Ensuring access to health care and medicines during COVID-19: critical challenges and feasible policy options for the medicines retail sector

Managing pandemics and ensuring ongoing access to medicines is a difficult task for any government. In most high income settings, this can be achieved by activities focussed on public health systems. In countries such as Uganda, however, 40-70% of medicines for fever, headaches and cough are delivered through drug shops, private clinics and pharmacies. Governments need to create policies and programmes so that the medicines retail sector (MRS) can continue to provide treatment for common infectious diseases like malaria and bacterial pneumonia; does not become a 'hotspot' for disease transmission; and can actively contribute to the public health response during disease outbreaks.

It is difficult for governments to know how to involve the MRS in responses to COVID-19. There are few guidelines to draw upon. The World Health Organisation is seeking ways to better support private sector actors so that they can be an effective part of the COVID-19 response and continue to provide care for other illnesses. Their work is stymied by a lack of evidence.

This project is part of a long standing collaboration between researchers in Uganda, UK and Denmark. It will build on recent research in the retail sector to rapidly create and disseminate new evidence on: the impact of current policies (including lockdown and curfew) on the MRS and community access to treatment; the ways in which members of the MRS are willing to be involved in COVID-19 public health response (health education, testing, surveillance); and what this would cost to scale up in the country.

Governments around the world are facing extraordinary challenges in tackling coronavirus disease 2019 (COVID-19). In Africa, community transmission is rising (Ntoumi et al 2020; Senghore et al 2020). Ways of minimising transmission while ensuring access to medicines must be found. In Uganda, drug shops, small private clinics and retail pharmacies deliver approximately 50% of the country's essential medicines including antibiotics and antimalarials (Ministry of Health, pers comm). Known collectively as the medicines retail sector (MRS), 40-70% of children with febrile illness (Mayora et al 2018) and 80% percent of malaria cases are treated in these settings (Mbonye et al 2013). As government facilities are reserved for COVID-19 case management, the need for access to health care through the MRS is likely only to rise.
In tackling COVID-19, however, global health actors and governments have failed to engage effectively with the MRS (O'Hanlon et al, 2020). In Uganda, the MRS has been excluded from all COVID-19 related training schemes, distribution of personal protective equipment, and exemptions from the 6-week lockdown and ongoing curfew. No advice has been issued on protecting staff or clients against infection; engaging MRS in surveillance or future testing. Lack of a whole system approach in the pandemic response could unintentionally restrict access to life-saving medicines.
This project, building on a decade of research in the Ugandan MRS, aims to understand and mitigate the vulnerability of supply and access to medicines within the Uganda health system (WHO Roadmap priorities 9.9, 9.11). We will document how COVID-19 and the national response to the pandemic has shaped the ability of the MRS to deliver antibiotics, malaria medicines and contraceptives; identify feasible, costed policy actions to mitigate any negative impact of COVID-19 on access to medicines; and identify ways that the MRS can play an active role in response to ongoing and future pandemics.