Drugs waste as authorities deny responsibility

A pile of expired drugs and testing kits welcomes you at Kalangala Health Centre IV.
A heap of mid-sized white boxes stuffed in red polythene bags rests abandoned on metallic bed right outside the main drugs store. These are anti-retroviral therapy drugs (ARVs) and testing kits; expired and abandoned.

The stack also contains small tins bearing a ‘USaid’ logo in full glare of patients seeking treatment at the health facility.

Clearly, the unsecured expired medicines pose a risk of being consumed by desperate patients. Worst still, the drugs could fall into the hands of unscrupulous people who might repackage them for sale.

During a recent visit to the island, Daily Monitor discovered that the drugs were either donated by the United States Agency for International Development or the Centres for Disease Control and Prevention (CDC) which is supporting HIV/Aids treatment in Kalangala District.

Concern
During the same visit, the body mandated to monitor utilisation Global Fund-supported programmes, the Country Coordinating Mechanism (CCM) expressed concerns over wastage of drugs by health facilities located on the district islands.

“It is painful to see drugs go to waste here yet there are people who are suffering without drugs in some other parts of the country,” says Syson Namaganda, Secretariat Coordinator at CCM during a fact finding mission by her team on how health facilities at the island are benefiting from the global funds.

She adds that the management at the National Medical Stores should come out to explain the circumstances under which these drugs expire resulting into gross wastage yet a lot of money is spent purchasing them.

However, Filliam Kerunoga, a senior clinical officer at Kalangala Health facility told Daily Monitor that the expired drugs are returns from lower health centres on the Kalangala islands after not being consumed or utilised.
“We are unable to utilise all of them due to expiry; they are brought when their date of consumption is very low,” he says.

Accused
However, Moses Kamabare, the NMS general manager said when drugs are delivered, their responsibility, proper use and management lies in the hands of the hospital or health facility managers.
“All medicines received by a facility are expected to be used before they expire,” he says.

But a NMS delivery note obtained from the medicines store at Kalangala Health Centre IV, indicates that co-trimoxazole drugs, with an expiry date of January 30, 2016 were delivered at the facility by NMS on December 11, 2015.
This meant that the shelf-life for the 100 units of co-trimoxazole was less than two months.

“Those are donations and not NMS normal stock that the facility would have requested with an undertaking to use them before they expire. That’s why the invoice value is 00 and the packs are only few,” said Kamabare.

He adds that under a different arrangement, the facility should have rejected or returned on delivery if they were not on special request.
However, an official at CCM said the 00 indicated on the invoice appears on all drugs supplied by the Global Fund. “This does not have an impact on money allocated on the budget line for a facility,” she said.

Upon expiry, Mr Kamabare said the district is supposed to arrange for the destruction of expiry drugs by paying the National Drug Authority (NDA) or NMS to destroy them on their behalf.

In scenarios where the drugs are supplied in excess, Kamabare said there is a government policy known to all districts on redistribution of excess drugs.
However, in an interview, Steven Wiersma, the CDC country director said they do not supply any drugs but only provide government with personal and technical support.

On behalf of Usaid, Susan Parker-Burns, the public affairs officer at the US Embassy in Kampala, said: “According to our partners in Kalangala, the expired medication was for the treatment of bilharzia.”

“This medication came from the National Neglected Tropical Diseases Programme. The centre was sorting these expired medications in preparation for placing them in the NMS district drug expiry container, per Government of Uganda protocols, ” she said adding that when US government-funded organisations receive drugs with a short shelf life from NMS, they prioritise sending them to high volume sites.”

HIV/Aids in Kalangala
According to Ms Christine Zawedde, the programme manager to the CDC and PEPFAR funded Compressive Public Health Services project, about 5,401 HIV patients are currently receiving treatment in the district.
The Kalangala District also has one of the Key most at risk populations, the fish folks, and its HIV/Aids prevalence is at 25 per cent higher than the national prevalence by almost three times.

Avert drug wastage
In order to avoid drug wastage and shortage, Emmanuel Higenyi, director technical services at the Joint Medical Stores, said there should be good coordination between drug distributors to avoid duplication in projections.
“There is a risk of having a bloated stock at times when wrong projections are made,” Higenyi opined, adding that specific diseases such as HIV/Aids, Malaria and tuberculosis require a vertical approach.

He explained that the concept requires each supplier to have a different segment of the population. Under this arrangement, NMS supplies to government owned facilities, JMS which supplies medicine to faith based health facilities and other supplies like Medical Access Uganda Ltd (MAUL) and Uganda Health Marketing Group (UGMG) to the private facilities
Higenyi said for medicines supply chain system to work well, four parameters including: shelf-life, consumption rate, storage capacity and the capacity of the users have to be synchronised.

On capacity of users as a yard stick, Higenyi explained that they must have the right attitude, professionally responsible and technically competent.
“The users are the ones who see patients and keep service statistics used in forecasting,” he said while emphasising the importance of proper record keeping.

“If the people are not able to competently collect data, then they don’t have scientific basis of making projections and this leads to gross shortage and gross of overstock, leading to expiry and wastage,” Higenyi said.
He added that inter-warehouse transfer can be employed during periods of a shortage crisis. ‘This involves movement of medicines from NMS to JMS and vice versa and the same can happen at the district level.

“There is need to employ a concept known as first-expiry, first out to manage the medicines at a facility level,” Higenyi advises, adding that stock with a shorter shelf life should be uterised first.
Hospitals and health facilities are also expected to ration medicines
Other measures in curbing medicines include, building capacity of cadres who handle the drugs at the health facilities.

Higenyi says that at JMS, they have deliberately put a programme to capacitate their people who handle their medical logistics. Under normal circumstances, expired drugs are supposed to be kept in a secure place before being transferred to Nakasogola District for destruction.

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