Thursday, August 25, 2011

Uganda tea yields to be reduced by climate change

By Esther Nakkazi

Uganda’s tea producers may well enjoy high yields but for a while as these will fall drastically if the latest climate change predictions come true.
The Uganda Tea Association raised its tea production forecast by about 9 percent for this year, attributed to use of fertilizers and more acreage put under planting the crop.
George William Sekitoleko the executive secretary of Uganda Tea Association said production would this year increase to 64 from 59.4 million kilograms last year. Tea export earnings are now on average about $100 million.
But climate scientists say a progressive rise in temperatures, which will be evident by 2020 and peak in 2050, would lead to increased attacks from pests and diseases and lead to steep declines in tea production in Uganda.
Overall climate will become less seasonal, with temperature in specific districts, increasing by about 1 ºC by 2020 and 2.3 ºC by 2050, said a report released last week by the International Center for Tropical Agriculture (CIAT).
Areas that will retain suitability- the capacity of the crop to produce acceptable yields- will decrease by 20 – 40 percent, compared with today’s suitability of 60 – 80 percent, the study ‘Future Climate Scenarios for Uganda’s Tea Growing Areas’ says.
Tea is now Uganda’s second agricultural export earner after coffee and having overtaken fish, it is grown in warmer, relatively low altitude areas, to produce a bright, flavored and delicious tasty tea.
“If average temperatures rise by an expected 2.3 degrees Celsius by 2050, some of Uganda’s most lucrative tea producing areas could be completely wiped off the map,” said the study funded by the UK-based Cafédirect Producers’ Foundation and German Society for International Cooperation (GIZ).
“Our tea depends on good weather and it has remained favorable. We have not had any set backs so far but if the predictions become true it will e very unfortunate,” said Sekitoleko.
Uganda’s tea industry, which produces some of the highest quality teas in the world, employs over 60,000 small farmers, and supports the livelihoods of up to half a million people.
Tea is mostly produced in the western part of Uganda, in the areas of Mpanga, Igara, Mabale, and Kayonza but the production area could be reduced to a narrow band of “marginal suitability”.
However, it says neighboring Kenya, where Uganda sells most of its tea through an auction market will not suffer as much. A study by CIAT released in June 2011 also showed the likely impact of climate change on tea production in Kenya, which also showed suitability take a serious hit.
Dr. Peter Laderach, a CIAT climate scientist on the team said the results were a ‘shock’. “We thought those from Kenya were severe, but in Uganda it’s even more serious. It is crucial to help minimize the risk to one of the country’s most important cash crops, and the hundreds of thousands of people who rely on it.”
The report advises for climate assessments for possible alternative crops; like cassava, banana, pineapple, maize, passion fruit, and citrus fruits.
“Helping farmers find practical, productive and profitable alternatives is a great way of spreading the risk of tea production,” said Laderach.
He advised against the shift uphill into cooler, more suitable zones for tea production because it could result in the clearing of forests and protected areas at a significant environmental cost.
The results of the study are will be disseminated to farmers, policy makers and other interest groups in Kenya and Uganda to ensure action from all stakeholders.
The Cafédirect Producers’ Foundation has met with farmer groups from Uganda and Kenya to discuss the implications of the CIAT reports, and to encourage their involvement in developing sustainable options for adapting to climate change, and reducing the environmental footprint of tea production.
“Most tea farmers in East Africa are aware that the climate is changing,” said Programme Manager Kenny Ewan. “The report has certainly helped us to show farmers some of the science behind their local knowledge.”
The Foundation is encouraging smallholders to develop their own, locally appropriate, adaptation and mitigation methods. For instance they can reforest hillsides and protect water sources, as well as planting kitchen gardens.
They are also advised to introduce more resilient tea varieties.

Monday, August 22, 2011

Uganda recovers stolen Malaria drugs

By Esther Nakkazi

Uganda has averted theft of malaria drugs worth Ush 4 billion ($1.6 million) since the formation of the Uganda Medicines and Health Services Delivery Monitoring Unit in 2009.

As a result of more preventive measures, malaria drugs, especially Coartem, which were the most counterfeited because of the cost and large available market are becoming less stocked out in Uganda health centres.

“I testify in court all the time on embezzlement of drugs, funds and absenteeism of health workers,” says Frank Byaruhanga an investigator with the Monitoring Unit who goes to court twice a week. Byaruhanga says stock outs for malaria drugs are now improving but the focus is now changing to injectables, which are easier to steal.

In the last three years the government has made some initiatives to curb stock outs; establishment of the drug Monitoring Unit, change in delivery system at National Medical Stores, embossed drugs with Government of Uganda (GOU) and increased budget funding for drugs in the 2011/12 budget.

But also the increase in consumer awareness and them knowing their rights as well as severe penalties of up to 5-7 years for embezzlement. This has changed the situation on stock outs a lot.

“It is now at ‘manageable levels’ says Byaruhanga also detective assistant Superintendent of police. “Previously there were no drugs in health facilities only a day after delivery but now they stay until they are used up by patients.”

“Stock outs have improved and the stock out campaign has gone down maybe because it has run for two years,” said Christine Munduru, the public health programme officer for Open Society Initiative for Eastern Africa (OSIEA).

“We now want to focus on community monitoring of the new drug delivery system.” OSIEA supports civil society organisations to use community scorecards to follow health care delivery.

The monitoring unit has also increased sensitization of the public on stolen drugs although the practice is still rampant on border towns between Uganda and DR Congo, Kenya, and southern Sudan. Very often the drug Monitoring Unit sends back antimalarials and mosquito nets to Kenya diverted into Uganda, said Byaruhanga but so far Kenya does not do the same.

The supply chain problems:

In 2009, the National Medical Stores (NMS) changed from the pull system, basically user driven for the selection of the type of drugs and quantities by the district to a combination of the push and pull system driven by the ministry of Health.

But the efficiency in drugs delivery can also be attributed to SURE -Securing Ugandans’ Right to Essential Medicines, a USAID funded project that started in 2009 to turn around the drug distribution landscape in Uganda. It is five years $39 million project.

The pull system was dogged with poor forecasting of medicines and procurement procedures as well as low budget allocation for drugs leading to stock outs. All medicine was procured through the District medicines credit line systems by the district medical stores at their headquarters, sub-counties and hospitals.

In this system funds were released from the Ministry of Finance, to the Ministry of Health and then to NMS. But from July 2009, funds for procurement of essential medicines through the credit line system started to be released directly to NMS, after the latter got a direct budget vote.

“Due to the new delivery system, there have already been an increase in availability of medicines in the public sector which may indicate that changes in the medicine supply policy that were effected in 2009 to improve efficiency of the NMS are paying off at higher levels of health care (Health Centre IV and hospitals),” said Dennis Kibira, the medicines advisor at HEPS-Uganda.

HEPS-Uganda, which produces a quarterly medicine price monitor in its Oct-Dec 2010 issue, shows that availability of malaria drugs Artemether/Lumefantrine (A/L) tablets in the dosage of 20/120mg increased to 93 percent in October-December 2010 from 68 percent in April-June 2009 in all public sector facilities. Its availability also increased in the mission sector and the private sector.

The medicine price monitor also shows that availability of the malaria drugs for pregnant women Pyrimethamine/ Sulphadoxine in public facilities grew by 10 points to 67 percent over the same period.

But the medicines monitor also shows that the availability of medicines for non-communicable diseases has continued to be a challenge in the public sector.

For instance anti-diabetic medicines Glibenclamide and Metformin plus medicines for hypertension, Nifedipine and Propranolol; and medicines for ulcers were all in less than 60 percent of both public and private health facilities.

But as if children are the most neglected in medicines availability in Uganda, most public health facilities suffered from paediatric formulations stock outs.

Suspensions like Amoxicillin, Cotrimoxazole and Metronidazole were only available at less than 50 percent of the time in all public facilities while oral rehydration suspension for diarrhea, which has consistently been the most stocked paediatric formulation declined.

Malaria mostly kills children below five years, but the paediatric malaria suspensions, Artemether/Lumefantrine was not available in the public, mission or private sector facilities in over half the time it was supposed to be there.

“The low availability of appropriate paediatric medicines for leading killers, such as malaria and pneumonia, continues to compromise the quality of care offered to children and may be the reason for failing to achieve the UN Millennium Development Goals on infant and child mortality,” said Kibira.

Kibira said that there is a lot of hope with the launch of the Affordable Medicines facility for malaria (AMFM) under the ministry of Health where both public and private sector have received subsidies that will increase availability and affordability of antimalarials.

Currently, first line treatment of malaria- arthemether/lumefantrine costs between Ushs. 1,500-2,000 ($0.5-0.7) in the private sector down from between 10,000-20,000/- ($3.8-$7.7) abut three years ago.

Stakeholders blamed the supply chain problems from lack of human resource and capacity at health facility level as well as lack of coordination in the supply management system.


Tuesday, August 9, 2011

I was in the 'labor ward' to deliver a fat baby girl for minutes

By Esther Nakkazi

Today I was a medical officer for some minutes and witnessed the birth of a fat baby girl in one of the parking yards of Mulago hospital. So besides being a freelance journalist (which I am trying for a few months now already, the highlight so far was getting arrested after an assignment on my way from southern Sudan) I am also trying to lead a team that will hold the second health journalists conference in Uganda. 

I have a team of volunteers’ mostly young people from the US on internship, research or something, which is great because Ugandans idea of volunteering is still low and I totally understand it. So these days I get to talk to various people in the medical field not for interviews for stories but to ask for a hand- to either come to speak at the conference or give us some funding. We promise to put up everything on the website

Anyways I go to Mulago, the school, often to speak about the programme. Today I had an appointment with Dr. Jolly Beyeza and got some progress. The Association of Obstetricians and Gynaecologists of Uganda (AOGU) has agreed to fund half a day of the conference. I was happy walking humming and decided to pass by and chat with my cousin, a nurse at Mulago hospital. 

After the chat I walked to the parking yard and there was this woman on the floor. The two women around her were screaming doctor, doctor, help, help!. Okay I was carrying my laptop but I am no doctor; I don’t even look like one. Mistake. 

Then I got closer to take a look anyway -what is the matter! I too added my screams to the two the baby was coming. Lucky, another passerby, a nurse who I later got to learn was Brian Kibuuka an ECN. He quickly asked for gloves, by this time the crowd was bigger. Although the hospital was 2 minutes away there was actually no doctor or nurse coming to help. 
This Brian was real quick with in five minutes the baby was out and the mother was padded and holding her bundle of joy. Then I called him aside amidst the shouts. “It was at the third stage of labor. It was not a complicated birth at all. Mother and baby should be fine but she should go to the hospital for a check-up,” Brian told me. It was his second roadside delivery but 61st birth since he became a nurse. 

Then he left. I pulled my phone to take some pictures to accompany this story/blog, but could not. You woman you are a journalist; now they knew; why are you taking this woman’s pictures. She had delivered already so I thought there was no harm. It is something we have discussed about in newsrooms, taking pictures in medical and health care reporting. The woman was still in a pool of blood nevertheless and on the floor. I felt a swell in my throat and the phone quickly back in my bag. 

But the disagreement ensured and persisted. Should Agnes go inside the hospital after having delivered her baby here in the parking lot or just go home. The majority of the women were shouting “No she should NOT go inside the hospital. Those nurses and doctors heard us screaming for help but none of them came to our rescue. This guy (Brian) was only passing by and he helped.” 

I was on the side of women saying no matter what the mother, Agnes, should go to hospital for check up and have the child checked out and given a tetanus jab. I have a sharp, piercing voice but it was like a whisper. It took about 10 minutes to just shout about this simple issue. 

One man, I suspected was the father, shouted the most that Agnes and baby should just go home. I guess he was afraid of paying bills. The medical people or they were not who passed by did not intervene. Agnes was just looking on saying nothing. 

Anyway I remembered I had to go for another appointment. As I was pulling out of the parking, I saw Agnes with her fat baby girl on a boda-boda leaving Mulago.

I only said a ‘thank you God’ because it was not a complicated birth or else it would be another maternal mortality and childbirth death statistic. Maternal health will be one of the issues we shall discuss extensively at the second health journalists conference due this September.

Sunday, August 7, 2011

Uganda Government Never Ready on Maternal Health Issues

By Esther Nakkazi
The courts adjourned the Constitutional Court case on preventable maternal death in Uganda last week after the government asked for more time to prepare their defense.

It was the only one time in four that the judges raised quorum but had insufficient defense. However, public interest remains high showing the increasing public alertness to their health rights and intolerance of poor health delivery by the government.

In this unprecedented case in East Africa, Civil Society Organisations and families of two women who died in childbirth are suing the Uganda Government for non provision of essential services for pregnant women and their newborns which breaches its fundamental obligation to uphold the Constitution and violates the right to health and the right to life.

David Kabanda the lead counsel said it is important that the government treats the case with the urgency it deserves but lobbying would continue. The next hearing is expected early September this year.

“They have not put in substantial affidavits in reply. But they have acknowledged that the evidence is overwhelming and will need technical support to be able to reply,” said Kabanda. The government said it is waiting for affidavits from the ministry of Health and Finance.

Previously, there was lack of quorum by the judges, a sign that the government was not serious and was not ready but the public turn up was high as about 750 people marching in three spots in Kampala, Arua and Mityana.

“It appears that the case is not being treated with the urgency it warrants despite the life and death issues being considered in this petition,” said Asia Russell from the US-based lobby group, Health Global Access Project (Health GAP).

Uganda’s maternal mortality rate is 435 deaths per 100,000 live births, while the infant mortality rate is estimated at 76 deaths per 1,000 live births.
In Uganda, 16 women die everyday in childbirth.

“The mere fact the violation continues is important that the constitutional court hears this case expeditiously. The turn up of a huge number of people in the court cases points to the fact that it is of public interest,” said Moses Mulumba the chief petitioner of the case.

The petition calls upon the judiciary to pronounce the escalating maternal deaths in Uganda as an issue that violates the Constitutional rights of Ugandans.

It highlights the case of Sylvia Nalubowa, a mother of seven children in Mityana and of Jennifer Anguko, a mother of three both of whom died as a result of the government’s failure to fulfill its constitutional obligations to provide basic maternal health care.

In May this year, the Centre for Health Human Rights and Development (CEHURD), a Ugandan NGO, and the families of Sylvia and Jennifer sued the government through the Ugandan Constitutional Court alleging the women’s deaths were caused as a direct result of Uganda’s failing healthcare system.

CEHURD officials urge the Court to declare that the continuous failure to implement effective policies on maternal healthcare, under-staffing, and the non-availability of basic maternal commodities in government hospitals amount to violations of pregnant women’s rights to health and life.

“Years have passed and the population is singing the same song over and over. No drugs, personnel are inadequate, personnel are rude to the sick... and the list continues. Where is government in all this,” asked William Kibaalya a social worker managing social welfare programmes for children in Uganda.

Lobbying the public outside court

But with the no show by the judges, the civil society has devised other ways of putting pressure on the government to pay attention.

Campaigners have initiated an online petition targeting the international community and a book collecting signatures of people affected by maternal deaths in Uganda.

The online petition, with an open letter to President Yoweri Museveni and the speaker of Parliament Rebecca Kadaga is urging the government to pay attention because this is a matter of life and death.

And a book launched two months ago has so far attracted 1,700 signatures from people who have been affected by maternal deaths- orphans, widowers and all those who have had a relative die in childbirth.

“We want to keep the momentum at the grassroots and also build pressure on the government that is why we have the book and now the online petition,” said Mabel Kukunda, advocacy and networking officer, Uganda Network of Health Consumer Organizations (UNHCO).

“We are hopeful that the Justices will acknowledge the plight of mothers in Uganda, and deliver a ruling that compels government to dramatically increases investments in essential medicines, in recruitment and remuneration of health personel and in equipping health facilities so that women get the services they need to survive and thrive before, during and after delivery,” the online petition reads.

 Background to the case

Sylvia Nalubowa died on 10 August 2009 from complications of obstructed labor while giving birth to her second twin baby in the eighth pregnancy.

Earlier, her husband Stephen Sebiragala was referred to Mityana district hospital about 15 kilometers away after being turned away twice at health centres with a midwife missing in one and a twin born in another health centre but the case became complicated.

At Mityana Hospital the staff demanded sh50, 000 ($ 20) before Sylvia could be attended to which was meant to purchase a ‘Mama kit’, a requirement of the cost sharing policy in Uganda, where mothers are expected to carry a kit containing basics to be used in the delivery of new babies.

Sebiragala, the widower says that if he had not had to spend so much money transporting his wife, he would have had enough money to save the lives of both Sylvia and his child. But even then, there was no medical doctor in theater so both Sylvia and the second twin died at Mityana hospital.

Jennifer Anguko, a mother of three was admitted to Arua Hospital on December 10 2010 with intense labor pains and waited for 15 hours for a doctor to carry out a caesarean section.

She died of obstructed labor after the uterus ruptured. Four other women died in the maternity ward that same day.

The petitioners argue that the tragic deaths of Sylvia Nalubowa and Anguko Jennifer are but two manifestations of a larger problem of an unacceptably high rate of maternal mortality in Uganda.

“Our hope is in the decision by Constitutional Court to compel government on its obligations to address the crisis of maternal mortality,” said Russell.


No More World Bank; Uganda Scientists Cry

By Esther Nakkazi

The Uganda government has decided not to put a further request for the World Bank Millennium Science Initiative (MSI) loan due to expire by the end of this year.

The move is a shock to the science community who despite putting Ush 17.2 billion ($ 6.8 m) budget to the government through Uganda National Council for Science and Technology (UNSCT) this financial year was not considered. 

Without reapplying for the MSI World Bank grant and with no budget funding for science and technology, Uganda risks relying on external funding for new innovations and with no ability to set its science agenda. Donors fund what is in their interests.

We are living in the best of scientific times and having scientific innovations funded by Uganda and designed to its needs would spur economic growth, Dr. Maxwell Otim the deputy executive secretary UNCST. 
Dr. Otim says Uganda would not reapply for the MSI loan because the government thinks research and science is such an important aspect to be left to the donors.

He is still putting a positive light on a disappointing development even after the budget was read on June 8th and UNSCT was not mentioned. Partially, due to President Museveni being a strong supporter of science.

“We remain hopefully that the government will fund the budget for this financial year, which will again be used for grants as the MSI project funds were used,” said Dr. Otim.

Kenneth Mugambe, the director budget, said that UNCST still has money from MSI, which has not been absorbed they cannot give them any more money until it is over.

In 2006, Uganda was the only country in Africa to win $30 million in loans as part of the World Bank’s MSI project. It was counter funded with $3.3 million by the Uganda government and its implementation began in 2007 by UNCST.

The 5-year project aimed to increase the number and quality of science graduates, to improve Uganda’s research output, and to help companies use the products of research.

Evidently, the MSI project has opened up research. With it Uganda has managed to design and develop a malaria vaccine, it has new information on the Nile Perch and has increased training for scientists and engineers through UNSCT. 

Products of the MSI in Uganda
The malaria vaccine has been tested in mice and baboons and it is so far a great success but there is still a lot of work to do. “The fact that we have tested it in baboons has made us get closer to humans and it will inform future malaria vaccine studies,” said Dr. Thomas G. Egwang the director General of Med Biotech Laboratories.

“We know what we can do and what ever we put out worked but we only put in one malaria sequence in the human gene sequence to serve as a booster,” said Dr. Egwang.

“We need more funds to do this again and again before we get to test it in humans. But it is unlikely that they will renew the MSI grant,” said Egwang.

The Nile Perch studies have come up with information on its biology; breeding, size of eggs, reproductive methods and the type of food it can eat.

These studies will enable the Nile Perch, whose stocks are dwindling in Lake Victoria to be reared under aquaculture conditions. However, the scientists need more funds to put in place what has been discovered in an aquaculture setting.

The MSI loan also funded the establishment of strategic courses in higher institution of learning like ICT related courses in Makerere, Kyambogo and Mbarara Universities.

Biosystems and textile engineering in Gulu and Busitema University respectively are offered at undergraduate level. “Textile engineering because we grow a lot of cotton but do not add value,” said Dr. Otim. 

In the MSI research there is human capital development so over 3,660 scientists and engineers have been trained through UNSCT; 102 are being trained at Master of Science (MSC) and Doctorate (PhD) level.

Uganda Science Problems;

But even if over the years, Uganda has increased investment in research and training scientists, it is yet to build a critical mass that would make an impact. It boosted its spending on research and development, from US$73 million in 2005-06 to $155 million in 2008-09.

Also, funding science and research, remains below a recommended threshold but there is also; lack of the public appreciation of science, low students’ uptake of training in science and lack of commercialization of research products.

The overall funding remains relatively low, totaling just 0.5 percent of GDP, according to Dr. Peter Ndemere UNCST executive secretary of UNCST. The African Union recommended at least 1 percent.

“Government should commit more resources to science and research which are key to development and creating jobs. It should get its priorities right,” said Ndemere.

Uganda has one of the lowest densities of researchers in sub-Saharan Africa with 25 researchers per million inhabitants. Only 20 percent of its researchers have PhDs.

With emerging universities and research institutions, research work in Uganda has been steadily growing but a few institutions offer science courses and do research.

At the UNCST, the number of new research projects registered there steadily increased from 166 in 2001 to 309 in 2008. But of the 27 public and private universities in Uganda, only 6-offer science related programmes. The ratio of arts to science graduates is 5:1 at these universities.

For instance in 2006, student enrolment in science and technology at both private and public universities was 27 percent of total registered students, below the minimum requirement of 40 per cent recommended for rapid and accelerated economic growth and effective contribution to an economy.

One of the problems is that there are no mentors for science and the public’s attitude to science is very negative.  We have a culture of applying science but we cannot link education to it. We have no general appreciation of what science can do to an economy, said Dr. Paul Nampala executive secretary, Uganda National Academy of Science (UNAS).

 “There are a few institutions that train in science because it is expensive. Why would you put up laboratories when only a few students want to take on science courses” asked Dr. Paul Nampala.

According to Nampala, the overall lack of interest among students is also reflected on the population. There are no science mentors ad the public’s attitude to science is very negative.

Uganda’s ratio of science and technology to the general workforce is 0.5 researchers per 1000 and there is only 1 personnel either   researcher or technician per 1000 of the labor force. In OECD countries it ranges between 5-18 personnel per 1000 of the labor force.

Although funding remains a major problem, without a one-stop centre like a ministry of Science to channel the funds and duplication of efforts, Uganda’s science problems are further magnified.

“Malaria is the number one killer but all the funding on its research comes from abroad. Now there are 20 projects on malaria in Makerere University but they do not talk to each other. If they just talked there would be no malaria in this country,” said Dr. Ndemere frustrated.  

“People use research as a means of survival not to solve a common problem. Everybody is hiding in a corner using research money to survive. Those who complete research cannot commercialize it.”

The solution should be the Ministry of Science, ‘funding has to be forceful so you need somebody in cabinet to defend your budget,” said Dr. Ndemere.

“In Uganda budgeting follows a sector. If we had a science sector and a line ministry, we should have had budget allocation for it,” concurred Dr. Nampala.

This story was also published in the local media. Here is the edited version