In the realm of Uganda’s healthcare system, a well-guarded secret exists – the staggering expenses entailed in treating diabetes are known primarily to patients and their closest kin.
This financial predicament is most dire for those grappling with type 2 diabetes mellitus (T2DM), a condition afflicting roughly 4.2% of Uganda’s populace.
A groundbreaking inquiry conducted by the Economic Policy Research Centre (EPRC), an esteemed think tank affiliated with Makerere University, has now unveiled the concealed fiscal implications of managing this form of diabetes.
Headed by the distinguished Dr. Madina Guloba, the team of researchers, including Blessing Atwine and Pauline Nakitende, embarked on a study entitled “Economic Burden of Type 2 Diabetes Mellitus in Uganda: A Cost-of-Illness Analysis.” This investigation, whose findings were unveiled in August, aimed to ascertain the comprehensive direct financial outlays associated with the treatment and care of T2DM in Uganda, encompassing both public and private healthcare sectors.
According to their findings, the cost of attending to individuals afflicted with type 2 diabetes consumes a substantial 13% of the Ministry of Health’s annual budget.
The Ministry was allocated UGX3.331 trillion for the fiscal year 2021/2022, with a substantial portion—approximately UGX 2.2 trillion—expended on medications, treatments, and the management of diabetes-related complications.
The report highlights that households shoulder the largest share of this financial burden, totaling UGX 1.7 trillion, while government spending for diagnosed T2DM patients accounts for 13% of the Ministry of Health’s budget, amounting to UGX 435 billion.
Dr. Guloba and her team revealed that out of the total expenditure of UGX 2.2 trillion for the 676,900 diagnosed T2DM patients across public and private healthcare facilities, the government’s contribution was a mere UGX 435.8 billion. This implies that the majority of patients bear the financial weight of the disease personally, impinging on their overall quality of life.
The researchers further underscored that if all those in need of care, including diagnosed and undiagnosed cases, were to receive treatment, it would impose a staggering cost of approximately UGX 4.2 trillion, equivalent to 8.7% of the total national budget for the year 2022/23.
It’s imperative to note that type 2 diabetes is a lifelong ailment that disrupts the body’s proper utilization of insulin, predominantly affecting middle-aged and older individuals, but not sparing children and teenagers.
Alarming statistics from 2019 reveal that type 2 diabetes, whether diagnosed or undiagnosed, afflicted 4.1% of Uganda’s population, with a mere 0.4% of cases being identified, treated, and under control. This ignorance of the condition’s prevalence prevails among the majority.
Consequently, six out of ten Ugandans live in oblivion regarding their ailment, a situation that often leads to late presentations with severe complications, greatly compromising their quality of life.
To curtail the progression to type 2 diabetes, regular check-ups for early diagnosis and treatment are essential.
The researchers found that for type 2 diabetes patients, the most significant cost driver is the expenses incurred for acquiring medications and equipment from both public and private healthcare facilities.
Diabetes, as one of the leading causes of blindness, kidney failure, heart attacks, strokes, and non-traumatic lower limb amputations in Uganda, poses a grave health threat. In 2021, it was estimated that around 716,000 adults in Uganda were afflicted with diabetes, with a staggering 89% remaining unmedicated and unaware of their condition, presenting to the healthcare system with challenging complications.
The EPRC study also unveiled that the costs associated with treating type 2 diabetes, both with and without complications, are consistently higher in private healthcare settings than in the public sector.
For example, the combined cost of medications, including insulin and oral drugs, in private facilities is approximately UGX 3 million, while it is roughly UGX 1.3 million in public facilities.
Patient visits for consultation and hospitalization incur about UGX 1.4 million in private healthcare, in contrast to UGX 617,440 in public healthcare establishments. Additionally, diagnostic procedures are significantly more expensive in private healthcare facilities, reaching UGX 353,000 compared to as low as UGX 160,262 in the public sector.
The study highlights that certain complications, such as diabetic eye treatment, incur costs of UGX 10.1 million in private facilities, whereas in public facilities, the expense drops to UGX 4.6 million.
The most expensive complication is kidney transplantation, requiring UGX 120 million, and undergoing hemodialysis, which costs between UGX 14 million and UGX 31 million, depending on the healthcare provider. It’s worth noting that kidney transplants are only available through private providers, as they are not offered within Uganda’s public healthcare system.
In 2019, another study titled “Quality and Barriers of Outpatient Diabetes Care in Rural Health Facilities in Uganda – A Mixed Methods Study” emphasized the inadequacy of diabetes care in rural areas, a serious impediment to controlling diabetes and its complications.
This research, conducted by Catherine Birabwa, Mulekya F. Bwambale, and Roy Mayiga, pointed out that the most common obstacle in delivering diabetes care was the lack of essential diagnostic and monitoring equipment, as well as crucial medicines.
Health workers interviewed for the study reported recurrent stockouts of type 2 diabetes drugs and diagnostics, particularly test strips, contributing to the suboptimal management of patients and healthcare service delivery.
It is essential to recognize the signs and symptoms of type 2 diabetes, including excessive thirst, frequent urination, blurred vision, fatigue, slow wound healing, recurrent yeast infections, increased hunger, unintentional weight loss, and susceptibility to infections, among other indicators.