Audit uncovers rot in Wakiso health facilities

Friday March 9 2018

John Muwanga, Auditor General

John Muwanga, Auditor General 


WAKISO- An audit into the state of health services in Wakiso District has pointed to below standard processes, including keeping expired drugs within the stores and understaffing as some of the underlying issues.

The Auditor General (AG), Mr John Muwanga’s 2017 report, indicates that after inspection, it was evident that the controls over expired drugs were not functioning as intended.

The AG says Part 9 – of the Management of Medicines and Health Supplies (MMHS) manual requires that expired items should be properly recorded, positioned in a designated area and destroyed in accordance with the local regulations.

“I observed that units of assorted essential medicines and health supplies had expired and had not been destroyed. This can result in the expired drugs getting redistributed to the market,” Mr Muwanga notes in the report, which was released in January.

Mr Luke Lokuda, the Wakiso District chief administrative officer, says drugs expire due to varied factors such as lowering prevalence of certain diseases, community adoption of local mechanisms to cure certain diseases, the expiry shelf life and decrease in prevalence of diseases.

“It is a combination of factors that lead to drug expiry. But we ensure they are kept safe not to get back into the community and wait for the National Drugs Authority to pick and destroy them,” he says.
The Auditor General’s report also pointed at understaffing, which is crippling service delivery at many health centres in the district.

At Buwambo Health Centre IV, for example, out of the 48 approved positions, only 17 (35 per cent) posts were filled, leaving 31 (65 per cent) posts vacant.

At Wakiso Health Centre IV, out of 16 approved positions, only 4 posts (25 per cent) were filled, leaving 12 (75 per cent) posts vacant.

Entebbe Hospital has an approved staff structure of 190 positions, but only 141(74 per cent) positions were filled, leaving 49 (26 per cent) positions vacant.

“The position of a pharmacist is critical in medicine management and requires urgent attention at Entebbe Hospital,” Mr Muwanga warns.

He says understaffing overstretches the available staff beyond their capacity and creates job-related stress to the fewer staff and negatively affects the level of public service delivery to the community.

While the majority of households in Wakiso District can access health facilities within a radius of 5km, there are still parishes without any public health facility.

Wakiso District controls 1,520 health units out of which 70 are government owned and non-profit agencies (38). Others are licensed pharmacies, drug shops, and medical centres, clinics or maternity homes.

In June last year, leaders in Wakiso said they could only provide accommodation to 27 of the entire health staff leaving out 877 employees.

This causes ineffectiveness in the sector contrary to Uganda’s Vision 2040 calls for effective health services among others in an attempt to transform Uganda to a middle income status.

Broken ambulances
Just like in many other districts, Wakiso is also suffering from a broken ambulance service.
Many of the Nissan Double Cabin trucks that were distributed some years ago and mounted with sirens to act as ambulances, have since broken down.

The district also suffers drug stocks, a situation Mr Muwanga says erodes patients’ confidence in the health sector, which leads patients to explore alternative, inappropriate and expensive systems of health care.

He says five items out of the 11 selected indicator experienced stock outs within the audit period, more significantly the mama kits were out of stock for 103 days and coartem for 63 days at Entebbe Hospital.

“The stock out may be a result of failure by NMS to supply drugs in the quantities ordered by Health centers and lack of reliable information on drugs usage and stocking positions.

Utility bills
Meanwhile, the AG indicates that by the time he compiled his report, there was an outstanding utility bill at Entebbe Hospital nearing Shs600m. Water bill arrears amounted to Shs342m, electricity bills (Shs153m) and (Shs188m).

“This creates a risk that the hospital may fail to settle the outstanding bills and get disconnected,” Mr Muwanga warns but the district administration has replied decrying a small budget, which has not been revised for the last 15 years.

Mr Lokuda says the Ministry of Finance has agreed to finance the arrears.
“They have asked us for the bank accounts of Entebbe hospital and soon arrears will be paid by government. That hospital manages an independent budget but it is too small to manage the needs,” Mr Lokuda says.

A recent report by State House Medicines and Health Service Delivery Monitoring Unit reveals that there is a dysfunctional and broken down healthcare system in Wakiso District.