Uganda has insufficient GeneXpert capacity – whether it is latent or real. Appreciating the high tuberculosis (TB) prevalence rates in Uganda, action should urgently be taken in order to increase GeneXpert capacity in the country. There are two ways in which this could be done.
The first, and the more practical way in terms of achievability in the short term, is ensuring the effective use of existing GeneXpert machines. The reasons for machine downtime and malfunctioning are within the means of the Government to eradicate, through the provision of finances in order to ensure that the machines are well maintained – serviced regularly and as scheduled, as well as repaired promptly when the need arises.
It is also within the Government’s means to make provisions for constant and adequate power supply, either through the national grid and/or through installation of backup power supply sources – installation of solar panels and generators at all healthcare facilities hosting GeneXpert machines, for example.
Issues related with stock-outs of supplies and materials, such as cartridges, can also be easily resolved by the Government through more efficient monitoring of supplies and the distribution system. Certainly, the current centralised distribution system needs to be reviewed and the option to replace it with regional or even district level distribution systems should be considered.
The second option, procurement and installation of additional GeneXpert machines, is the more costly, but which could be achieved in the longer-term if Government would take seriously the provision of adequate financing for TB management in Uganda.
Yes, GeneXpert machines are very expensive. For example, the 29 GeneXpert machines that were donated to Uganda by the U.S. Government, according to media reports cost US$ 17,000 (about 61 million shillings) each.
Add to that the installation costs per machine, which can range from as low as 9.4 million shillings, if laboratory space and electricity are available at the health facility; to 25.4 million shillings, if space and power are not available. These installation costs estimates are derived from calculations of researchers in the context of Nigeria, but are applicable to Uganda as well. If these cost estimates hold true in the context of Uganda, then it means that the cost for one fully installed GeneXpert machine would be a minimum of 70 million shillings.
Implementing the second option requires strategic thinking in determining the location of the machines. Population size and density should be factored in.
It is important to first try to install new GeneXpert machines in health facilities which have laboratory space and electricity. However, in cases when it is not feasible, and the installations are done in facilities needing space and electricity, it is prudent and frugal for the Government to make sure that the requisite laboratory space, the equipment such as fridges, and the constant electricity power supply which is need are provided as part of the installation.
These recommendations are based on the findings of an empirical qualitative investigation into TB in Uganda that CPAR Uganda Ltd conducted.