Technical assistance to support national morphine production
Start of Project: October 2010
Length of Project: Indefinite
Objective: Improve access to oral morphine for Ugandans with moderate or severe pain
Accurate data on the number of people with moderate or severe pain in Uganda do not exist, but a minimum number can be estimated. The World Health Organization (WHO) estimated that 112,000 people died from HIV and 17,000 people died from cancer in 2010. Assuming that 50% of those who died from HIV and 80% of those who died from cancer experienced moderate or severe pain, 69,000 of those deaths required treatment with opioid analgesics, according to the WHO pain treatment guidelines. This number reflects a minimum need, since it does not include people who died of other conditions with pain, such as trauma or myocardial infarction, and people who suffered with painful conditions but did not die.
The government of Uganda reports opioid consumption to the International Narcotics Control Board on an annual basis. The average reported consumption of opioids from 2009-2011, standardized as morphine-equivalents, was 11.0 kg. Assuming that patients, on average, are treated for the last 3 months of their life with 67.5 mg of morphine per day, 11.0 kg would have provided a full treatment for 1,800 people. The amount of opioids required to treat 69,000 people is 428 kg. Please see our fact sheet on access to pain relief in Uganda for more data.
TABLE 1. SNAPSHOT OF ACCESS TO PAIN RELIEF IN UGANDA
Establishing a national oral morphine production program
In October 2010, Treat the Pain established an indefinite partnership with Hospice Africa Uganda to improve access to oral morphine for the treatment of moderate or severe pain. At the time of the agreement, Uganda’s public sector had been without oral morphine for about six months.
We worked with key partners, including the African Palliative Care Association, Hospice Africa Uganda (HAU), Ministry of Health (MOH), National Medical Stores (NMS), National Drug Authority (NDA), Joint Medical Stores (JMS) and the Palliative Care Association of Uganda (PCAU) to set up a partnership for Hospice Africa Uganda to import morphine powder and produce oral morphine solution on contract to National Medical Stores for distribution to public and private, not-for-profit hospitals. The cost of oral morphine solution produced by Hospice Africa Uganda is about 3 USD for a week of treatment, but the government makes it available to hospitals at no charge.
The first deliveries under the new contract began in March 2011 and NMS has had continuous availability of oral morphine solution since that date. In 2011, HAU produced 16 kgs of oral morphine for NMS and in 2012, the amount increased twofold to 31 kgs. Treat the Pain has provided ongoing support to HAU to assist with implementing NDA requirements and to analyze program costs and set prices for the finished product.
Treat the Pain pharmacist, Christopher Ntege, is based at the Palliative Care Association of Uganda and provides technical support to improve morphine production and distribution.
Expanding patient access
Once clinicians in Uganda have been trained in opioid prescribing, they must have a site inspection before the site is accredited to receive medicines. There is currently a backlog of about 80 health facilities awaiting accreditation. So in June 2013, Treat the Pain granted the Palliative Care Association of Uganda funds to hire a full-time staff member to visit and accredit health facilities for opioid prescribing.
New project to develop innovative ways to scale-up clinical training
Treat the Pain has also received a new grant, in partnership with the Harvard Global Equity Initiative, to develop, pilot, and implement an e-learning platform to train clinicians in pain assessment and treatment. These activities will begin in late 2013.