At just 0.38 mg per person annually, Uganda is among the lowest consumers of medically prescribed morphine. But need was apparent; in 2016, the PCAU – which is marking its 20th anniversary this year — set out to change things.
Since 2016, a concerted, sustained effort by the Palliative Care Association of Uganda (PCAU) to make prescription pain medicine more readily available in hospitals has had an enormous impact.
‘When doing the baseline at commencement of American Cancer Society’s Pain Free Hospital Initiative (PFHI), at one hospital we walked through wards and saw children crying in pain,’ says PCAU Programs Manager Mark Mwesiga. ‘We recently went back and the children were smiling. Even a nonmedical person realizes the great change.’
The association developed a detailed advocacy plan at the same time as starting the initiative. The challenges at the beginning were great; even though the government pays for all morphine nationally, a key difficulty was an unreliable supply chain.
Gaps were numerous.
‘Sometimes health facilities do not order properly or they do not use the right ordering forms,’ says Mwesiga. ‘Other times, the National Medical Stores (which supply medical morphine) does not respect reorder levels, or they deliver a wrong order, or they deliver more or less than needed. There could be an occasional stock out at the hospital, or the trained nurse or clinical prescriber has been transferred. Smaller health facilities may not have a full-time, qualified doctor.’
Complicating matters, no one has a handle on actual need, as there is no historical precedent to guide them. ‘If all facilities were supplying the right information on cunsumption,’ Mwesiga knew, ‘we could streamline and supply the demand.’
PCAU targeted teaching hospitals and Regional Referral Hospitals, and has been doing the following:
PCAU efforts in the education realm have also paid off, with Uganda introducing an Advanced Diploma in Palliative Care Nursing in government training institutions. ‘About 20 nurses have enrolled in the nine-month course at Mulago School of Nursing and Midwifery. We hope the commitments from Uganda Nurses and Midwives Council that graduates will be registered palliative care nurses will materialize.’
PCAU has recently expanded its efforts with a pilot PFHI project in two of the country’s biggest not-for-profit hospitals. ‘Our dream and desire,’ says Mwesiga, ‘is that, seeing the benefit of what the initiative can do, the government is convinced that it is in the interest of the country to implement the program in all general hospitals.’
Funding is a constraint, as Uganda does not even have the budget to cover essential services, he says. Regardless, the advocacy work will continue.