{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T08:39:47Z","timestamp":1781080787552,"version":"3.54.1"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2005,8,10]],"date-time":"2005-08-10T00:00:00Z","timestamp":1123632000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Public Health"],"published-print":{"date-parts":[[2005,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Despite growing HIV and cancer prevalence in Sub-Saharan Africa, and WHO advocacy for a public health approach to palliative care provision, opioid availability is severely limited. Uganda has achieved a morphine roll-out programme in partnership with the Ministry of Health. This study aimed to evaluate that programme by identifying challenges to implementation that may inform replication.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A multi-methods protocol appraised morphine regulation, storage, prescribing, and consumption in three phases: key informant interviews throughout the opioid supply chain, and direct observation and audit of clinical practice.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Regulation had achieved its goal of preventing misuse and leakage from the supply chain. However, the Government felt that relaxation of regulation was now appropriate. Confusion and complexity in storage and authorisation rules led to discontinuation of opioid pain management at the patient level and also wasted service time in trying to obtain supplies to which they were entitled. Continued neglect to prescribe among clinicians and public fear of opioids led to under prescribing, and clinical skills showed some evidence of need for improvement with respect to physical assessment and follow-up.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>The Ugandan programme offers a successful model for both advocacy and Governmental support in achieving opioid roll-out across health districts. Despite initial concerns, abuse of opioids has not been evident. Further work is required to ensure that available supplies of opioids are prescribed to those in need, and that clinical standards are met. However, the programme for roll-out has proved a useful model to expand opioid availability as the first step in improving patient care, and may prove a useful template for other Sub-Saharan African countries.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/1471-2458-5-82","type":"journal-article","created":{"date-parts":[[2005,8,11]],"date-time":"2005-08-11T06:23:54Z","timestamp":1123741434000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":63,"title":["An evaluation of a morphine public health programme for cancer and AIDS pain relief in Sub-Saharan Africa"],"prefix":"10.1186","volume":"5","author":[{"given":"Dorothy E","family":"Logie","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Harding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2005,8,10]]},"reference":[{"key":"237_CR1","volume-title":"Cancer pain relief and palliative care","author":"World Health Organisation","year":"1990","unstructured":"World Health Organisation: Cancer pain relief and palliative care. 1990, Geneva: WHO"},{"key":"237_CR2","volume-title":"Cancer pain relief; with a guide to opiate availability","author":"World Health Organisation","year":"1996","unstructured":"World Health Organisation: Cancer pain relief; with a guide to opiate availability. 1996, Geneva: WHO"},{"key":"237_CR3","volume-title":"Use of essential narcotic drugs to treat pain is inadequate, especially in developing countries","author":"International Narcotics Control Board","year":"2004","unstructured":"International Narcotics Control Board: Use of essential narcotic drugs to treat pain is inadequate, especially in developing countries. 2004, [http:\/\/www.incb.org\/e\/press\/2004\/press_release_2004-03-03_6.pdf]"},{"key":"237_CR4","volume-title":"Pain and palliative care in the developing world","author":"M Spencer","year":"2003","unstructured":"Spencer M: Pain relief in Thailand. Pain and palliative care in the developing world. Edited by: Rajagopal M, Mazza D, Lipman A. 2003, New York: The Haworth Medical Press"},{"key":"237_CR5","volume-title":"Health Sector Plan 2003","author":"Ministry of Health (Uganda)","year":"2003","unstructured":"Ministry of Health (Uganda): Health Sector Plan 2003. 2003, Kampala"},{"key":"237_CR6","doi-asserted-by":"publisher","DOI":"10.4324\/9780203413081","volume-title":"Analyzing qualitative data","author":"A Bryman","year":"1994","unstructured":"Bryman A, Burgess RG: Analyzing qualitative data. 1994, London: Routledge"},{"key":"237_CR7","volume-title":"Handling Class A Drugs","author":"Ministry of Health (Uganda)","year":"2001","unstructured":"Ministry of Health (Uganda): Handling Class A Drugs. 2001, Kampala"},{"key":"237_CR8","volume-title":"Oxford Textbook of Palliative care medicine","author":"D Doyle","year":"1998","unstructured":"Doyle D, Hanks GW: Oxford Textbook of Palliative care medicine. 1998, Oxford: Oxford University Press, 2","edition":"2"},{"key":"237_CR9","volume-title":"Pain and symptom control in the cancer and\/or AIDS patient in Uganda and other countries","author":"A Merriman","year":"2002","unstructured":"Merriman A, Benton TF: Pain and symptom control in the cancer and\/or AIDS patient in Uganda and other countries. 2002, Kampala: Hospice Africa Uganda, 3","edition":"3"},{"key":"237_CR10","volume-title":"Introducing palliative care","author":"RG Twycross","year":"1995","unstructured":"Twycross RG: Introducing palliative care. 1995, Oxford: Radcliffe Press"},{"key":"237_CR11","volume-title":"Handling Class A Drugs","author":"Ministry of Health (Uganda)","year":"2001","unstructured":"Ministry of Health (Uganda): Handling Class A Drugs. 2001, Kampala: Ministry of Health"},{"key":"237_CR12","volume-title":"Pain and palliative care in the developing world","author":"J Stjernsward","year":"2003","unstructured":"Stjernsward J: Instituting palliative care in developing countries \u2013 an urgently needed and achievable goal. Pain and palliative care in the developing world. Edited by: Rajagopal M, Mazza D, Lipman A. 2003, New York: The Haworth Medical Press"},{"key":"237_CR13","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1016\/S0140-6736(01)05322-3","volume":"358","author":"M Rajagopal","year":"2001","unstructured":"Rajagopal M, Joranson D, Gilson A: Medical use, misuse, and diversion of opioids in India. Lancet. 2001, 358: 139-143. 10.1016\/S0140-6736(01)05322-3.","journal-title":"Lancet"},{"key":"237_CR14","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1093\/heapol\/16.3.240","volume":"16","author":"EF Nsutebu","year":"2001","unstructured":"Nsutebu EF, Walley JD, Mataka E, Simon CF: Scaling-up HIV\/AIDS and TB home based care: lessons from Zambia. Health Policy Plan. 2001, 16: 240-7. 10.1093\/heapol\/16.3.240.","journal-title":"Health Policy Plan"},{"key":"237_CR15","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1136\/bmj.326.7385.368","volume":"326","author":"SM Murray","year":"2003","unstructured":"Murray SM, Grant E, Grant A, Kendall M: Dying from cancer in developed and developing countries: lessons from two qualitative interview studies of patients and their carers. BMJ. 2003, 326: 368-371. 10.1136\/bmj.326.7385.368.","journal-title":"BMJ"},{"key":"237_CR16","doi-asserted-by":"publisher","DOI":"10.1007\/b100338","volume-title":"AIDS in Africa","author":"M Essex","year":"2002","unstructured":"Essex M, Mboup S: AIDS in Africa. 2002, New York: Kluwer Academic, 2","edition":"2"},{"key":"237_CR17","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1136\/bmj.327.7408.192","volume":"327","author":"E Kikule","year":"2003","unstructured":"Kikule E: A good death in Uganda: survey of needs for palliative care for terminally ill people in urban areas. BMJ. 2003, 327: 192-4. 10.1136\/bmj.327.7408.192.","journal-title":"BMJ"},{"key":"237_CR18","volume-title":"Planning and Economic Development (MoFPED) Poverty Status Report","author":"Ministry of Finance (Uganda)","year":"2002","unstructured":"Ministry of Finance (Uganda): Planning and Economic Development (MoFPED) Poverty Status Report. 2002, Kampala: Ministry of Finance"},{"key":"237_CR19","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1136\/bmj.327.7408.209","volume":"327","author":"C Sepulveda","year":"2003","unstructured":"Sepulveda C, Habiyambere V, Amandua J, Borok M, Kikule E, Mudanga B: Quality care at the end of life in Africa. BMJ. 2003, 327: 209-213. 10.1136\/bmj.327.7408.209.","journal-title":"BMJ"},{"key":"237_CR20","volume-title":"Palliative care in Sub-Saharan Africa: an appraisal","author":"R Harding","year":"2004","unstructured":"Harding R, Higginson IJ: Palliative care in Sub-Saharan Africa: an appraisal. 2004, London, UK, Diana, Princess of Wales Memorial Fund, [http:\/\/www.theworkcontinues.org]"},{"key":"237_CR21","doi-asserted-by":"publisher","first-page":"1971","DOI":"10.1016\/S0140-6736(05)66666-4","volume":"365","author":"R Harding","year":"2005","unstructured":"Harding R, Higginson IJ: Palliative Care in Sub-Saharan Africa: an appraisal of reported activities, evidence and opportunities. Lancet. 2005, 365: 1971-1977. 10.1016\/S0140-6736(05)66666-4.","journal-title":"Lancet"}],"container-title":["BMC Public Health"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/1471-2458-5-82.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/1471-2458-5-82\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/1471-2458-5-82","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/1471-2458-5-82.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,31]],"date-time":"2021-08-31T22:46:42Z","timestamp":1630450002000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpublichealth.biomedcentral.com\/articles\/10.1186\/1471-2458-5-82"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2005,8,10]]},"references-count":21,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2005,12]]}},"alternative-id":["237"],"URL":"https:\/\/doi.org\/10.1186\/1471-2458-5-82","relation":{},"ISSN":["1471-2458"],"issn-type":[{"value":"1471-2458","type":"electronic"}],"subject":[],"published":{"date-parts":[[2005,8,10]]},"assertion":[{"value":"20 April 2005","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 August 2005","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 August 2005","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}}],"article-number":"82"}}