NEWS: Drug shortage hits Uganda

Medical officers dispense drugs to a patient at Kiruddu Kampala City Council Health Centre in 2006

Friday, 20th March, 2009 from NEW VISION

UGANDA is facing a shortage of essential drugs in Government health facilities, according to the latest survey by Uganda Country Working Group. The study, conducted over the past four years, show that 32-50% of essential medicines to treat common diseases like malaria, pneumonia, diarrhoea, HIV/AIDS, TB, diabetes and hypertension are not readily available.

Consequently, a consortium of five Ugandan health civil society organisations on Thursday launched a nationwide campaign, code named Stop stock-outs. Their partners are Action for Development, Action Group for Health, Human Rights and HIV/AIDS and Alliance for Integrated Development and Empowerment, Coalition for Health Promotion and Social Development and National Forum of People Living with HIV/AIDS Networks in Uganda.

According to these organisations, an essential medicines crisis is looming in Uganda because a major stock-out is establishing itself in government hospitals and clinics.

A workshop on Health Sector Transparency and Accountability organised by Action Group for Health, Human Rights and HIV/AIDS in Soroti recently revealed that there is a national stock-out of the first line recommended drug for malaria – Coartem at the National Medical Stores (NMS). And, as a result, malaria was being treated by quinine in many of the facilities. In some cases, quinine for children was not available and health workers said they improvised by breaking the adult tablet into smaller pieces to give the children the required dosage. Sometimes, where adult doses were unavailable, adults were treated using Coartem for children.

One official from the district health office told the workshop that Soroti had received tuberculosis medications remaining with only three months to the expiry date.

The situation is the same countrywide. Patients are forced to travel long distances to other health facilities where they still fail to get drugs, opt for alternative medicines or, in the worst case scenario, just wait at home to die.

Doctors say this trend may lead to treatment failure and emergence of drug resistance. They complained that it can take up to 60 days instead of 30 to process and deliver an order to the district. In some cases, the districts receive drugs which have not been ordered.

Participants, who included health officials, doctors, administrators and development partners, blamed monopoly by the NMS as the major cause of delayed drug supply and called upon the Government to decentralise the drug supply and procurement mechanism.

Currently, districts buy drugs either through the conditional grants or through District Medicines Credit Line System, where districts can buy essential drugs from NMS on creditand the finance ministry pays later. Where drugs are not available, NMS is required to issue a certificate of non-availability so that districts can procure the essential medicines from elsewhere, like the Joint Medical Stores. However, a the workshop it was revealed that NMS in most cases fails to issue these certificates, making it difficult for the districts to order drugs from elsewhere hence the stock-outs.

Denis Kibira, the Stop Stock-outs campaign coordinator, says although Uganda updated its Essential Medicines List in 2007, it does not adequately provide for key medicines crucial for the treatment of diseases like cancer. It also does not cater for specific age groups like children and the elderly.

He adds that two-thirds of the Government health centres do not have the list, according to the 2008 Pharmaceutical Situation Assessment survey by the health ministry.

The Uganda Country Working Group is a collaboration of the Ministry of Health, the World Health Organisation and Health Action International Africa (HAI-Africa).

It conducts quarterly surveys on medicine prices and availability in the four regions of the country. This is part of monitoring the ongoing interventions by the Ministry of Health within the second Health Sector Strategic Plan (HSSP II) to increase access to essential medicines for all Ugandans. The Coalition for Health Promotion and Social Development (HEPS-Uganda) represents HAI-Africa. “Stock-outs disproportionately affect the nine million Ugandans (31.1%) who live on less than a dollar-a-day,” Kibira said.

“To compound these problems, stock-outs force people in already dire circumstances to buy medicines at much higher prices from the private facilities.”

Medicines are often the largest health-related expense for poor families, he said. He calls for representation of civil society on the board of the National Medical Stores and increased transparency in medicine supply management.

He also wants the Government to live up to its commitment to spend 15% of the national budget on health care and to provide a dedicated budget line for essential medicines.

According to the survey, the availability of Coartem, the first line anti-malarial, was 28% in the private sector. Drugs for children were found to be consistently below 30% in the public sector, Amoxillin suspension was 13% and of Cotrimoxazole (Septrin) suspension was 29% and yet upper respiratory tract infection is a leading cause of death in children.

Availability of anti-diabetic medicines Glibenclamide and Metformin was respectively 46% and 25% in public sector.

Medicines for hypertension, like Nifedipine, was available in 46% of public sector facilities. “The continued low availability of children, anti-diabetic and anti-hypertensive medicines in both public and private sectors is not a good prioritisation of medicines for children and chronic diseases during procurement and hence poor emphasis on the non-communicable diseases which are on the increase in Uganda,” the report states.

However, NMS spokesperson, Hamis Kaheru, wondered how they could tell there is a stock-out because they are not the only suppliers. “We supply only 30-40% of medicines to the Government health centres,” Kaheru said. “The rest are bought by district health officials using the money given to them by the Government.”

He said if there are any shortages, they should be blamed on corrupt district officials who either fail to buy medicines or sell some to private clinics.

“We suspect the biggest cause of shortages could be theft of medicines,” he said. He added that the solution is to follow President Yoweri Museveni’s directive to have all Government medicines embossed (labelled). “At NMS, we are already doing it. But since we are the smallest suppliers, it may not solve the problem.”

Kaheru also dismissed reports that they delay processing districts’ orders for medicine. He said under the new management that is almost a year old, they now publish delivery schedules. These indicate the date when the health facility placed an order and the day medicines leave NMS for the districts.

“Some districts delay to send orders and yet we follow our monthly delivery schedule,” he said. “Those who miss will have to wait for the next schedule when the truck goes to their region again.”

HOW MEDICINE GETS TO YOU

 The Government forecasts how many medicines will be needed to treat the population, based on the major public health challenges in the country.

 Orders and tenders are then generated by the National Medical Stores.

 Medicines are then purchased and stored centrally.

 District stores and local health facilities decide what quantity of medicines they need and then place orders for these at the national medical stores.

 National Medical Stores then delivers the drugs ordered and if they are out of stock, they issue a certificate of non-availability for the facilities to procure the drugs externally.

 Patients then receive the medicines from health facility pharmacies