1

AVAILABILITY OF DRUGS: WHAT DOES IT MEAN IN

UGANDAN PRIMARY CARE?

Jessica Jitta, S. R Whyte, N. NshakiraChild Health Development Center Makerere University Uganda & Institute of Anthropology University Copenhagen Denmark

2

ABSTRACT

Presentation covers areas below:

• Introduction/background

• Objectives

• Methods

• Findings

• Conclusions

3

INTRODUCTION

• Uganda public- 40%, PNFP 25% and PP 35%• Health reforms Ugandan HS initiated 1990s as

central efforts to rebuild the health system • Reforms assume rational drug management

ensures drug availability &quality care• Tension assumption- reality HWs responsive to

users’ demands& being rational drug manager• Introduction user fees -health as commodity

and users demanding value for money

4

OBJECTIVES

• To examine drug availability at primary health care level, with a focus on the inconsistencies in drug supply policy and the gap between policy and practice.

5

METHODOLOGY

• Cross-sectional qualitative and quantitative KI, FGD,observe consultations and records review

• 6 units- a public rural hospital OPD, 3 HCs, a sub-dispensary and an church NGO dispensary

• Policy makers/administrators (KI 67); users (54FGD)observed consult(140) exit interviews (160) entries patient registers (600)

• Analysis -significance drug availability HCW, users and planners/administrators-realities that HCWs and their patients face -district context national policy

• Supply, utilization and expectations/demand for inj chloroq, penicillin & availability of needles/syringes.

6

FINDINGS- Sources of drugs

• Public units- EDMP pre-packed kits quarterly to districts , district buy suppl drugs, special vertical programs (TB, STD) & h/units procure drugs &needles and syringes

• Patients referred to drugshops buy drugs- 40%• NGO depend only procuring drugs-not limited• Planners concerned EDMP, no policy on drug

supplements by units• To users most important- obtain needed drugs

7

FINDINGS- Types drugs available

• Volume and range services at unit determine EDMP kits supplied and National Standard Guide available for rational drug use

• Most used drugs anti-malaria, antibiotics and analgesics

• Inj medicines on high demand, went o/s first• Units put user fees to supplement stocks to

overcome chronic o/s & increase range of drugs, needles & syringes and IV fluids

• Health unit records on supplements poor

8

FINDINGS- Diagnosis & prescript

• Varied with cadre and number of h/providers- skills vary with level health units

• Symptomatic diagnosis lack of support facilities • Very sick patients (children vomiting) injections

prescribed• High rate use of combination antibiotics and anti-

malaria- many drugs (poly-pharmacy) • Very high injection rates 35-85% compared to

recommended 15%-providers respond users demands- previous oral form taken no response

9

FINDINGS- Drug suff/adequacy

• New kits open only exhausting contents• Drugs used at different rates• Injection drugs run out first unit supp• 40% exit interviews referred drug shop• Planners/admin EDMP adequate in units• Providers unsatisfied injection drugs

antibiotics and anti-malaria• Users concerns drug availability at unit,get

injections, affordable and adequate dosage

10

FINDINGS- Availability issues

• Health sector reforms have changed the conditions for managing, supplying and using drugs through decentralization, user fees and privatization.

• Injection drugs in kits ran out quickly and were purchased by the unit or the patient at nearby drug shops.

• Government health units both compete with & use local commercial sources of drugs undermining technical premise rational drug use and supply built into kit system.

11

FINDINGS- Quality care perspt

• Drugs availability is fundamental quality of care by all 3 categories of actors PHC, perspective differ& shifting

• Plan/admin- securing suppl EDMP kits-delivery, records account/stocktaking, mism’gment/leakages at HU-control & security of drugs-manuals&guidelines rational use drug

• H/workers not relate insuff to drug to diagnosis prescription but-inadequate supplies in kits, large numbers infectious diseases and need to satisfy pts with injections- purchase suppl drugs, refer pts buy p/shops

• Users- in terms whether all prescribed drugs are good obtainable at HU regardless source, inj preferred form

12

CONCLUSIONS

• Problem of drug availability interlinked, so is perspectives and interests of actors

• Dialogue and realism are needed in order to create policies that respect both good medical treatment standards and the concerns of frontline health workers and their patients.

• Rethinking of the meaning of drug availability in PHC calls for methodologies examining the changing context of h/care & position of diff actors, at national and district levels, to address gaps existing between drug policy and practice