Uganda Faces TB Drug Shortage on World TB Day

Today, March 24, is World Tuberculosis Day. On World TB Day, we celebrate and commemorate the lives of those who have been affected by TB across the globe.

According to the World Health Organization, about 1/3 of the world population is infected by the TB bacillus. TB poses one of the greatest public health risks of our time. According to the Stop TB Partnership, four out of ten people who become ill with tuberculosis fail to get accurate diagnosis and effective treatment. As a result, drug resistant TB is on the rise in many countries and is not being addressed with sufficient speed or commitment.

Considering the incredible risk posed by drug-resistant TB, I am saddened and troubled by reports from our partner in Uganda, the Action Group for Health, Human Rights and HIV/AIDS (AGHA), about a TB drug stock-out in Mulago Hospital, Uganda’s National Referral Hospital based in Kampala.

The Stop Stock-Outs Coalition put out the following statement yesterday, regarding these disturbing trends:

For the last seven months, since October 2008, Mulago Hospital has been experiencing shortages of anti-TB drugs. These shortages have been affecting not only Mulago Hospital, but also the sub-district health centres. This is disastrous to Uganda’s efforts to prevent and eliminate TB cases in the country. According to the World Health Organization (WHO), Uganda ranks 15th in the world for TB burden. Mulago hospital receives about 25% of all the country’s TB cases, attending to 250 or more patients every month. Mulago is not the only public health facility affected; TB medication stock-outs are also being experienced at sub-district health centres across the country.

This ongoing situation is totally unacceptable. Children with TB have not been able to get TB treatment at Mulago Hospital because there have been no pediatric TB medicines at the hospital since December 2008. Even more alarming, are the reports that Mulago Hospital’s stocks of ethambutol/INH combination (a TB medicine used in the continuation phase of TB treatment) expired in January 2009 and some patients are currently receiving expired medication! Ironically, while the slogan for this year’s World TB day states “I am stopping TB”, the Ugandan Government, by allowing this situation to prevail, is doing the opposite, and instead is promoting the spread of the disease because:

  1. Patients identified with TB have to delay starting treatment because of the stock-outs. This delay means that these TB patients can potentially infect more people. It is important for someone infected with TB to start medication as quickly possible, because the chance of infecting another person is drastically reduced after even one week of treatment.
  2. The stock-outs mean that patients who are already on treatment will have to interrupt the course of treatment because the medicines they need are not in stock. Patients who interrupt their treatment are at increased risk of developing multi-drug resistance (MDR) TB. This exacerbates the crisis as MDR TB is more expensive and more difficult to treat.

Sandra Kiapi, Executive Director of AGHA and member of the Stop Stock-outs Ugandan campaign says:

This situation is totally unacceptable. The slogan for this year's World TB day is, 'I am stopping TB', but by allowing this situation to prevail, the Ugandan Government is doing the exact opposite.

The statement goes on to explain that TB medications are among the list of essential medicines that the Government is obliged to make available to Ugandans free of charge under the Uganda National Minimum Health Care Package. By neglecting to take action on these stock-outs, the government of Uganda is failing to meet its moral obligations to its people, as well as its human rights obligations under the International Covenant on Economic, Social and Cultural Rights (ICESCR).

The New Vision, one of Uganda’s daily newspapers, also published an article on the TB stock-outs, which quotes Justin List, a PHR student leader currently living in Uganda.

Stock outs of essential medicines have been an ongoing issue in Uganda. AGHA published research in 2007 on stock-outs of essential anti-malarial medicines which has raised awareness about how medicines stock-outs are effecting health facilities at the community level.

Ensuring continual access to TB medications is essential in order to control this vicious disease and stop the spread of drug-resistant TB. The Government of Uganda must immediately take action to make available quality TB medications at Mulago Hospital and all other public health facilities in the country where there are stock-outs and address the bottlenecks in medicines procurement, supply and distribution that contribute to the ongoing stock-outs.

On this World TB Day, we must hold all governments accountable to their commitments and obligations to addressing this global epidemic. Access to TB medications and proper care for those infected must be guaranteed if we are serious about stopping TB.

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