Poor roads in Uganda, especially at landing sites at Kigugo Island, are making it difficult for HIV positive patients to access antiretroviral treatment at St Francis Hospital in Nkokonjeru.
Kigugo landing site in Buikwe District, like the majority of other landing sites, is located in a remote area where access to health, education, water and other services is very limited. Residents of Kigugo have to travel a distance of four and half kilometres, on a potholed road, to access treatment at St Francis hospital Nkokonjeru.
Such a long distance is very cumbersome to HIV patients whose body system is already weakened by the virus and who may also lack the money to pay for their transport. As a result, some patients are missing hospital appointments and failing to adhere to their treatment.
Cost of transport
Francis Nakuzabasajja, 60, a resident of Namukuma Parish at Kigugo landing site said that he has to save 28,000 Uganda shilling (11 US dollars) on a monthly basis to get to the hospital for his treatment.
“I have to ride as a passenger on a motorcycle to get to the hospital because it is the only means of transport which is available. However if I do not have the 28,000 shillings transport fare I miss out on the treatment,” Nakuzabasajja explained.
Mary Nankanja, 54, said: “At times, if I do not have money, I walk to the hospital on foot, but if I am very weak I remain at home. Sometimes I want to buy simple tablets like septrin to supplement my antiretroviral treatment, but I still do not have the money.”
Septrin tablets are used in the treatment of various illnesses, including HIV, and are lawfully sold in clinics and pharmacies. This means HIV patients like Mary can buy them if they have the money.
Outreach services
Buikwe District Health Officer Dr Joseph Bbosa admitted that since there is no official district vehicle, the health department has resorted to outreach services.
“The district is working hand-in-hand with development partners like Nyenga Mobile, Mildmay Services and the African Social Development and Health Initiative to offer free testing and counselling services to residents in the hard to reach areas at the landing sites,” Bbosa explained. He added that they still have a problem with HIV patients who have to immediately be referred to hospital.
Buikwe District Chairman Mathias Kigongo said that district leaders meet with these development partners and devise ways of how HIV patients can access antiretroviral treatment, whenever they need it.
Hilda Namutebi, a social worker with the African Social Development and Health Initiative, said that they decided to work in communities at landing sites after research showed there are limited health facilities.
Namutebi explained that although the government recommends a health centre II (a facility led by an enrolled nurse which treats common ailments like malaria) in every parish, this is not the case at the landing sites. She added that some HIV patients have to walk a distance of over 30 kilometres to access treatment at the nearest health facility.
“Since most HIV patients have to access antiretroviral treatment on a monthly basis, automatically some might miss if they lack transport fares,” Namutebi said. “It is high time the government repaired roads, so that taxis, which charge a smaller fee can transport them.”
Hospital assistance
Martin Agaba a medical clinical officer at St Francis Hospital Nkokonjeru, said: “At times we allow a relative or a friend of the patient to collect their medication, but the standing order is that this can only be done twice. On the third occasion, the patient has to either collect the medicine personally or else miss out.”
Agaba said antiretroviral treatment keeps on changing depending on the patient’s CD4 count (the level of infection-fighting white blood cells in their blood). This means it is not possible to always give the treatment to a third party.
Village health teams speak out
Joseph Mwavvu is a village health team member at Kigugo landing site, who is responsible for assisting in giving out medicines to patients at a village level. There are village health team members in various parishes who are given free bicycles to help with transport, but Mwavvu said they are not given antiretroviral treatment to deliver on grounds that it is too complicated.
He added that health and district leaders should educate village health teams on how antiretrovirals are administered, so they can help the HIV patients who cannot get to St Francis Hospital.
Read about HIV and human rights
Well done Esther for the good work!