Our Side of the Story - Ugandan health workers speak up - VSO

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Our Side of the Story: Ugandan health workers speak up Medicine supplies Medicine shortages and ‘stock-outs’ emerged as one of the biggest challenges for government health workers. Unable to give their patients the drugs they needed, health workers grieved for their patients’ suffering and became demoralised by the futility of their roles. They struggled with disappointed or angry patients and their limited understanding of the reasons for shortfalls in supplies. They were deeply hurt by accusations of stealing drugs, the lack of trust the public had in health facility staff, apparent press hostility and by what they saw as politically motivated moves to discredit them. The drug supply situation Outside the government sector, medicine supplies were generally thought adequate to treat most conditions. A sufficient supply brought health workers the satisfaction of working effectively, as well as pride in an efficient facility that logged all movements of medicines. The not-for-profit sector was not immune to shortages, however; in one facility shortages were said to be due to loss of revenue because it gave impoverished patients drugs on credit. In parts of the government sector there was some acknowledgement that government efforts to improve the delivery system of the central medical store had brought improvements in supplies of essential medicines. It was also noted that drug supply increased after a government stamp on packets was introduced. There was enthusiasm that better supplies now benefited patients: “Now we have enough drugs, I would not say all drugs, and inpatients get the drugs the doctors prescribe.” There was a sharp contrast between praise for medicine supplies in better-stocked facilities and disgruntlement among workers elsewhere. Health workers said some essential drugs were used up in a matter of weeks, or even days: “They bring one tin of quinine tabs for the whole unit” and “Just five tins of Panadol which the department can use up in one day.” Complaints centred on undersupply for population demand; shortfalls in supply where deliveries did not match orders; erratic deliveries, such as oversupply of condoms but no anti-malaria drugs; and irregular deliveries which did not conform to promised quarterly schedules. Shortages were said to be made worse by patients taking unfair advantage of brief periods of plenty, but with no testing equipment it was hard to refuse drugs to patients who claimed the common complaint of malaria. And it had been noted that patients turned up with a different patient record book every day of the week in order to stock up with drugs at home. Government facilities typically could not stretch their budgets to purchase drugs in the private market, and were forced to sit and wait for the next delivery from the central medical store. However, one hospital dedicated a quarter of its private wing income to medicines. The impact on health workers and the quality of care Health workers said they felt “disappointed” and that the lack of drugs “demoralises” them. Job satisfaction suffered when they were unable to give patients the drugs they needed. Their presence in the workplace sometimes seemed futile: “You are here, and there is nothing to give the patients. You are just sitting waiting for them, then tell them to go back as there is no drug.” Especially hard to bear was being forced to tell poor patients to buy their medication in the private market: “I hate the situation of being helpless before the patient when they can’t afford to buy drugs” and “You feel you have not done much for the patient when they have to buy.” It seemed like fobbing off the patient: “You tell them to buy, but the patient is expecting answers.” It was hard to be seen as letting down patients keen to have family planning supplies who could barely afford the transport to the facility: “You feel so bad, it seems as if you are deceiving them and they lose confidence.” Self-esteem suffered when drugs were not available: “They look at you and think the health workers are bad, and yet it is the government not us” or “Their eye looks at the nurse and that doesn’t make me able to be the nurse I want to be.” The biggest source of distress for health workers was the impact on patients, and they spoke emotionally about how they felt for their patients when no medicines were available. In the case of antiretroviral drugs against HIV, which should be taken for the rest of a person’s life, it was very hard to see patients go for up to six months without treatment. A patient at Masindi district hospital, Uganda. Working with inadequate and missing equipment is a huge challenge for health workers. 20
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Page 36: ISBN 978-1-903697-13-9 9 781903 697

Our Side of the Story - Ugandan health workers speak up - VSO

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