Community-led monitoring of anti-TB essential medicines in Uganda
The Global Pan to Stop TB (2006-2015) identifies a need to empower communities to take ownership and drive the agenda for TB elimination. Communities are vital partners for policy makers and implementers in addressing TB, MDR-TB and TB-HIV, and diverse strategies are required to support their full participation.
Community-led monitoring of drug supply and procurement can be a vital tool to document challenges people with TB might be facing and also to lead to solutions. A good example rests in Uganda. "My organization was monitoring a list of 15 essential medicines in Uganda. After a training I underwent with Treatment Action Group (TAG) and ICW, I understood the importance of TB and HIV drugs and the need to monitor them as well. After considerable efforts, I could convince my organization to add the TB/HIV drugs to the list of essential drugs we monitor" said Prima Kazoora, Coalition for Health Promotion and Social Development, Uganda. "During monitoring of essential medicines, we discovered that there were frequent drug-stock outs and there were times when TB drugs were not available for more than three months! There were patients with TB who were put on anti-TB treatment who got their treatment disrupted due to drug stock-outs lasting months at times. This could lead to increase in drug resistance and poor treatment outcomes" shared Prima.
"We also found out that the TB laboratories were often out of reagents and therefore unable to conduct any TB test" said Prima. "TB treatment is available in public sector hospitals only. It is not available in private sector hospitals. Anti-TB drugs are also not available in pharmacies. So when government-run centres had drug stock-out, people with TB were left with no other option" said Prima Kazoora.
"Lack of paediatric formulations was another major challenge. Health workers were asked to break down tablets in equal parts for children" said Prima.
So Prima's organization continued monitoring, documenting and reporting these issues. They investigated using community networks that the problem due to which drug stock outs occur in Uganda are mostly in distribution system and interruption in funding cycles. Uganda government was mostly relying on external funding to procure these drugs. So when Uganda government wasn't able to access funds from the Global Fund to fight AIDS, TB and Malaria (GFATM), it led to stock outs.
"Government should earmark funds for essential medicines to ensure no drug stock outs occur" suggested Prima.
"Stop Medicine Stock-Out Campaign engaged a wide network of organizations and began lobbying to ensure regular drug supply of essential medicines. During this campaign, we highlighted issues and build pressure on authorities to respond. Eventually the President of Uganda came up with drug monitoring unit for drug distribution and procurement campaign increasing access and availability of essential medicines" said Prima.
Prima's work has allowed TB/HIV activists to be recognized as crucial partners in the fight against TB in Uganda. She was selected to serve on the Technical Working Group on Medicines that advises the Ugandan government on policies related to purchase and accessibility of essential medicines.
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