Important note: Information in this article was accurate in 2006. The state of the art may have changed since the publication date.
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New Vision (Kampala) - November 28, 2006
Elvis Basudde
"That was relieving news to me," Ndalise said. "Even when I went back and was told to return the following day, it did not wipe off the smile on my face." However, Ndalise says he was always told to go back the following day, yet his health was deteriorating.
The commissioner of health services, Dr. Sam Okware, said from 2005, when the ministry started providing free ARVs and recently during the freezing of the Global Fund: there have been free ARVs to last the next five years. "People should access the drugs from over 100 health facilities that have been accredited to provide them," he added.
The ministry was receiving assistance for distributing ARVs from the Global Fund, World Bank and PEPFAR. Over 150 health facilities were accredited and about 100 of them started providing free ARVs by the start of 2005. According to Okware, the target was 70,000 people by the end of 2005. Both government and non-government health units were accredited.
They included two national referral hospitals: Mulago Hospital (800 patients allocated) and Butabika Hospital (60 patients); 12 regional referrals, 43 district/government hospitals, 24 private not-for-profit hospitals, 10 private-for profit hospitals and 16 health centres. Over 44,000 patients started on Anti-Retroviral Treatment (ART).
Recently, there were reports that the National Medical Stores (NMS) had expired ARVs.
NMS acting general manager Apollo Mwesige told The New Vision recently that more ARVs will expire next month. He, however, said Mulago Hospital does not get its ARV supplies from NMS. According to the Ministry of Health records, Mulago uses President's Emergency Plan for AIDS Relief (PEPFAR) funds to supply free ARVs.
According to Ndalise, some patients, who have been on Mulago's ARV list, were told to go back later. "There seems to be a problem here," a patient said. "Some of my friends have sought other alternatives to get the drugs." Ndalise was given a referral letter to go to Joint Clinic Research Centre (JCRC) for ARVs.
A doctor at JCRC, who preferred anonymity, confirmed that a few patients with chits from Mulago Hospital were received at JCRC for ARV treatment (ART).
"They come here with chits saying they are unable to get drugs from Mulago Hospital. Those who can afford, have bought ARVs from here and those who can't, we have given free drugs."
The assistant commissioner/Nursing for Mulago Hospital, Mariam Walusimbi, agreed that Mulago has no capacity to take on new patients.
"We are understaffed. New clients who are eligible for the drugs cannot get them. We advise them to try elsewhere."
Walusimbi said Mulago had a target of 800 patients this year. "PEPFAR gave us enough money to cater for 600 people, but the number of new patients is overwhelming. We can comfortably provide ART for 677 clients and we have an excess of 123 patients we cannot sustain," she said.
Walusimbi adds that sometimes even the supply from the ministry fluctuates causing problems. "A total of 123 clients qualified, but we could not put them on ART. It is unethical to start them on drugs when you cannot sustain them with continuous supply," she said.
Another doctor at Mulago, who preferred anonymity, said ARV shortage is not just a Mulago problem, but exists in a number of health facilities accredited to provide free ARVs.
Dr. Stephen Watiti, a clinic manager of The Mildmay Centre in Kajjansi, advises everyone on free ARVs to save some money in case the free supply runs out.
A month's supply requires a minimum of sh25,000.
He says it is risky to interrupt ART because one risks resistance. "According to Ministry of Health, of the 200,000 people who need ARVs, only 75,000 are getting them," Watiti says. "Uganda is estimated to have 1.2 million people infected with HIV. All these need to be put on ARVs at one point in their lives."
As we prepare for World AIDS Day on Friday, universal access to ARVs should be given utmost attention.
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