Availability of drugs what does it mean in ugandan primary care
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AVAILABILITY OF DRUGS: WHAT DOES IT MEAN IN UGANDAN PRIMARY CARE?. Jessica Jitta, S. R Whyte, N. Nshakira Child Health Development Center Makerere University Uganda & Institute of Anthropology University Copenhagen Denmark. ABSTRACT. Presentation covers areas below:

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AVAILABILITY OF DRUGS: WHAT DOES IT MEAN IN UGANDAN PRIMARY CARE?

Jessica Jitta, S. R Whyte, N. Nshakira

Child Health Development Center Makerere University Uganda & Institute of Anthropology University Copenhagen Denmark


Abstract l.jpg
ABSTRACT

Presentation covers areas below:

  • Introduction/background

  • Objectives

  • Methods

  • Findings

  • Conclusions


Introduction l.jpg
INTRODUCTION

  • Uganda public- 40%, PNFP 25% and PP 35%

  • Health reforms Ugandan HS initiated 1990s as central efforts to rebuild the health system

  • Reforms assume rational drug management ensures drug availability &quality care

  • Tension assumption- reality HWs responsive to users’ demands& being rational drug manager

  • Introduction user fees -health as commodity and users demanding value for money


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OBJECTIVES

  • To examine drug availability at primary health care level, with a focus on the inconsistencies in drug supply policy and the gap between policy and practice.


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METHODOLOGY

  • Cross-sectional qualitative and quantitative KI, FGD,observe consultations and records review

  • 6 units- a public rural hospital OPD, 3 HCs, a sub-dispensary and an church NGO dispensary

  • Policy makers/administrators (KI 67); users (54FGD)observed consult(140) exit interviews (160) entries patient registers (600)

  • Analysis -significance drug availability HCW, users and planners/administrators

    -realities that HCWs and their patients face -district context national policy

  • Supply, utilization and expectations/demand for inj chloroq, penicillin & availability of needles/syringes.


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FINDINGS- Sources of drugs

  • Public units- EDMP pre-packed kits quarterly to districts , district buy suppl drugs, special vertical programs (TB, STD) & h/units procure drugs &needles and syringes

  • Patients referred to drugshops buy drugs- 40%

  • NGO depend only procuring drugs-not limited

  • Planners concerned EDMP, no policy on drug supplements by units

  • To users most important- obtain needed drugs


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FINDINGS- Types drugs available

  • Volume and range services at unit determine EDMP kits supplied and National Standard Guide available for rational drug use

  • Most used drugs anti-malaria, antibiotics and analgesics

  • Inj medicines on high demand, went o/s first

  • Units put user fees to supplement stocks to overcome chronic o/s & increase range of drugs, needles & syringes and IV fluids

  • Health unit records on supplements poor


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FINDINGS- Diagnosis & prescript

  • Varied with cadre and number of h/providers- skills vary with level health units

  • Symptomatic diagnosis lack of support facilities

  • Very sick patients (children vomiting) injections prescribed

  • High rate use of combination antibiotics and anti-malaria- many drugs (poly-pharmacy)

  • Very high injection rates 35-85% compared to recommended 15%-providers respond users demands- previous oral form taken no response


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FINDINGS- Drug suff/adequacy

  • New kits open only exhausting contents

  • Drugs used at different rates

  • Injection drugs run out first unit supp

  • 40% exit interviews referred drug shop

  • Planners/admin EDMP adequate in units

  • Providers unsatisfied injection drugs antibiotics and anti-malaria

  • Users concerns drug availability at unit,get injections, affordable and adequate dosage


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FINDINGS- Availability issues

  • Health sector reforms have changed the conditions for managing, supplying and using drugs through decentralization, user fees and privatization.

  • Injection drugs in kits ran out quickly and were purchased by the unit or the patient at nearby drug shops.

  • Government health units both compete with & use local commercial sources of drugs undermining technical premise rational drug use and supply built into kit system.


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FINDINGS- Quality care perspt

  • Drugs availability is fundamental quality of care by all 3 categories of actors PHC, perspective differ& shifting

  • Plan/admin- securing suppl EDMP kits-delivery, records account/stocktaking, mism’gment/leakages at HU-control & security of drugs-manuals&guidelines rational use drug

  • H/workers not relate insuff to drug to diagnosis prescription but-inadequate supplies in kits, large numbers infectious diseases and need to satisfy pts with injections- purchase suppl drugs, refer pts buy p/shops

  • Users- in terms whether all prescribed drugs are good obtainable at HU regardless source, inj preferred form


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CONCLUSIONS

  • Problem of drug availability interlinked, so is perspectives and interests of actors

  • Dialogue and realism are needed in order to create policies that respect both good medical treatment standards and the concerns of frontline health workers and their patients.

  • Rethinking of the meaning of drug availability in PHC calls for methodologies examining the changing context of h/care & position of diff actors, at national and district levels, to address gaps existing between drug policy and practice


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