For a district with some of the highest malaria incidence rates in the country, stealing of essential anti-malarials turned the malaria situation from bad to worse
APAC: A 14-year old child lets out a shrieking cry that pierces through the sleepy newly refurbished children’s ward at Apac Hospital on a cold Tuesday as her mother struggles to force her to drink some fluids.
She has been diagnosed with malaria and has just finished taking her final dose of the day. Her mother is not willing to divulge her and the daughter’s identity for fear of victimisation by hospital authorities.
But the patient is a lucky girl to have found the malarial drugs (coartem) readily available at Apac Hospital. Had she fallen ill last year, her story could have been different.
The 2015/16 Auditor General’s report cast a dark shadow over Apac Hospital, citing theft of 14 boxes of Lumartem (30 x 18), 112 boxes of Lumatem (30 x 12), 169 boxes and 120 boxes of Artefan/Coartem (30 x 6) and Lumarten (30 x 24) in Apac Hospital.
Although 71,877 units of medicines were also unaccounted for at the Kabale District Health store, no district registered more serious drug thefts than Apac Hospital that year.
Apac and Kabale hospitals are mere stand-out examples of a problem of drug thefts that is slowly but surely holding back the health sector in Uganda.
Drug theft rampant
In 2010, Health ministry officials were quoted by The Observer newspaper saying that at least 76 per cent of drugs in government health facilities disappear before reaching patients.
Essential drugs for the treatment of malaria and other common ailments and vaccines for immunising children, contraceptives for family planning, oral rehydration salts to treat diarrhoea and cotrimoxazole for cough were some of the most stolen medicines, The Observer reported.
At Apac Hospital, anti-corruption investigators discovered that Coartem and Lumarten, the basic and most critical anti-malarial drugs, could not be found for administering to desperate patients because they had somehow vanished into thin air.
For a district with some of the highest malaria incidence rates in the country, stealing of essential anti-malarials turned the malaria situation from bad to worse.
According to the etymological infective rate (EIR) conducted in 2004, the district was found to have the highest number of mosquito bites in the world standing at 1,564 bites
Apac District, sandwiched by three water bodies-Lake Kyoga and two swamps; Arocha and Wirewiri-make the district a major breeding point for anopheles mosquitoes, the malaria transmitting parasites.
The southern boundaries of the district are also along Lake Kwania and the River Nile, further adding up the mosquito breeding grounds in the area.
When the rains peak in April and August, the malaria incidences also shoot up, according to Jimmy Elvis Omoko, a medical records officer at Apac Hospital.
Thirty seven per cent of the deaths in Apac District are due to malaria, according to the 2009 statistical Abstract compiled by the Apac District Local Council.
“Whereas malaria is the number one killer in the district, it was found to be in the third rank for spending because malaria treatment drugs are cheap and no other expenditure on its control had been identified such as mosquito bed nets and their treatment plus chemicals used in control of malaria,” reads the abstract.
A 2006 story by Uganda Radio Network (URN) quoted Dr Jessie Stone, a malaria researcher, saying the malaria transmission rate in Apac is over 250 times worse than in Kampala, adding that medical researchers had found out that Apac has the highest malaria rate in the world.
With such a background of high incidences of malaria, residents in Apac District were troubled when they heard that boxes of critical anti-malarials had gone missing at Apac Hospital, leaving patients at the mercy of private medical facilities that are scarce in the sleepy district.
Problem is bigger
Mr Tom Superman Opwoya, the executive director the Apac Anti-Corruption Coalition (TAACC), says the theft of drugs at the hospital points to a larger crisis crippling the national health sector.
“If such essential drugs are missing at a hospital in a district with such high malaria rates, that explains how bad it is. It is possible that there were some deaths because of the missing drugs given how dangerous malaria can be,” Mr Opwoya says.
Dr Fanuel Sabiiti, the Acting Medical Superintendent at Apac Hospital, says the matter of drug thefts is under investigation by the Chief Administrative Officer (CAO) and he could not give an update about the inquiry.
But Dr Sabitti believes the National Medical Stores(NMS) still has its work cut out if distribution of drugs from Kampala down to respective health facilities is to be streamlined.
When asked about the matter, the Chief Administrative Officer(CAO) Stella Abyeto declined to respond to inquiries about the progress of the investigation but rather rebounded the questions to the hospital medical superintendent.
Ms Abyeto said she has just been posted from Gulu, and is not familiar with the case.
Ms Evelyn Ayuge, the head of Health Monitoring and Accountability at The Apac Anti-Corruption Coalition (TAACC), says the district leadership and the District Health Officer (DHO) have been lacklustre in dealing with the problem of drug thefts.
“When a child is brought struggling with malaria and there are no drugs to be administered to the child, the health workers tell us that in most cases, they end up losing the child. In many cases, we have alerted the district leadership about drugs going missing but nothing has been done. When we inform the Ministry of Health directly, then the district leaders get angry at us,”Ms Ayuge says.
TACC has investigated the case of drug thefts at Apac Hospital but its investigation ran into headwinds because there was no co-operation from the district leadership.
But successes have been registered in some health centres in the district, further highlighting the problem of drug thefts in this malaria prone district.
At Chawente Health Centre III in Chawente Sub-County, TAACC investigators managed to recover 161 malaria testing kits that had gone missing in December 2016. The malaria testing kits were meant to aid training for Village Health Teams (VHTs) in the sub-county.
The team also recovered 54 boxes of coatem [for adults] and 18 boxes of coatem [for children].
Although the in-charge at Chawente Health Centre III was directed to take up the matter with police by the District Health Officer (DHO), no action was ever taken, according to a report by TAACC’s Health Monitoring platform.
At Chengere Health Centre II, TAACC’s investigators recovered anti-malaria drugs worth Shs1.9m from the in-charge of Chegere Health Centre II in May 2016.
A report compiled by TAACC discovered that: “to date, the district authorities have failed to recover the drugs yet there is always shortage of drugs for patients at Apac Hospital.”
The Apac Anti-Corruption Coalition (TAACC) offices are just a stone’s throw away from Apac Hospital, making investigation into the mess at hospital a tad easier.
In 2009, President Museveni established the Health Monitoring Unit (HMU), a department within State House that was supposed to cure challenges within the health sector but particularly deal with the crisis of drug thefts.
In 2006, he directed ministry of Health officials to label government-owned drugs as “UG, NOT FOR SALE” but that strategy did not seem to work.
Mr Moses Mulumba, the Executive Director of the Center for Health, Human Rights and Development (CEHURD), a health rights advocacy group, says the HMU should change its working style if drug thefts are to be foiled.
“I think that its approach is highly ad hoc and could be made better. The HMU could, for instance, focus on strengthening the already established structures like Health Unit Management Committees (HUMCs) and Hospital Boards (HBs) and spend less effort in enforcement which is the work of the police,” Mr Mulumba wrote in an interview via email.
The current approach of the HMU, Mr Mulumba wrote, has relegated it into an agency that is feared by the very people it would have collaborated with [to deal with] medicine thefts in facilities.
Dr Ojera Jackson, the head of the HMU, says the unit has recovered supplies worth Shs15b since 2009 but quickly points out that challenges abound.
A forensic medicine audit carried out by the HMU confirmed the theft of drugs at Apac Hospital, Dr Ojera says, explaining that the matter is now before the Anti-Corruption Court.
As a solution to drug thefts, Dr Ojera argues that there needs to be: “continuous surveillance of supply chain management and prompt detection and reporting of thefts.”
“Expedite the process of the National Health Insurance[Scheme] and start operationalisation. This will be a lasting solution in streamlining per capita health expenditure,” Dr Ojera wrote in an email interview.
The National Health Insurance Bill, 2012 that seeks to create the National Health Insurance Scheme (NHIS) is currently before Parliament’s Health Committee.
For drug supply and distribution, the National Medical Stores (NMS), the body that was established to procure, store and distribute essential medicines and other medical supplies to public health facilities, still grapples with enforcement challenges.
With some stolen drugs found in neighbouring countries, especially eastern Congo and South Sudan, according to the NMS website, arresting offenders in foreign countries can be legally tricky.
This story was reported with support from the Centre for Policy Analysis (CEPA).