The availability of medicines to treat chronic diseases, such as heart disease and diabetes, varies widely throughout Uganda, said Yale researchers and their collaborators in Uganda and at Mt. Sinai School of Medicine. The new study reveals previously unreported disparities within the African nation, where chronic, non-communicable diseases have become among the leading causes of death and disability.
To gauge the availability of essential medicines, as defined by the World Health Organization, the research team used a dataset known as the Service Availability and Readiness Assessment, or SARA. They then fit an analytical model to identify possible determinants of medicine availability at health facilities throughout Uganda. The facilities included both public and private hospitals and clinics in rural and urban areas, as well as facilities providing either basic or specialty services.
In their analysis, the members of the research team identified multiple disparities. For example, the number of available essential medicines was 98 percent higher at for-profit facilities than at public ones, where drugs are provided free of charge. The medicines were also more readily available at facilities that offer higher-level services than ones providing primary care. That is troubling, the researchers said, because patients need to be able to access medicines for chronic diseases at local primary care facilities, not just at large hospitals.
“This represents a real challenge in terms of access to drugs needed to treat common conditions,” said senior author Dr. Jeremy Schwartz, an assistant professor of medicine at Yale School of Medicine. “The ramifications are great and speak to the need for better resource distribution to allow for more equitable access.”
The study also demonstrates a novel way the SARA data can be used to evaluate a range of healthcare services in Uganda, and in other low- and middle-income countries, said lead author Dr. Mari Armstrong-Hough.