A ‘stock-out’ is when a pharmacy temporarily has no medicine on the shelf. It may affect one medicine or many medicines, or in the worst case, all medicines. The consequences for patients are grave; they may go without the medicines they need, or seek alternative and sometimes inappropriate medicine. A campaign in five African countries – Kenya, Malawi, Uganda, Zambia and Zimbabwe – is underway to combat stock-outs.
Woman MP Nabila leads march
Denis Kibira tells more about the campaign in Uganda.
In Uganda, only 45.7 per cent of public facilities had a basket of 28 essential medicines selected for the study. In 2007-2008, the duration of stock-outs in public health facilities averaged 72.9 days per year . Stock-outs can happen for a number of reasons, such as low funding, poor coordination of procurement and distribution, gaps in management and pilferage.
The Stop Stock-Outs campaign is a civil society initiative to advocate for improved availability of, and access to, essential medicines in public health facilities. In Uganda, the campaign was implemented by a consortium of five civil society organisations (CSOs): The Coalition for Health Promotion and Social Development in Uganda (HEPS); the Action Group for Health, Human Rights and HIV/AIDS (AGHA); the National Forum of People Living with HIV/AIDS in Uganda (NAFOPHANU); Action for Development (ACFODE); and the Alliance for Integrated Development and Empowerment (AIDE).
The campaign aims to lobby, influence and pressure the government to make essential medicines available at all public health institutions, ensure there is sufficient funding, give civil society representation on the board of the National Medical Stores, enhance transparency in medicines supply management, provide a dedicated budget line for essential medicines, and live up to its commitment to spend 15 per cent of the national budget on health care.
The campaign
The campaign, launched in March 2009, has used a variety of approaches. These have included the use of publicity material like t-shirts, banners, fact sheets, fliers and policy briefs. A local artist, Bobi Wine, and a woman member of parliament were approached to champion the cause. The campaign has undertaken various activities including: press statements and conferences, public rallies, radio talk shows and media articles to generate public debate in the media and other fora.
One of the most interesting things we did was to organise something called a Pill Check Week in June 2009. This involved a spot check of medicine stock-out in public health facilities. It was carried out in 11 of the country’s 81 districts. Each of the 11 districts was represented by one government facility. The check covered 10 key essential medicines and highlighted that stock outs, especially of paediatric preparations, were still a major problem in the public health system.
The Pill Check Week took place in all five of the African countries participating in Stop Stockouts and used a Google map to identify where the stock outs were a reality. http://stopstockouts.org/ushahidi/
What difference has it made?
So far the campaign has been covered widely in the media. Interest in medicine issues and stock-outs increased after the launch of the campaign. There were reports of events, news and issues in radio, television and print media.
The increased media reporting prompted responses from wide sections of society. The sustained reports in the media have generated a public debate on medicine stock-outs, their causes and possible solutions. There are frequent independent stories of medicine stock-outs in public health facilities, including arrests of unscrupulous health workers caught stealing drugs.
The National Medical Stores (NMS) responded to the media reports with a statement and Op-ed articles in national newspapers to explain the causes of stock-outs explaining the challenges, and blaming other players, particularly health facilities for delayed orders. Members of the Social Services Committee of Parliament made an unannounced visit to NMS to ascertain the stock levels and causes of stock-outs. In July 2009, NMS was given more responsibility in procurement and distribution of medicines, while the responsibility of the district local governments was reduced.
On 31 August 2009, Parliament passed the 2009-2010 national budget, approving a separate vote for NMS for the first time ever. This means the money for medicines will no longer go through the Ministry of Health, where in the previous year, part of it had been diverted to other budgets. It is expected that the decision will lead to less bureaucracy and increase resources for medicine procurement on a timely basis.
The President on several occasions, including his Independence Day speech, highlighted reasons for stock-outs. In October, the President’s Office announced the establishment of a Drug Monitoring Unit in the President’s Office, with a mandate to investigate and curb theft of medicines in government hospitals.
The Stop Stock-outs campaign has raised more awareness about the right to health and to access essential medicines in Uganda than ever before. The public are becoming more active in debating the issues, reporting stock-outs and holding institutions to account. The Government is responding to the campaign in a positive way and changes are taking place at policy and implementation level.
Stop Stock-outs is funded by the Open Society Institute (OSI)
Denis Kibira, Campaign Coordinator, Uganda
http://stopstockouts.org/
Filed under: Access to medicine Tagged: | access to medicines, esse, HIV&AIDS, stop stock-outs
