Under the Health Policy Advocacy, HEPS-Uganda advocates for consumer-friendly health and health related laws and policies at different levels. Through this strategic focus, HEPS-Uganda conducts health policy analysis and research to inform its advocacy initiatives. HEPS-Uganda also builds strategic partnerships with other civil society organisations and institutions that share the same agenda. It also conducts advocacy activities at the various levels of decision making.
The Health Policy Advocacy Programme advocates for consumer-friendly health laws and policies at district, national and international levels. HEPS-Uganda undertakes its advocacy activities through the Uganda Coalition for Access to Essential Medicines (UCAEM).
Through this programme, HEPS-Uganda conducts health policy analysis and research; initiates and actively participates in health policy formulation, monitoring and evaluation of the implementation of health laws and policies; disseminates research findings on implementation of health laws and policies to stakeholders; and lobbies policy makers for improved health service delivery in Uganda.
Under the Health Policy Programme, HEPS-Uganda has implemented various successful campaigns, and projects.
HEPS-Uganda ended its two months long campaign in May and June 2012 on Intellectual Property Rights Bills (Anti-Counterfeit Goods Bill No. 22/2010 and Industrial Property Bill, 2009) and their impact on access to medicines.
The focus of this campaign was on awareness creation on how the proposed IPR Bills negatively impacts on access to medicines by being TRIPS-Plus (not fully utilizing TRIPS Flexibilities that do not protect and promote Public Health); the IPR interest on the Patented Medicines (Branded) verses the Generic medicines; and the confusion between Counterfeits, Substandard, fake with products of a generic version.
This campaign started with the enlightenment of the different stake holders from the Civil Society dubbed as Uganda Coalition on Access to Essential Medicines (UCAEM), the Parliamentarians, the Health Care Providers, the Media and Stakeholders in a bigger entity called Multi stake holders by identifying the loops in the Bills.
LDCs like Uganda have according to the TRIPS Agreement been given up to 2013 to become TRIPS compliant for other commodities and 2016 for Pharmaceuticals products.
“Rosette Mutambi the Executive Director of HEPS Uganda in her Opening Remarks during IPR & Access to Medicines Dialogue with Multi-Stakeholders held at Hotel Triangle funded by OSIEA urged the UCAEM Partners to be clear of the words in the proposed IPR Bills in order for those keen on IPR enforcement not to take advantage of them.
She stated that words like fake drugs; counterfeit drugs, substandard drugs, branded and generic drugs if not looked into properly in the IPR bills or IPR general language with care would hamper access to medicines in Uganda.”
The campaign involved Two IPR & Access to Medicines Capacity Building Trainings for CSOS (One for UCAEM partners in Kampala and another for CSOS, CBOS, FBOS, District Health Workers and Local Government Representatives from Mbarara); 3 Dialogues on IPR & Access to Medicines with; 9th Parliament Parliamentarians from the Social Services, Trade and Legal Affairs Committees; Media Houses and Multi-Stakeholders from the Judiciary, Health and Private Sector
“Stop stock-outs” is a regional campaign in six countries in Uganda and five other African countries, including Kenya, Madagascar, Malawi, Zambia and Zimbabwe to stop continued stock out of essential medicines in public health facilities. In Uganda, a consortium of 5 CSOs (HEPS Uganda, AGHA, AIDE, ACFODE, NAFOPAHU) is now undertaking the campaign. The campaign was launched in Uganda on 17th March 2009.
The “Stop the Stock-outs” campaign is calling on Uganda government, Ministry of Health and local governments to end stock-outs of medicines now by ensuring that there is sufficient funding for the medicines within minimum healthcare package; giving representation of civil society on the board of the National Medical Stores and at local government level.
Enhancing transparency in medicine procurement by districts; ending corruption in the medicine supply chain to stop theft and diversion of essential medicines; living up to commitments to spend 15% of the national budget on health; and providing free essential medicines at all government health facilities
As the world commemorates the World T.B Day on the 24th of March 2012 with the Theme: Stop T.B in our life time, it has been noted that there are messages in the media by National medical stores that are geared towards refuting the state of T.B medicines stock outs in the country.
This press conference was held to react to these messages saying there were no shortages of TB medicines in the country.
The coalition members came in one voice to agree to the fact that the World TB Day comes at a time when the country is been hit by a crisis of TB medicines stock out and the Ministry of Health is giving messages contrary to the state of TB medicines in the country.
“We feel this is irresponsibility and abuse to the patients because medicines for TB have been out of stock since November 2011, although some facilities started getting these medicines, others have not and patients have been complaining while health centre officials have been frustrated by this.” Denis Kibira the Medicines advisor HEPS-Uganda and the National coordinator of Stop stock out campaign said.
Patients reported that: Jinja Hospital, Balukuba health centre, Ruharo hospital, Oguru Health centre IV in Lira, Arua Referral Hospital, Gulu, Masaka, Rakai, and Nyantondo among others have no medicines.
Kibira further noted that this contravenes reports by National Medical Stores that there are medicines at the National Medical Stores. It doesn’t mean that if there are medicines at the National Medical stores there will be automatically medicines in the health facilities. Availability of medicines is when patients can go out to the health facilities and find these medicines
As the World tries to stop TB in our generation, we are here as civil society to have action from the government.
Mathias Mulumba the Board chair said, “Uganda as a country should stop relying on donors especially for medicines as cheap as those ones for T.B, since we know Uganda heavily relies on funds from Global Funds, PEPFAR, and once these funds cease to be, then this means Ugandans will die. Uganda therefore needs to devise means of how it can afford medicines locally and also work on a sustainable solution to keep up the system.”
The government has an obligation to protect its citizens and we the Coalition members demand Ministry of Health to come out to give the true state of medicines in the country and take an action against the pandemic of stock outs.
The Press conference was attended by HEPS-Uganda and the other coalition members who included among other members from: CEPARD, NAFOPHANU, CEHURD, AGHA UYF and Mamas club held at the HEPS Uganda Secretariat.
Coalition partners are urged to advocate as one voice in matters regarding Pre-Exposure Prophylaxis, PREP since some key people in relevant government institutions have already begun raising questions regarding PREP.
As part of a greater goal to promote access to medicines in Uganda, HEPS Uganda organized half day advocacy workshop for the discordant couples to fine tune what it had already written on paper about PREP after keenly assessing the participants’ active and direct involvement. This workshop was held at Hotel Sojovalo in Mengo on 15th of April 2012.
Richard Hasunira, the HEPS Uganda PREP coordinator said that current interventions on HIV/AIDS prevention were not being fully utilized. He informed participants that PREP has a potential of being accepted by those in need with the target population being; HIV Negative people with HIV Positive Spouses, Gays & Commercial Sex Workers.
Raymond Ruyoka of NAFOPHANU commented that as people with hands on HIV & AIDS Care, there is need not to be influenced by the MoH desire to have a language that suits them being used. What is more important now is to assess the impact of PREP on the behaviors & attitudes of the people; their condom use status & the issue of PEP as a method of prevention.
The PREP Concept is good, but there is need for Statistical Data on it in relation to other countries experience for example the relevance of PREP in Botswana & Rwanda to be borrowed by Uganda & other partners yet to come on board; that MoH has changed its strategy to EMTCT and therefore there is need for partners to ascertain what EMTCT encompasses.
The transparency and accountability campaign focuses on improving governance in the procurement and distribution and management of essential medicines in Uganda. Under this campaign, HEPS-Uganda is involved in two projects:
(1) Medicine Transparency Alliance (MeTA Uganda), a multi-stakeholder alliance aimed at improving access and affordability of medicines for the poor people who are unable to access essential medicines due to high cost or local unavailability. MeTA was launched in Uganda in March 2009. HEPS-Uganda is involved as the coordinator of the civil society, co-chair of the MeTA Uganda governing council and as part of the secretariat.
(2) Transparency and Accountability Project (TAP), a project sponsored by US-based Results for Development and World Bank, aimed at enhancing transparency and axcountability in the delivery of medicines. It is a one-year project tracking government financing of essential medicines in the two districts of Lira and Kamwenge.
Under the Monitoring of Medicines Prices campaign, HEPS-Uganda documents availability and affordability of key essential medicines in the four major geographical regions of Uganda in order to inform policy. Medicine surveys are conducted on a quarterly basis under the framework of the Uganda Country Working Group, which includes the Ministry of Health, World Health Organisation (WHO) and Health Action International (HAI). HEPS-Uganda represents HAI on the group in Uganda.
Several projects have been undertaken under this campaign:
(1) A national campaign on improving access to reproductive health services and commodities is being implemented with support from Reproductive Health Uganda (RHU), and is a one-year project running to June 2010
(2) HEPS-Uganda and other civil society organisations in northern Uganda have assessed the access situation to reproductive health services and commodities in Lira district and implementing a one-year advocacy campaign in the district. The project is being implemented under the Northern Uganda Coalition for Health Advocacy (NUCHA)
(3) Community empowerment and participation on maternal health project in Kamwenge district: May-June 2007
(4) Promoting access to maternal health services by expectant mothers in Kawempe Division of Kampala district, implemented in 2007
(5) Community empowerment on maternal health rights in Pallisa and Budaka districts, implemented in 2007 and 2008.
(6) Community empowerment on maternal health rights in Lira district, implemented over a three-year period from 2007-2010.
The PMTCT campaign is being implemented through a number of projects:
(1) Missing the Target No.7 of the International Treatment Preparedness Coalition (ITPC). HEPS-Uganda participated in a multi-country action research on barriers to access to PMTCT services and is implementing a one-year project to advocate for improved access. The project is focusing on improving awareness on infant feeding guidelines for HIV-positive mothers and eliminating stock-outs of PMTCT medicines in Uganda.
(2) Monitoring the impact of routine testing and counselling on access to essential reproductive health services in Kawempe Division of Kampala district. The study phase of the project is expected end in December 2009 before moving to the advocacy stage.
(3) Consolidating participatory approach to increase community participation in prevention of parent-to-child HIV/AIDS transmission in Kamwenge and Kiboga Districts, carried out in February 2009.
The campaign was focused on issues arising from the draft Uganda Counterfeit Goods Bill, 2008 from the perspective of access to essential medicines. The campaign has undertaken an analysis of the bill, published a policy briefing paper, organised civil society workshops including an expert panel definition, held lobby meetings and written a petition letter to the speaker of parliament.
The campaign to influence intellectual property legislation in Uganda started in 2005, and has since focused on campaigning for amendment of clauses in the Industrial Property Bill that would undermine access to essential medicines if passed in their current form. HEPS-Uganda has done at least two reviews of the drafts and engaged policy makers in various fora.
HEPS-Uganda has been part of the civil society campaign against the proposed criminalisation of HIV transmission in the draft HIV Prevention and Control Bill 2008. The civil society conducted country-wide consultations and produced reports that were submitted to the HIV/AIDS Parliamentary Standing Committee.
HEPS Uganda, under the umbrella of Uganda Coalition for Access to Essential Medicines (UCAEM), which it hosts and coordinates, petitioned the Geneva-based Global Fund and recommending the involvement of civil society in management of global fund at national level in Uganda structure. The petition, signed by over 40 CSOs and dated 26th October 2005, resulted into a delegation from the Global Fund led by the Director of Operations coming to Uganda to discuss the letter’s recommendations. The Global Fund and Uganda Government agreed to incorporate the CSOs’ in the Fund’s institutional structure for management, strengthening measures to verify the capacity of sub-recipients of grants, and clarifying responsibilities. The participation of CSO’s on Uganda Global Fund structure in Uganda is no longer being questioned.
Save Children save the future, Save Children Save the future
CEPA is a three-year Campaign to End Pediatric HIV/AIDS (CEPA) that focuses on overcoming policy and implementation bottlenecks to scaling up prevention of parent-to-child transmission (PMTCT+) and pediatric diagnosis, treatment, and care programs led by Global AIDS Alliance (GAA) with a focus in six countries in sub-Saharan Africa: Kenya, Tanzania, Uganda, Zambia, Nigeria, and Mozambique. The overarching objective of the campaign is to raise coverage for Prevention of Mother to child Transmission (PMTCT) and paediatric treatment services from the current average of 30 to 40% to the globally agreed target of 80%. The campaign will also try to accelerate action to reduce the incidence of paediatric HIV/AIDS and measurably improve the delivery of treatment to children and mothers.
CEPA’s Core Objectives
The Campaign to End Pediatric HIV/AIDS will work to advance the following objectives:
1. Family-Centered Care and Nutrition. Expand access to PMTCT+ and pediatric treatment, care, and support, including nutrition services, and integrate child and family services with other health services in order to improve survival rates and health outcomes for children, HIV-positive mothers, and their families.
2. Early Infant Diagnosis and Treatment. Expand access to early infant diagnosis and earlier and improved pediatric treatment in order to improve survival rates and health outcomes for children.
3. Access to Appropriate Medications. Reduce distribution barriers and increase the global supply of high-quality, low-cost lifesaving medicines for children and their families, including ARVs, drugs to treat opportunistic infections, and first and second-line regimens to ease dosing and administration.
4. Full Funding to Eliminate Pediatric AIDS. Secure the financial resources needed to facilitate country-level scale-up of PMTCT+ and pediatric and maternal treatment programs.
In Uganda, the situation of children is also very bleak. The Ministry of Health estimates that 1,153,000 people are living with HIV in the country as of December 2008; including 88,919 children aged 0-14 years. This includes a total of 324,115 adults and 33,152 children in need of ART. However, only 43% of the adults and 40% of the children needing ART were actively on treatment by the end of September 2008. It is has also be revealed that each year, more than 20,000 mothers who give birth in Uganda also pass on HIV infection to their babies. HIV prevalence in young people 15-24 years in the capital city is estimated at 9.95%. Other impeccable studies have also show that without care and treatment, over 80% of children living with HIV die before they reach their second birthday, the majority of known children with HIV are above 5 – a possible pointer to delayed/late diagnosis.
Some of the national stakeholders include: Uganda Paediatric Association, ANECCA- Uganda, HEPS Uganda, TASO, MAMA’s Club, NACHOLA, AGHA, Development Research Centre among others .
HEPS Uganda commissioned a study, “Involve All, Tell All; Making the Global Fund Work Even Better for Uganda”, in 2004 to assess the challenges in implementation, including stakeholder involvement, and make recommendations for its improvement. The report has since been an invaluable source of information to the public, journalists and CSOs, especially during the consultation process aimed as improving the Global Fund’s management after its suspension. A full-page article of the report was published in a national newspaper, Daily Monitor, on Tuesday, 26th January 2006, titled: “Clouded policies could have prompted Global Fund scandal”.
HEPS Uganda in partnership with Action AID International Uganda and over 50 CSOs involved in the fight against HIV/AIDS, TB and Malaria on 26th March 2006 organised a public demonstration and held a joint press conference at which they called for the prosecution of the Government officials implicated by the Judicial Commission of Enquiry in the Mismanagement of the Global Fund. A petition letter was delivered to the Office of the President, demanding legal action against, and resignation, within 14 days, of the Minister of Health, two junior health ministers, and their permanent secretary.
HEPS Uganda and UCEAM held a press conference on 3rd September 2005 and delivered a petition signed by over 200 local and international CSOs challenging the Government’s role in down playing condom use. The CSOs urged the Government to: release the withheld condoms; lift the taxes on condoms; educate the public on condom use in the fight against HIV/AIDS; eliminate abstinence-only programs; and probe the condom shortage in the country. HEPS Uganda and other petitioners threatened to sue the Government if it failed to pay attention to the Coalition’s demands and recommendations.
In response, the Ministry of Health issued a press release published in Daily Monitor on 2nd June 2006,“Resumption of Free Distribution of Condoms by the Ministry of Health”; and issued “fact sheets” on condoms use were inserted in major national daily newspapers . The Fact Sheets were signed by the Minister of Minister and endorsed by 30 health professionals and HIV advocates including the donor community with messages, with such messages as ‘condoms are effective’, ‘condoms work if used correctly and consistently’, ‘condoms prevent STD/HIV infection’, and ‘We support condom use’. The press releases and fact sheets about condom use issued by Ministry of Health addressed most of HEPS Uganda concerns and recommendations.
HEPS-Uganda petitioned and called upon the East African Council of Ministers to commit themselves to promoting and protecting access to essential medicines for all people by unconditionally exempting all Essential medicines from 10% tax that had been introduced. The campaign including a press release in a national news paper the New Vision 2nd 2005 ‘ Exempt All Essential Medicines from 10% Tax resulted into East African Customs Union abolishing the 10% tax on all pre-packaged medicines in East Africa.
HEPS- Uganda also participated in an Anti-Corruption Week in Dec 2007 calling upon the government to ensure access to affordable, efficacious and quality essential medicines to all Ugandans. The following recommendations were made;
- Government must live up to its obligation of ensuring that essential medicines are available in the public health facilities to which poor and vulnerable people depend for healthcare;
- Government should review the medicine procurement and distribution chain to avoid drug expiry, stock-outs, diversion, leakage, and theft of medicines in public facilities;
- Corruption must be fought by the relevant organs of Government by strengthening controls and swiftly prosecuting culprits and recovering lost money from them; and
- Government must be transparent by involving Civil Society at all levels of decision making in the medicine management, and supply system.
HEPS Uganda, with support from Treatment Action Group, based in the United States of America, participated in the Global Conference Union Against TB and Lung Disease 2007, World Conference and Pre-Conference Satellites, from November 6th-12th, 2007, Cape Town, South Africa.HEPS Uganda was represented by two members of staff and theexposure gave HEPS Uganda space to dialogue with activists, researchers, policy makers, and funders to examine how the challenges of Multi-Drug Resistance (MDR), extra drug resistance (XDR-TB) and HIV co-infection can be met through joint action. The conference also gave HEPS staff an opportunity to learn about recent trends in TB, recent scientific findings on TB and TB/HIV, as well as how TB and TB/HIV can most effectively be addressed, participated in a demonstration on global access to TB treatment organized by Treatment Action Campaign
HEPS Uganda joined and represents Uganda on the Global Missing the Target Team that advocates for increased access to HIV/AIDS treatment. The Missing the Target team is coordinated by US-based International Treatment Preparedness coalition and is comprised of over 14 countries. The team has monitored and advocated for the improvement in HIV/AIDS treatment at global and country level through joint reports and press releases at international and country level.
HEPS Uganda, in partnership with Journalists Against AIDS (JAAIDS) of Nigeria and with support from the African Microbicides Advocacy Group (AMAG), on 5th December 2007 held a media dialogue with over 15 journalists and discussed among other issues the media role in reporting and publicising HIV/AIDS issues. The dialogue was also used as a platform to discuss the results of the partnership study, “Uganda New HIV Preventive Technologies Media Mapping and Assessment,” that was undertaken in October 2007. The study assessed the current NPT research and advocacy, identified active and relevant media and other stakeholder groups, and identify national advocacy priorities. As a follow up activity HEPS Uganda, JAAIDS and AMAG will carry out media training in Kampala for journalists and advocates in February 2008. This will improve and strengthen HEPS-Uganda relationship with the media in reporting Health issues in Uganda.
HEPS Uganda with support from National Democratic Institute and coalition members carried out a public dialogue in 4th July 2007 on maternal health situation in Uganda. The dialogue was focused on barriers urban poor women face in accessing antenatal care services and what can be done to address the problem. A charity walk was later organised on 29th September to fundraise for maternal kits of poor and vulnerable women in Kawempe a suburban slum of Kampala. Seventy mama kits were raised for Kawempe Health Centre. Fifty maternal kits have been raised and kawempe division leaders committed to increase budget for maternal health.