Uganda has seen the number of those accessing antiretroviral (ARV) drugs jump from 45 000 in 2004 to 121 200 in September 2007--a bit more than one-third of some 312 000 who need it. Although drug supplies have increased in volume, the national programme faces delays in procurement and distribution, poor storage and weak quality control, stock-outs and a chronic lack of manpower.
"The management of the whole supply chain is very weak and problematic," Dr Elizabeth Madraa, manager of Uganda's AIDS Control Programme in the health ministry, told the Bulletin. "We are now moving slowly as a result of the stock-outs because if we spread out rapidly and ran out of drugs, it would be disastrous."
"I think Uganda is making a lot of progress with regard to access to ARVs," the World Health Organization (WHO) Representative Dr Melville George says, adding that: "This in itself calls for a number of things like a good and reliable supply of drugs ... because if patients run out of ARVs they may develop resistance."
George suggested that Uganda needs to put in place a good community-based care system that will look at a comprehensive package to include nutrition, social support for patients, management of other opportunistic infections and other social responsibilities.
One of the beneficiaries of the government ARV programme is Elinah Kasubo. Access to ARVs has enabled the primary school teacher to live longer and continue working. But she complains of irregular drug supplies and a lack of antibiotics to fight infections that are a constant risk to people like her with weakened immune systems. "We want a stable and consistent supply of ARVs and treatment for opportunistic diseases."
Kasubo also complains of the queues teachers face when they fetch the drugs from government hospitals. "It takes a whole day lining up for ARVs in government hospitals because we are many. As if that is not enough, pupils missing their teacher for a whole day is too much."
AIDS and malaria are the biggest threats to the health of Ugandans and account for over 50% of the national health budget, according to the health ministry. The Ugandan government has committed itself to providing free ARVs and--to treat malaria--free artemisinin combination therapy to all those who need them. This is only possible if these remedies are available at prices the government can afford.
Uganda imports most of its drugs. But that may be about to change, q-he first batch of locally produced generic ARVs and antimalarial drugs are expected to be delivered to the health ministry this year in a move that will see the cost of these life-saving remedies dropping from between USS 15 and USS 9 to between USS 9 and USS 2 per patient per month, Ugandan officials say.
The drugs are to be produced by a pharmaceuticals factory in Kampala, a joint venture between Quality Chemical Industries Ltd. (QCIL), a local company, and Indian generics manufacturer, Cipla. The plant--the first of its kind in east Africa--opened in October 2007 in Luzira, a suburb of the city, to manufacture mainly ARV and antimalarial drugs.
In time, the plant is expected to lower the cost of these drugs and make them more widely available in Uganda. At one time, ARVs cost USS 1500 per month, far beyond the pocket of the average Ugandan. The Ugandan government and QCIL signed an agreement in 2006 committing the government to buy ARVs and antimalarial drugs from the Luzira-based company. Approved in March 2008 by the National Drug Authority on behalf of the Uganda government, the new plant aims to produce two million tablets a day, once it achieves full capacity.
This year the government budgeted for an extra 50 000 patients out of the expected production in Luzira.
Uganda's ARV programme is 95% donor funded which raises the issue of sustainability. The programme is funded by the Global Fund to fight AIDS, Tuberculosis and Malaria, and the USA President's Emergency Plan for AIDS Relief. …