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

Outline About AGHA Background: Uganda human rights and other obligations Health Financing in Uganda 3. Medicines Stock-Out Project: The Promise Unmet 4.The Stop-Stock outs campaign

About AGHA

Background:

Uganda human rights and other obligations

Health Financing in Uganda

3. Medicines Stock-Out Project: The Promise Unmet

4.The Stop-Stock outs campaign

1. About AGHA AGHA’s Mission is to raise the awareness of all health care providers and the communities they serve in Uganda about the human rights aspects in health with emphasis on HIV/AIDS.

AGHA’s Mission is to raise the awareness of all health care providers and the communities they serve in Uganda about the human rights aspects in health with emphasis on HIV/AIDS.

AGHA’s Objectives Training and educating health providers and the communities they serve on global health advocacy and the relationship between health and human rights; Conducting advocacy and media publicity for observation of human rights; Researching aspects of human rights violations that impair health; and Networking and collaborating with other human rights organizations to advocate for human rights-based health policies and programs.

Training and educating health providers and the communities they serve on global health advocacy and the relationship between health and human rights;

Conducting advocacy and media publicity for observation of human rights;

Researching aspects of human rights violations that impair health; and

Networking and collaborating with other human rights organizations to advocate for human rights-based health policies and programs.

AGHA’s Main Campaigns Increase and Improve Health Financing Aimed at advocating for Increases in the Health Sector Budget to at least 15% and promoting transparency and accountability in the health sector The Access to medicines campaign is a part of the health financing campaign Support Health Workforce Development Stop Stigma in Health Settings Build Capacity for Health Rights Leadership-SEHC, IFFHRO, Shadow Reporting

Increase and Improve Health Financing

Aimed at advocating for Increases in the Health Sector Budget to at least 15% and promoting transparency and accountability in the health sector

The Access to medicines campaign is a part of the health financing campaign

Support Health Workforce Development

Stop Stigma in Health Settings

Build Capacity for Health Rights Leadership-SEHC, IFFHRO, Shadow Reporting

2. Background: Uganda’s Human Rights treaty & other Obligations The Right to Health is enshrined in article 12 of the ICECSRs to which Uganda is a Party Under General Comment 14-Obligation to provide Available, Accessible, Acceptable and Good Quality (AAAQ) Health Services Key Resources for AAAQ include infrastructure, health workers, but also drugs 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, 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

The Right to Health is enshrined in article 12 of the ICECSRs to which Uganda is a Party

Under General Comment 14-Obligation to provide Available, Accessible, Acceptable and Good Quality (AAAQ) Health Services

Key Resources for AAAQ include infrastructure, health workers, but also drugs

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, 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

Background: Financing the Health Sector in Uganda: the figures Population is 28 Million, growing at 3.4% p.a 31% of population live below poverty line-9.3 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) 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 Currently there is a shortage of medicines for Malaria and Tunerclosis which has been going on since October last year

Population is 28 Million, growing at 3.4% p.a

31% of population live below poverty line-9.3 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)

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

Currently there is a shortage of medicines for Malaria and Tunerclosis which has been going on since October last year

1.A Promise Unmet: Access to Medicines in Rural Uganda General objective: To track the availability of essential medicine in rural districts health facilities 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

General objective:

To track the availability of essential medicine in rural districts health facilities

Materials and Methods Study area: The study was done in three new districts of Lyantonde, Isingiro and Ibanda Burden of disease: Malaria, ARI/RTI, and intestinal worms Study Design: A longitudinal survey in the selected health facilities, using trained health workers as data collectors. Baseline data Follow-up data collected over 3 months

Study area: The study was done in three new districts of Lyantonde, Isingiro and Ibanda

Burden of disease: Malaria, ARI/RTI, and intestinal worms

Study Design: A longitudinal survey in the selected health facilities, using trained health workers as data collectors.

Baseline data

Follow-up data collected over 3 months

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

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

Results: Trends of drug stock-outs

Results: Trends of drug stock-outs

Results: Trends of drug stock-outs

Results: Trends of drug stock-outs

Results: Trends of drug stock-outs

Results: Trends of drug stock-outs

Challenges Severe lack of human resources Serious gaps in medicines funding Lack of training and staff to do quantification and forecasting Lack of medicine transport and storage facilities Challenges with procurement and purchasing process Gaps in coordination

Severe lack of human resources

Serious gaps in medicines funding

Lack of training and staff to do quantification and forecasting

Lack of medicine transport and storage facilities

Challenges with procurement and purchasing process

Gaps in coordination

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

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

Stop-Stock-Out Campaign A consortium of five Uganda Health Civil Society Organizations (CSOs) formed a Coalition called Stop-Stock-outs during a meeting in NBI Organised by HAI-funded by OSI-AGHA, HEPS, ACFODE, NAPHOPANU, AIDE The partners launched a national wide campaign on March 19 and held a series of activities including Visit to a health Center in Kisenyi- a slum in the outskirts of Kampala with a Local Musician to attract attention A Press Conference Engaging the Media to Report on TB Drug shortages Press Statement on World TB Day

A consortium of five Uganda Health Civil Society Organizations (CSOs) formed a Coalition called Stop-Stock-outs during a meeting in NBI Organised by HAI-funded by OSI-AGHA, HEPS, ACFODE, NAPHOPANU, AIDE

The partners launched a national wide campaign on March 19 and held a series of activities including

Visit to a health Center in Kisenyi- a slum in the outskirts of Kampala with a Local Musician to attract attention

A Press Conference

Engaging the Media to Report on TB Drug shortages

Press Statement on World TB Day

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.

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.

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 which will be in the country in a few days LPO for malaria Drugs from Quality Chemicals a Local Pharmaceutical Company

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 which will be in the country in a few days

LPO for malaria Drugs from Quality Chemicals a Local Pharmaceutical Company

“ 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

“ 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