Access to controlled medicines during COVID-19 in Ethiopia

Categories: Care, Featured, and People & Places.

Author: Natnael Alemayehu, MD

Medical Oncology & Palliative care Physician

COVID-19 poses an alarming challenge on access to controlled medicines in Ethiopia. The system of palliative care we created for years at Hawassa to make the hospital a place for comfort is being shadowed by the shortage of opioids due to prolonging the suffering of our clients.

For years, the palliative care provision in Ethiopia is challenged by the limited access to care. There are few centers in the country, most located in urban areas. These centers have long been challenged by the unsustainable supply system for essential drugs especially opioids. The use of opioids in Palliative care is of paramount importance for symptom control at the end of life. From pain control to dyspnea and sedation opioids play a significant role. The most essential opioid in palliative care is Morphine, especially in the developing world.

Access to Morphine was a challenge for decades if not centuries. Years back a local pharmaceutical company started manufacturing Morphine in the country. But since production ceased due to multiple factors accessing Morphine and other opioids has been difficult, particularly the required preparation of Morphine in the required amount.

In this era of COVID-19 the already weak health care system is being challenged both logistically and incapacity and one of the disciplines most highly affected is palliative care.  Palliative care patients are at higher risk of developing severe COVID-19 and though they require frequent follow-up, the pandemic prevents them from receiving this. They are at high risk of becoming isolated and without the proper expression of affection to the family members. With family income already compromised due to their chronic illness, their finances are further affected by their restricted stay at home and the economic impact of the pandemic globally. Patients who do receive homecare visits are also diverted to a phone call-based care rather than a physical presence.

Since much of the treatment of COVID-19 is symptom control there is a scramble to access essential symptom control drugs due to increased demand in the consumption of these drugs. This challenge is reflected profoundly on the availability of opioids as it is in use for the management of breathlessness and pain control in COVID-19 patients.

Due to the global current challenge in the production and distribution of goods, Ethiopia is affected by limited access to opioids. This is reflected by an interrupted supply of opioids; unstable market price; the difficulty of accessing the right preparation of opioids and a limited range of opioids available. For instance in Hawassa University Comprehensive Specialized Hospital Palliative care unit (HUCSH), Morphine was out of stock for more than two consecutive months in a row. This is compounded by the unstable supply from private stores, which was previously available prior to COVID. When it is possible to access Morphine in the hospital the syrup preparation is no longer available, forcing patients to divide the only available 30 mg tablet preparation into multiple parts to get the required low dose of the medicine. There is no alternate strong opioid to Morphine in Ethiopia. The issue is similar to other weak opioids i.e. tramadol and codeine.


Woynshet’s Story – a challenge to access opioids

Woynshet is 47-year-old stage four breast cancer female patient who was on our palliative care for the past one and half years at (HUCSH). She initially presented with very severe bone pain and a fungating breast mass.  She is one of the first patients to benefit from our home care service.  Her husband abandoned her when she was diagnosed with the disease and she is living with her two sons aged three & five.  Although she is working as a cleaner for wealthy families in the neighbourhood, the disease prevents her from working at additional sites to cover the daily needs of herself and her children. The home care provision benefited Woynshet to bring this needy but rare care at her doorstep with the most possible supports. She is evaluated for symptoms regularly every week at which time she can raise her concerns and try to be addressed at the earliest time possible. HUCSH is providing home-based palliative care services in collaboration with Hospice Ethiopia. Woyneshet is getting holistic home care service and food support through this project.

With the breakout of COVID-19 her employer prevented her from going into their home in order to protect themselves from the disease, creating a challenge for Woynshet to support her family financially. The country’s weak health insurance system covers her treatment costs at public hospitals and public pharmacies only.  With private supplies of Morphine three to five times the cost of the drug through the government health system and therefore unaffordable for patients like Woynshet. She spent nearly a month suffering while waiting for the medicine to be available at public hospitals or public pharmacies. Since the incidence of Covid, the challenge to access opioids is highly affecting thousands of patients like Woynshet

In summary, COVID-19 besides the obvious direct burden on the health care system is having an intense impact on the delivery of palliative care in Ethiopia. Lack of availability of essential drugs impacts directly on the quality of life of people at the end of life in the country. A coordinated effort locally and globally needs to be in place to avail these essential medicines like Morphine to fulfill the patient’s human right – “to live without suffering”.


Author: Natnael Alemayehu, MD

Medical Oncology & Palliative care Physician

Hawassa University Comprehensive Specialized Hospital

Palliative care Unit

Hawassa, Ethiopia

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