Education, 18 February 2022

Julia Gaal’s research report

Julia Gaal is a medical student and a student assistant in the global health team of the Department of Nephrology and Medical Intensive Care. She recently conducted her medical research assignment on barriers to accessing NCD medication in Nakaseke, rural Uganda.

As part of a research module of the curriculum at Charité, I got the chance to travel to Uganda, where I spent a total of two and a half months conducting interviews and focusing on other projects as part of my work as a student assistant in the global health team of the Department of Nephrology and Medical Intensive Care.

James (Balamu Clinical Officer) and Julia

In preparation, I conducted a literature review. This involved analyzing the data globally, in Africa, in SSA, in Uganda and finally in Nakaseke district. Since the data was heavily limited, as assumed prior to the start of the study, a primary qualitative data analysis was included. Thus, I conducted two weeks of  semi-structured interviews with NCD health experts including the operational ACCESS project team, administrators, pharmacists, and nurses in our three partner clinics enrolled within this project. These interviews explored the challenges of obtaining prescribed medications, patient medication-seeking behaviors, and the supply of NCD medications in rural Uganda. On most days, I had the chance to talk with two to three experts, whose interviews lasted between 20 and 45 minutes.

Access to NCD medication is still problematic in Nakaseke. Unsurprisingly, financial restrictions turned out to be the major barrier on all levels, followed by insufficient service provision and supply restrictions. According to the study findings, this is mainly due to the cost of medicines and transport, inadequate services, and persistent shortages and stock-outs. Under the impact of COVID-19, the already precarious situation has worsened considerably. Study participants indicated that the situation was worse than ever before.

In talking about the poor supply situation of NCD medication, I had the opportunity to discuss proposed solutions with the study participants. Most importantly, to overcome those obstacles NCDs must become a public health priority in Uganda. Participants reported that health insurance schemes, health education strategies, patient-centered services, innovative programs, and Ugandan pharmaceutical production of NCD medications, could improve access to affordable and available NCD medication in rural Uganda.

Not only did I gain insight into the supply of NCD medication, but I was also able to get valuable impressions of clinical practice in private and public facilities from a lower level of resources. It is my hope that the new findings can contribute to sustainable improvement and expansion of NCD care in rural Uganda.