Browsing by Author "HEPS"

Now showing 1 - 7 of 7
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    Advocacy For Affordable Malaria Diagnosis In Uganda
    (HEPS, 2018) HEPS
    Malaria is the biggest single cause of illness and death in Uganda. The country has the third highest number of malaria deaths and one of the highest reported malaria transmission rates in the world. Malaria accounts for 30%-50% of outpatient visits, 15%-20% of hospital admissions, and up to 20% of all hospital deaths. Overall about 16 million cases and about 10,500 deaths are reported per year. Early diagnosis and treatment of malaria reduces disease and prevents deaths. Accurate diagnosis is vital to good malaria case management. Testing makes treatment more effective; allows a health work to carry out further investigations on a patientwho tests negative; and plays a central role in combatting rising levels of resistance to anti-malarial medicines. It also contributes to reducing malaria transmission. The National Malaria Control Policy recommends that parasite-based diagnosis with microscopy or malaria rapid diagnostic test (mRDT) before treatment is performed for any suspected malaria cases. However, access to testing is still far from universal. An end-use verification (EUV) survey conducted in April 2016 by the US President’s Malaria Initiative (PMI) found that only 69% of the treated malaria cases received a diagnostic test – still lower than the 90% national target, but an improvement from the 2015 survey (61%). Malaria diagnosis in the public sector is in principle accessed free of charge, but in the private sector it accessed at a cost. A poll conducted by HEPS Uganda and Trac Fm among 3,200 listeners of eight FM radio stations spread in different parts of Uganda – conducted in January and February 2017 – showed that up to 24% of them do not test for malaria before treatment because of high prices of the test. In addition, the number of mRDT manufacturers and mRDT brands have increased rapidly over the past few years. These have led to different prices, which has created confusion among policy makers, service providers and service consumers alike and undermined access and confidence in making choices. High prices also result from the fact that some importers are – against policy – taxed. Others are not taxed, but make provision for taxes – which they the pass on to consumers in form of high prices for fear that future tax audits may require them to pay tax arrears.
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    Community involvement in MDP 301 microbicide trial in Masaka: Successes and failures
    (HEPS-Uganda Policy Briefing Series, 2010) HEPS
    The MDP 301 microbicide trial used multiple approaches at the Masaka site to mobilise and sensitise the community, get feedback, share information, and communicate the final trial results. While this broad approach contributed to the success of the trial, a survey conducted early 2010 found no evidence that civil society advocacy groups were invited to contribute to the trial’s design and implementation. By outlining the key successes and failures of the trial’s community involvement initiatives, this brief highlights the need for HIV prevention research in general to follow good community participatory practice guidelines by nurturing local advocates from the civil society to partner with the investigators in the conduct of research.
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    Family Planning Commodity Financing And Supply Chain In Uganda
    (HEPS, 2021) HEPS
    Uganda was represented at the 2012 London Family Planning (FP) Summit at the highest political level by President Yoweri Museveni who pledged to ensure an enabling policy environment to allow women to exercise their FP choices, to increase the country’s financial investment in FP, and to strengthen service delivery. Government of Uganda (GOU) pledged to increase its annual budget allocation for FP supplies from USD 3.3 million (FY 2012) to USD 5 million for the next five years and to mobilize an additional USD 5 million annually from donors. This would be supported by the development of a reproductive health (RH) sub-account to track RH resource flows. During the 2017 London FP Summit, GOU renewed its FP2020 commitments, but this time around the it pledged to raise an additional USD 20 million annually from Health Development Partners (HDPs) to top up on to the USD 5 million annually from the domestic budget. A substantial number of clients access FP commodities from the private sector through out-of-pocket payments. Out-of-pocket payments expose the population to catastrophic and impoverishing health expenditures, increasing socioeconomic inequality, thereby undermining progress towards Universal Health Coverage (UHC). The national health insurance scheme (NHIS), which would have cushioned people against such risks, has dragged and existing schemes do not cover FP. FP commodities for use in the public sector are included in the Uganda Clinical Guidelines (UCG) and the Essential Medicines and Health Supplies (EMHS) List of Uganda. These commodities also must be registered by the National Drug Authority (NDA). The Ministry of Health’s National RMNCAH Quantification Report guides GOU and partners on the quantities of commodities required and when to procure them. Guided by the Supply Plans in the quantification report, GOU and Health Development Partners (HDPs) make financial commitments andand initiate the procurements of the commodities.The main funders of FP commodities include GOU, UNFPA, USAID and the Global Fund. GOU funding consists of direct allocations from the national budget and grants and loans from HDPs. The commodities are then cleared through customs and warehoused at National Medical Stores (NMS) for the public sector and Joint Medical Store (JMS) for private-not-for-profit (PNFP) sector. In spite of the increased financial allocation by GOU and HDPs to FP commodities, major gaps in financing and access to contraceptives continue to persist in Uganda. The financial need for FP for FY2020/21 is estimated at USD 32.93 million, of which GOU’s contribution from domestic resources is estimated at USD 4.21 million, leaving a funding gap of USD 28.72 million to be filled by HDPs, grants and loans. It is important to note that out of the domestic finances invested in FP commodities,98% of these investments have been used to procure mama kits. Additionally, in 2020, World Bank donated USD 15 million (UGX 57 billion) from its maternal child health project to the COVID-19 national response. Part of these funds had been intended for sexual and reproductive health (SRH) essential medicines and commodities, including FP commodities.
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    Global Fund: Making Uganda’s CCM Work Through Full Engagement of Civil Society
    (HEPS, 2008) HEPS
    HIV/AIDS have over the recent years been receiving increasing funding, especially from the donor community. However, due to the absence of a mechanism to monitor and aggregate the contributions from the wide range of funders, the exact amount of funding coming from foreign donors, non-governmental organisations, individuals and even the Uganda government itself, is not known. Independent attempts to determine the actual level of funding have been hampered by the Ministry of Health’s failure to harmonize the various funding structures of the different funders, the multi-sectoral nature of the response, reluctance by the donors to provide complete information about their budgets and expenditure, and difficulty in capturing household contributions towards HIV/AIDS care. There is therefore, a gap that needs to be filled by regular tracking of HIV/AIDS funding, to establish the actual level of funding and the extent to which it reaches the intended beneficiaries. Even with the limited information available, it is obvious that funding for HIV/AIDS is still insufficient, given that access to HIV/AIDS services – from counseling and testing (HCT) to anti-retroviral therapy (ART) and care and support – remains limited. The health care system is urgently in need of additional resources, particularly to accommodate the burden of the HIV/AIDS epidemic. The public sector needs not only to increase its per capita health expenditure to US$28 – and up to US$40 when anti-retroviral drugs (ARVs) are included – to enable its citizens realise their right to health, but also to make the available work for the poor.
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    Sexual & Reproductive Health Commodities: Measuring Prices, Availability & Affordability Findings and recommendations – Uganda
    (HEPS, 2017) HEPS
    Good sexual and reproductive health (SRH) is a state of complete physical, mental and social well-being in all matters relating to reproduction for both men and women, including adolescents. Maintaining good SRHVmeans people need access to accurate information and to safe, effective, affordable and acceptable contraception methods of their choice. They must be informed and empowered to protect themselves from sexually transmitted infections and, when necessary, receive timely and affordable treatment. And when they decide to have children, women must have access to services that ensure they have a fit pregnancy, safe delivery and healthy baby. Every individual has the right to make their own choices about their SRH and family planning. Poor reproductive health constitutes a significant portion of the disease burden in developing countries, yet essential reproductive health commodities often are not available to the majority of the population in low and middle-income countries. In Uganda, the lack of access to and use of reproductive health commodities threatens the well-being of individuals, families, and communities due to a number of challenges. The Ugandan Government has acknowledged that insufficient supplies and commodities is one of the key challenges facing effective delivery and utilization of effective maternal health services. The Government of Uganda renewed its commitment to Reproductive Health Commodities at the London Family Planning Summit held on July 11, 2017. These commitments included;  To reduce the unmet need for family planning to 10 percent and increase the modern contraceptive prevalence rate among all women to 50 percent by2020and;  Allocating $US 5 million annually for procurement and distribution of reproductive health/family planning supplies and commodities to the last mile.
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    Uganda’s Preparedness For Equitable Access To Covid-19 Medical Products
    (HEPS, 2021) HEPS
    Coronavirus disease 2019 (COVID-19) is a highly infectious respiratory syndrome caused by the Severe Acute Respiratory Syndrome Corona virus 2 (SARS-CoV-2) virus. The symptoms include shortness of breath, high fever and dry cough. The disease broke out in China towards the end of 2019 and has since spread across the world and mutated into four other variants: Alpha, Beta, Gamma and Delta.
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    Viral Load Testing For HIV Treatment Monitoring In Uganda
    (HEPS, 2015) HEPS
    Measurement of HIV viral load, which for the past two decades has been used for routine monitoring of treatment effectiveness in HIVinfected patients in developed countries, have not been widely used in ART programmes in poorresource settings such as Uganda, due to their prohibitive cost and inadequate laboratory capacity. A survey of availability of key HIV and TB medicines and diagnostics in Uganda in December 2014 and January 2015 found the majority of a sample of HIV ART centres did not have viral load machines or conduct viral load testing. Only eight centres (out of 107) reported having viral load testing machines, and only six reported to send samples to a lab at another site. At two of the sites that offered the tests clients pay for the tests (HEPS-Uganda 2015). In the absence of routine viral load testing, treatment failure has generally been defined by clinical criteria and CD4 cell count. To be diagnosed with AIDS, a person with HIV must have an AIDS-defining condition (symptom) or have a CD4 count less than 200 cells/mm³. World Health Organisation (WHO) prescribes the clinical manifestations of AIDS that clinicians can identify through observation, history taking and simple examination to enable them make important clinical decisions, such as initiating ART or switching a client to a stronger regimen, in resource-constrained settings where access to laboratory tests is limited or non-existent. In the Uganda case, clinical staging has been used in combination with CD4 count for many of the ART clients. A CD4 count is a lab test that measures the number of immune cells (CD4 cells) in the client’s blood and is an indicator of the strength of the client’s immune system and how much damage HIV has done to it. However, the use of the WHO clinical staging system and the CD4 count – even when used in combination – may not be effective in detecting treatment failure in a timely manner. Changes in CD4 cell counts are difficult to interpret as a result of individual variations in the immunological response to ART. In addition, studies have demonstrated the poor predictive value of the WHO immunologic criteria for virologic failure, and have shown that delayed detection of treatment failure leads to accumulation of HIV drug resistance (MOH 2014). At the same time, improvements in technology and an associated gradual reduction in prices over the recent years are making the use of viral load testing possible in low-income countries as well. And in The main rationale for viral load monitoring as the preferred approach compared with immunological and clinical monitoring is to provide an early and more accurate indication of treatment failure and the need to switch to second-line drugs, reducing the accumulation of drug-resistance mutations and improving clinical outcomes. Measuring viral load can also help to discriminate between treatment failure and non-adherence, and can serve as a proxy for the risk of transmission at the population level (Petti et al. 2007). WHO recommends routine viral load monitoring (every 6-12 months) to enable treatment failure to be detected earlier and more accurately. In settings with limited access to viral load testing, a targeted viral load strategy to confirm failure suspected based on immunological or clinical criteria should be used to avoid unnecessary switching to second-line ART. Targeted viral load monitoring is less costly than routine viral load testing, but as with clinical and immunological monitoring, has the potential to delay switching to second-line ART and may subsequently increase the risk of disease progression, selection of ARV drug resistance and HIV transmission. In addition, viral load testing combined with an adherence intervention may help patients with poor adherence to therapy maintain use7 of their firstline regimen, preventing unnecessary switches in treatment. The cost of providing second-line ART has been estimated to range between 2.4-10 times when compared to that of first line (Long et al. 2010). response, WHO issued “Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection” in 2013, recommending viral load monitoring as the preferred monitoring tool for the diagnosis and confirmation of ART treatment failure.