Applying human rights to advocacy campaigns for access to essential medicines in Uganda

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Presentation on applying human rights to advocacy campaigns for access to essential medicines in Uganda by the Executive Director, Action Group for Health, Human Rights and HIV/AIDS (AGHA) Uganda …

Presentation on applying human rights to advocacy campaigns for access to essential medicines in Uganda by the Executive Director, Action Group for Health, Human Rights and HIV/AIDS (AGHA) Uganda during the MeTA Uganda CSO workshop, April 2009.

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  • The concept of minimum healthcare package has been used as a means of setting priorities for national health budgets. The aim is to identify a set of health services for which the Government can afford free access: this is intended to assist with resource allocation in the face of huge health
  • This year, AGHA launched its innovative “Stock Out Survey.” The survey, which took place in three new districts in rural Southwestern Uganda, collected data on the supply of essential malaria and anti-biotic medicines and staffing levels at selected health facilities. The objective of this study was to assess the trends of drug availability in health facilities in three districts, while also exploring the challenges faced by health workers in getting drugs at the health facility level.
  • This study found that the drugs being tracked were often out of stock in the facilities visited. Availability of Malaria Medicine : CoArtem, the Ministry of Health mandated first line treatment for malaria was often unavailable in health clinics in all three districts. In Ibanda, 10-30% of clinics experiences CoArtem stock outs over the course of 5 visits. In Isingiro, all clinics had CoArtem at 3 of the 6 data collection visits; the other 3 visits found 10-40% of clinics had no CoArtem in stock. In Lyantonde, CoArtem stock out rates ranges from 10% to 50% at one visit, meaning half of all clinics visited that day did not have the first line treatment for malaria—the leading killer in Uganda. Availability of Antibiotics : The study found high levels of stock outs in antibiotics at health centers in all three districts. For example, for the first month of the study, 60-80% of clinics in Ibanda had no access to the 4 major antibiotics traced by this study. In Isingiro district, access to any of the four antibiotics traced differed significantly, from less than 20% to 85% in stock, but never reached 100% coverage for any medicines during the survey time.
  • In September, AGHA held a meeting for members of parliament, ministry of health officials, health professionals, and civil society organizations to launch the results of the survey and to present policy recommendations. These policy recommendations included: Addressing Budget Gaps by scaling up spending to meet the 15% target from the Abuja Declaration and loosening any macroeconomic structures which prevent increased health spending Reforming drug purchasing and distribution by creating more flexible drug purchasing systems and financing mechanisms Improving the monitoring and evaluation of the drug procurement and distribution system Address human resources for health issues by meeting staffing targets, training staff on drug forecasting, and providing incentives for workers to join new districts Build better communication systems between districts, health facilities, and central bodies such as the NMS and the Ministry of Health. AGHA is currently planning follow-up meetings in the districts that participated in this study to continue putting pressure on policy makers to address these issues.

Transcript

  • 1. Applying Human Rights to Advocacy Campaigns for Access to Essential Medicines in Uganda Lessons from AGHA Sandra Kiapi Executive Director, Action Group for Health, Human Rights and HIV/AIDS (AGHA) Uganda
  • 2. Outline
    • What is the Right to Health
    • Rights Based Approach
    • Uganda human rights and other obligations/medicines
    • Key Elements of the Right to Health
    • Standards of the Right to Health
    • 2. Health Financing in Uganda: Facts and Figures
  • 3. 1. Right to Health
    • The Right to Health is a right to an effective and integrated health system encompassing health care and other determinants of health
    • It is not:
    • The Right to be Healthy
    • It is not a limitless right to receive medical care for every illness/disability
    • It is a right to enjoy a variety of facilities and conditions necessary for good health which include:
    • Those necessary for health care
    • Those relating to general conditions affecting health ie safe water, food, sanitation,
  • 4. Rights Based Approach
    • Human Rights are concern with the disadvantaged
    • Resources given to those with the greatest need ie
    • are resources going to those who least need them?
    • What is the state doing for those rural and poor populations?
  • 5. Uganda’s Human Rights treaty & other Obligations in relation to access to medicines
    • The Right to Health is enshrined in article 12 of the ICECSRs to which Uganda is a Party: provision of medicines is a core obligation
    • Under General Comment 14-Obligation to provide Available, Accessible, Acceptable and Good Quality (AAAQ) Health Services
    • ACHPRs- art.16 obliges states parties to take measures to protect the health of their people
    • 1995 Constitution-state shall take practical measures to ensure provision of medical services to the population
    • Alma Ata 1978, PHC Includes Provision of Essential Drugs
    • Ouagadougou Declaration on PHC and Health Systems Strengthening Calls upon the Governments to set up sustainable mechanisms for increasingly available, affordability, and accessibility for essential medicines and other health supplies
  • 6. Key elements of the Right to Health
    • Accountability: countries that sign treaties affirm the right to health and a state agrees to be accountable to the international community & citizens for the fulfillment of its obligations
    • Participation: the right to participate in decision-making is a guiding principle: people must participate in the design and delivery of health services.
    • Particularly the involvement of communities has been shown to increase likelihood that needs of communities will be met more effectively
  • 7. Standards of the Right to Health: AAAQ
    • Availability: public health and care services should be in sufficient quantities taking into account a country’s developmental and economic need;
    • Accessibility has 4 dimensions:
    • Non discrimination: health facilities, goods and services must be accessible to all especially the most vulnerable
    • Physical accessibility: services must be within physical reach
  • 8. Standards cont’d
    • (c) Economic accessibility: affordability
    • (d)Information access: right to seek, receive and impart information concerning health issues
    • Acceptability: health services are ethically and culturally appropriate ie respectful of individuals, minorities, peoples, and communities
    • Quality: requires that health services must be scientifically and medically appropriate and of the highest quality
  • 9. Financing the Health Sector in Uganda: the figures
    • Population is 28 Million (last census), growing at 3.4% p.a= currently 31,000,000
    • 31% of population live below poverty line (UBS, 2008) -9.3-10,000,000 million cannot fend for themselves at all
    • Uganda spends 9.6% of its national budget on health-(trend down from two years ago at 11% next financial year, figures might be lower) (2009/10 state house 91 B, Mulago Hospital gets 41.87 B, Budget for military remains constant or Increases, yet Health fluctuates)
  • 10. Health financing cont’d
    • Uganda spends US $ 7.84 per capita on health, yet to meet the UNMHCP, at least US$ 28, and 40 are needed when ARVs are included
    • Health Sector needs US $ 6.5-8 per capita to cover EMHS
    • In 2006/2007, only US $ 0.72 was availed by GOU: donors topped up to US $ 4.06
    • On a positive note: 2008/2009 60 billion allocated to procurement of ARVs and Arteminsin Based Combinations
    • In the past few months, there is a shortage of medicines for Malaria and Tuberculosis which has been going on since October last year
  • 11. Case Study: A Promise Unmet: Access to Medicines in Rural Uganda
    • General objective:
    • To track the availability of essential medicine in rural districts health facilities: Do the most disadvantaged have access to medicines?
    Specific objectives 1) To assess the trends of drug availability in health facilities in the new districts 2) To explore the challenges faced by health workers in getting drugs at the health facility level
  • 12. Results: Trends of drug stock-outs
    • Key Finding: There were frequent stock-outs of essential malaria and antibiotic drugs at all health centres.
      • For example:
      • CoArtem, the Ministry of Health mandated first line treatment for malaria, was often unavailable in health clinics in all three districts.
      • For the first month of the study, 60-80% of clinics in Ibanda had no access to the 4 major antibiotics traced by this study
  • 13. From Research to Policy
    • Launch event targeting Members of Parliament, Ministry of Health officials, and health professionals
    • Presented findings & policy recommendations
      • Address Budget Gaps
      • Reform drug purchasing and distribution
      • Improve monitoring and evaluation
      • Address HRH issues
      • Build better communication systems
    • Follow-up meetings in districts with policy makers
  • 14. Stop-Stock-Out campaign
    • The Civil Society Organisations want the government to:
    • Ensure availability of essential medicines at all public health institutions.
    • Ensure that there is sufficient funding for the medicines within minimum healthcare package.
    • Give representation of civil society on the board of the National Medical Stores.
    • Enhance transparency in medicines supply management.
    • Provide a dedicated budget line for essential medicines.
    • Live up to their commitments to spend 15% of national budgets on health care.
  • 15.  
  • 16. Results of this campaign
    • The Media reported extensively on the current drug shortage especially the TB medications (PHR website: http://phrblog.org/blog/2009/03/24/uganda-faces-tb-drug-shortage-on-world-tb-day/ >
    • Pressure on the Government and Ministry of Health (MOH) came out openly to announce that there was a drug shortage
    • WHO has procured some TB Medications
    • GFTAM signed agreement with GOU to fulfill their undelivered commitment under previous grants
    • LPO for malaria Drugs from Quality Chemicals a Local Pharmaceutical Company
  • 17.
    • “ Under-funding of the health sector is tantamount to deliberately giving an under-dose of medication to a patient and hoping that he will still get better. Government needs to commit to the 15 percent to help alleviate these issues.”
    • – Honorable Dr. Francis Epetait,
    • Member of Parliament
    Keeping the Promise