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UGANDA: Distribution Policy Means Not Enough Drugs for Clinics

Joshua Kyalimpa

, Jun 21 2011 (IPS) - The nurse at Najembe Health Centre in Buikwe district says the centre’s supply of malaria drugs will be finished in two days. A malaria epidemic has hit the area and the demand for the drugs is high. But the centre, which serves the entire sub-county, will have to wait up to six weeks before their supply will be replenished.

The health centre gets supplies from the Kawolo district referral hospital every two months and last received supplies at the end of May. The next supply will only be delivered at the end of July. Meanwhile, staff from the centre cannot make a special request to either the district hospital or the National Medical Stores for drugs that are in short supply. So those patients in need of anti-malarial drugs will have to go without or will have to privately purchase the drugs.

“They give us the same quantities of drugs irrespective of the needs and this means we are always running out of some drugs, while other drugs expire because nobody is using them,” says the nurse who prefers not to be named.

The Ugandan government changed the policy of distributing drugs to parish and sub-county health centres in 2009 by implementing a policy where the National Medical Stores decides what drugs to supply and in what quantities. (A parish health centre is a clinic that provides medical treatment for up to 12 villages.) Previously heads of these health centres requisitioned the drugs, depending on their needs. The National Medical Stores supply 70 percent of the drugs in public health centres and district health officials locally procure the remaining 30 percent.

Hamis Kaheru, spokesperson of the National Medical Stores, says the policy change was necessary because there was a lack of competent personnel at lower levels to handle the old system.

“Personnel at the health centres (at parish and sub-county level) had no capacity to ascertain their needs and were not sending their requests on time. In the end the National Medical Stores was not sending drugs on time and some items would be missing because they were omitted from the list,” Kaheru says. He adds that they have been reviewing the policy every six months and is convinced it is working.

But the system is not working according to Denis Kibira medicines advisor at the Coalition for Health Promotion and Social Development (HEPS) a civil society organisation campaigning to stop the shortage of drugs. Kibira says the policy is wrong and should be reviewed.

“Drugs are out of stock most of the time and the moment people learn that some have been brought at their health centre they rush to get as much as possible to keep some for use during a shortage. This means the drugs will be always out of stock,” Kibira says. He says this is possible because most nurses at the parish and sub-county health centres do not test patients to identify their illnesses but instead treat them based on symptoms. He says most people fake symptoms to get the drugs that are in short supply.

Kibira says the HEPS have conducted research in at least 20 districts since government first revised the drug distribution system and found the system is not working, despite government’s assurances. At one health centre in Kayunga district villagers told IPS they did not have medicine for over two months and there was no nurse on duty.

Government implemented the current system in an attempt to reduce chronic shortages of essential medicines that were experienced by the parish and sub-country health centres from 2008 to 2009. Kibira, however, says those shortages were largely due to mismanagement of supplies, deficiencies in the procurement process and inadequate funding.

“We were under the impression that the original shortages were because of no money. Our expectation was that when the budget allocation to the National Medical Stores went up, the services would (improve). But what we are seeing is the reoccurrence of the disease we hoped to heal,” says Kibira.

In the 2009/2010 national budget the National Medical Stores received an allocation of almost 90 million dollars compared to a previous allocation of only 20 million dollars.

Kibira says with this kind of money the National Medical Stores should be in a position to supply vital drugs to health centres across the country without resorting to a policy change. Previously the National Medical Stores was not allocated funding through the national budget and would supply drugs on credit and then invoice the ministry of health and other health facilities for payment. This caused terrible delays.

But Kaheru says the policy has already been reviewed twice after consultations with the district medical officers, who should know the needs of their areas of jurisdiction.

“This policy solves more problems than it creates, the reason why drugs run out is because health officials at the lower levels are just giving people drugs under the clinical treatment based on symptoms and without testing. This (leads) to shortages and not because the policy is bad,” says Kaheru.

But HEPS have asked government to review the policy and increase funding. Currently government supplies about 400 dollars worth of drugs to each parish health centre monthly. Sub-county health centres receive about 800 dollars worth of drugs each.

Kibira says HEPS have met with ministry of health officials who have assured them that they will revert to the old system. The National Medical Stores, however, denies this will happen.

Meanwhile, the nurse at Najembe Health Centre has no option when the drugs run out. She will have to give her patients prescriptions for the anti-malarial drugs and hope that they will have the money to buy them.

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