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Lack of Access to birth attendants causing fistula, health experts say

By Sarah Tumwebaze & Agatha Ayebazibwe

Lack of access to skilled birth attendants is the major cause of fistula in Uganda, health experts have said. The commissioner clinical services, Dr Jacinto Amandua, said women get complications such as fistula because they lack skilled medical intervention during child birth.

“Out of every 100 women that give birth, 15 per cent of them need help that will require a skilled medical personnel but because the experts are rarely available, this explains why some women end up with conditions like fistula,” Dr Amandua said yesterday in Kampala during the launch of a report on fistula.

Fistula is an injury that occurs during childbirth, usually when a woman is in labour for too long or when delivery is obstructed. It causes an abnormal opening of the birth canal resulting into the continuous leakage of urine and stool leaving the woman with a persistent odour.

Dr Jane Aceng, the director general of health services, said fistula is one of the most devastating consequences of difficult labour to a mother. While Dr Aceng confirmed that fistula represents an important public health problem in Uganda, she added that the actual prevalence of this condition remains unknown.

High prevalence
Currently, the prevalence is based on a 2006 Uganda Demographic Health Survey which shows that 2.64 per cent (200,000) of Ugandan women have ever suffered from symptoms of fistula, while 1,900 new cases are registered yearly.

Speaking at the same event, Ms Edith Ronah Mukisa, the country manager of EngenderHealth, said another cause of fistula are delays. “Delay at home, delay to get to the health centre and delayed intervention while in hospital,” she said.

The report that is based on a four-year study revealed that transport was also a challenge to women in labour, forcing them to give birth from home with no medical personnel to attend to them.

Dr Amandua said although government has trained experts to attend to pregnant women, providing family planning services and bringing health centers closer to people, government needs to mitigate the magnitude of fistula in Uganda. “This will help sort the challenges of planning, budgeting and service delivery,” he said.

www.monitor.co.ug/news

Do We Really have Drug Shortage?

Analysis by Paul Abusharizi

Nalongo’s son had just under­gone an operation and it was long past the time he was supposed to get his final pain killer for the day. She looked on helplessly as he whimpered in pain as his father went in search of the doctor on duty.

The nurse on duty, when she came around three hours after the 6:00pm prescribed time for the young man’s doze, claimed the drugs were not in stock and that they should go outside the hospital to buy the drugs, which prescription she hastily scribbled on a piece of paper.

As it turns out the drug was very much in stock. For those in the know this was a subtle attempt by the nurse to extract some money from the parents of the in-pain boy.

All this happened at the national referral hospital — Mulago. While the end user is un­der the impression that our health centres are suffering a perennial drug shortage, National Medical Stores is sitting on tons of drugs which are reportedly in short supply.

“My warehouses are full of drugs to the point that I am asking my suppliers to hold with future deliveries as I try to work these ones out of the system,” NMS boss Moses Kamabare told Sunday Vision.

Clearly, between NMS warehouses and the end users, there is a bottle neck that is pre­venting the end users from accessing lifesaving drugs.

Three years ago in an attempt to alleviate the perennial drug shortages in public facili­ties, government centralised the procurement process under NMS.

Previously, the procurement of drugs was decentralised to the national referral hospitals ‑Mulago and Butabika, the regional referral hospitals and the districts, which supplied the health center II to IV.

By centralizing drug procurement govern­ment hoped to take advantage of the discounts possible with the ensuing economies of scale, create uniformity of supply and curb drug thefts.

Under the current system the referral hos­pitals and the districts provide NMS with a procurement plan, which guides NMS as to the drugs and their quantities to buy for the year as well as how regularly they should be dis­bursed. NMS only procures according to these plans.NMS has a delivery schedule which is monthly for Mulago and Butabika and once every two months for everybody else.

Since the capacity to quantify needs was lacking at the lower health centres the health ministry came up with a basic kit, which has most of the essential drugs and supplies like gloves, which are supplied to the health cen­tres two and three.

So NMS clients are supposed to requisition their drugs according to their pre-determined procurement plans and only then will they be supplied with the drugs.

“That is where the problem starts. We quick­ly found out that either they do not requisition, so we don’t dispatch or they requisition less than they already planned for leaving us with unused stock,” Kamabare said.

That is where the discrepancy between shortages at the health centres against the contradiction of NMS’ full warehouses begins.

By not requisitioning or under requisition­ing you have health centres without drugs for months or running out of supplies ahead if schedule respectively.

Why this happens is a mixed bag of motives that range from incomprehensible incompe­tence to sabotage of an innovation that would expose the old practitioners to individual abuse of the system to meet personal needs.

“For example some prescribers can prescribe medicines that are not on our national essen­tial medicines list. The idea being the patient would have to go out of the hospital to order the drugs living the impression that the hos­pital is short on drugs while the truth is that a perfectly adequate drug is readily available in the health facility’s dispensary,” Kamabare said.

Clearly a holistic solution to the prob­lem including increasing health workers pay and welfare and training many more health workers is required.

But as a start beyond the streamlining procurement Kamabare counsels the use of medicines only listed in the national Essential Medicines List and prescribe as stipulated in the Uganda Clinical Guide­lines – which has detailed descriptions of common ailments in the country and how they should be prescribed for.

“Artificial scarcities are being created and sustained contrary to the truth, “ the NMS boss says. “Among the drugs we are over laden with are those for cancer, TB, ARVs, family planning supplies, rabies vac­cines, insulin and mama kits.

My concern is not that my warehouses are full but what is happening to the rightful patients of these drugs …. Aren’t they dy­ing because of a failure of our systems?”

https://www.cehurd.org/2012/05/do-we-really-h…-drug-shortage

We shall block budget if health funding is not increased – MPs

By MERCY NALUGO

Next financial year’s budget framework indicates that funding to the health sector might shrink, a move MPs threaten to oppose.

MPs on the Social Services committee have asked the government to increase funding to the health sector in next year’s expenditure estimates and warned that a failure to accept their recommendation could provoke them into blocking the ministry’s budget.

According to the 2012/13 National Budget framework paper, the health ministry is expected to absorb a reduction of Shs52.7 billion from the Shs814 billion which was allocated to it this financial year with the government proposing to spend Shs761.6 billion for the next financial year.

The Minister for Health, Ms Christine Ondoa, while appearing before the committee yesterday, brought the matter to the attention of the legislators where she attributed the reduction of the budget to a decrease in the donor-funded project component.
The reduction, however, means that the sector’s allocation will account for 8 per cent of the overall national budget which is way below the 15 per cent target set in the Abuja Declaration which Uganda ratified.

“The strengthening of reproductive and mental health programme under Butabika Hospital has ended and the donor budget will therefore reduce from Shs19.5 billion to Shs5.4 billion. Also, the project of rehabilitating and equipping health facilities in the central region is coming to an end and its donor budget will reduce from Shs53.7 billion to Shs15 billion,” Ms Ondoa said.

The legislators in a meeting chaired by Dr Sam Lyomoki (Workers MP), however, indicated that the budget cut would have a significant impact on the already sick health sector.

Ngora District Woman MP Jacqueline Amongin said the committee will not pass the budget if government does not increase the funding.

“It is surprising that the government is cutting money for the Ministry of Health and yet the same government committed itself and ratified the Abuja Declaration which talks of at least 15 per cent for the ministry,” Ms Amongin said.
“We still have so many challenges of health as women are still dying either because there is no transport or the health centre is very far. It’s unbelievable that in Ngora we have no doctor in the hospitals,” she added.

Ms Sylvia Namabidde, the Mityana Woman MP, said Uganda will not meet its Millennium Development Goal targets on health if government does not prioritise the health sector given the increasing population.

Poor services
While the government has endeavoured to set up health facilities across the country, the Uganda Local Government Councils Score Card 2009/2010 report by Advocates Coalition for Development and Environment, shows that improvements are only in infrastructure, especially in construction of health centres.

The report said problems such as shortage of drugs, understaffing, shortage of equipment, absenteeism of health workers, and weak accountability mechanisms still exist.

The minister had also noted that despite a government proposal to recruit about 1,020 health workers, there is no money for the exercise. But the MPs said unless the issue of human resource is handled, the public health sector will continue to fail to deliver services.

Ms Angelina Osege, the Soroti Woman MP, wondered why the government had not allocated money for the treatment of tuberculosis yet it is one of the leading killer diseases in the country.

Meanwhile, government has announced a Shs33 billion enhancement for health workers’ salaries. The 21 per cent increment is expected to benefit all public health workers although they have always demanded for a 100 per cent increment.

Dr Asuman Lukwago, the acting permanent secretary in the ministry, however, said Shs214 billion would be required to effect the 100 per cent increment but they are constrained by resources.

mnalugo@ug.nationmedia.com

Source: http://www.monitor.co.ug/News/National/-/688334/1401578/-/ai16p8z/-/index.html

Kenya: Court Ruling on Generic Drugs Sets Precedent for the Region

BY HENRY ZAKUMUMPA, 4 MAY 2012
GUEST COLUMN

Thousands of people living with HIV and Aids in East Africa were given new hope on 25 April 2012, when a high court judge in Nairobi ruled that Kenya’s anti-counterfeit law was unconstitutional in its interpretation of generic HIV drugs as illegal counterfeits.

A generic drug is an identical copy of a branded or listed medicine – one that is usually developed and manufactured by private pharmaceutical companies. Branded drugs, such as those manufactured by Pfizer and Norvatis, are sold at prices tailored to Western markets and thus, generally, are unaffordable for the majority of patients in sub-Saharan Africa.India has developed a thriving generics industry, leading to it being dubbed “the pharmacy of the developed world” for the low cost of its generic drugs, especially antiretrovirals, some of which cost as little as a tenth of the brand price.

Indian generic drug manufacturers such as CIPLA, imitate the exact formulas used in branded antiretroviral (ARV) medicines through a process called ‘reverse engineering. The drugs are the equivalent of the branded products and as effective.

Justice Mumbi Ngugi ruled that intellectual property rights do not override the right to life and health. She found the definition of a ‘counterfeit’ in the Kenya Anti-Counterfeit Act of 2008 to be too broad leading to generic HIV drugs being bundled together with other counterfeits. Justice Mumbi said this vagueness is posing a grave threat to the right to life and health for thousands of Kenyans who depend on life-saving generic ARVs.

The high court judge has now instructed the Kenyan parliament to review the Anti-Counterfeit Act of 2008 and to amend the offending articles. Until this point, generic HIV drugs could be subject to arbitrary seizure on the assumption that they are ‘counterfeits’, as happened at a Dutch port last year.

Under common law, a high court ruling in Kenya sets a precedent for countries such as Uganda and Tanzania, and it is now thought that human rights activists in Uganda and the rest of East Africa will invoke the ruling in any potential suits that seek to outlaw generic medicines.

The news also comes as a welcome development for Ugandan pharmaceutical companies such as the Quality Chemicals Plant in Luzira, most of whose products are generic drugs.

While testifying before a Ugandan parliamentary committee last month, Moses Mulumba, a human rights lawyer and intellectual property rights expert, revealed that the Uganda Counterfeit Bill 2010 regards generic Aids drugs as ‘counterfeits’ and would render 90 percent of HIV drugs in Uganda illegal should the bill be passed by parliament and approved by President Yoweri Museveni.

With efforts to deepen East African regional integration taking centre stage, the Kenya High Court ruling becomes even more instructive for Uganda and the rest of the members of the East African community.“

A vast majority of people in Kenya rely on quality generic drugs for their daily survival. Through this important ruling, the High Court of Kenya has upheld a fundamental element of the right to health,” said UNAIDS Executive Director Michel Sidibé. “This decision will set an important precedent for ensuring access to life-saving drugs around the world.”

“The court has correctly interpreted the Constitution and guaranteed the right to health. This ruling speaks against any ambiguity that serves to undermine access to generic medicines and puts the lives of people before profit,” Patricia Asero, one of the three petitioners, was quoted as saying.

The last week of April also marked the successful passage of the East Africa HIV/Aids Prevention and Management Bill 2012 by the East African Legislative Assembly, a timely milestone as the assembly’s term of office expires this June.

Henry Zakumumpa is a Ugandan journalist and a member of the Key Correspondents Team – a network of citizen journalists reporting from some 50 countries who focus on a range of topics including health and community development.

Source:http://allafrica.com/stories/201205050203.html

Kiyunga: A sick health centre

Luuka

Kiyunga Health Centre IV in Luuka District is facing a host of problems impeding service delivery at the facility. People with premature babies at the health facility are forced to light charcoal stoves and lamps to give the babies warmth since there is no electricity at the hospital.

There is congestion at the facility which has only two wards, the maternity and a general ward, the latter is shared by both male and female patients, children and adults.

The facility also lacks a mortuary, a situation which has forced patients on several occasions to share their ward with dead bodies overnight. According to Luuka officials and residents the lack of a mortuary has lead to a miscarriage of justice.

“We find it very hard in cases of death. The hospital where we would take bodies for postmortem has no mortuary and sometimes we fail to access medical (postmortem) reports on such deaths because relatives are left to take their bodies because there is no mortuary,” the acting District Police Commander, Mr Charles Nyongesa, said, citing cases of suspected murder and accidents.

The former mortuary at the hospital is dilapidated and unusable. It is roofless and has no windows.

Mr Wilber Meregulwa, a resident of Kasozi Mawembe in Bulongo Sub-county, says he had to keep the body of his one-and-a-half-year-old boy who died at around 8pm in the ward until the following day.

“We were stranded and some nurses advised me to cover the body within the bed until the next day because I had no ready means of transporting the body to my village and the health centre ambulance lacked fuel,” Mr Meregulwa said.

Dr Matthias Wabwire Panyako, the officer in-charge of the facility, says they are always stranded with bodies after patients die. He says: “Immediately one dies, we assist the bereaved relatives to arrange for transporting the body to their respective village. We have an ambulance that was donated by the area MP Johnson Bagoole, readily available for fuelling to remove bodies out of the health facility.”

Dr Panyako says the health facility, which is due for elevation to a district hospital status after rehabilitation by the Ministry of Health expected to start this month, serves more than 150 patients daily and registers at least one death every day.

The District Health Officer, Dr Enock Kwikiriza, says: “We have written to the line ministry to give it (mortuary) a first priority during the redevelopment and maintenance of the centre,” he said.

editorial@ug.nationmedia.com

Source: http://www.monitor.co.ug/News/National/-/688334/1398438/-/view/printVersion/-/2g01uhz/-/index.html