By Dan Kimosho
The problem is not scarcity of but inefficiency of some drugs managers
For some time there has been widespread condemnation of the government by the public over poor medical services in Uganda, much of it attributed to shortage of drugs in government aided hospitals and other health units. The media is consistently awash with reports of patients whose lives have been endangered as a result of absence of drugs in government health units.
Whereas I agree that some government health facilities may at times run out of some drugs, it is important to note that the problem is not due to scarcity of drugs at the center but rather due to the inefficiency of some drug managers at different levels.
Up till 2008, all funds for drugs would be disbursed to the districts. This was premised on the argument that each district had its own unique drug demands and thus should be left to procure drugs as and when need arose. This policy was frustrated by the custodians of these monies at the districts and other administrative levels, who diverted the funds to personal use. At the time, the availability of drugs in government hospitals was at around 22%.
Moreover it was not easy to account for this money, most of which was always withdrawn through Automatic Teller Machines (ATMs). As part of the accountability, patients’ registration books were regularly forged to falsely show that drugs were given out. This ugly trend appeared to have been effectively contained when the mandate of procuring, warehousing and distributing drugs in the country was given to the National Medical Stores (NMS). But losers over this policy shift have since sought to undermine the authority of NMS through malicious propaganda.
Ugandans should be asking themselves why there was little drug shortage outcries when the availability percentages of essential drugs were 20% yet now the outcry is louder when availability percentages are clocking 80%. I am really sorry if this information offends anyone but silence is killing this country and the time is now to lay the facts bare.
The idea of embossing drugs was also another useful deterrent. Some health personnel have since the introduction of this innovation, been substantially denied the opportunity of selling them lest they land in the hands of whistleblowers. The reaction of such insatiable medical personnel has been to keep the embossed drugs in stores, at hospitals and health centers, in order to create market for their drug stocks in their own private clinics. Other medical personnel keep requisitioning for less drugs so as to create scarcity in government health units thereby raising demand at their private drugs shops. It’s an open secret that most medical personnel refer patients to their own clinics and drug shops, for drug purchase, as soon as disease diagnosis is complete.
Feeling unsafe to sell embossed drugs within Uganda, some medical personnel find a more convenient black market among communities across the country’s borders for some of these embossed drugs.
We also have a problem of careless and unprofessional drug storage systems in many hospitals and other health facilities. The recommended first expire- first-out formula is rarely followed. As if that is enough there is always a very big gap between the stores and doctors who manage patients at the ward. This trend has resulted in doctors continuing to prescribe unavailable drugs when there are other drugs that can be used to manage the same problems. While this may sound accidental, some health personnel have deliberately refused to follow Uganda clinical guidelines and continue to intentionally prescribe drugs that cannot be found in government hospitals when they are aware of the availability of excess alternatives in stock.
I want to interest each one of us to follow closely the ownership of pharmacies and drug shops across the country. You will obviously find a conflict of interest amongst your area health facility management and the owners of the private clinics, drug shops and pharmacies.
I beg not to be misunderstood; am not discouraging business. Instead I am simply saying that people should stop denying Ugandans free health services and causing serious loss of lives because they want to make money out of them. This is savagery at its worst.
Maybe my very last appeal for now is that all people who are entrusted with supervision should take charge and stop lamenting. I want to conclude by giving you a list of people who are supposed to make sure that government drugs are put to right use at the district level. I will obviously start with the Chairmen LC 5 and his Executive, councilors, Chief administrative Officers(CAO),Resident District Commissioners and his deputy, Regional Police Commander and all the District Police Commanders in his region, District Director of Health Services, Regional Internal Security Officers, District Internal Security Officers, Gomborora Internal Security Officers, Sub county Chiefs,Lc111 Chairpersons, and etcetera. All these are charged with the responsibility of monitoring the use of our drugs but the big question is; how many times have they passed by their area health centres to check on the conditions of these facilities? Oh Uganda may God up hold thee!
Consequently, the president of Uganda established a very competent drug monitoring unit with the clear headed leadership of Dr Dian Atwine. However without public vigilance and support by all stakeholders, this unit may find an uphill task in restraining these saboteurs.
Dan Kimosho is the Public Relations Officer National Medical Stores