Monday, August 22, 2011

Uganda recovers stolen Malaria drugs

By Esther Nakkazi

Uganda has averted theft of malaria drugs worth Ush 4 billion ($1.6 million) since the formation of the Uganda Medicines and Health Services Delivery Monitoring Unit in 2009.

As a result of more preventive measures, malaria drugs, especially Coartem, which were the most counterfeited because of the cost and large available market are becoming less stocked out in Uganda health centres.

“I testify in court all the time on embezzlement of drugs, funds and absenteeism of health workers,” says Frank Byaruhanga an investigator with the Monitoring Unit who goes to court twice a week. Byaruhanga says stock outs for malaria drugs are now improving but the focus is now changing to injectables, which are easier to steal.

In the last three years the government has made some initiatives to curb stock outs; establishment of the drug Monitoring Unit, change in delivery system at National Medical Stores, embossed drugs with Government of Uganda (GOU) and increased budget funding for drugs in the 2011/12 budget.

But also the increase in consumer awareness and them knowing their rights as well as severe penalties of up to 5-7 years for embezzlement. This has changed the situation on stock outs a lot.

“It is now at ‘manageable levels’ says Byaruhanga also detective assistant Superintendent of police. “Previously there were no drugs in health facilities only a day after delivery but now they stay until they are used up by patients.”

“Stock outs have improved and the stock out campaign has gone down maybe because it has run for two years,” said Christine Munduru, the public health programme officer for Open Society Initiative for Eastern Africa (OSIEA).

“We now want to focus on community monitoring of the new drug delivery system.” OSIEA supports civil society organisations to use community scorecards to follow health care delivery.

The monitoring unit has also increased sensitization of the public on stolen drugs although the practice is still rampant on border towns between Uganda and DR Congo, Kenya, and southern Sudan. Very often the drug Monitoring Unit sends back antimalarials and mosquito nets to Kenya diverted into Uganda, said Byaruhanga but so far Kenya does not do the same.

The supply chain problems:

In 2009, the National Medical Stores (NMS) changed from the pull system, basically user driven for the selection of the type of drugs and quantities by the district to a combination of the push and pull system driven by the ministry of Health.

But the efficiency in drugs delivery can also be attributed to SURE -Securing Ugandans’ Right to Essential Medicines, a USAID funded project that started in 2009 to turn around the drug distribution landscape in Uganda. It is five years $39 million project.

The pull system was dogged with poor forecasting of medicines and procurement procedures as well as low budget allocation for drugs leading to stock outs. All medicine was procured through the District medicines credit line systems by the district medical stores at their headquarters, sub-counties and hospitals.

In this system funds were released from the Ministry of Finance, to the Ministry of Health and then to NMS. But from July 2009, funds for procurement of essential medicines through the credit line system started to be released directly to NMS, after the latter got a direct budget vote.

“Due to the new delivery system, there have already been an increase in availability of medicines in the public sector which may indicate that changes in the medicine supply policy that were effected in 2009 to improve efficiency of the NMS are paying off at higher levels of health care (Health Centre IV and hospitals),” said Dennis Kibira, the medicines advisor at HEPS-Uganda.

HEPS-Uganda, which produces a quarterly medicine price monitor in its Oct-Dec 2010 issue, shows that availability of malaria drugs Artemether/Lumefantrine (A/L) tablets in the dosage of 20/120mg increased to 93 percent in October-December 2010 from 68 percent in April-June 2009 in all public sector facilities. Its availability also increased in the mission sector and the private sector.

The medicine price monitor also shows that availability of the malaria drugs for pregnant women Pyrimethamine/ Sulphadoxine in public facilities grew by 10 points to 67 percent over the same period.

But the medicines monitor also shows that the availability of medicines for non-communicable diseases has continued to be a challenge in the public sector.

For instance anti-diabetic medicines Glibenclamide and Metformin plus medicines for hypertension, Nifedipine and Propranolol; and medicines for ulcers were all in less than 60 percent of both public and private health facilities.

But as if children are the most neglected in medicines availability in Uganda, most public health facilities suffered from paediatric formulations stock outs.

Suspensions like Amoxicillin, Cotrimoxazole and Metronidazole were only available at less than 50 percent of the time in all public facilities while oral rehydration suspension for diarrhea, which has consistently been the most stocked paediatric formulation declined.

Malaria mostly kills children below five years, but the paediatric malaria suspensions, Artemether/Lumefantrine was not available in the public, mission or private sector facilities in over half the time it was supposed to be there.

“The low availability of appropriate paediatric medicines for leading killers, such as malaria and pneumonia, continues to compromise the quality of care offered to children and may be the reason for failing to achieve the UN Millennium Development Goals on infant and child mortality,” said Kibira.

Kibira said that there is a lot of hope with the launch of the Affordable Medicines facility for malaria (AMFM) under the ministry of Health where both public and private sector have received subsidies that will increase availability and affordability of antimalarials.

Currently, first line treatment of malaria- arthemether/lumefantrine costs between Ushs. 1,500-2,000 ($0.5-0.7) in the private sector down from between 10,000-20,000/- ($3.8-$7.7) abut three years ago.

Stakeholders blamed the supply chain problems from lack of human resource and capacity at health facility level as well as lack of coordination in the supply management system.


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