BY D SEBUNYA: Access to palliative care in Uganda remains a significant hurdle despite its numerous advantages. As the Palliative Care Association of Uganda (PCAU) celebrates its silver jubilee, actors in this sector are seeking ways to make this component of medical health more popular.
According to the World Health Organization, “Palliative care is an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illness. It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual.”
Statistics show that only 10 percent of the 3.5 million Ugandans who need this care every year can access it. This is mainly due to limited awareness and insufficient financing. This medical care strategy is legally recognized in Uganda’s health care systems.
While celebrating 25 years of PCAU, Dr. Billdad Baguma, the executive director of the Joint Medical Stores, commended the association for its great service to Ugandans, which he says deserves national recognition. He adds that their work needs to be supported by every Ugandan. “Palliative care is work that we are all duty bound to support,” he stated.
Meanwhile, he notes that much needs to be done to expand access to palliative care services across the country. For example, in Ntungamo district, these services can only be accessed in Itojo health center. He says there is a need for collective responsibility to solve the lack of access problem through having outreach entities, rather than institutionalized access, which is somewhat more expensive. Baguma also mentions that stigmatization of palliative care limits access and calls for increased awareness to empower people with knowledge. “Making more people know and appreciate what palliative care is and what it’s all about, why people need it and that any one of us may need it at any point, is very important,” he stated.
He suggests increased advocacy for the service, increasing the number of health facilities accredited to offer oral morphine, forming broader coalitions to increase the number of participants and supporters, and offering advanced pain management, which can be paid for by those who are well-off, with their payments used to service the poor.
Martha Grace Agiro, the assistant commissioner for pharmaceutical health in the Ministry of Health, assured that the government is gradually solving the funding problem that hampers the steady supply of essential drugs, including those used in palliative care. This would help increase access to the service since what is needed would be readily available.
“We have seen increments in the budget for medicines and medical supplies, and hope that in five to seven years, this will be solved. We want to make sure that morphine is available in all the facilities, and we want to know all the patients that are supported, so that the drugs are delivered by the National Medical Stores and Joint Medical Stores. Morphine is among the commodities that we shall be tracking to make sure that it has been put to good use.”
Mark Mwesiga, the PCAU executive director, mentioned that despite the limited access, the palliative care concept in Uganda had developed over the years, and is now embedded in the country’s health care policy. It has been recognized under different health acts like the Law on Narcotics and Psychotropic Substance Control, the Uganda Cancer Institute Act, and the Uganda Heart Institute Act, among others, and is also recognized in the Uganda National Minimum Health Care Package.
Meanwhile, Mwesiga says as palliative care service providers, they are pushing for a standalone legal regime, and it is what they are focusing on at the moment. “We still need a standalone strategy, and the team in the ministry is working on that we have already initiated. Though we quarrel with the government, we are at least somewhere,” he stated.
He also appealed to the government to consider home care a serious form of medical service after hospital, and to provide the necessary support for patients nursing life-threatening illnesses at home. He also called for scholarships for training in palliative care, acknowledging that the country now offers palliative care studies up to the bachelor’s level.
According to the executive director, up to 36 districts don’t have any form of palliative care services despite efforts to provide integrated services across the country. In efforts to popularize the service, he announced that the association has developed an online directory application to help patients locate the nearest palliative care provider, and there is also a manual directory for the same purpose.