Improving Access to High-Cost Medicines in Low Income Countries in Africa: Creating a Functioning Pharmaceutical System in Uganda

Low-income countries face immense challenges in enabling access to high-cost medicines, especially for chronic non-communicable diseases. In this chapter, we discuss the approach Uganda is taking to provide access to medicines with focus on high-cost antiretroviral therapies (ART) by creating a stronger, more cost effective and harmonised pharmaceutical supply system based on approaches taken to addresses challenges in providing ART, which was the first class of high-cost medicines to attract global attention and action and remains the priority high-cost medicines class in Uganda. Uganda uses a comprehensive, multi-pronged system-focused approach for capacity building at the facility, district and central levels of the pharmaceutical sectors to enable access to high-cost medicines. The approach includes strengthening supply chains and procurement processes, capacity building, increasing management effectiveness and providing sound information for shared decision-making by multiple stakeholders. This approach is producing a more efficient supply chain which is critical for all medicines and supplies but especially important for the high-cost items which is highly dependent on system improvements yielding cost savings and reducing waste of scarce financial resources, all of which are critical to improve access to medicines. The system strengthening interventions undertaken form the basis for further actions that will enable affordable, equitable access to other, even higher cost medicines for chronic non-communicable diseases.