Quarterly NewsletterOctober 2014 - December 2014

4th Edition, October - December 2014

Making Health Rights And Health Responsibilities A Reality

HEPS Uganda changing lives in communities

Quarterly Newsletter

Quarterly NewsletterJanuary 2015 - March 2015

CONTENTS

PG 3

PG 4

PG 5

PG 6

PG 7

PG 8

Community Talks : Health responses grow stronger

National Dialogue on ART Access, Pictorial

Advocacy beyond national level - Tour to Germany

Community Volunteering for positive change

Beatrice’s story of change.

About US

Quarterly NewsletterOctober 2014 - December 2014

Universal access to essential medicines remains an outcry across the country for most

vulnerable communities in Uganda. Despite the government efforts, media reports and surveys conducted show that the situation is deteriorating.

Factors affecting access are ranging from limited budget line for procure-ment of essential medicines and medical supplies which is at 400billion, bureau-cracy at NMS and the delays at the dis-trict have contributed to stock of drugs in public health facilities.

In districts like Kiboga and Lira, HEPS Uganda has engaged communities by providing a sharing platform between community members and service pro-viders using a hybrid of social account-ability approaches.

This engagement identified a number of concerns particularly the increased community awareness on entitlements

and their interest in pushing health workers to meet their expectations, a sit-uation that has put community members at easy to express themselves and point out the most pressing issues they encoun-ter as they access services openly.

HESP has also used social media to raise awareness using community loud speakers during market days and the local stations in the respective district,s the approach has wider coverage since

the radio programmes reaches out to other sub coun-ties that are not targeted.

50% of the communities reached by the community monitors show that account-ability projects promote com-munity participation in hard to reach areas.

HEPS has identified a network or partners under the

“Kiboga Advocacy Forum” and “North-ern Uganda Coalition on Health Advo-cacy (NUCHA)” coalition to strengthen collective efforts in addressing some

of the factors affecting access to essen-tial medicines. The networks are linked to the Uganda Coalition on Access to Essential Medicines (UCEAM).

Community Talks : Health responses grow stronger

In districts like Kiboga and Lira, HEPS Uganda has engaged communities by providing a sharing platform between community mem-bers and service providers using a hybrid of social accountability approaches.

Quarterly NewsletterJanuary 2015 - March 2015

National Dialogue on ART Access: Civil Society demands more gov’t commitment

HEPS-Uganda carried out a survey of access to essen-tial medicines and diagnos-

tics for HIV/AIDS and TB. The survey assessed progress and identified gaps in access to HIV and TB treatment, and diagnostics for the period of December-January 2014. The study was a follow-up to the three earlier surveys that have been conducted with support from HIVOS since 2009. It was conducted in 118 public, private and private-not-for-profit (PNFP) health facilities accred-ited by Ministry of Health to provide ART in central, northern, eastern and western Uganda. A basket of 67 essen-tial medicines for TB and HIV was sur-veyed: 57 ARVs and 10 anti-TB’s.

The dialogue was organised on 26th of November not only to disseminate the findings but also provide opportunity to exchange and share ideas between key stakeholders, including the media, members of parliament, CSOs and UCEAM members.

Highlights of the surveyThere was no presence of the con-

demned triple therapy HIV drug Tri-omune which was a good develop-ment given the toxicity of the drug and the need to move to more user-friend-ly drugs in order to promote adherence and retention.

Low availability of HIV medicines for children as well as for second and third line. There were unconfirmed reports that Abacavir, a second line drug, was being given to clients on first line therapy, which was said would be a worrying development for the future treatment needs of such clients.

On diagnostics, it was discovered that all HIV treatment sites surveyed had Determine kits but availability of other brands was low, which undermined their ability to conduct confirmatory HIV tests.

The report showed positive findings on availability of TB medication, the com-bination Rifampicin/Isoniazid/Pyrazi-namide/Ethambutol, used in the initi-ation stage of treatment, was the most

available anti-TB which implies reduced reliability on monotherapies and their attendant pill burden.

The dialogue was informed of pro-grammatic changes that PEPFAR will be putting in place effective 2015 that will have direct impact on access to ART across the country. The changes involve allocation of a fixed annual amount of money (about US$ 184 million) to each of the PEPFAR supported countries. In addition, PEPFAR funds will be direct-ed to key populations as a way of gen-

erating greatest benefit. The decision is ostensibly occasioned by the global financial crisis and the need to increase benefits from US support.

Stakeholders expressed civil society concern that the PEPFAR’s decision is likely to hit Uganda hard, given that there is a rising number of PLHIV and a rising demand for treatment. A flat amount of support from PEPFAR means that the country must find alternative funding for treatment of the additional numbers projected to join the demand for ART between now and 2020.

The meeting recommended that there is need for government to provide resources from domestic sources to cover the anticipated shortfall arising from the new ceiling on PEPFAR’s support. Civil society should demand more commit-ment from government and ownership of the country’s HIV programme. Partic-ipants specifically appealed for the expe-dited implementation of the AIDS Trust Fund which is proposed in the new HIV prevention and control act.

As it happened in pictures

Government should pro-vide resources from do-mestic sources to cover the anticipated shortfall arising from the new ceil-ing on PEPFAR’s support.

HEPS deputy Executive Director, denis Kibira talks to the media briefly after making his presentation at the national dialogue on access to ART. (File Photo)

Quarterly NewsletterOctober 2014 - December 2014

BukoPharma-Kampagne (a member of Health Action International) of

Bielefeld, Germany with local associate HEPS Uganda con-ducted a survey in 2013. The study report is titled Poor and forgotten: Examination of the business behavior of Boehrin-gerIngelheim, Bayer and Baxter in Uganda. The study was part three of a series of studies; other studies having been conducted in India and Brazil in previous years. The main objective of the tour was to promote the survey report and also to Highlight the health status of Uganda to policy makers and advocacy groups to focus development aid to main challenges of the country.

Speeches were conduct-ed for small groups of 15-20 advocates, politicians in cities/towns including Bielefeld, Greven, Munster, Hamm, Aachen, Cologne, Leverkusen, Bad Oeyn-hausen, Ingelheim, Dussel-dorf and Krefed. Several other cities visited includ-ed Hengelo, Bad Bentheim, Duisberg, Dortmund, Brack-wede, Herford, Minden and Hameln. The major advoca-cy points raised in all meet-ings were;

• Stakeholders in Germany

to support medicine price regu-lation in Uganda.

• Federal Germany govern-ment to work with Ugandan government and pharmaceu-tical stakeholders to support pharmaceutical human resource development including student exchanges, research and devel-opment, technology transfer.

• Germany government and development partners to support consumer health educa-tion in Uganda.

In Greven: a meeting was held with the Left Party of Parliament while in Leverkusen, a

meeting was held with officials

from Bayer

Healthcare Pharmaceuticals including the Vice President (Corporate Commercial Rela-tions) Klaus Brill and Ute Menke the Head of Sustainability and External Reporting. During the meeting Bayer agreed to assess the possibility of differentiating market according to socio-eco-nomic status in order to provide cheaper prices in Uganda and Africa. Although patent for Mox-ifloxacin was ending in 2014, company had not made decision on lowering its price but was looking to g e n e r i c compe- tition t o he lp

lower the price. Additionally, Company will

continue to provide Jadelle (the long term contraceptive) at a subsidized U$8 (from market US$18) even after end of the USAID-Gates Foundation Con-traceptive Security Program in 2018. Company agreed to be willing to partner on HR devel-opment and technology trans-fer.

Dusseldorf: a meeting was held with Members of Parlia-ment from the Green Party including Andrea Asch and ArifUnal and Ministry of Health officials.

As a Way forward stakehold-ers recommended the need to up required for programming col-laboration with BukoPharma-Kampagne. The Follow up to be done with WHO and Minis-try of Health over issues related to technology transfer Research and Development and human resource development. Follow the links below for film shows for the Streamed project in Bielefeld. http://vimeo.com/105434652 and Uganda truth trip. https://docs.google.com/file/d/0B4-hxn-4gtcrSlhjanNLWTNrZ0k/

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Advocacy beyond national level - Tour to Germany

META was represented in the Inter-national META Secretariat meeting held in Geneva to share country experience, identifying promising and recommended strategies to improve transparency and account-ability and identify ways of sustain-ing META across all countries.

HEPS together with Clinton Health Access Initiative (CHAI), conducted a survey on to monitor the avail-ability of ORS/ZINC treating diar-rhea in children under the age of five (5) in 95 districts in Uganda.

HEPS staff attend a Conference on Universal Health Coverage in Oc-tober organized by World Health Organization in Germany’s capital, Berlin(October 2014).

META represented HEPS,CHAI partner HEPS staff in Berlin

Their PEPFAR changes are effective 2015. The changes involve alloca-tion of a fixed annual amount of money (about US$ 184 million) to each of the PEPFAR sup-ported countries. In addition, PEPFAR funds will be directed to key populations as a way of generat-ing greatest ben-efit. The deci-sion is ostensi-bly occasioned by the global financial crisis and the need to increase benefits from US support.

PEPFAR introduces changes in policy

Uganda has been ranked 142nd in the 2014 Global Corruption Perception Index released by Transparency International on Wednesday, dropping two places compared to last year.

The Global Corruption Percep-tion Index ranks countries and territories based on how cor-rupt their public sector is per-ceived to be.

Last year, Uganda was in 140th position, having dropped ten places from 130th in 2012

Uganda drops two places in global

corruption ranking

Quarterly NewsletterJanuary 2015 - March 2015

Community volunteering is an act of involving the local community members

in contributing to the implementation of com-munity programs/ activities that are benefi-cial to the local environment at a voluntary basis. That is, a collaborative strategy between local community members and implementing agents, in community service implemented at a no cost basis or without pay but at times involving little facilitation in form of allowanc-es to the community members.

The local community members who partici-pate at a voluntary basis are referred to as vol-unteers. Depending on the sector they work, the terms may differ under which these vol-unteers are described, for example in Pallisa district, these are called village health teams (VHTS), community linkage coordinators (CLFs), or community focal persons (CFP) and volunteer peer educators (VPE). Volunteers range from parishes, sub counties and district level and these play a greater role in ensuring that community work is performed in their respective communities

Regardless of the description, the VHTS have been behind the success of most of the imple-mented programs that require community involvement. Normally, if any development is to be realized, it is advisably right for the com-munity members to always be involved in par-

ticular programs that are designed to benefit the entire community. VHTS are therefore involved in programs that require mobiliza-tion and sensitization like immunization, pesti-cide management, and distribution of govern-ment item like nets pesticides among others.

They can also be involved in health facilities to help out in HCT services, malaria testing at health center one, two, and at threes as linkage facilitators to carry out follow ups, tracking of clients in TB and HIV sections, mobilize com-munities for other services like SMC activities.

Community Volunteering for positive change HEPS beyond Uganda

MeTA Global Forum: stakeholders urged to be committedThe global meeting were HEPS-Uganda was rep-resented, was intended to share country expe-riences, identify promising and recommended strategies to improve transparency and account-ability and ways of sustaining MeTA across countries. Upon closure of META country respondents agreed that there is need for commitment from stakeholders to continue with MeTA in the long

term according to IMS sustainability survey con-ducted in December 2013. However, funding was noted as the biggest challenge to sustainability followed by government support. The proposed solution was institutionalization of MeTA within countries following the end of DFID funding in August 2015. In the Uganda country presenta-tion and other presentations, proposals were made on how MeTA can be institutionalized; • MeTA Jordan has been involved in develop-ment of second National Medicines Policy. A task force has been established for implementa-tion of the NMP. Uganda’s last NDP was devel-oped in 2002 but has no limit. It is an opportu-nity to review this plan during the review of the National Pharmaceutical Sector Strategic Plan. • Using price surveys, MeTA Peru has start-ed an online medicine price observatory which was approved by MoH as legislation. This is something MeTA Uganda can emulate. • MeTA is registered as an NGO in Ghana and Phil-ippines. It can be registered in other countries.

Funding was noted as the biggest challenge to sustainability followed by government support. The proposed solution was institu-tionalization of MeTA within countries follow-ing the end of DFID funding in August 2015.

Quarterly NewsletterOctober 2014 - December 2014

HEPS beyond Uganda

The US Agency for International Develop-ment (USAID) grant for the Uganda Health Supply Chain program started in August 2014 and runs through August 2019. It is led by Management Sciences for Health (MSH) with its partners; HEPS-Uganda, Harvard Pilgrim Health Care Institute; Euro Health Group; Imperial Health Sciences; and Maker-ere University College of Health Sciences. The mission for this program is to contribute to the Ministry of Health’s (MOH) medicines policy objective of improving the health status of the Ugandan population by increasing the avail-ability, affordability and appropriate use of es-sential medicines and health supplies (EMHS), including reproductive, maternal, neona-tal, and child health (RMNCH) commodities.USAID/ Uganda Health Supply Chain focuses on three result areas including (1) Nation-al policies and strategies that support cost effective, equitable, and transparent use of available EMHS resources (2) Strengthening country capacity to manage and use EMHS effectively and (3) Increasing availability and access to EMHS for priority populations.The Uganda Health Supply Chain operates di-rectly in 75 districts while working through implementing partners in 37 districts in Ugan-da including MOH technical programs, Nation-al Medical Stores (NMS), Joint Medical Stores (NMS), National Drug Authority (NDA), private sector providers, US government implementing partners, United Nations organisations, and oth-er development partners. With strong collabora-tion, a number of activities have been effectively implemented and have registered a number of achievements. For further details on the Uganda Health Supply Chain’s district support contact.

About the USAID/Uganda Health Supply ChainBeatrice a community

member from Kaduka village in Kamuge sub-county lost her

husband six year`s ago to HIV and has been living in denial. Her only hope was prayer from the village pastor. By the time she met Esther Nyende –the HEPS community linkage facilitator, Kamuge Sub-county coordinator, she had full blown HIV/AIDS with sores in her mouth and private parts. Esther encouraged her to go and test for HIV, talked to her about positive living and the availability of med-icines that can prolong her life. Esther escorted her to TASO -Mbale for v a r i o u s tests that were all a l a r m i n g including CD4 which was zero.

However, Beatrice Takaliis not alone, the problem of HIV in pallisa district is much bigger with a prevalence rate of 5.3% (UBOS 2005/6), the HIV counseling and testing services were poorly utilized due to lack of community linkage with the available health systems and also weak referral systems. Additionally, the failure to follow up patients enrolled on ART treatment and babies born to HIV positive mothers has contributed to poor adherence.

Esther is among the 110 com-munity linkage facilitators trained and mentored by HEPS-Uganda under the performance based grant from STAR-E to promote the

comprehensive HIV prevention, ART adherence and EMTCT messages.

The facilitators have been mobilizing and giving infor-mation to desperate com-munity women like Beatrice in 11 sub-counties (Kamuge, Gogonyo, Kasodo, Okwatata, Agule, Pallisa Rural, Pallisa

Town Council, Oloki, Apopong, Akisim and Chellekura in Pallisa district targeting Most at Risk Populations (MARPS) mainly fishing communities of sub counties of

Agule, Gogonyo, Apopong and

Kasodo. After attending the HES training,

I had to translate the key HIV pre-vention messages and pass them on to the community members as well as refer them to the health facilities. Now I have the life skills. I can communicate without any fear and have empowered many women in knowing their health rights and responsibilities.” Says Nyende Esther

In this project period the 110 community linkage facilitators have reached over 6087 referred for HCT services, 505 male referred for safe circumcision, 90 HIV+ patients followed up for adher-ence to ARVs, 1,537 mothers sup-ported to access ANC for safe motherhood, 60 HIV positive mothers and their exposed babies followed up on adherence and retained into care and treatment, 752 people referred for TB screening and diag-nosis, 8 family support group`s capacity enhanced in Pallisa HC111, Kamuge HC111, Apopong HC111, Opwate-ta HC11, Palisa TC, Kasodo HC111 and 2 new

family support groups created in Gogonyo and Agule HC111s, 21 unique individuals followed up on adherence, 195,321 condoms distributed to the communities and 34,316 people reached with prevention messages.

“The referral system has been working more efficiently since the introduction of standardized forms throughout the network. As a result, all service providers understand the purpose of refer-ral forms, family support regis-ters and how the referral system works.” says Dr. Mulekwa Godfrey, the DHO Pallisa district.

This has enabled community members including women like

Beatrice to easily access HIV/AIDS and TB

and SMC services that have enabled them to live a healthier and productive life.

Beatrice’s story of change...

Esther Nyende (L) talking to Beatrice (R) at Kaduka Village in Kamuge Sub county. Beatrice says that though HIV positive, the HEPS training has helped her cope better. She now has life skills and can communicate without any fear and had empowered many other women. (PHOTO by Pelagia Tusiime)

Quarterly NewsletterJanuary 2015 - March 2015

ABOUT HEPS UGANDAHEPS – Uganda is a health and human rights organization that advocates for health rights and health responsi-bilities, with a special focus on access to essential medicines and rational use of medicines.

HEPS – Uganda focuses on addressing bottlenecks that hinder access to quality healcare for the majority of Ugandans. HEPS believes that more preventive and curative means are paramount to good health and that they should be designed from a health consumer’s perspective.

A just and fair society in which all Ugandans can exercise their health rights and healthy responsibilities

OUR VISION

To enable Ugandans attain equitable access to health services with emphasis an access to medicine especially on access to medicine policy advocacy and community empowerment.

OUR MISSION

STRATEGIC OBJECTIVESObjective 1: Advocate for health consumer friendly laws, policies and health packages and their implementation at all levels in Uganda. Objective 2: Empower health consumers in Uganda with Knowledge and skills to claim their right to health and ex ercise their health responsibilities. Objective 3: Strengthen the capacity of HEPS– Uganda and Civil Society partners to meet her set objectives

CONTACT USHEPS-UGANDA HEADQUARTERS, PLOT 351A, BALINTUMA ROAD– NAMIREMBE, P.O. BOX 2426, KAMPALA, TEL: +256 414-270970, E-MAIL: info@heps.o r.ug, WEBSITE: www.heps.or.ug, FACEBOOK: HEPS-UGANDA

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