Introduction
Given that international organizations and national governments have declared non-communicable diseases a priority, this study aimed to explore the availability of diagnosis and management of diabetes in adults in Uganda. It focused on identifying problems and in documenting the ways that health workers and patients were making do in situations of scarce resources.
Methods
Using qualitative methods—mainly semi-structured interviews, observations, and case stories—we explored the availability of and access to glucose testing, monitoring, and medication for diabetes in adults. In 2011 and early 2012, we worked in Butaleja District and Mbale town in southeastern Uganda, Kasese District in the west, and three districts of Acholi Region in the north. Site visits and observations included public and private health care facilities and retail outlets. Interviews were carried out with several cadres of health staff, as well as patients.
Results
There were shortages and irregularities in supply of diagnostic equipment and medication at all public units that were supposed to provide treatment for diabetes. Even the hospitals with designated diabetes clinics were not always able to avail testing and medication. The shortages were most acute for diagnostic equipment. NMS was not supplying glucometers or strips to public facilities at the time of the study. One solution was to refer patients to private clinics and drug shops where they could purchase medicines and tests. Another was to arrange for glucose testing to be provided for a fee at the hospital, in the private wing or through the services of a patient organization. Because the glucometer strips are relatively expensive, many patients went for months without testing their glucose levels. An additional problem was the need to obtain strips that matched the available glucometer (about 30 types were found in the areas visited). Economic constraints were exacerbated by costs for transport to the limited number of diabetes treatment facilities.
Conclusion
There is a severe lack of free diabetes testing and treatment possibilities in Uganda. Health workers and patients are developing strategies for ensuring glucose tests and medicine, but these are neither consistent nor sufficient nor equitable