Vera Villanueva

A recent Yale study led by School of Public Health professor Mari Armstrong-Hough focused on Uganda’s lack of access to medication for noncommunicable diseases, like heart disease and diabetes. The study pointed out disparities in the availability of essential medicines for these diseases, both regionally and among different types of facilities.

Using data collected by the Uganda Ministry of Health, Armstrong-Hough’s group applied a statistical model to predict the likelihood that a facility would have medication for chronic illnesses. For example, the researchers found that, independent of other factors, private, for-profit facilities were nearly twice as likely to have these treatments in stock as their public counterparts. Public sector facilities often provide these medications free of charge, whereas the price of the same drugs at private facilities can be out of financial reach for much of the Ugandan population.

According to senior author Jeremy Schwartz, a professor at the School of Medicine, the problems underlying the access disparity are multilayered and multifaceted.

“There are numerous factors at play here,” Schwartz said. “First, health facilities have limited budgets for medicines … Second, the Essential Medicines and Health Supplies List of Uganda designates the lowest level health facility at which each Medicine should be available … Third, demand is poorly characterized. In other words, there is currently no method for the Ministry to know what the demand for each of these medicines is — what is being prescribed by providers.”

Gerald Mutungi, a co-author of the study and an official from the Ministry of Health, said he was not surprised that the team discovered a disparity of access to essential medicines.

The Ministry of Health compiled the available information using the Service Availability and Readiness Assessment, a World Health Organization procedure designed for universal use among countries. The data was published and was intended for internal use. But the Yale research team found that it could also use SARA statistics to document major wellness problems in developing countries.

According to Armstrong-Hough, her group has demonstrated just one of numerous ways other countries’ SARA data can elucidate health issues. Using specific statistical models, the group was able to predict the availability of medications for asthma and diabetes, among other diseases.

“We’re trying to encourage people to do this for all of the other SARA data sets that are out there,” said Armstrong-Hough. “These disparities are not at all evident if you just look at percentages. When you fit this kind of Poisson regression, we can say there is pretty convincing evidence that there are particular predictors of high or low availability of essential medicine.”

The paper also found facility correlations between the availability of HIV services and noninfective diseases treatments. Facilities that offered HIV treatments with no testing or counseling were less likely to have chronic-disease medications in stock, but those that provided HIV testing and counseling services were more likely to offer the medications.

According to the Centers for Disease Control and Prevention, noninfective diseases are the fifth leading cause of mortality in Uganda, while HIV and tuberculosis, two infectious diseases, are the combined third leading cause of death in the country. But Armstrong-Hough said that it is important for Uganda not to treat these two types of diseases as competing for resources and instead focus on their implications on one another.

“There is a real relationship between good care for noncommunicable diseases and the outcomes of these communicable disease epidemics,” said Armstrong-Hough. “We know that people living with HIV, particularly people who are on highly active antiretroviral therapy, are probably at an increased risk of Type 2 diabetes. Ideally what we would want to see is integration of [noncommunicable disease] services into care for HIV.”

The Uganda Ministry of Health conducted the SARA test in 2013.

Allen Siegler |

Correction, Feb 22.: A previous version of the article incorrectly referred to Jeremy Schwartz only as a doctor; in fact, he is both a doctor and professor at the School of Medicine.