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Audit exposes gap in health sector standards monitoring

By Flavia Nassaka

Experts worry as pharmacies, drug shops remain unregistered

The National Drug Authority is facing challenges in fulfilling its mandate to issue annual licenses to drug shops and pharmacies, according to the latest audit report of government departments.

The Auditor General’s report for 2014 which was released recently in Kampala showed that most drug shops and pharmacies were operating illegally because NDA had failed to issue them with licenses by the due date of Jan 31.  In the report, the auditor general pointed out that NDA management attributed their inability to issue licenses to all Pharmacies and Drug shops by the due date to low staffing levels and general complacency of the operators of drug outlets.

According to NDA’s Fredrick Ssekyana, there are over 700 pharmacies and 5000 drug shops operating currently since the last list to be published had 672 pharmacies. There are about 607 drug shops in the central region, 154 in eastern region, and 267 in the north whereas the western region had 629 registered pharmacies as of Feb last year. Ssekyana says to register; a pharmacy in Kampala must pay Shs1 million and a drug shop Shs400, 000. They are also required to pay an annual license of Shs500,000 and Shs250, 000 respectively.  Most operators are unwilling to pay and NDA lacks capacity to enforce compliance.

Under the government policy of privation in the health sector, many health facilities have sprung up. Latest reports indicate that health facilities have increased from 930 in 1986 to 4,722 as of 2014. Many more are sprouting every day. Unfortunately, the monitoring and enforcement of standards appears to be overwhelmed.

Dr. Robert Balikuddembe; a pharmacologist based at the Mulago National Referral Hospital says most drug outlets; especially those in slums and upcountry districts operate illegally and play hide and seek with the authorities.

He says according to the law, for one to open up, NDA supervisors should first confirm that the facility is up to the World Health Organisation’s requirements of the suitability of premises and they must also have a practicing certificate but this rarely happens.

Betty Nakayima a pharmacist technician told The Independent about the cat-and- mouse games between the NDA and drug-shop operators.

The young university graduate recalls a time when she worked as a supervisor in a pharmacy owned by an entrepreneur with no medical background. Nakayima says she worked with four colleagues who were unqualified. They all depended on her for guidance. She recalls of how the pharmacies in that area used to alert each other whenever they suspected officials from the National Drug Authority (NDA). She says her former work place dodged paying the license for three years.

“Building health facilities without ensuring that they are staffed with qualified licensed medical officials and the right equipment will not help us achieve good health for all,” she says.

But the AG’s report had more bad news.

It revealed that out of 1,195 Specialists on the Uganda Medical and Dental Practitioners’ Council register, only 757 (37%) renewed their practicing licenses during the year.

The number of unregistered medical practitioners could be higher because Dr. Katumba Senyonjo, who is the registrar of the Uganda Medical and Dental Practitioners’ council, (UMDPC), puts the number of doctors in the country at 3,845.

This means there are more unregistered practitioners in practice.

Katumba said most of those who had not registered were from areas farther away from Kampala and that this problem could be solved if regional registration centers are set up in the regional referral hospitals.

The gaps in the health sector have attracted the attention of the parliamentary Committee on Health. Dr. Jeremiah Twatwa who is member of the committee told The Independent that the products dispensed by unlicensed pharmacies and drug shops pose a health hazard to the unsuspecting public. On the issue of unlicensed medical workers, Twatwa said they could be behind the perennial drug stock-outs at public facilities since some practitioners have no idea about dispensing drugs which leads to poor quantification and eventually result into shortages, excesses of stocks causing expiries.

These issues of inefficiency at NDA and lack of qualified staff come at a time when Uganda is in the process of exporting medical personnel to the Caribbean Island nation of Trinidad and Tobago.

The move by the government has attracted widespread censure as members of the public opposed to the move say that this gap will hurt the already ailing health sector in Uganda in which patients requiring even minor specialised treatments are routinely referred to facilities out of the country. The Institute of Public Policy Research (IPPR); a local think tank in November 2014 petitioned the High Court to impose an injunction on the exportation.

But is what could be a fatal blow to the petition, Justice Elizabeth Musoke of the High court on April 10 rejected the application for a temporary injunction on the government’s move. The ruling potentially opens the gates for the export of over 280 medical practitioners.

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