Fighting Childhood Pneumonia in Uganda

Pneumonia, as Calkins and Palamountain (2017) point out in their article, Fighting Childhood Pneumonia in Uganda, remains one of the leading causes of death for children under the age of five across the world. As a matter of fact, more children have died from pneumonia related complications in recent times than from measles, malaria and HIV combined. This, in essence, is an indication to the seriousness of the issue – particularly in developing countries. In Uganda, for instance, “approximately 20,000 children under five died from the illness” in 2012; with the said figure being representative of “15 percent of under-five deaths in Uganda” (Calkins and Palamountain, 2017, p. 10). Various initiatives have been undertaken by both the government and INGOs in an attempt to arrest the situation. However, no single approach has yielded significant benefits. Therefore, taking the context of this discussion into consideration, the all-important question remains: what would be the most effective approach towards bringing down childhood mortality rates in this case? The key consideration on this front would be to make an impact with limited funding from INGOs over a specified period of time.
Discussion
Many approaches have been adopted in an attempt to battle childhood pneumonia in this developing East African country. It is important to note that despite this, childhood pneumonia still remains a challenge. Some of the approaches that have been implemented in the past, according to Calkins and Palamountain include; Village Health Teams, the Sustainable Drug Seller Initiative, the Patient Awareness Campaigns, Pharmaceutical Manufacturer Negotiations, and Healthcare Provider Training and Diagnostics. The failure to significantly bring down child mortality rates despite these efforts is a clear indication that at hand is a rather complicated problem.
One of the key issues that have limited the success of the said initiatives is cost. The Village Health Teams (VHTs) for instance could have proven too costly if they were to be rolled out across the country – especially given that finding volunteers proved a challenge. It is important to also note that overreliance on INGOs to fund initiatives with recurring expenditure over the long-term would be a gamble as donors could experience donor fatigue – with their exit being fatal and effectively eroding any gains made. The government of Uganda cannot also be relied upon as an effective long-term partner when it comes to the supervision of ongoing programs, especially where cost is an issue. This was clear in the Sustainable Drug Seller Initiative whereby there was an attempt to arrest childhood pneumonia via the enhancement of drug-shop sellers’ training and skills in the diagnosis as well as treatment of respiratory illness patients in the localities. In this case, “monitoring by the government was too infrequent to be meaningful” (Calkins and Palamountain, 2017, p. 13). The most workable approach should therefore be self-sustaining and require very little, if any, supervision or monitoring.
Proposed Solution
On the strength of the key issues raised in the case under consideration, the approach that would have the most impact would involve the fusion of infrastructural commitments and training. Donor funds could in this case be allocated towards the establishment of a drug manufacturing plant in the country – in partnership with the government and a pharmaceutical company of repute. The said plant would focus on the production of drugs to combat pneumonia. Already, there are experts who, according to Calkins and Palamountain, are of the opinion that this would help do away with the persistent challenge of childhood pneumonia mortality. One of the key advantages of this approach is that it would require a one-off outlay of funds with no recurring expenditure after completion. The concern of donor fatigue, and hence possible exit, as a consequence of cost escalation would therefore be eliminated. In addition to growth in expertise, the country could also benefit from increased job opportunities for its citizens even as it seeks to reduce or completely eliminate foreign drug supplier dependence. This approach has gained traction in international circles with the Director of the Division on Investment and Enterprise at the United Nations Conference on Trade and Development having been quoted saying that local production of drugs could be of great relevance “for developing countries to ensure the security of access to medicines for their populations…” and further observing that such countries should be assisted “to build their competitive edge in the production of generic medicine” (United Nations Human Rights, 2017). The World Health Organization points out that approximately “30 percent of the world’s population – approximately 2 billion people – still lacks regular access to essential medicines” (Nkrumah and Mensah, 2014, p. 111). The situation, according to the authors, is worse in developing countries. Local production would improve access to antibiotics in the case of Uganda. The cost savings in this case would be as a consequence of a myriad of factors including, but not limited to, decreased transport costs.
Infusing training of shop-keepers in select drug shops into the foundational approach would further cut costs and enhance access significantly. It would also put to rest fears of misdiagnosis and discourage the self-treat behavior of patients. It should be noted that while government healthcare in the country provides essential services free of charge, the public infrastructure is overburdened due to the significant number of people seeking services. Private healthcare facilities on the other hand are too expensive for most people to afford. Drug shops could therefore be used as first-line healthcare providers. This would call for the training of selected shop keepers on basic diagnostic and prescriptive procedures, after which those who complete training could have their drug stores accredited. It is important to note that while this recommendation agrees with the Sustainable Drug Seller Initiative in concept, it differs from the same in application. In this case, there is no blanket focus on drug-shops. Instead, the selection of drug stores earmarked for accreditation ought to be on the basis of the need to complement other health centers/facilities – both public and private. For instance, this can be implemented as per the appropriate area or population to be covered. The selection of a few model drug shops would also reduce program implementation costs significantly and would effectively increase the pace of expansion across the country. The government can thereafter take over the training of shop keepers and minimal supervision of the drug shops after the pilot program is laid out. This is more so the case given that while the initial outlay could be significant in terms of original training costs, the subsequent costs associated with the maintenance of the program would be minimal as shop keepers do not need to be retrained on an annual basis – with retraining or skill improvement being done on a need basis.
When implemented alongside an expanded local drug production initiative, training of shop-keepers in select drug shops would further contribute towards the eradication of childhood pneumonia in Uganda. Of key relevance when it comes to the merging of these two approaches are reduced costs, better diagnostic and treatment outcomes, and increased coverage. Upon the successful implementation of the approach highlighted herein, the same could be adopted in other developing nations to address other challenging health concerns such as malaria and HIV/Aids. This more so the case given that Uganda, as Calkins and Palamountain point out, has a ‘pathfinder’ country status – which effectively means that “it could serve as an example for other counties wrestling with the same issues.”

References
Calkins, T, & Palamountain, K. (2017). Fighting Childhood Pneumonia in Uganda. Retrieved from https://services.hbsp.harvard.edu/services/proxy/content/72006155/72006157/5014d36c8a70f53dec5cb0411a30b81d
Nkrumah, Y. & Mensah, J. (Eds.). (2014). Accelerating Health Reforms through Collective Action: Experiences from East Africa. Washington, DC: World Bank Publications.
United Nations Human Rights (2017). Human Rights Council Holds Panel Discussion on Access to Medicines. Retrieved from http://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=21325&LangID=E