Uganda continues to grapple with the challenge of expired medicines and health supplies
Findings conducted by The Observer, a Kampala based newspaper, indicate that instances of expired medicines and health supplies in Uganda is still rampant, and that expired drugs were still on the shelves at various health facilities during a recent survey conducted by the newspaper.
In 2012 the Uganda Ministry of Health put in place the national guidelines on the redistribution and prevention of expiry and handling of medicines and health supplies to provide a harmonized framework for the redistribution and prevention of the expiry of medicines in Uganda. Nonetheless, Uganda continues to face challenges regarding expired medicines and health supplies.
In the recent past, evaluations of drug wastage conducted by the Uganda Ministry of Health indicated that 10 million doses of antimalarial and US$550,000 worth of antiretroviral (ARV) had expired. According to health experts, expired products are not only ineffective but can result in the emergence of resistance to antimicrobial agents, toxicity in humans and other animals.
The Observer stated that at Kasangati health center in Uganda, IV drugs past their use-by- dates were still on shelves ready to be served to patients, and expired aluvia syrup for HIV/Aids-infected children below five years was found at Kiswa Health center III. At Kyabazaala health centre III in Mukono district, there was expired niverapine syrup for babies exposed to HIV/ Aids, aluvia syrup for HIV-positive babies and lumartem for malaria- the news report can be accessed here.
The findings of The Observer newspaper confirm the findings of the OIG audit report released on Malaria, HIV/Aids and Tuberculosis on February 26, 2016. According to the report, 12% of the 50 facilities visited were testing for HIV using expired test kits, and 14% of facilities visited did not perform confirmatory tests on clients diagnosed as HIV positive. This increases the risk of patients getting false HIV results.
Speaking to The Observer newspaper, the Assistant Commissioner for Integrated Curative Services at the Uganda Ministry of Health, Dr. Jackson Amone, said the findings by the Global Fund report pointed to a worrying trend. "If 54 per cent of the health facilities were found with expired medicines, it means more than half of the health centres had expired drugs," he said. The article can be read here.
In an article by the Daily Monitor- another Ugandan based newspaper, the Country Coordinating Mechanism (CCM) expressed concerns over wastage of drugs by health facilities in Kalangala district islands. Ms Syson Namaganda, the Secretariat Coordinator told the Daily Monitor that “It is painful to see drugs go to waste here yet there are people who are suffering without drugs in some other parts of the country." This was during a fact finding mission by her team on how health facilities at the island are benefiting from the global funds, adding that the management at the National Medical Stores should come out to explain the circumstances under which these drugs expire resulting into gross wastage yet a lot of money is spent purchasing them.
In Uganda, the National Medical Stores is mandated with supplying of health commodities. The OIG report indicates that the Joint Medical Stores supplied and delivered test kits to some facilities with just two months of shelf life. During the audit, among the 50 (40 public and 10 private facilities) visited country-wide, there was widespread use of expired drugs. The increase availability of expired medicines and test kits at health facilities is attributed to supplying commodities with short shelf-lives and supplying commodities that have not been requested by the health facilities.
In an interview with the Daily Monitor, Moses Kamabare, the National Medical Stores (NMS) general manager said when drugs are delivered, their responsibility, proper use and management lies in the hands of the hospital or health facility managers. "All medicines received by a facility are expected to be used before they expire," he says. Adding that upon expiry, the district is supposed to arrange for the destruction of expiry drugs by paying the National Drug Authority (NDA) or NMS to destroy them on their behalf. The problem of expiring drugs includes not only public providers, but also extends to private wholesalers, hospitals, clinics and pharmacies.
However, the most recent value-for money audit on NMS by the Office of the Auditor General showed the tug of war within the organization to maintain the legally-mandated buffer stock levels of four months while at the same time ensuring that they don’t overstock medicines.
“NMS stocks drugs without regard to buffer stock levels; as such, certain drugs are in excess of the one year’s requirement while others are under- stocked. There were huge stocks of expired drugs within the stores of NMS,” said the report, which was released in March 2010.
In an article by The Observer newspaper more than six years later, workers at the health facilities, which were visited during the two months of this investigation, indicated that NMS has not yet found a lasting solution to the problem. Different sources at these health facilities said that NMS uses a “push system” of dumping unrequested medicines in a bid to avoid audit queries over expiries in their stores.
“Health centres can’t also redistribute these drugs to other centres since they don’t have the mandate. As a result, medicines end up accumulating and expire,” explained a medical officer at Kasangati health centre IV, who declined to be named for fear of retribution. The news article can be accessed here
According to the assistant commissioner in charge of the Pharmacy Department at the ministry of health, Morris Seru, in the case of ARVs, the periodic changes of HIV/AIDS treatment to match new scientific findings affect the government’s ability to utilize all the medicines it stocks: “When policies change, some regimens of ARVs drop from use, yet they had stocked many and then expire,” he stated in The Observer article.
A World Health Organization bulletin identified causes that lead to drug expiry in Uganda and suggested solutions:
- Procurement of medicines with short shelf lives
- Expiry due do treatment and policy change
- Slow turnover of expensive medications
- Slow turnover of medicines with unpleasant tastes
- Slow turnover of medicines that treat rare diseases
The Global Fund has disbursed US$623 million to the Republic of Uganda since 2002. The OIG noted that only 46% of funds disbursed to the Ministry of Finance between January 2013 and June 2015 had been spent at the time of the audit. The country has made significant headway in the treatment of the three diseases, for example: new HIV infections have decreased from 140,000 in 2010 to less than 100,000 in 2014, the number of people receiving anti-retroviral treatment for HIV has gone up from 21% in 2010 to 50% in 2014; and malaria prevalence in young children has decreased from 42% in 2009 to 19% in 2015.
Information for this article comes from the 26 February, 2016 OIG audit report on the Global Fund grants to the Republic of Uganda, and survey findings by The Observer Newspaper and the Daily Monitor Newspaper.