CONTENTS | ANB-BIA HOMEPAGE | WEEKLY NEWS
by Crespo Sebunya, Uganda, May 1999
THEME = AIDS
The government opt for better cost- effective measures to battle AIDS
The plan will involve emphasising home-care because costs are far less than out-patient care in a hospital. Dr.Clement Chela, a Zambian medical consultant, was asked by the Ugandan AIDS Commission (UAC) a government body coordinating Uganda's anti-AIDS programme to draw up a five-year programme emphasising home-care. It is being implemented by the National STD/AIDS control programme through the Care and Support Unit (CASU) in Uganda's Ministry of Health. CASU has already assessed what is needed.
Home-care is receiving the backing of NGOs and mission hospitals, but exisiting medical facilities are unable to cope with increasing demand.
Dr.Janet Kayita is a paediatrician at the Department of Paediatrics and Child Health, Mulago Hospital (the largest in Uganda). She is also at Makerere University Faculty of Medicine. Together with Mr.John Kyakulaga, a statistician at the same university, she has produced a study showing that among the 5,952 outpatients at Mulago Hospital, 32% are AIDS patients.
Dr Chela says this is not cost effective. The cost of hospital- based care (HBC) is calculated at $0.43 per visit, whereas community-based care (CBC) is only $0.14 and more time can be given to each CBC patient.
"Making use of more local and basic levels of health care in the health care system is more cost effective than using district and central hospitals, which are often poorly staffed and frequently lack necessary drugs and material, thus deterring patients from attending them", Chela observes.
Nsambya Hospital in Kampala is run by the Catholic Church in Kampala. Their home-care programme operates within a radius of 10 km, and the average period for each visit is 30 minutes. The programme caters for 150 AIDS patients. Carers who are mostly members of the sick person's family and who have to support the invalid, can get loans of up to Shs 500,000 ($300) to engage in rabbit and chicken rearing, screen printing, carpentry and metal work. 80% of those receiving loans have repaid them.
In the fiscal year 1990-1991, total expenditure on AIDS reached $14 million; by 1996-1997 it had reached $58 million. In the 1998-1999 financial year it had already topped $43m. Of this, only 10% is contributed to by the government, the rest comes from donor agencies such as USAID, the World Bank, UNICEF, WHO and UNFPA. In the next two years, total expenditure on AIDS is expected to be as high as $140 million. Depending mostly on donor-help, brings with it unexpected problems such as the likelihood of cutting back the amount of money donated.
The AIDS control programme includes an AIDS prevention programme, the strengthening of Uganda's capacity to control AIDS, home care, counselling and AIDS-related research and information.
Nevertheless, much of the help received from donor agencies at present, may not be in the best interests of Ugandans. To- date, 600 AIDS patients are being treated with anti-retro viral medication (ARV) involving AZT and protease inhibitor. Though heavily subsidised, it costs $600 per patient per month. In addition, more than 9,000 Ugandan pregnant mothers have already been short-listed for AZT tests in an effort to gauge what form of protection their offsprings would have against HIV.
Dr.Njie is WHOs representative in Uganda, and says there is a danger that Ugandans will be forced to undergo such tests. "It is a method many developing countries are trying to avoid", he said. Sandy Foreman, a senior US White House advisor on AIDS issues and who visits Uganda to check and advise of the AIDS programme, agrees. "Sophisticated AIDS control programmes like the use of protease inhibitors, don't suit countries not having a good health infrastructure".
In their document: ""International initiative for antiretroviral drugs in the management of HIV infection in Sub- Saharan Africa", published in December 1997, Professor Jean- Pierre Couland and Marie Ahaovanto warn developing countries against accepting such strategies without adequate supervision even when they are provided free-of-charge. "In a country where the illiteracy rate averages 50%, the AZT treatment regime is very complex. There is five-times daily intake of capsules containing 100 mg which could be difficult to adhere to", the scientists warn.
There have been comprehensive reform measures taken within the UAC aimed at improving the quality and professionalism of their work and boosting sagging morale. An internal UAC document states: "It is difficult to know precisely the actual number and type of activities carried out by UAC relating to HIV/AIDS. Nobody seems to know how UAC funds are managed." This is now being looked into. Also, the UAC's thirty-strong staff have received a substantial salary increase.
The UAC has an important role to play in the fight against AIDS, and so should be given every opportunity to fulfil its task.
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CONTENTS | ANB-BIA HOMEPAGE | WEEKLY NEWS
PeaceLink 1999 - Reproduction authorised, with usual acknowledgement