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Q&A: Dr Diana Atwine Speaks on Drug Stocks, War on COVID-19 and Boosting Healthcare

Health Ministry Permanent Secretary Dr Diana Atwine this week held a live Twitter Q&A with social media enthusiasts regarding Uganda’s health sector.

He outlined achievements and also challenges being faced especially at a time the country is grappling with the COVID-19 pandemic.

Excerpts:

QN: What are some of the health infrastructure milestones recorded over the last 5years?

The rehabilitation and equipping of Lower Mulago Hospital is ongoing and the current progress of work is at 95%. The hospital has been partially opened for the management of COVID-19 patients and other services

Rehabilitation and equipping of Kawolo Hospital started on 1st May 2017, completed in 2019 and is operational

Construction of Kayunga and Yumbe hospital is complete and undergoing installation of equipment. The hospitals will be upgraded to Regional Referral Status

Construction of the Regional Specialized Paediatric Surgical Hospital was commissioned in February 2017 in Entebbe and has been completed. The hospital will provide services to the nation and the region.

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The construction of International Specialized Hospital of Lubowa is ongoing. This 240 bed facility is a specialized referral, tertiary treatment, research, and teaching hospital, which is intended to treat patients travelling out of the country to seek specialized medical care:

  • renovation and expansion of Lira, Arua and Gulu RRHs is ongoing
  • 6 HC IVs have been upgraded to hospitals
  • A total of 10 HC IIIs have been upgraded to HC IVs in FY 2019/20 in line with the NRM Manifesto of having an operational health Center IV in every sub-county
  • A total of 186 HC IIs have been upgraded to HC IIIs in the last 2 FYs. Currently, 108 HC IIs are under upgrade this FY 2020/21.
  • Construction of HC IIIs in the 134 sub-counties without any health facility will commence once the upgrades are complete. This is to ensure that there is a health facility within 5km distance

QN: One of the big challenges in the sector has been the issue of drug stock outs. How has the sector faired in the last 5 years in reducing the frequency of stock-outs of essential drugs?

NMS designed the Last Mile Delivery in 2012 to make sure that medicines are delivered directly to the health centre.

 The private contractors whom NMS engages in delivering the medicines directly deliver at the door stops of individual government health facility.

 NMS designed the Last Mile since it had observed that the system of delivering medicines to the District Health Officer’s Office who was then responsible for delivery at health centres had its own inefficiencies such as delays; forcing patients to receive medicines late or resorting to buy from private clinics.

 The Last Mile innovation was fundamental since it became an experiment for other African countries. NMS also designed the Delivery Schedule; which is a contract between NMS and all health facilities in the country.

 The contract is meant to help health facilities understand when to expect medical supplies after making an order. The schedule is also designed with telephone numbers and toll-free lines in case of any challenges and delays in receiving supplies.

 NMS is able to share the delivery schedule in all health facilities in the country. Each in charge at a government health facility knows exactly when they have given NMS an order and when they expect NMS to deliver.

 NMS has also established eleven regional centres for Customer Care Representatives across the country. These include: Moroto, Mbale, Soroti, Hoima, Gulu, Arua, Kampala, Fort Portal, Mbarara and now Jinja.

 To keep pace with the digital era, NMS developed the SmartCare App which enables everybody involved in the chain of delivery to give NMS feedback in time.

NMS’ new pharmaceutical storage facility will have 19 walk in cold rooms of positive storage (87% for vaccine storage and 13% other cold chain pharmaceuticals)

The app allows a health worker who has received medical supplies to give feedback to NMS if there’s any problem such as delivering short expiry drugs, items not ordered or late delivery. The health worker can log into the system and send complaints to NMS.

 Another digital innovation is the Delivery Monitoring Tool (DMT)- an innovation that helps in tracking and informing health workers of medical deliveries from NMS to health facilities. The DMT also informs DHO’s, RDC and each Member of Parliament of that particular area. The system also gives names and telephone numbers of the health workers who have received the medicines.

NMS created an innovation of embossing the drugs. Today, every medicine that goes to a medical facility has a distinguishing mark of ‘Government of Uganda- Not for Sale’.

This means that Ugandans can now distinguish medicines that belong to government and those that do not. Maintaining quality NMS mandate is to maintain the quality of drugs from the time it receives them to the time of delivery. However, after delivery, the mandate is passed on to the health workers.

The imposing NMS structure in Kajjansi will be commissioned later this year

To maintain quality, NMS has storage facilities with ambient temperature since most medicines are stored at different temperatures. Vaccines are stored in cold rooms and fridges. The quality is maintained until delivery.

During transportation, the same temperatures are maintained in trucks. For vaccines, trucks are kept in refrigeration. Our trucks are powered between 2 and 8 degrees centigrade. Some vaccines like Ebola require -80 degrees centigrade.

Global Alliance for Vaccines and Immunizations (GAVI), World Health Organization (WHO) and UNICEF have certified NMS as the best in vaccine logistics. NMS has since agreed with National Drug Authority to set up its own quality control laboratory to continue carrying out of tests of medicine.

QN: At the start of the COVID-19 pandemic the country was reported to have only 55 ICU beds? How far have we gone in scaling up our ICU capacity since?

We have supplied 143 ICU beds complete with ventilators, patient monitors, high flow oxygen therapy apparatus, X-Rays including pendants and accessories. This has been supplied to 13 Regional Referral Hospitals and 4 other hospitals.

Additionally, new oxygen plants have been supplied to Entebbe Grade B, Kayunga, Mbarara and Mulago Hospitals

QN: In October last year, there was a mass measles vaccination campaign. Can you say you successfully vaccinated all children in the country under 15 years?

We successfully conducted the mass Measles-Rubella campaign targeting 18,100,000 children under 15 years. A total of 19,241,348 were vaccinated giving 106% coverage. This campaign was the largest of its kind on the African continent – a first made possible by the NRM Gov’t.

QN: Malaria remains the single-biggest disease-killer in Uganda. How has the sector performed in reducing its prevalence over the last 5 years?

As a sector, we are doing well in terms of reducing the Malaria Prevalence. In 2017, Malaria prevalence was 19% and now 9%. This is commendable progress. For example, the prevalence in Kampala and Wakiso stands at less than 1%.

In the last five years, Gov’t conducted two mass mosquito net distribution campaigns where over 30 million mosquito nets have been distributed to all Ugandans as part of our interventions to reduce Malaria. The second mass campaign is on-going and so far 92 districts have received mosquito nets. Through routine visits, all pregnant women who attend ANC and children who come for immunization to our health facilities are given mosquito nets

We have embarked on larviciding and indoor residual spraying in selected districts. This will subsequently be rolled out across the entire country

QN: Over the last 5 years, Mulago has been undergoing an upgrade. How far that upgrade gone, and what has new and improved services can Ugandans now access at Mulago as a result of the upgrade?

Mulago is now a super specialized hospital capable of carrying out highly specialized medical conditions. The recent achievements include: separation of the conjoined twins, heart surgeries, retina replacement, and other organ transplants including infertility treatment.

Mulago National Specialized Women and Neonatal Hospital

QN: There have been fears that the new improvements on Mulago also come with higher charges on patients, making the National Referral Hospital unaffordable. What do you say to that?

Another concern has been the issue of insufficient ambulance services especially on our highways. Has the sector made any progress in this regard over the last 5 years?

We have made significant progress in improving emergency medical care in the country. Government has procured 80 ambulances: 63 road ambulances and 17 boat ambulances.

Out of these, 75 are type B (basic life support emergency vehicles) for universal coverage and 5 type C mobile intensive care units) for advanced care.

We have an approved Emergency Medical Service Strategic Plan, Emergency Care protocols, draft EMS policy and draft Ambulance norms and standards.  We have drafted a National Ambulance policy, and we are now decentralizing the ambulance response to ensure that all districts have a functional ambulance and able to respond to emergencies.

Atwine says the health Ministry has increased on the fleet of road ambulance services to 80

QN: Let’s talk infant and maternal mortality: Are fewer women and infants dying today than was the case 5 years ago?

Uganda has made good progress in reducing infant and maternal mortality and increasing life expectancy. A child born in Uganda today can expect to live to the age of 63 years.

More children survive today and infant mortality rate went down from 54 per 1,000 live births in 2011 to 43 per 1,000 live births in 2016 (UDHS, 2016) – this fell by approximately 17%. Uganda is among the few countries that managed to attain the global MDG target on halving child mortality by 2015 compared to the 1990 rates

The MMR fell by approximately 23% from 435 in 2011 to 336 per 100,000 live births in 2016.

The next UDHS is expected next year in 2021 and we are optimistic that our results will be even better given the intensified efforts to improve health systems including recruitment, training staff including awarding them scholarships, better infrastructure through construction and upgrading of lower level facilities to HCII and HCIV to enable more quality maternity care and obstetric surgery to take place, procurement and distribution of commodities including family planning and childhood illness treatment at the community level.

Many infectious disease and conditions which kill children and mothers such as malaria and anemia have reduced markedly also and could explain the reduction in deaths

QN: Let’s talk staffing and healthcare personnel: What is the doctor: patient ratio today Vs what it was 5 years ago?

The health worker (doctors, nurse and midwives) population ratio of 1.92 health workers per 1,000 population

Overall staffing level in public health facilities stands at 78%.  While there are still shortages in critical cadres such as Doctors, Anaesthetic Officers, Dispensers, Pharmacists and Theatre staff, Government is offering scholarships – so far, over 500 individuals have benefitted from this program and been deployed in various health facilities across the country

The stock of qualified health profession in the health sector increased from 90,412 in 2017 to 114,341 by June 2020

Ministry of Finance provided funds for recruitment of additional health workers and PHC Non-Wage grant for the completed health facilities.

 QN: Retention of healthcare professionals’ especially specialists has also been a key challenge for Uganda’s health sector, prompting expensive medical tourism abroad. Are we doing any better today than we were 5yeears ago in regard to retaining healthcare professionals?

Yes. Through payment of enhanced salaries and specialized training to motivate retention.

QN: A major issue encouraging the exodus of medical professionals has been the pay. Has there been an improvement in remuneration for healthcare workers over the last 5 years?      

Yes. There has been great improvement in the remuneration for healthcare workers. This has been made possible by the commitment by the President, H E Yoweri Kaguta Museveni. In July 2019, the welfare of health workers was increased by 60%.

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