National Medical Stores: Turning a new page in the handling and disbursing of medicine

NMS has had all sorts of accusations levelled at them, from storing expired drugs to taking drugs to the wrong places. Sheila Naturida speaks to the NMS General Manager, Moses Kamabare about the issues.

How has the change in policy on budgetary disbursement to NMS for procurement and distribution of drugs impacted on your service delivery?

The 70-30 policy is welcome to NMS. As written in the papers and other media, there has been resistance to this policy for reasons best known to the people who used to handle the money. What amazes us is that to anybody who had never been to Uganda before, if you opened the pages of a publication, and saw what was written about the policy shift and the condition of lack of medicine in the health centres, you would actually think that before the shift, health facilities would be full of medicines and because of the policy shift, they are not.

We think that is false and this new policy is going to help the country and the people get what they require. We are in a learning curve. There are uncoordinated movements between ourselves and the districts, the people who sometimes don’t give us orders in time, we also still have a few people who want this policy to fail so that they continue doing things their own way but we think time is going to settle all that and we should all be able to agree that this policy will be the best thing that has happened to this country at this time.

Any basic reason why it was changed?
The main reason it happened was that the government realised it had created an organisation in the name of NMS to handle all government procurement and distribution of medicines but over the years, the actual action of procurement and distribution had found its way out of NMS, probably as a result of decentralisation. But also, the government realised that much as they were providing money for procurement, whenever they would visit the health facilities, they would not find the medication. So they were trying to work with the system that is NMS to get value for their money. So we think their decision was the right thing to do.

Expired drugs and other unlicensed medicines are a rampant phenomenon; who is responsible and how has this affected NMS’ image? What role do you play in fighting the crime?
I wouldn’t know where to find the expired drugs. But just to put it in perspective, that is the mandate of the National Drug Authority (NDA), not NMS. They are in charge of the quality of medicines, inspecting and licensing all drug outlets and therefore they should be in a better position to know what they are doing. However when it comes out in the media and there’s public outcry that there are expired drugs, it does affect the image of NMS because I think the population doesn’t know the difference between us and NDA. There were also situations in the past when some medicines used to come to NMS and they would expire there for one reason or another. People then started saying expired medicines come from NMS and it was perceived that way for some time.

Are there adequate and recommended storage facilities at your disposal?
We have the most adequate storage facilities, which are really warehouses. They are not stores as we would want to call them but warehouses that provide the most optimal storage and if you have time, you can visit them and see that it’s impossible for medicines to expire because of our storage conditions. We also have elaborate systems that don’t permit us to give out expired medicine. If for any reason medicines expire on our premises, we get them out in good time so they don’t mix with other medication.

Do you have fridges?
For types of medicines that require refrigeration, we have cold rooms. Others are under room or optimal temperature.
Districts are stuck with expired drugs for lack of proper storage facilities and poor drug management; what options are available to NMS and district hospitals to improve on drug storage to minimise wastage?
Really, now it’s not a matter of educating the districts on storage but rather decongesting stores, removing the expired drugs because we cannot go on debating when people have expired drugs and don’t know what to do with them. We are working with other responsible partners like the Ministry of Health, about dealing with these drugs but as NMS, we don’t have the money.

We could have helped but we want to make it clear that when medicines expire from the health centres, it’s the responsibility of the districts to arrange for their incineration, not just burning them in the open but putting them in an incinerator so they don’t harm the environment. The difficult part is that we have only one approved incinerator in the country which is located in Nakasongola and belongs to the military.

It is the only one with the highest temperatures to highly incinerate. The ones in hospitals are small for small items syringes, so there must be an arrangement in place to remove all those items from those districts to that incinerator in Nakasongola. Now that cannot be a role of just one person. The ministry needs of mobilise district health authorities to collect expired items and pack them and be able to provide labour to load them onto trucks. On the part of NMS, since after delivery of medicines to the districts, our trucks return empty, we could as part of our corporate social responsibility carry these items.
So you agree that there are expired drugs?
There are. We know stocks that have accumulated over years, people talk of 15 years of expired drugs and expiration of drugs is a common thing and shouldn’t be looked at as irresponsibility because you cannot adequately project what people will take. If for example you anticipate that 100 people will suffer from malaria and during that period, only 30 do, you cannot use the remaining medicine to treat diarrhoea. You will keep the items and they will expire in the process. So the point here is not to blame anybody on how the expiry came about but to ensure that we remove those items, and protect both the environment and the unsuspecting people from being harmed. So once we bring them here, then NDA could arrange with Nakasongola because it has to supervise the incineration. So all the three players or four for that matter, including the districts with which we work, can solve these problems.

Do you ever meet with NDA to address this issue?
We do meet; we actually have always met and compared notes. Their work is actually not to follow up what happens in government facilities but to monitor. Their mandate is to ensure that drugs are handled by qualified people, are of good quality and that is when you hear them closing some of the health facilities that don’t have all the requirements. So we meet regularly and sometimes when they go to the field, they also give us feedback on the issues they think we need to address. We have been working well together and used to all be under the Ministry of Health and the two acts that created us were passed by Parliament. In other words, we complement each other.

How do government-labelled drugs end up in private clinics and medical centres? What security is in place at NMS to ensure drugs are not stolen?
The government-labelled drugs that have been found in private clinics don’t come from NMS. They must be finding their way there from government health facilities where we supply. Therefore as NMS, we think that we have done our part and empowered the people to be able to identify those cases and report them because that medicine is supposed to be gotten free of charge. There is no need for safety measures because there is totally no theft here at the medical stores but all the same, we have sufficient security in form of CCTV cameras and security officers and it’s not possible for anything to get out from here.

What is the expected outcome of the new management information system (Macs/Sage) that replaced Navision?
The new management information system is the best system we have now. It’s specifically for warehouse management, Navision was basically financial. It was adjusted over the years to adapt to warehouse management and it didn’t have functionalities like being able to monitor, for instance receiving of items, storage and distribution etc. You would only have to go in to know the amount that had been distributed, but now by just a touch of a button, I can know what trucks have gone to which districts at anytime. If I wanted to know what medicines have been bought, I would know but in the past, I would have to go to the warehouse and count. Loading is also faster now because you don’t have to count each and every packet but to just scan. So it makes work easier for everybody.

How big is the budget for medicines that NMS is handling and how does it relate to the national needs for medicines?
Currently, it’s about Shs75.711bn this financial year but we have been promised 100 per cent because that is about 67 per cent of money for medicines needed. We hope that next financial year, we will be able to procure all we need. Because of the policy shift from the 30 percent we used to handle, we were given the 70 per cent this time and we expect to get 100 per cent next time.

NMS has had several changes of management in recent times; what is the cause of these changes?
We have not had many changes recently. I came in one year and 10 months ago. There are a number of things we are trying to put in place in order to be appreciated better by our customers and be able to serve them better. We work in shifts including night shifts, which is not common in traditional government bodies. So you may find me here today and next week, I am on the night shift We have met with all staff and decided that if we are to stay on top of things, there is no way we are going to work only eight hours out of the 24. Now, people can give us their orders anytime and if we have an emergency order say at 5p.m., it will be delivered by 8a.m.