AVAILABILITY OF MORPHINE IN
SUB-SAHARAN AFRICA
Botswana, Ethiopia, Tanzania, Uganda, Zimbabwe
| Situation: |
Barriers: |
| · 128 million people | · Severe “opiophobia” |
| · Heavy burden of HIV/AIDS and cancer | · Distributing to remote areas |
| · Unrelieved pain a major public health problem | · All opioids are imported |
| · Ethiopia, Tanzania: injectable, but no oral morphine | · Lack of knowledge about morphine |
| · Uganda: effective, but limited model to distribute oral morphine | · Shortage of prescribers, dispensers |
| · See morphine consumption graph | · Stigmatization of HIV/AIDS patients |
Mg/Per Capita Global Consumption of Morphine, 1999
| Global mean | 5.9 |
| Africa Region mean | 0.7 |
| South Africa | 3.4 |
| Botswana | 0.1 |
| Uganda | 0.008 |
| Tanzania | 0.001 |
Ethiopia and Zimbabwe did not report
for 1999 |
|
Empty narcotics cabinet at hospice in Botswana
Objectives: The World Health Organization (WHO) in Geneva has initiated a public health demonstration project to expand palliative care in 5 sub-Saharan African countries. A central component is making oral morphine available and accessible to HIV/AIDS and cancer patients.
Method: In July 2002, a WHO workshop was conducted in Gaborone, Botswana to assist teams from each country to develop proposals to expand palliative care. The Pain & Policy Studies Group/WHO Collaborating Center (PPSG/WHOCC) assisted the country teams in learning how the government regulatory systems to prevent narcotic abuse should also ensure patient access to pain medications.
Results: Each country team prepared
a preliminary National Action Plan for Opioid Availability:
Common elements of the plans include:
Pain
& Policy Studies Group