inspections, therefore, are important in ensuring good pharmacy practices. Until now, NDA had only inspected private sector pharmacies who had more resources to achieve what was required to be certified.

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