Registration and local production of essential medicines in Uganda

Universal access to high quality essential medicines is critical to sustainable development (SDG 3.8). However low- and middle-income countries struggle to ensure access to all medicines on their national essential medicines lists (EML). Market registration is the first step in determining both access and availability yet the extent to which essential medicines are registered for use at country level is not known. Companies apply for a marketing authorisation, however low price or lack of a market is a disincentive. Local production has been promoted to ensure availability of essential medicines but research in this area is also limited.; The study took place between 2011 and 2015. We systematically examined the registration status of medicines and vaccines listed in the Ugandan 2012 EML and conducted 20 interviews with regulators, ministry of health representatives, donors, and pharmaceutical producers and analysed quality assurance issues affecting registration, procurement, and local production of medicines in Uganda. In 2017 we conducted a further three interviews to clarify issues around non-registration of essential medicines highlighted by our analysis.; Of the 566 essential medicines and vaccines nearly half (49%; 275/566) had no registered product in 2012. Of the 3130 registered products, just over a quarter (28%; 880/3130) were listed on the EML. Six local producers had registered 138 products of which 40 corresponded to 32 unique essential medicines. Interviews highlighted alternative routes to availability other than registration. Local producers faced considerable barriers to achieving international quality standards required for international procurement of medicines for the domestic market.; Monitoring and audit of the registration of essential and non-essential medicines should be a priority nationally and, regionally through harmonisation of registration requirements in the East African Community. National and regional manufacturing plans should consider local production of unregistered essential medicines

The availability of six tracer medicines in private medicine outlets in Uganda

Abstract Objectives: Many low income countries struggle to provide safe and effective medicines due to poor public health care infrastructure, budgetary constraints, and lack of human resource capacity. Private sector pharmacies and drug shops are used by a majority of the population as an alternative to public pharmacies. This study looks at the availability of six essential medicines in private drug outlets across Uganda. Methods: A standardised medicines availability survey developed by the World Health Organization and Health Action International was adapted for use in this project to collect availability data for six tracer medicines in 126 private medicine outlets across four districts in Uganda from September 2011 to October 2012. Results: Artemisinin-based combination treatments and metformin were the most commonly found medicines in the private medicine outlets surveyed. Ninty-nine percent of all outlets carried artemisinin-based combinations while 93% of pharmacies and 53% of drug shops stocked metformin. Oxytocin was found in one third of outlets surveyed. Fluoxetine was in 70% of pharmacies yet was not found in any drug shops. Rifampicin and lamivudine were found infrequently in outlets across all districts; 10% and 2%, respectively. Not all brands found in surveyed outlets were listed on the Ugandan National Drug Register. In particular, five unlisted brands of rifampicin were found in private medicine outlets. Conclusions: The regulatory process should be improved through the enforcement of outlet licensing and medicine registration. Additional studies to elucidate the reasons behind the use of private medicine outlets over the public sector would assist the government in implementing interventions to increase use of public sector medicine outlets

The Rwandan agrarian and land sector modernisation:confronting macro performance with lived experiences on the ground

Rwanda has embarked on an ambitious policy package to modernise and professionalise the agrarian and land sector. Its reform fits into a broader call – supported by major international donors – to implement a Green Revolution in Sub-Saharan Africa. After 10 years of implementation, there is increased production output and value-addition in commercialised commodity chains. These are promising results. However, poverty reduction, particularly in more recent years, seems limited. Moreover, micro-level evidence from the field calls into question the long-term sustainability of the agricultural and land sector reform. In this article, a group of researchers, having engaged in in-depth qualitative research in a variety of settings and over an extended period, bring together their main research results and combine their key findings to challenge the dominant discourse on Rwanda as a model for development

Statistics versus livelihoods: questioning Rwanda’s pathway out of poverty

Recent statistics indicate that poverty in Rwanda decreased impressively between 2006 and 2014. This seems to confirm Rwanda’s developmental progress. This article however argues for a more cautious interpretation of household survey data. The authors contrast macro-level statistical analysis with in-depth field research on livelihood conditions. Macro-economic numbers provide interesting information, however differentiated evidence is required to understand how poverty ‘works’ in everyday life. On the basis of the Rwandan case study, the authors conclude that because of the high political stakes of data collection and analysis, and given that relations of power influence the production of knowledge on poverty, cross-checking is crucial

Formalizing the informal in Rwanda: From artisanal to modern brick and tile ovens

The policy of the Government of Rwanda to formalize the informal sector has affected local livelihoods. This paper acknowledges the accomplishments of the Government in improving the business climate. However, its efforts to attract large-scale, capital-intensive projects have discouraged small-scale investment initiatives by local entrepreneurs. Through a case study on the brick and tile business in two rural settings in Rwanda, we analyse how the transition from informal to formal can have negative impacts on employment creation and local livelihoods