Moses Kafeero, 24, is a resident of Kasensero in Rakai district. He weighs 112 kilograms.Kafero is one of the thousands of Ugandans suffering from Non Communicable diseases. Kafeero just like others is not aware that one of the risk factors associated with high blood pressure and diabetes is obesit
By Patrick Jaramogi
Moses Kafeero, 24, is a resident of Kasensero in Rakai district. He weighs 112kilograms.
Kafero is one of the thousands of Ugandans suffering from Non Communicable diseases.
Kafeero just like others is not aware that one of the risk factors associated with high blood pressure and diabetes is obesity.
The country is sitting on a time bomb due an increase of lifestyle diseases known as Non Communicable Diseases (NCDs).
Non-Communicable disease is a medical condition or disease which by definition is non-infectious and non-transmissible among people. NCDs may be chronic diseases of long duration and slow progression, or they may result in more rapid death such as some types of sudden stroke.
These include chronic respiratory diseases such as asthma, diabetes, cancer, kidney disease, cardio-vascular diseases, mental illness and hypertension.
The availability and affordability of medicines is only a part of the factors responsible for poor accessibility of medicines needed to address a chronic condition as diabetes in the country.
The UN Millennium Development Goal 8 invites partnerships with pharmaceutical companies to provide access to affordable essential drugs in developing countries.
Tobacco smoking and the latest shisha craze among the teenage youths is linked to chronic obstructive pulmonary disease (COPD) where lungs lose their elasticity, making it difficult to breath.
The World Health Organization (WHO) projects that NCD deaths will increase by 17% over the next 10 years. According to Dr. Gerald Mutungi, the program manager NCDs in the Ministry of Health, 25% of the Ugandan population have hypertension, with diabetes accounting for 3-8% (of the population) and between 300 out of 100,000 are diagnosed with cancer annually.
Mutungi says there are 300 out of one million cases of kidney related problems but the unfortunate part according to him is that 80% of the people suffering from NCDs don’t know.
“NCDs are mainly associated with four shared behavioral risk factors including tobacco use, unhealthy diets, insufficient physical activity and the harmful use of alcohol,” said Mutungi.
Research has indicated that unhealthy diets such as consumption of food containing lots of sugars, fats, salt, coupled with lack of regular exercises and excessive intake of alcohol puts one at risk of NCDs.
According to Dr. Charles Kiggundu, over 80% of the persons with such ailments are ignorant about its dangers and have limited access to medicines.
Cost-effective medicines to treat NCDs are available and in mostly low cost generic forms although they remain inaccessible and unaffordable to many who need them especially in Uganda where the prevalence of NCDs is increasing. “Scaling up access to NCD medicines is critical to global efforts to ameliorate the burden of NCDs and also in achieving the millennium development goals (MDGs),” said Dr. Kiggundu.
Dr. Mutungi notes that challenges to scaling up access to NCD medicines reflect each country’s situation and need to be addressed in a country’s specific way to achieve sustainable and equitable accessibility. “Concerted global efforts are important for improving access to NCD medicines and the emergence of a NCD global health initiative (GHI) could be a viable platform,” said Mutungi.
Primah Kwagala, the program officer Center for Human Health and Development (CEHURD) says governments, in collaboration with the private sector, should give priority to treating chronic diseases and improving the accessibility of medicines to treat them.
Studies have shown that important mechanisms for providing sustainable access to NCDs include efficient procurement and distribution of these medicines or the provision of viable financing options, generic promotion policies and the development and use of evidence based guidelines for the treatment of NCDs.
Medicines are essential in primary and secondary prevention of NCDs. Dr. Mutungi says that the appropriate use of medicines alone can reduce up to 80% of the burden of non-communicable diseases in Uganda.
Unfortunately, for many of the over 8 million people living with diabetes in Uganda, the cost of the basic oral treatment is unaffordable when compared to the yardstick of one day’s wage.
Most families with patients suffering from NCDs still can’t afford essential medicines such as Atorvastatin for treating obesity, Olanzapine (for treating dipolar disorder), schizophrenia, and Lipitor for lowering cholesterol.
“Many of us who are suffering from NCDs still find access to Liptor and schizophrenia a challenge,” he said.
The lowest-priced generic combination treatment regime for diabetes cost over two days’ wages in Uganda. Joseph Mangeni, a petty trader in Busia town, near Uganda's border with Kenya was diagnosed with diabetes three years ago but access to Atorvastatin is still a challenge.
The cost is even higher for branded products. In some countries, a family living on $ 1 (sh2600) a day would need to spend about half its monthly income to buy 1 vial of insulin from a private pharmacy.
Gordon Sematiko, National Drug Authority (NDA) executive director, says sectors which dispense a substantial proportion of medicines to patients include the public sector, the NGO/mission (PNFP) and the private for profit sector.
"Overall, indicators of geographic access to medicines suggest that the majority (72%) of households is close to a public health care though Indicators of availability of medicines suggest that stock out of medicines in public health care facilities affects access to medicines," said Sematiko.
He acknowledges that affordability of medicines suggest that the price households pay for medicines is an obstacle to households accessing medicines.
According to Nazeeem Mohamed the Chief Executive officer Kampala Pharmaceuticals Limited (KPI) access to medicines is still a challenge due to lack of promotion of competition for multi-source products.
"We need large quantities of generic medicines including generic substitution coupled with equity pricing and competition for single-source products," said Nazeem.
He said equity pricing policies that are still lacking will ensure that, from the point of view of the community and the individual, the price of a drug is fair, equitable, and affordable.
"Those in favour of equity pricing argue that the poor should pay less for essential medicines," he said. He described as unfortunate what he called differential pricing (sometimes also called tiered pricing).
The sale of the same good to different buyers at different prices with the aim of improving the affordability of drugs while generating revenue for the pharmaceutical industry.
Nazeem says the cost of a one-month course of intermediate-acting insulin has been estimated to range from between $5 (shs12,000) a day. “In a typical Ugandan home a patient may need to spend one third to one half of monthly income to buy 1 vial of insulin from the two major companies supplying insulin internationally,” he said.
He notes that the added cost of syringes, needles and glucose tests, further compounds the inaccessibility to insulin treatment for millions of diabetics who need insulin.
Nazeem says access to, and use of medicines by households in Uganda should be improved in order to ensure equity in access to basic medical treatments especially for the poor.
“We produce drugs the same way that top multinational companies do. The only difference is that our facilities and some of the documentation may not be smart.
Nazeem says many medicines are still not quite affordable in Uganda. “Half our population lives on less than two US dollars a day, so how can they afford medicines? It is a huge problem that us why local pharmaceuticals need subsidies to help bring the prices of NCD medicines down,” he said.
Although trade in medicines is increasing rapidly, most of it takes place between wealthy countries, with developing countries accounting for just 17% of imports and 6% of exports. It is estimated that one-third of the developing world's people are unable to receive or purchase essential medicines on a regular basis.
"The provision of access to medicines depends on rational selection and use of medicines affordable prices, sustainable financing, and reliable health and supply systems," says Dr. Morris Otim a renowned physician.
Silas Mubiru, a resident of Mutukula notes that reducing taxes, tariffs and margins, and developing pricing policies would ease access to essential medicines among the rural folks.
With the provisions in the new IP Act, that allows price competition, parallel importation and compulsory licensing, high charges imposed by patent holder will be safeguarded.
According to Mulumba, the Act allows compulsory licensing, where governments may issue a licence to allow the use of an invention (e.g. a patented drug) without the consent of the patent holder on grounds of public interest (e.g. national emergency, anti-competitive practices or for public, non-commercial use) may help ease access to essential medicines.
The report was supported by Center for Health Human Rights and Development and funded by KIOS.
Uganda grapples with access to drugs for Non Communicable Diseases