The overall resource envelope available has grown by about 5% from 7,552 billion in 2010/2011 to 8,004.1 billion for 2011/2012. However, budgetary allocations for the majority of the sectors including health have not changed from last financial year. Infact, the health Sector Budget Framework paper indicates that the health budget will remain at 660 billion in 2011/2012. The Ministry of Health has internally increased the budgetary allocation for Essential Medicines from 201.73 billion to 204.43 billion. This will contribute to ensuring that health facilities receive adequate stocks of essential medicines and health supplies. However, the percentage of the budget allocation to health (including donor support) has gone down from to 8.7% to 8.2%. Government has once again failed to meet the Abuja target of 15% to which Uganda committed in 2001
Domestic investment in Essential Medicines and Health Supplies (EMHS) particularly for Anti Retroviral Therapy (ART) and Prevention of Mother to Child Transmission (PMTCT) in particular remains very low compared to the needs. Funding for EMHS/National Medical Stores (NMS) will remain at 201billion in 2011/2012. Of this allocation, 90 billion is support from the Global Fund. Although there has been a slight increase in availability of medicines since Vote 116 giving NMS autonomy was enacted in August 2009, owing to the funding gap, the supply of EMHS still does not match the current need.
According to the Ministry of Health STD/ACP, a total of 578, 860 PLHIVs (by January 2011) in Uganda required ART but only 263, 154 on ART. Of these, 99, 170 are children but only 19, 903 are on treatment. According to Uganda’s proposal to Global Fund Round 10, to reach the treatment target to provide for 50% of the PLHIV, at least 2443 patients have to be put on treatment in 2011. To reach the treatment target of 61%, at least 92, 756 people have to be put on treatment in 2012. Bearing in mind that Uganda’s proposal to the GFTAM Round 10 (HIV) was unsuccessful, there is need to increase domestic investment in HIV treatment and PMTCT scale up.
The costing of the HSSIP indicates that to address the EMHS need would require 877 billion in 2011/2012, yet only a less than quarter of this has been allocated (201 billion). Moreover, Uganda largely relies on donor funds (PEPFAR, GFTAM, CHAI and other partners) for ART and PMTCT supplies. Of the 201 billion allocated, 90 billion is support from GFTAM Round 7 and 60 billion from GoU for ARVs and ACTs, and only 50 billion has been allocated for other EMHS.
Furthermore in 2010, the Government introduced the BASIC KIT system which supplies a pre determined set of EMHS to HC IIs and IIIs. The KIT does not contain all drugs on the Essential Medicines list of 2007 but also some critical EMHS like panadol are supplied in minimal quantities. For example, Essential medicines for mental health and epilepsy were introduced into the essential medicines list in 2007, however, there is still a critical shortage of mental health drugs. According to BASIC NEEDS, an organisation working to advocate for increased access to mental health services, health centres (HC) IIIs receive only one tin of chlorpromazine (25mg) and one tin of Phenobarbital (30mg) for uncomplicated epilepsy. In effect the HC can only treat 1 or 2 adults with schizophrenia or bipolar affective disorder and 3 children with epilepsy every two months. “There is now a danger of over 99% of those who had already started treatment relapsing (experiencing symptoms again) due to limited supply of medicines, the ripple effect of which will be the reversal of the gains made in reducing the treatment gap for mental disorders and epilepsy.” Insufficient supply of EMHS limits the ability of health workers to deliver the Uganda National Minimum Health care package especially for maternal and child health, communicable, non communicable and services.
There is need for additional domestic investment in the procurement of cotrimoxazole, anti-tuberculosis medicines, diagnostic and monitoring equipment and medicines for mental health and priority essential health commodities. GoU must increase the budgetary allocation for ARVs, and other EMHS especially those provided in the BASIC KIT and allocate a budget for PMTCT to cover the treatment gap. In addition to the 201 billion, an increased allocation to of an additional 100 billion, with a focus on scaling up domestic investment in ART, PMTCT, cotrimoxazole, anti-tuberculosis medicines, diagnostic and monitoring equipment and doubling the supply of EMHS in basic KIT (HC II & III) in order to reach the goals described in the NDP and HSSP III. Increasing financing for EMHS will ensure that essential, efficacious, safe and good quality and affordable medicines are available, which will contribute to strengthening the management and organisation of the national health system
Thanks.
ReplyDeleteYou raised very important points. There is a link between mental illnesses and noncommunicable diseases. The increased need to address mental illnesses should in turn lead to increased access to mental health services. This is in turn should mean that Health Centres (HC) III's should receive more than one tin of chlorpromazine (25mg) and one tin of Phenobarbital (30mg) for uncomplicated epilepsy. Depression, Post traumatic Stress, schizophrenia or bipolar affective disorder and epilepsy are some of the cases that are prevalent in Uganda. With a large treatment gap for mental disorders and epilepsy there is a likelihood for other diseases, disabilities and deaths. Four common behavioral risk factors e.g., tobacco use, excessive alcohol consumption, poor diet, and lack of physical activity can be exacerbated by mental illnesses. This can lead to or can be associated with four disease clusters (cardiovascular diseases, cancers, chronic pulmonary diseases, and diabetes) that account for about 80% of deaths from noncommunicable diseases. According to WHO estimates, noncommunicable diseases contributed to 36 million deaths globally in 2008, accounting for 63% of 57 million total deaths. The Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) estimated that mortality due to noncommunicable diseases (with the use of a somewhat different definition of noncommunicable diseases than that used by the WHO) increased from 57% of total mortality in 1990 to 65% in 2010. About 80% of deaths related to noncommunicable diseases occur in low- and middle-income countries, which also have a high proportion of deaths in middle age; such countries account for 90% of the 9 million noncommunicable disease–related deaths that occur before 60 years of age. This staggering toll of noncommunicable diseases and premature mortality in low- and middle-income countries sometimes surprises those who suppose that mortality in these countries is still dominated by maternal and child deaths and deaths due to infectious diseases.