Saturday, March 31st, 2018
Is the National Medical Stores (NMS) to blame for the glitches in the supply of medical products in Uganda? “It is not our problem,” says NMS General Manager Moses Kamabare while responding to an array of questions we put to him Thursday after giving a talk on the state of affairs at NMS.
Although there is general consensus of improved delivery of medicines in the country, complaints still abound of drug stock outs or insufficient supplies and expiry of medicines in health centres, among others.
But according Mr Kamabare, these problems are arising as a result of other key players failing to play their part, in what he summed up as “the key challenges we are facing as NMS,” which in term gives them bad publicity “for other people’s failures.”
The failure to align procurement plans with order cycles, especially by upstream health facilities (General Hospitals to National referrals), is one of the major problems affecting efficiency in the availability of medicines.
“They give you a procurement plan saying this is what we need, you procure those products, when a cycle order comes which is calling things off, it is talking of something different,” said Kamabare (pictured above) . “So if you give us in your procurement plan that every two months you will for example require 500 doses of Coartem, we procure, and when a cycle order comes someone says I want 1000. So where do you want us [NMS] to get the other 500?” He further argues that “for the fault finders,” the reference point here should not be the cycle order but the procurement plan.
Also, well aware of the changes in disease burden, Kamabare explained that NMS gives a flexibility of 20 percent above and 20 percent below the procurement plan.
Asked how the apparent lack of competency by facility managers to make proper orders could be fixed, Kamabare said there must be deliberate effort by Government to increase the numbers of trainees in pharmacy at degree as well as diploma level and dispensers, in order to help health facilities and districts make the correct procurement for medical supplies.
Another challenge blamed for some of the reported lack of medicines, especially at lower health facilities is politics, according to Mr Kamabare.
“Politicians wake up and create a Health Centre. They tell us we have sat in the council and decided to create a Health Centre 2. We say thank you but there is no budget for you,” Kamabare disclosed adding that lately, NMS has instead been asking districts presenting such requests to get a certificate of approval from Health ministry because of the financial implications these facilities present.
Irrational and over prescribing by health workers is yet another challenge blamed for the reported flaws in the chain. Kamabare explained: “A client tests positive for malaria, there is Coartem in stock and a health worker prescribes Halfan. And the patient thinks there no antimalarial yet what is not there is Halfan but the Coartem is there. So health workers prescribe what they clearly know is not there but always available in a drug shop close to the health facility and cause artificial shortages in the process.”
Similarly there are situations where health workers are unnecessarily prescribing more than what patients need in what the NMS chief referred to as polypharmacy (the use of four or more medications by a patient). Mr Kamabare asked health workers right from the lowest facilities to referral hospitals to follow the health ministry clinical care guidelines. Compliance with the guidelines, he alleged, is below 10 percent.
And, regarding the needs of the specialised facilities like the health and cancer institutes at Mulago, only increased funding will be the solution to their problems, according to the NMS manager.
NMS employee prepares stock at the Entebbe warehouse
Article by Kakaire Ayub Kirunda
Credits also go HPPM staffers Dr S. Kiwanuka, Dr E. Ekirapa-Kiracho, Dr Peter Waiswa, Mr Chrispus Mayora, Mr David Walugembe and Mr Moses Tetui for contributing questions