In late 2015, health facilities in Uganda faced a potential shortage of anti-TB and HIV drugs, caused by rising prices due to fluctuating currency and an unexpectedly high enrollment in the country’s treatment program that threatened supply.
TB remains a major killer in Uganda and high infection rates make it one of the most affected countries grappling with the highly contagious and hard-to-treat illness.
A meeting with the Uganda permanent secretary for Ministry of Health on TB drug stock-outs. Photo: PATH/Deogratias Agaba
“TB patients rely heavily on a complex daily regimen of drugs,” said Moses Dombo, director of the PATH-led USAID Advocacy for Better Health (ABH) project, which advocates for a range of health issues, including TB prevention and treatment. “When we learned that there was a drug shortage, we knew we had to act, and quickly.”
Compelling evidence supported the need for prompt action. Data showed that anticipated stock-outs could put more than 250,000 lives at risk, while also increasing susceptibility to multi-drug resistant TB (MDR-TB)—a particularly virulent, expensive, and hard-to-treat form of TB.
“Persistent stock-outs can increase cases of MDR-TB,” said Dr. Busluwa Paddy, technical advisor at the Uganda Stop TB Partnership. “And government commitment to funding TB prevention and treatment is low, which further exacerbates the problem.”
Concerned that the government might not respond fast enough to avoid a stock-out crisis, PATH’s ABH project assembled a strong coalition of partners* to conduct a campaign to pressure the government to increase resources and prevent the shortage.
Fighting for attention and action
Advocates meet with senior officials at the Uganda Ministry of Health over TB drug stock-outs. Photo: PATH/Deogratias Agaba
Campaign activities began in November 2015, when the coalition took their case to government decision makers, distributing updated dossiers on district stock-outs and conducting radio spots and press conferences. They held face-to-face meetings and presentations with top government officials, including Uganda’s Office of the Prime Minister and the First Lady.
At Uganda’s first-ever national TB conference that same month, survivors asked the government to prioritize TB treatment.
One woman named Mary shared her experience of surviving MDR-TB: “I wouldn’t wish to have anyone go through what I did,” she said. “I would like to see our government provide for the basic rights of all Ugandans to live their lives free of TB.”
Getting the message home
Citizens participate in an advisory forum where they received reponses from Ugandan leaders on issues affecting them including drug stock-outs. Photo: PATH/Deogratias Agaba
Within a month, the government responded. They expedited a parliamentary debate on a US$200 million loan to help fund medicines, prioritized drug distribution within health facilities, and negotiated with the Global Fund to front-load future budgets for immediate purchases. The advocates’ swift action averted a major public health crisis and ensured TB and HIV treatment will be guaranteed for many more patients.
At the national Annual Health General Assembly in January, the minister of health acknowledged the effort, saying “The message has gotten home.”
Keeping their eyes on the prize
Advocates are motivated by their success in reaching decision-makers, but are focused now on increasing allocations towards the country’s next health budget, which will help address TB funding shortfalls for the longer-term.
“Our campaign was successful, but only addressed the symptom of a broader problem,” says Dombo, “The long term goal is ensuring that all Ugandan citizens have a stronger voice in accessing quality, affordable healthcare. We are now marching on with that objective.”
*EDITOR’S NOTE: The coalition includes the National Forum for People Living with HIV in Uganda (NAFOPHANU), the Coalition for Health Promotion and Social Development (HEPs-Uganda), The AIDS Support Organisation (TASO Uganda), Uganda Network of AIDS Service Organizations (UNASO), the National Community of Women Living with HIV/AIDS (NACWOLA), Uganda Cares, and various media outlets.