The Mayuge district health center has experienced stock outs of antiretroviral drugs since August 2015. Key drugs missing include Septrin, Efavirenz, Attripla, and AZT/3TC/NVP. The stock outs are due to delayed and insufficient drug supplies from the National Medical Stores. This has resulted in patients being given only weekly doses of drugs or being sent away without treatment. It poses risks of drug resistance and increased costs as patients must travel long distances to seek alternative treatment. The district is advocating for more antiretroviral treatment sites to improve access and address this ongoing drug supply challenge.
If your pet is facing any health issues? No worries!! Animal Clinic At Wellington Reserve provides experienced professional doctors to take care of your pets in a better way.
Canadian Medical community is as shocked and surprised as Cystinosis Patient Families. The Health Canada decision to remove choice from our system while increasing cost of a small patient group of 70 by $50M annually is negligent. Horizon Pharmaceutical Procysbi has a spot in the line up, it just shouldn't be the default or only option when Cystinosis patients in Canada have been well managed for since Mylan Cystagon was used to start treating it back in 1994.
If your pet is facing any health issues? No worries!! Animal Clinic At Wellington Reserve provides experienced professional doctors to take care of your pets in a better way.
Canadian Medical community is as shocked and surprised as Cystinosis Patient Families. The Health Canada decision to remove choice from our system while increasing cost of a small patient group of 70 by $50M annually is negligent. Horizon Pharmaceutical Procysbi has a spot in the line up, it just shouldn't be the default or only option when Cystinosis patients in Canada have been well managed for since Mylan Cystagon was used to start treating it back in 1994.
Speaking at the CCIH Annual Conference in 2015, Dr. Tonny Tumwesigye of the Uganda Protestant Medical Bureau (UPMB) describes the organization's contribution to ending extreme poverty in Uganda through providing a significant amount of the nation's healthcare. He also addresses the challenges the organization faces and makes recommendations on how to scale up healthcare in the nation.
Faith-based organizations provide a significant amount of healthcare in many developing nationa. In Uganda, Catholics, Protestants and Muslims work collaboratively and with their country government to provide health care services. The Uganda Protestant Medical Bureau will share how they build bridges to work with other groups to provide crucial health services.
3.2 Hubs and collaboration - Greg Kalita, Dave BearmanNHS England
Hubs and collaboration. Hub-based working and collaborating across boundaries to improve access and care. Including examples from Sheffield, Devon and Cornwall. Greg Kalita and Dave Bearman, Northern, Eastern & Western Devon and South Devon & Torbay CCGs.
7023 tf039 care home ward rounds poster 2012 julMinney org Ltd
The virtual ward is a way of targeting the most needy and vulnerable, and providing care. In Seaham in County Durham (North East England), we ran a service which reduced hospital use and improved patient experience for this group. the results are shown in a poster
Rebecca Rosen: Supply-induced demand in primary careNuffield Trust
In this slideshow Dr Rebecca Rosen, Senior Fellow, Nuffield Trust, discusses the concept of supply-induced demand as it relates to primary health care. She discusses the factors driving demand for increased service access and the unclear nature of the relationship between increased access and continuity of care.
Dr Rosen spoke at the event: "Supply induced demand as it relates to general practice" (http://www.nuffieldtrust.org.uk/talks/supply-induced-demand-it-relates-general-practice) in March 2014.
The Solomon Islands HiT determines that the country’s health system has significant weaknesses but also considerable strengths. Despite the range and difficulty of issues facing policy-makers in the Solomon Islands, there have been significant achievements in health, including considerable progress in advancing population health status. The performance of the health system is positive, achieving high coverage, high satisfaction levels, and steady progress on health outcomes. Nonetheless, the country faces important health challenges that could undermine development gains made to date
Speaking at the CCIH Annual Conference in 2015, Dr. Tonny Tumwesigye of the Uganda Protestant Medical Bureau (UPMB) describes the organization's contribution to ending extreme poverty in Uganda through providing a significant amount of the nation's healthcare. He also addresses the challenges the organization faces and makes recommendations on how to scale up healthcare in the nation.
Faith-based organizations provide a significant amount of healthcare in many developing nationa. In Uganda, Catholics, Protestants and Muslims work collaboratively and with their country government to provide health care services. The Uganda Protestant Medical Bureau will share how they build bridges to work with other groups to provide crucial health services.
3.2 Hubs and collaboration - Greg Kalita, Dave BearmanNHS England
Hubs and collaboration. Hub-based working and collaborating across boundaries to improve access and care. Including examples from Sheffield, Devon and Cornwall. Greg Kalita and Dave Bearman, Northern, Eastern & Western Devon and South Devon & Torbay CCGs.
7023 tf039 care home ward rounds poster 2012 julMinney org Ltd
The virtual ward is a way of targeting the most needy and vulnerable, and providing care. In Seaham in County Durham (North East England), we ran a service which reduced hospital use and improved patient experience for this group. the results are shown in a poster
Rebecca Rosen: Supply-induced demand in primary careNuffield Trust
In this slideshow Dr Rebecca Rosen, Senior Fellow, Nuffield Trust, discusses the concept of supply-induced demand as it relates to primary health care. She discusses the factors driving demand for increased service access and the unclear nature of the relationship between increased access and continuity of care.
Dr Rosen spoke at the event: "Supply induced demand as it relates to general practice" (http://www.nuffieldtrust.org.uk/talks/supply-induced-demand-it-relates-general-practice) in March 2014.
The Solomon Islands HiT determines that the country’s health system has significant weaknesses but also considerable strengths. Despite the range and difficulty of issues facing policy-makers in the Solomon Islands, there have been significant achievements in health, including considerable progress in advancing population health status. The performance of the health system is positive, achieving high coverage, high satisfaction levels, and steady progress on health outcomes. Nonetheless, the country faces important health challenges that could undermine development gains made to date
1. MAYUGE DISRICT FACT FINDING MISSION ON STOCK OUT OF ARVS
Date: 10/9/2015
Compiled by: Namuzimbi Cissy PM
Introduction
The district has 13 sub counties with only 7 ART sites. Mayuge H/C 111 is a high volume Health
Facility with over 2330 PLHIV ever enrolled into care but of these about 1100 are active clients.
The health center is serving sub counties of Bukatube, Manyiro, Makuutu and Mayuge T/C
Originally, this was a TASO site which was later put under government when TASO withdrew.
This health center has been experiencing drug stock outs since August 2015 and the problem was
reported by the linkage facilitator and follow up was done by NAFOPHANU Programme
Manager in the district. The Programme Manager interviewed the Team Leader Mr. John
Gambani at Mayuge Health Center 111, Mr. Balidawa John and Paddy Babolana, the Linkage
Facilitators at the facility.
Missing drugs
The H/C started experiencing stock of Septrin (960mg, 120mgs) 3 weeks ago when they
received an insufficient order from NMS. According to the Team leader at this H/C the
missing drugs include Septrin (960mgs, 120mgs), EFV (600mgs, 200mgs), Attripla,
AZT/3TC/NVP. They also received 9 packs of test kits out of the 35 ordered for. Each
pack has 100 test kits but these are not enough given the fact they have outreaches at
landing sites and an eMTCT programme.
Testing kits. Only 9 packs were delivered out of 25 ordered for
Problem analysis
Delayed supply by NMS in the previous quarter. The order made in May was delivered in
June 2015.
2. Insufficient supply from NMS. There was a variance of what was ordered and what NMS
supplied. Septrin and Dapson were not supplied despite the fact that they had ordered,
195 doses of Efeverenz were supplied out of 387 ordered
The Septrin that was supplied was under essential medicines which means it was for the
general community not specifically PLHIV. Each clinic day, the facility needs 4 tins of
septrin
NMS did not supply the health center with a certificate of non available for missing drugs
as was the case before and up to now there has been no explanation from NMS for the
insufficient order
This facility was initially under TASO but when TASO left, there was no other service
provider to take over so it is solely a public health facility.
Generally, the district has problems of limited access to ART services with only 6 sites.
There has been a lot of advocacy from PLHIV but the process is slow at national level
because it has budget implications. This affects utilization of services as narrated by the
linkage facilitator Balidawa John.
“Even when drugs are there, some people fail to come due to long distances”
Interventions to address the problem
- The H/C has been borrowing from nearby Health Centers. However, some of these
centers like Wabulungu H/C 111 are also affected by the stock out since 15th July ( EFV
600mgs, TDF/ 3TC/EFV and Septrin 960mgs.
- Patients have been given doses for only week while some are sent away without drugs
- They used the 200mgs EFV which was in supply to make doses for adults but at the
moment this is also finished
- Patients buy their own Septrin and dapson. In the last order these were not supplied
- For patients on Attripla, they have been using a combined dose of 3TC, TDF and EFV
which increases the pill burden. Right now, this is also out of stock
- An emergency order has been written and will be delivered to NMS on 9/9/2013
Effects of the problem on PLHIV
- Resistance to the drugs due to interrupted adherence
3. - People are likely to be switched to second line drugs which are more toxic and expensive
- High transport cost as patients have to move to the health center all the time to look for
the few drugs available. Patients come from sub counties of Bukatube, Manyiro,
Makuutu and Mayuge T/C which have no ART sites.
Conclusion
This was a problem that arose due to inefficiencies in the supply chain management process
which are highlighted mainly in poor coordination at national level and lack of proper channels
for communication.
Mayuge request sent to NMS in May 2015