Uganda approves first-ever OST clinic

Uganda approves first-ever OST clinic

PITCH has been instrumental in PEPFAR’s commitment to fund the first-ever opioid substitution therapy (OST) clinic in Uganda. The clinic, which will be based at Butabika National Mental Referral Hospital under the leadership of the Ugandan Ministry of Health, will initially operate as a pilot.

It is being funded by PEPFAR through its Key Population Investment Grant, due to be allocated to Uganda by the end of March.

Uganda approves first-ever OST clinic

The decision comes after PITCH embarked on a year of advocacy to convince the Ministry of Health of the need for the clinic.

“We first put forward the proposal for the clinic during a PEPFAR regional planning meeting in Johannesburg in March last year,” says Gracias Atwiine, PITCH country focal point in Uganda.

“The Ministry of Health claimed drug use was not a big issue in Uganda, also that it was a sensitive, multisectoral issue that needed the Ministry to work with other departments such as the Ministry of Internal Affairs, so they are not misinterpreted as promoters of drug use in Uganda. The Minister of Health [Dr. Jane Ruth Aceng] also said that she had not seen any size estimation report [on the number of people who inject drugs] to warrant or justify such a clinic.”

 

One of the first things PITCH did was to share a size estimation report for Mbale and Kampala, which showed significant populations of people who inject drugs in both cities.

 

Necessary steps

After continued dialogue between PITCH partners and the Ministry of Health, the ministry granted PITCH permission to approach PEPFAR during the 2019 planning meeting with a proposal. Persuaded by the evidence put before her, Dr. Aceng, the Minister of Health, then began taking the steps necessary to bring the clinic into existence.

“She informed us that she had approved medicines for drug dependence and harm reduction and directed us to contact the in-charge at the Mental Health Clinic in Butabika Hospital to ascertain what medicines they had procured,” says Gracias.

“Because of this, by the time we approached PEPFAR, we were aware of what the Ministry of Health had already approved and procured, and PEPFAR was able to appreciate the efforts being made by the Ministry of Health towards reducing harm among people who inject drugs.”

Funding of clinic

The proposal was submitted to PEPFAR and subsequently approved. The OST clinic will be funded through PEPFAR’s US$10 million Key Population Investment Grant (KPIG), an additional fund that will sit alongside other PEPFAR-supported programmes in Uganda. Around 80% of the fund is being allocated directly to organisations led by key population groups, people who are most affected by HIV, in order to reach more at-risk people with HIV testing and treatment.

“I’m currently working the leadership of Butabika Hospital to craft a budget and share with PEPFAR and CDC Uganda for consideration,” explains Gracias. “I’m in touch with organisations in Ukraine to support us in drafting this, as the country is a leader on harm reduction.

“We have been told the KPIG will be coming into Uganda by end of March so we are also planning to meet with various key population-led organisations so they are ready to apply when the call comes out.”

Positive consequences

Although there are many steps to take before the OST clinic at Butabika Hospital opens, the process that has led to the clinic’s approval has already had many positive consequences, not least an increased awareness of PITCH’s objectives and goals among health ministry staff.

“This achievement has a given PITCH mileage in terms of high-level engagement and advocacy, as well as partnerships and collaboration”, says Gracias.

 

“Now I’m able to email directly, call or text the Health Minister and Permanent Secretary for any ‘asks’ and they will respond.”

 

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