1. By Fred Kigozi M.D WPA Zone 14 Representative/ President Uganda Psychiatric Association, Director Butabika Hospital E-mail: buthosp@infocom.co.ug or buthosp@infocom.co.ug BUILDING SERVICE DELIVERY SYSTEMS FOR SUBSTANCE ABUSE TREATMENT UCLA INTEGRATED SUBSTANCE ABUSE PROGRAM CONFERENCE, SEPTEMBER 5 – 7, 2005; ISTANBUL, TURKEY

2. Introduction:  Uganda is located in East Africa.  Size – 236,04 Sq. kms - Land – 199,710 sq km - Water - 36,330 sq km  Population - 24.7 million - Male - 12.1 M - Female - 12.6 M - Urban population % = 12%  Kampala – Capital city  Equatorial climate  Politically stable save for Northern insurgency  GDP - 340 USD  Economy – Mainly Agricultural

3. Health Indices:  IMR - 28/1000  Life expectancy - 43 years  MMR - 504/100,000  Fertility – 6.9  Safe water coverage – 43%  Age structure - 0.4 years ~ 4.9 M

4. Major Religion:  Anglican - 10.2 M  Catholic - 8.8 M  Muslim - 2.96 M  Others - 1.1M

5. : Drug Abuse Situation : Alcohol: ‣ Most commonly abused drug in the country with a per capita consumption of 17.4% (WHO – 1995). Tobacco: ‣ Commonly used all over the country. ‣ Serves as a gateway to use of other drugs by the youth. ‣ Many times used in combination with other drugs. Cannabis: ‣ Mostly commonly abused narcotic in the country. ‣ Contributes significantly to the admissions at the National Referral Mental Hospital (Approximately 10%) ‣ Grows all over the country ‣ Several seizures are made every year by police e.g. between June 2003 - June 2005:- - 27,315 kg of herbal cannabis was seized - 48,853,511 cannabis plants were destroyed. - 160 kg cannabis seeds were seized

6. Drug Abuse Situation: (Contd) Heroine: Recently introduced in Uganda. Initially known to be in transit from Asia  Europe. Of late used by both indigenous Ugandans and common especially among the business community, students and people returning from abroad. Methods of use; sniffing, injecting – beginning to surface. Cocaine: Not commonly used. Is available in very small quantities. Khat: A legal drug at the moment. Originally used by foreigners from the Horn of Africa (Ethiopia, Somalia) culture now spread to indigenous Ugandans. Others: Organic solvents mainly by street children, victims of war and HIV/AIDS.

7. Magnitude of the Problem: Studies rather scanty. Per capita consumption of alcohol 17.4l (WHO – 1995). Hospital admission due to alcohol/drug abuse on the increase in Butabika Hospital ~ 15%. Police reports of seizures on the increase between 2003 & 2005: - Heroin - 10.3 kg - Cannabis - 27,315 kg - Coccaine - None Drug related crimes on the increase. School surveys indicate increasing problems e.g. schools within the City – 20% admit to regular use of alcohol.

8. Substance Abuse related problems Neuro-psychiatric Disorder HIV through: - Impaired judgement after use - Commercial sexual workers - IDU Physical injuries through RTA – resulting from use of Alcohol and drugs. Physical illness due to withdrawal intoxication or chronic use.

9. Treatment: Available at all levels of care due to our integrated treatment approach. Specialized care is available only at the National Referral Mental Hospital. A specialized facility 30 beds is available. This is supported by Government and clients get free treatment. The Hospital also runs an Outpatient Treatment facility. There are two NGOs based treatment centres with bed capacity of 12 and 15 beds respectively. These are paying facilities. Clients pay on average 20 USD per day. Detoxification is done at any of the Government hospitals both at Outpatient and Inpatient levels. One NGO based Treatment Centre offers detoxification following support of UNODC – ROEA. Methadone is not used. After-care services exist alongside the emerging AA and NA support services. On average, the National Referral sees 80 clients per year. The two NGO Centres see about 100 clients per year.

10. Challenges: Lack of an IMDCC. Lack of policies related to demand reduction. Weak and ineffective laws. Low public awareness and education. Limited skilled human resources. Limited inpatient facilities. No National Drug Control master plan.

11. Thank you