In Uganda, the true extent of the financial burden imposed by diabetes care remains largely unknown to the general public. The cost, especially for type 2 diabetes mellitus (T2DM), affecting around 4.2% of the population, has recently been brought to light through a study conducted by the Economic Policy Research Centre (EPRC), a think tank based at Makerere University.
The study, led by renowned researchers such as Dr. Madina Guloba, Blessing Atwine, and Pauline Nakitende, titled “Economic burden of type 2 diabetes Mellitus in Uganda: A cost-of-illness analysis,” has revealed the previously underestimated financial aspect of caring for this type of diabetes.
This investigation, whose findings were published in August, sought to estimate the total direct economic costs of managing and treating Type 2 diabetes mellitus (T2DM) in Uganda, encompassing both public and private healthcare perspectives.
According to the study, the cost of caring for individuals with type 2 diabetes consumes a significant portion, approximately 13%, of the Ministry of Health’s budget. In the fiscal year 2021/2022, the Ministry received an allocation of UGX 3.331 trillion. In 2022, approximately UGX 2.2 trillion was allocated for medication, treatment, and managing complications related to type 2 diabetes.
The report highlights that households bear the largest financial burden, totaling UGX 1.7 trillion, while government expenditure on diagnosed T2DM patients accounted for 13% of the Ministry of Health’s budget, approximately UGX 435 billion.
The study’s findings also reveal that both the government and households continue to shoulder the financial weight of diagnosed Type 2 diabetes, with most patients covering the cost of the disease out-of-pocket, impacting their overall quality of life.
Furthermore, the researchers noted that treating all individuals in need of care, both diagnosed and undiagnosed, would cost the country approximately UGX 4.2 trillion, equivalent to about 8.7% of the 2022/23 total national budget. Type 2 diabetes, a lifelong disease that interferes with the body’s insulin utilization, primarily affects middle-aged and older individuals but can also affect children and teenagers. In 2019, it was found that 4.1% of Uganda’s population was affected by Type 2 diabetes, with only 0.4% having been diagnosed, treated, and under control.
From the research findings, it becomes evident that a majority of Ugandans live in ignorance of their medical conditions and often present late with complications that significantly worsen their quality of life. Early diagnosis and treatment are crucial in preventing the progression of the disease to type 2.
For type 2 diabetes patients, the study identifies the cost of medicines and equipment at both public and private healthcare facilities as the primary driver of expenses. Diabetes is a leading cause of blindness, kidney failure, heart attacks, strokes, and non-traumatic lower limb amputations in Uganda. In 2021, an estimated 716,000 adults in Uganda had diabetes, with about 89% being neither on medication nor aware of their condition, leading to challenging-to-treat complications.
The study also reveals that the costs of treating type 2 diabetes, with or without complications, are generally higher in private healthcare facilities compared to public ones. For instance, the combined unit cost of medication for insulin and oral drugs in a private facility is approximately UGX 3 million, while it is about UGX 1.3 million in a public facility. Patient visits, including consultation and hospitalization, cost about UGX 1.4 million in private healthcare, whereas it costs UGX 617,440 in public healthcare facilities. The cost of investigations is approximately UGX 353,000 in private health facilities and as low as UGX 160,262 in public health facilities. The study notes that the costliest complication is a kidney transplant at UGX 120 million, and undergoing hemodialysis ranges from UGX 14-31 million, depending on the healthcare provider. Notably, kidney transplants are only available privately in Uganda.
A prior study in 2019, titled “Quality and barriers of outpatient diabetes care in Rural Health Facilities in Uganda – a mixed methods study,” revealed that the quality of type 2 diabetes care, particularly in rural areas, faced significant challenges. Poor availability of diagnostic/monitoring equipment and essential medicines emerged as the most common cross-cutting barrier in the delivery of diabetes care. Health workers frequently experienced stockouts of type 2 diabetes drugs and diagnostics, affecting patient management and overall service delivery.
Lastly, recognizing the symptoms of Type 2 Diabetes is essential for early diagnosis. Signs and symptoms include excessive thirst, frequent urination, blurry vision, fatigue, slow wound healing, recurring yeast infections, increased hunger, unintentional weight loss, and susceptibility to infections.
