Ronald Lubega was diagnosed with duodenal ulcers in 2004.
Since his initial prescription by a doctor in Masaka in 2004, Lubega has been refilling his medicine supplies from pharmacies without a doctor’s prescription. It was not until last August, when Lubega started feeling terrible contractions in his stomach and he was rushed unconsciously to Masaka referral hospital, that it was discovered he had been taking the wrong medication for seven years.
“I was initially given Esomeprazole 5mg but I have instead been buying Esomeprazole of 50mg. For me, I could not realize the difference but the doctors said that I was developing a cancer in my stomach because of this strong drug,” Lubega says.
Lubega’s case is just one of millions of incidences where Ugandans through self medication have been taking wrong drugs. Many take anti-malaria drugs when what they needed was an antibiotic for an infection. Many more self-diagnose and choose what drug to buy from a pharmacy, like it were a supermarket.
Only 476 pharmacists
With Uganda’s population close to 34 million, records by the pharmaceutical society of Uganda as of December 2011, indicate 476 licensed and registered pharmacists. This implies 1 pharmacist for every 100,000 Ugandans, compared to the recommended ratio of 1:2,000 by the world health organization. To make matters worse, more than 90% of these pharmacists practice in the central region which leaves the rest of the regions lacking.
As a result of this shortage, many resort to self medication and over reliance on community based drug shops often not operated by pharmacists, but rather business people. Today, almost every individual with money wants to start a pharmacy in the rural areas and the public cannot differentiate between informal and professional service providers.
With these unscrupulous businessmen, come risks of overdoses and expired drugs. The law requires every pharmacy to have a pharmacist and according to the pharmacy and drug act of 1970, a pharmacist can at most supervise or open up two pharmacies. If this was to be followed, there would be no more than 1,000 pharmacies in Uganda, but today, there are roughly 10,000 pharmacies around the country, owned by medical doctors, nurses, as well as lay people, putting the lives of Ugandans at a risk.
A pharmacist should be in position to prescribe drugs for people who come and do not know which medicine to take. Unfortunately, this is not the case in most pharmacies. Based on the global pharmacy workforce and migration report 2007, Uganda ranks worst compared to Kenya and Ghana. With a population of 21 million people, Ghana had 2,162 while Kenya registered 1,342 pharmacists in 2005 for a population of 24 million.
Although these figures are not the best, at least they show some progress for those countries. The administrative manager of the pharmaceutical Society of Uganda, Ronnie Bagonza, says the society is working hand in hand with the National Drug Authority (NDA) to see that they extend monitoring and supervision of pharmacists to rural areas.
“We monitor the practice of pharmacists and NDA supervises the quality of drugs. We thus have to work together as most illegal practitioners are in rural communities,” said Bagonza.
Pharmacy Practice in Uganda is currently governed by the Pharmacy and Drugs Act, 1970 but various changes have occurred since, which necessitated a review of the current law.
Prohibitive cut-off points
The society in 2001 proposed amendments to introduce the Pharmacy Profession and Pharmacy Practice Bill, which was to replace the 1970 Act, but ten years on, the bill has never been passed into law. The pharmaceutical sector takes up over 45% of the health budget annually but less is being done to streamline professionalism.
In Uganda, pharmacy as a course at Makerere University still has one of the lowest intakes of students, due to high cut-off points, which do not help matters in a country with an acute need for the professionals. But all hope is not lost; in 2010, Makerere university launched a new pharmacy building that can accommodate 320 students. Bagonza says that in recent years, university intakes have increased where Makerere can admit 80 students, Mbarara University also admits 80 students plus 60 students at KIU.
As a result, roughly 200 graduates will be expected in coming years. Bagonza projects that in five years, the pharmacist:patient ratio will have fallen significantly.