Why health centres have no medicine
None of the MPs at the caucus answered the question. The hall was silent. I have carried that question since Munyonyo, because as MP for Kabweri County in Kibuku district, my people ask me the same question every day at Kadama, Kibuku and Bulangila health centres.
Patrick Godfrey Wakida. (Courtesy)
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OPINION
By Patrick Godfrey Wakida
During the National Resistance Movement (NRM) parliamentary caucus meeting at Munyonyo Commonwealth Resort on August 7, the President looked at us MPs and asked a direct question: “I hear there is no medicine in the health centres, is it because the medicine is stolen or we are getting it wrong on budget allocation?”
None of the MPs at the caucus answered the question. The hall was silent. I have carried that question since Munyonyo, because as MP for Kabweri County in Kibuku district, my people ask me the same question every day at Kadama, Kibuku and Bulangila health centres.
Allow me to answer this question, not with politics, but with budget facts and with research I conducted 20 years ago.
In 2005, I conducted field research on the quality of primary healthcare under decentralisation in Uganda for my PhD at the University of Warwick, UK. My thesis, available at https://wrap. warwick.ac.uk/id/eprint/3685/ studied exactly this problem. My central finding then was that funding shortages under decentralisation were the primary driver of medicine stock-outs and poor quality of care. Districts were given responsibility for health without adequate funding for essential drugs. I made recommendations then that remain exactly the same as I make today.
The Problems
The Government has done their part on infrastructure. Today, 91% of Ugandans live within 5km of a health facility, largely because of NRM’s construction of health centres II, III and IV. The buildings are there. The health workers are there. The shelves are empty. We have three problems at once:
1. First, budget allocation – we are getting it wrong: The Government has allocated, in the budget for the financial year 2026/27, sh5.23 trillion, representing 6.2% of the sh84.39 trillion national budget. This shows commitment.
However, the medicines budget does not match the need.
The National Medical Stores (NMS), whose mandate is to procure, store and distribute essential medicines and medical supplies, requires sh773b to supply all public facilities for a full year. Parliament appropriated sh623.51b. There is an unfunded gap of sh150b from day one of the financial year. This means we have planned to stock out.
Of this budget, sh205b is allocated to actual medicines; therefore, per capita medicines spending is sh4,080 per person annually, making it sh340 per person monthly, less than the price of one Panadol sachet. It is practically impossible to run a health centre for 12 months on sh4,080 worth of drugs per person annually.
Kits delivered for a two-month cycle are finished in two weeks. The remaining six weeks are a stock-out period.
This is the same finding I documented in Kibuku and other districts in 2005: Decentralisation without medicines financing equals empty shelves. Today, it has worsened. It is no longer only health centres II and III. Stock-outs now affect health centres IV and community health centres, including Kibuku Health Centre IV, Kadama Health Centre III and Bualangila Health Centre III in my constituency, which lack oxytocin, IV fluids, antibiotics, anti-hypertensives and anti-malarials for weeks. When a health centre IV has no supplies, staff refer mothers in labour to Mbale Regional Referral Hospital, 52km away.
Kenya, therefore, spends 1.5-2 times more on health and five times more on medicines per citizen than Uganda.
The World Health Organisation estimates Uganda’s current total health expenditure at $57 per capita, below the $86 minimum recommended to deliver essential services, and below the purchasing power parity estimate of $127 in 2022. We were 50.9% donor-funded in 2020/21. External health funding fell from 49% in 2022 to 23% last year. When donors cut, we face ARV and malaria stock-outs.
-About 30% is lost in theft: Truthfully, theft exists and should be punished severely. Several agencies confirm the magnitude as follows:
The chairperson of the National Drug Authority (NDA), Dr Medard Bitekyerezo, said about 30% of government drugs are stolen from hospitals and health centres across the country, with malaria and HIV drugs most-targeted and smuggled to the neighbouring countries or sold to private clinics.
Similarly, Ministry of Health and NMS officials estimate that up to 30% of donated or procured drugs vanish before reaching patients, fuelling illegal sales in private pharmacies and cross-border markets in South Sudan and the DR Congo. This is why the Government has now fitted consignments with radio frequency identification and global positioning systems seals.
The NDA spokesperson has even said half of the drugs that the Government sends end up stolen, describing it as a syndicated crime between health workers and private dealers. The Inspectorate of Government’s 2021 Report confirmed that theft of medicines and equipment is the commonest corruption in health. If Kadama Health Centre III is allocated sh10m worth of medicines per cycle, about sh3m may leak. So we have both — we underfund, then we lose a third of the little we fund.
-Donor medicines arrive near expiry and are returned to NMS; double loss:
This is why we see expiry and stock-out at same time, as Auditor General reports.
A senior ministry official stated on record: “The bulk of expired drugs in health facilities are from third parties, euphemism for donors who dump medicines and supplies, especially during humanitarian crisis, even when there is no local demand.”
WHO policy requires at least 12 months remaining shelf life on donated drugs, but in Uganda, donations often come with six months or less. By the time NMS clears them, transports to districts and from districts to health centres II/III, they have two to three months left.
NMS also buys them short-dated and pushes down. Parliament public accounts committee found that: “Essential medicines and health supplies are sent down by NMS without requisition, those which are about to expire, and therefore, have a short shelf life.”
An investigation found that NMS sometimes procures medicines with one-year shelf life remaining and supplies to health centres with six months to expiry. Presumption is that the recipient health unit would have exhausted drugs by next replenishment delivery, two months later. Sometimes, they don’t, resulting in pile-up.
Facilities are supposed to redistribute drugs with less than six months to expire, but many rural health centres cannot find another facility that can use them in time. The Ministry of Health manual says whatever (medicine) you cannot use before expiry date should be redistributed at least six months before expiry. If drugs expire, separate them, mark “expired”, document them and return to the district medical store and NMS.
Waste is huge. The 2024/25 audit flagged sh8b of medicines expired and were destroyed before they could be distributed, minister Chris Baryomunsi demanded a report from NMS. In one previous cycle, 1,500 tonnes of expired stock were collected from 6,619 facilities for incineration. At Mbale Regional Referral Hospital alone, 2.32 tonnes of expired drugs were returned to NMS in one year; Moroto had expired drugs worth sh9m mixed with live medicines.
Reforming NMS
NMS is the same entity that procures, stores, distributes and destroys medicines at high cost. So sh2,128 per person is partly spent transporting drugs twice — out and back as expired — and paying NDA for incineration, and writing off stock that never reached patients. Parliament recommended breaking the NMS monopoly because prices beyond the market and push-system causes expiry. Kenya reformed KEMSA to pull the system where facilities order what they can use; Uganda still largely pushes from NMS to health centres II/III, which amplifies the donor near-expiry problem.
Caution on arrests
I support zero-tolerance for theft. But in many places, health workers are arrested for “telling patients to buy outside”. They are not thieves. They have no medicine. When stock is zero for three to four weeks, a clinician faces a choice: watch a mother bleed or write a prescription for the family to buy outside during the stock-out period. We are criminalising a coping mechanism created by the sh150b gap.
What government should do
Same as in my 2006 thesis, I suggest we do the following:
- Close the sh150b (NMS) essential medicines gap in the financial year 2027/28 budget and the supplementary.
- Raise medicines per capita to at least sh10,000 per year.
- Fast-track full digitisation of NMS tracking, from warehouse to patient, with public dashboards so citizens in Munyonyo and in Kabweri can see what their facility received.
- Distinguish theft from system failure: publish verified stock-out days per facility and stop blanket arrest of staff who prescribe medicine to buy from outside during confirmed stock-outs. Punish the real thieves.
None of the MPs answered this question at Munyonyo because the truth is uncomfortable: we have funded the health system to fail.
The answer to the question asked by President Museveni in Munyonyo is this: Yes, some medicines are stolen, but we are also failing to budget enough, failing to manage what we procure, and allowing medicines to expire before they reach the patient. If we want full shelves in our health centres, we must confront all the three problems — not just arrest the health worker standing in front of an empty shelf.
For God and my country.
The writer is the Kabweri County MP