The Pain-Free Hospital Initiative – Integrating Pain Management into Health Service Delivery at Hospitals in Uganda.

PCAU held a session on integrating pain management into health care delivery in Ugandan hospitals at the 3rd Uganda Conference on Cancer and Palliative Care. The workshop was aimed at bringing together key stakeholders from the Ministry of Health, public and private teaching hospitals, civil society, and patient representatives to share progress in pain relief in Uganda and to develop an action plan to support the pain relief medicines supply chain and long-term pain assessment and management in Ugandan hospitals.

During the workshop, Rosemary Canfua, a Consultant, Morphine production and Access, Treat the Pain, American Cancer Society noted that while medical opioids like morphine are crucial in pain management, developing countries have the highest burden of diseases associated with moderate and severe pains (e.g. Cancers and HIV/AIDS among others). She added that 90% of the world’s medical opioids are consumed in high-Income Countries (12% global population) and less than10% is consumed by developing and middle-income countries (88% of the global population). Additionally, there is low budget allocation to African health sectors due to competing priorities.

In Uganda, PCAU has been running the Pain Free Hospital Initiative (PFHI), which aims to motivate clinicians to evaluate and treat pain, supply appropriate drugs, engage hospital staff to create pain awareness, equip clinicians with skills and tools to effectively treat pain, and measure initiative impact by documenting patient pain scores. The PFHI has been implemented at 17 facilities, including 12 regional referral hospitals, two private not for profit hospitals, two national referral hospitals, and one military hospital.

Christine Ebong, Public Health Pharmacy Technician at National Medical Stores stated that among the vital drugs are those used in pain management, such as Oral Morphine, which is one of the prescriptions for pain management. She did, however, mention that COVID-19 had a detrimental influence on the demand and supply of pain relievers, and that normal ordering and supply had been disrupted, from the production stage through consumption.

Christine, on the other hand, stated that there are new distribution channels to government and Public Health Facilities, as well as continuing collaborative multi sectorial engagements to build awareness, strengthen management abilities, and expand usage of Oral Morphine in pain management.

According to Emmanuel Higenyi, Director Technical Services at Joint Medical Stores, JMS works with the government of Uganda through the Ministry of Health to offer necessary medications and health supplies, but one of the issues is that most health institutions place rush orders. The facilities do not have a firm ordering date, and they are investigating what is causing this. There had also been a spike in stockouts throughout the pandemic.

Kenneth Mwehonge, Programs Manager, Health Policy Advocacy Staff at HEPS- Uganda appealed to the government to scale up harm reduction programs and policies, decriminalize or de-penalize drug use and possession, and reform regulations concerning essential controlled drugs.

We are grateful to the American Cancer Society and the Ministry of Health for supporting the PFHI. However, there is need for scaling up the pain-free hospital trainings to District health facilities, monitoring and support supervision of accredited health facilities, strengthening of the Morphine Supply Chain to enhance access and availability as well as promoting Palliative Care education.


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