Although the infrastructure at most public hospitals has been given a facelift, the service delivery has not been upped.
It has become commonplace to hear complaints about shortage of drug supplies in government health facilities. It is a story that brings to bare the shortfall that has defined government health facilities.
Right from the big hospitals to health centres in villages, the cry about drug shortage is a binding factor.
Where is the problem?
But the major question is how did the situation get this bad? Engaging National Medical Stores (NMS), the government’s agency supplying drugs, reveals some key issues that need to be dealt with if the country is to satisfactorily utilise the drug supplies.
“Until we are able to do something about theft of drugs, expiry of drugs, the prescription of these medicines, even if a hospital is given Shs100 billion worth of medicines monthly, there will still be a shortage,” Moses Kamabare, the NMS general manager says.
With a rapid increase in population, a number of health facilities have been stretched beyond their capacity, however, outside the stretch is a bigger problem that involves a racket of thieving health workers, who with impunity, steal drugs from health facilities.
The theft, one could argue, could be the key reason that has kept health facilities across the country in perennial lack of drugs, notwithstanding the fact that drugs are supplied.
Recently, medical workers in Rukungiri and Kanungu districts complained of shortage and late delivery of drugs in the two districts’ health facilities.
Jonathan Kintu, a senior nursing officer at Rukungiri Health Centre IV told a consultative meeting for in-charges of government health centres held in Rukungiri Town that: “NMS does not supply drugs according to requisition despite inviting health officials every year to participate in the budgeting for their health facilities.”
The drug stockouts, the health workers said, had resulted into absenteeism at the facilities.
They said it was pointless to be at a health centre when there are no medicines to give patients.
Kamabare refutes the claims saying health facilities receive what they requisition for.
“Health facilities across the country draw budgets at the beginning of the financial year which are submitted to NMS. It is these budgets that we use to determine supplies,” Kamabare says pointing out that the stores also follow a specific delivery schedule. He noted that according to the schedule, drugs are supplied to different districts every two months.
Despite following a schedule, the case of drug shortage, according to Kamabare, will not be solved unless the menace of drug theft is dealt with.
Theft of drugs has been a cancer that is perpetuated through connivance between the public, which cares less, health facilities and leaders at district level.
“We have a policy that requires us to have a member of the public or district official witness drug deliveries at the districts. But it has not yielded any success as people always come up with excuses for their absence which to us creates a major loophole that sometimes is exploited by the thieving racket,” Kamabare says.
Beyond the drug thefts, shortages are sometimes artificial created by health facilities dispatch officials.
Last year, a case of drug shortage was reported in Bududa District, however, unknown to the public at one health centre that was given an impromptu visit by the Health minister and NMS officials, was that supplies had been delivered, packed in the stores, perhaps waiting to expire.
“How do you blame NMS on such an issue?” Kamabare asks, urging the district officials to get involved especially by making sure that when drugs are delivered they are sufficiently dispatched for patients’ use.
But is it just an issue of theft or there could be genuine shortage even at NMS?
For Kamabare, drug shortage at the national stores should not be an issue but the issue should be where the ones which are supplied disappear to.
“We supply enough drugs to all government health facilities across the country and in the right time but the media is always reporting shortages across the country,” Kamabare says, asking who uses the ones we supply.
In January, various newspapers reported that there was severe drug shortage of anti-malarials and antibiotics in Kabale District. Health workers said NMS last supplied drugs on November 27. This, according to the NMS delivery schedule, meant that they would supply drugs to the district again at the end of January.
In fact when asked, Dr Patrick Tusiime, the Kabale District health officer, admitted that they have already received the stock-out reports of both antimalarials and antibiotics from Kashambya, Rwamucucu, Bukinda, Muhanga, Kamwezi, and Kamuganguzi health centres due to the outbreak of malaria in the district.
He, however, expressed optimism that NMS will supply more drugs by the close of the month (January). Dr Tusiime, blamed the stock-outs to the theft of drugs by some of the government health workers. He said his office had received reports that some health workers sell the drugs to private clinics in Kabale Municipality and middlemen who sell the drugs to DR Congo.
Therefore, Kamabare says, health facilities are expected to request for enough drugs in consideration to their patient to drug ratio or the common ailments most of their patients in the area grapple with.
“Health facilities know how much their budget is at the beginning of the year. The budgets together with drug specifics are availed to NMS. It is from here that we determine what to supply to the facilities throughout the year. But in case of shortage, there is a toll free line on which patients, health workers can call and alert the NMS,” Kamabare says.
Deliveries alone cannot solve the shortage problem the public too, should get vigilant and report drug theft. Kamabare says fighting drug theft cannot be left to the government alone.
Mulago hospital, according to Kamabare, gets about Shs13 billion in drug supplies every year which is about Shs1 billion per month but the facility has the highest number of complaints when it comes to drug stockouts.
But the irony is claims of the drug thefts that end up in private pharmacies in and around Kampala and beyond continue undeterred.
“Why should we accept deceptions?” Kamabare asks adding “Can a pharmacy be richer than the government. Citizens should seek to solve this mystery.” “Until we are able to do something about drug thefts, even if a hospital is given Shs100 billion worth of medicines we will still have a shortage,” Kamabare says.
The Daily Monitor story “Stolen govt drugs recovered in private hospital” on January 27, revealed that some government drugs had been recovered in a private clinic in Tororo. The police spokesperson for Bukedi region, Michael Odongo, said the recovered drugs, including 500 doses of hepatitis B vaccines and testing kits found had been reported missing from Molo Health Centre IV in Molo Sub-county. “We discovered that the hospital was offering Hepatitis B treatment at a very cheap price. We began inquiring about the source of their vaccine. We eventually discovered that both the vaccines and testing kits were bearing government of Uganda symbols,” Odongo, said.
In his letter “It’s a joy campaigning for NRM; the party is simply unstoppable” published in the Daily Monitor on December 23, President Museveni said Uganda has more than 193 health centre IVs and 930 health centre IIIs. He, however, said there are persistent complaints of drug thefts and absenteeism, but added that the Health Monitoring Unit, which has so far made 227 arrests of suspected drug thieves, is building capacity to stamp out the vice.
On January 26, a Daily Monitor story revealed that two medical workers at Kasambya Health Centre IV in Mubende District were arrested over stealing government drugs, taking bribes from patients in order to give them government drugs. Their arrest followed an investigation by the Health Monitoring Unit.
Most prone drugs
According to Dr Diana Atwine, the Health Monitoring Unit boss, most sold drugs are anti-malarials and ARVs. “Many heath workers have turned selling government drugs into a business. This is illegal. We shall not relent until we completely fight the vice,” she said.
Dr Atwine also said Mama Kits which are given free of charge are sold to expectant mothers adding that some health workers unpack the kits and sell the contents separately. She said the medics sell the cotton wool at Shs1,500, gauze (Shs5,000), polythene paper (Shs5,000)and gloves (Shs1,500).
The Health Monitoring Unit was established by President Museveni in 2010 to check theft of medical supplies from public health facilities.
But like Kamabare says, unless the aforementioned loopholes in managing drugs are addressed, there will never be adequate resources for drugs. “You cannot say there isn’t enough water in your jerrycan when it has a leakage,” he says.
In October last year the State House Health Monitoring Unit team revealed government medicines were being sold in DR Congo by health workers in Kasese District.
Dr Pontiano Jjumba, the assistant director of the Monitoring Unit, said this after police had intercepted government drugs at Mpondwe –lhubiriha border enroute to DR Congo.
He told district leaders in Kasese that health workers are either accomplices in the scam or they are often absent from their duty stations when the drugs are stolen.
“If you went to DR Congo now, you would see what we are telling you, every drug you ask for in the drug shops and clinics has the “UG” label, meaning that it is our health workers who sell the drugs there. Whoever does not explain how drugs are used at his or her health facility will be punished,” Dr Jjumba warned.
He had also noted that at Bwera Hospital laboratories, the attendants were using expired reagents, thus putting people’s lives at risk.