Pharmacy in the other worlds…Uganda

A census surveillance done across 9 districts of Uganda recorded information on the types of pharmacy outlets and antimalarial medications available in Uganda.[i] Below are some information from the census:

• Numerous antimalarials are avilable for sale with 174 antimalarial medications found on the market and each outlet had an average of 6-9 different antimalarial medicines. 
• Least expansive but ineffective (resistance to the malaria strain in Uganda) medications such as chloroquine are widely avaiable. 
• Chloroquine prices ranged from 200 to 500 Uganda Schillings (US$0.13 to US$0.34) 
• An effective 1^st line recommended antimalarial combination: Artemisinin-based combination therapy or ACT prices ranged from 9,000 to 20,000 Uganda Schillings (US$6,2 to US$13,6)
• The main driver for antimalarial drugs is cost. Only 50% of patients purchased a full course of medicines. It requires 28-50 days of work by the lowest paid government worker was required to cover a family’s (2 adults, 3 children) annual treatment of ACT if purchased in the private sector. An average of 14-25% of household income was required to cover a family’s ACTs annual treatment if purchased in the private sector.

Even though this is only a snapshot of the conditions with antimalarial drugs, the implications of affordable effective medcations and the availability of these medications can be applied to other concerning areas such as TB and HIV.

                In Uganda, a population of approximately 30 million, only 688 pharmaceutical personnels (which include pharmacists, pharmaceutical assistants, pharmaceutical technicians and related occupations) are available to help with medication management.[ii] With approximately 750 outlets (including private, public, mission & for-profit; formal & informal) selling at least 174 different formulations, strength, and manufacturer permutations of just the antimalarial medications, it is necessary to have enough trained personnel to operate these facilities and to provide education for these medications.¹

                Other options to solving these problems include, political buy-in from the government to reduce cost, widen distribution through OTC status, provide microfinancing to healthcare clinics, generating demand for ACTs and tracking progress and impact.

What do you think? 

---

¹ Understanding the Amtimalarials Market: Uganda 2007 – An Overview of the supply side. Medicines for Malaria Venture and the Ministry of Health and Civil Society (HEPS).  Accessed April 2009. http://www.mmv.org/article.php3?id_article=536&recherche=uganda

[ii] World Health Organization. Uganda healthcare workforce statistics. Accessed April 2009. http://apps.who.int/whosis/database/core/core_select_process.cfm?country=uga&indicators=healthpersonnel