Securing Ugandans' Right to Essential Medicines: Our Impact

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.

In Uganda, management of tuberculosis (TB) medicines is fully decentralized. Like other government and private programs, the Ministry of Health’s (MoH) National Tuberculosis and Leprosy Program (NTLP) procured and supplied tuberculosis (TB) medicines independently to district stores.

One of the new prescription and dispensing logs distributed to facilities through Uganda SURE. {Photo credit: MSH.}Photo credit: MSH.

Providing more patient information in medical records and making those records easily accessible helps health care workers ensure that patients take their properly prescribed medicines correctly.

 {Photo credit: MSH.}Securing Ugandans' Right to Essential Medicines (Uganda SURE) Chief of Party Birna Trap.Photo credit: MSH.

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?

A National Medical Store in Uganda. Photo Credit: MSH Staff.The US Agency for International Development recently awarded MSH a five-year, $39-million cooperative agreement to implement the Securing Ugandans’ Right to Essential Medicines (SURE) Program. SURE’s mandate is to make certain that Uganda’s people have access to good-quality essential medicines and health supplies by strengthening the national pharmaceutical supply system.

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