HEPS Uganda: Civil Society Making a Difference

This study is about the growth, organisation, and work of the Coalition for Health Promotion and Social Development in Uganda (HEPS Uganda). As stated in the introduction: "HEPS Uganda is a coalition of health advocates, health practitioners, civil society organisations, community-based groups and individuals who have come together to work towards the realisation of affordable, accessible, quality health care that includes access to essential medicines and more rational use of medicines in Uganda." With financial and technical support from Health Action International Africa (HAI Africa), HEPS has become a key civil society organisation (CSO) in a collaboration with the World Health Organisation (WHO) and Uganda’s Ministry of Health (MOH). HEPS was formed through two HAI workshops: Networking for Rational Use of Drugs in Uganda (November 1999) and Access to Essential Drugs in Uganda (March 2000). The HEPS mission is to work towards the realisation of accessible, affordable, quality health care and more rational use of medicines by all the people of Uganda. In 2002, HEPS started the Uganda Coalition for Access to Essential Medicines to advocate for universal access to medicine.

According to HAI, "this case study was carried out so that other civil society organizations can share the lessons learnt while they work to improve their own societies." The following challenges in healthcare are the focus of the work of HEPS: disease - including malaria, tuberculosis, diarrhoea, respiratory infections, and HIV/AIDS; turning political will into action; economic poverty; lack of access to essential medicines; inadequate number of professionals at all levels; health consumers’ lack of voice in health sector; and poor recognition of the human right to health. Problems in the area of access to medicines includes:

1. High prices
2. Inadequate human resources;
3. Patents;
4. Inadequate national commitment and lack of political will; and
5. Lack of coordination of international aid.

The following points from a 2002 Baseline Survey of the Pharmaceutical Situation in Uganda help to underline the health care context: 75% of key medicines are available in public health facilities, but with high stock-out durations of up to six months; there is an unacceptably high use of antibiotics and injections (63.2% and 23.1% respectively); three out of four patients surveyed do not know how to take their medicines; and there is a large price variation for the same medicines between private dispensing outlets. A medicines price survey done collaboratively by HEPS and its partners showed: "in private pharmacies, innovator brand medicines were 13.6 times more expensive than the international reference price and were 5 times more expensive than the prices of their generic equivalents...85% of the medicines at National Medical Stores (NMS) and 72% at Joint Medical Stores (JMS) cost less than the international reference price. Some medicines, despite being on the Essential Drug List of Uganda (EDLU), were not found at either warehouse.”

As listed here, the HEPS strategy includes:

• "Health outreach: Empowering ordinary Ugandans, especially the poor and vulnerable, with information that will enable them to know and demand their health rights and accept and exercise their health responsibilities.
• Health policy advocacy: Advocating for consumer-friendly health laws and policies at all levels through policy analysis, policy formulation and monitoring policy implementation. Efforts have also been channelled in policy research and information dissemination.
• Health complaints handling and counselling desk: Linking health consumers to health practitioners in a bid to facilitate better health services in the country. This is achieved through instituting a redress mechanism and provision of counselling services for health consumers whose health rights have been violated."

The HEPS serves in the watchdog role, tracking the Global Fund in Uganda. HEPS carried out the 2002baseline pharmaceutical survey, a 2004 medicines pricing survey in partnership with WHO, MOH, and HAI Africa, and continues to work on health policy advocacy. In 2003, it carried out a demonstration in favour of health access; released a joint statement with partners MOH, /WHO, and HAI Africa at the East African Intellectual Property Rights Conference in Arusha, Tanzania (2005); advocated for lifting of the 10% tax on medicines imposed under the East Africa Customs Union (2005); and did analysis and formulation in cooperation with MOH and MPs for the Intellectual Property Rights Bill 2004. The organisation has done community training sessions on health rights and rational use of medicines that include: participatory analysis of health problems; presentation of health rights; appropriate use of medicines; malaria, HIV/AIDS, and diarrhoea prevention; and formulation of action recommendations for local health. HEPS uses dialogue meetings, debate, and workshops for advocacy, particularly focused on parliamentarians (MPs), parliamentary associations, and public officials. It monitors access to anti retroviral therapy (ART) with a focus on providing academicians and MPs the information they need, for which HEPS is hoping to establish a resource centre. The organisation is continuing to work on health issues through its members and volunteers, its strength of presence within the government, among CSOs and in the media, its continued coalition building, and its work on health as a core value in society.