Medical stores run out of anti-malaria drugs

Esther Nakkazi | 03 Jan 2009
The East African
Even after Uganda's drug procurement and distribution was overhauled, more people will still die of malaria, the country's worst killer disease, as the National Medical Stores (NMS) are running out of anti-malaria drugs.

However, NMS officials blame the situation on poor planning exemplified by inconsistencies between the quantity and actual consumption of drugs imported, as well as the kind of medicines and what is demanded on the country. Officials also reported poor procurement procedures and low budget allocation for drugs as other causes.

Under the procurement system, drugs are procured by a district from NMS and Joint Medical Stores (JMS) under the district medicines credit-line system, which uses the pull system, a user-driven method, as opposed to the push system that was Ministry of Health-driven.

Under this system, all government health institutions at the national, district and sub-county level assess their drug quantity needs and send them to NMS and JMS.

"The district medicine credit system is inefficient. NMS may take 60 days instead of 30 to process and deliver an order to the district," said Dr Mshialla Maghanga, a lecturer at the Faculty of Medicine at Gulu University.

The 2004/05 and 2005/06 budgets were 9.6 per cent and 10.6 per cent of the national budget respectively which is below the 15 per cent commitment to health made by African heads of state in Abuja, Nigeria in 2001.

The situation is exacerbated by cashflow problems, which lead to delayed procurement of medicines leading to stock-outs, said an NMS official. There is also poor warehousing at the district stores and inadequate supervision.

"Most of the drugs that expire are donations brought in with a short shelf-life. We usually re-export or destroy them, sometimes we give them to a hospital that can distribute them within a month," said Victoria Birungi Kwesiga, Inspector of Drugs at the National Drug Authority.

According to Mr Kwesiga, some NGOs and faith-based organisations accept drug gifts unconditionally, especially during epidemics or disease outbreaks, without a system to determine what and how much is needed, resulting in oversupply.

However, some of the drugs are just dumped to dodge the exorbitant costs of destroying them in developed countries.

"Usually, with poor storage conditions at districts and a limited shelf life, the drugs expire," said Martin Oteba, the acting Assistant Commissioner in charge of Pharmaceuticals at the Ministry of Health.

NMS also blamed the media for "over-reporting" about expired drugs.

"Every time someone from the media goes to NMS, they say there are expired drugs, but those are the same packages they see every time. We do not dispose of them easily because of costs," said an official.

Lack of personnel is yet another problem. Of the 14,000 pharmacists required to dispense drugs to a population of 30 million, Uganda has only 350 qualified personnel to do the job.

"Supply is affected by lack of continuity. Sometimes the tools are there, the system is in place but there are no people to implement them," said Mr Oteba.