OPINION

By Abiaz Rwamwiri

For the last couple of weeks, National Drug Authority (NDA) high-alert teams have been spending sleepless nights working together with the Police tracking and breaking down rackets of dealers involved in the theft, illegal possession and sale of Government drugs and medical supplies.

The recent battle started on August 19, 2023 when our team arrested an enrolled nurse who was also the in-charge of stores at Nakawuka Health Centre III together with two accomplices. They have all been remanded to Luzira prisons.

On September 4, I joined our team that was tracking the gang dealing in illegal sale of government drugs in and around Kampala and indeed, seven suspects were arrested around Equatorial Mall and Wilson Street with several boxes of Government of Uganda labelled drugs including antiretrovirals (ARVs).

On September 17, NDA team headed to western Uganda after our intelligence had mapped out a cattail of both health workers and dealers illegally possessing, selling, rebranding Government drugs and medical supplies.

This turned out to be one of the biggest crackdowns. NDA team, working with the Police, arrested seven suspects in Ntoroko and Kyenjojo districts in connection with illegal possession and sale of government drugs and medical equipment worth over sh300m.

The Ntoroko and Kyenjojo Districts operation led to the arrest of Samuel Lan Mwesige, an in-charge of Bweramule Health Centre III, Mary Mbabazi, a nursing assistant who was also acting as the stores in-charge for Bweramule Health Centre III and Alex Mbusa, a porter working with Bweramule Health Centre III in Ntoroko District, Assistant Inspector of Police (AIP) Kule Yusuf Katuramu who is also a health officer working with Kyenjojo Police Health Centre II, Denis Blessing, who was running an illegal pharmacy in Kyenjojo, Isingoma Isiah and Bwamabale Tom who were facilitating the distribution of stolen drugs.

During this intelligence-led operation, several government drugs and medical supplies, including ARVs, anti-malarials, Malaria, HIV and Hepatis B test strips, several doses of unpacked Antibiotics and Paracetamol all worth over sh300m were recovered. This operation has four high levels of concern; like the Nakawuka story, the two health centres (Bweramule Health Centre III and Kyenjojo Police Health Centre II) were losing key drug supplies to the very people who are entrusted to keep these drugs. A fresh sound of the stories of “stealing from the sick”!

The other disturbing finding is that Denis Blessing, who has been a lead broker of government drugs in the region was also masquerading as a pharmacist of Buhinga Hospital in Fort Portal and was a key source for illegal drug operators. He had established an illegal pharmacy (Denis’s pharmaceutical) and was conducting unlicenced mobile distribution of drugs using motorcycles in remote villages of Kitangwenda, Kyegegwa and Kyenjojo where he thought NDA and/or police would never track him down. He was found in possession of over 32 boxes of assorted drugs suspected to be repackaged government drugs.

The third and complex issues is that when Alex Mbusa (working as a porter at Bweramule Health Centre III) after his arrest in possession of several cartons of Government drugs, mainly ARVs at his home in Karugutu town, Ntoroko District, he confessed to NDA and Police that he sells these drugs to brokers who take them to Democratic Republic of Congo (DRC). This is something security agencies should get interested in.  

The last and more disturbing issue is the arrest of Assistant Inspector of Police (AIP) Kule Yusuf Katuramu, a police officer who is also a health officer working with Kyenjojo Police Health Centre II. He was ambushed by our teams in his police residence as he prepared lunch. He quickly accepted that he had received the drugs and was “wrongly” keeping them in his house. This is a senior police officer who is supposed to protect law and order but most importantly holding government drugs on behalf of his colleagues and their families but was instead stealing from them!

My colleagues at NDA have been emphasizing the challenges associated with increased illegal access and possession of classified drugs in wrong hands. First of all, diverting drugs meant for government facilities deprives the public of their right to access healthcare and has long lasting consequences on the country’s development as well as loss of trust in the country’s healthcare system.

The theft of government drugs denies those on treatment the opportunity to get full doze or continued supply and this is one of the causes of drug resistance and its associated public health challenges including worsening of disease condition among others.

This crime compromises the drug supply chain integrity as it is a key source of ineffective, repackaged, expired drugs whose quality, efficacy and safety have been compromised given the conditions these drugs are stored in while in concealment. In the case of Mbusa Alex, he was storing several boxes of both sealed and unsealed medicines in his small house, exposing them to unregulated temperatures which affects their efficacy.

The theft of government medicines is a significant component of the illicit trade in pharmaceutical products worldwide. This public health burden has moved from the initial small-scale thefts committed for personal usage to organised criminal networks that work in concealment targeting high-priced medical products, either to reintroduce them into the supply chain or sell them on the black market. This creates leakages in the supply chain as it puts drugs in the hands of those who are unregulated like hawkers. Drugs on illegal market and in hands of unqualified people creates a public health emergency, it does not only impact on and threaten the quality of the drug but also increases chances of drug misuse (overdose and underdose) as neither the drug seller nor the consumer is aware of the correct dosage and duration of treatment or drug related reactions. Falsified and substandard medicines is one of the major causes of death from preventable and curable conditions.

The impact of this crime goes beyond the value of the stolen goods, including harmful impacts on citizens’ health, legitimate drug companies, and public health care and public health systems. At the heart of it is the total selfish conduct by some health personnel misusing their privileged access to pharmaceuticals for selfish gain in total disregard of the public safety.

We all know that drug theft is not a new phenomenon, the challenge is a widespread practice not only limited to Uganda Misappropriation is a widespread practice. According to several Auditor general reports (2017-2020), it is estimated that the average Ugandan health facility drug leakage involving facility health workers is as high as 78%, and the motivation is to resale the stollen drugs. In many other developing countries, the situation is similar if not worse. All this represents a financial loss to the health care system, and affects health outcomes negatively. It also contributes to the growing sense of mistrust and disrespect for the health professions and their institutions.

At the face of this challenge is denying the patient access to the much-needed drugs that government has provided with tax-payers’ money! World Health Organization (WHO) argues that enjoyment of the highest standards of health is one of the fundamental rights of every human. This notion was emphasized in 1948 by General Assembly of the United Nations Universal declaration of human rights which passed a resolution that everyone has the right to a standard of living adequate for the health of him/herself and of his/her family, including medical care.  By this declaration, governments have an obligation to see the right to health by every citizen is progressively realized. This responsibility for prevention, treatment and control of disease.

Health is enlisted by United Nations as a human right to access medicine patients desperately need and given the sensitivity of drugs, they must be stored and distributed in suitable conditions that will not compromise their potency and ensure that they remain safe, of good quality and efficacious. According to WHO, quality care demands that people are able to get the right drug, in proper dosage, at any time they need it. A good drug has to be used appropriately for it to work well.

The essential role of drugs in public health cannot be overstated, given their therapeutic importance in treating, preventing and saving the lives of millions of people worldwide. Every country requires a steady supply of safe, efficacious, good quality and affordable medicines to promote public health and patient care. Drugs make an important contribution to reductions in diseases and death across the globe. In many developing countries like Uganda, medicines represent the largest household health expenditure. According to the 2023/24 budget, the government is spending 500 billion on medicines, translating to an average of Sh 9,000 on drugs and health commodities per month per citizen!

The ministry of health continues to put in place mechanisms of monitoring the drug supply, whereas there could be gaps, this system was helpful in linking the recovered drugs in Ntoronko to the health centre where they were stolen from. The documentation system should be digitalized to ensure that it even tracks who receive drugs from health centre A cannot get the same dose from health centre B in real time. This will curb issues of overstocking of drugs by patients especially of long-term doses like ARVs.

At NDA, we believe that whereas enforcement operations and arrests create substantial impact, they cannot alone fully get rid of this illegal and public health menace, the drug regulator and police cannot be everywhere, all the time. NDA is therefore increasing public awareness so that Ugandans appreciate the grave risks associated with this crime, increase network of our intelligence of informers who will frustrate the efforts of rackets.

NDA has widened access to medicine with now almost every parish in Uganda having a drug outlet, it is therefore inexcusable for someone buy any drug from a hawker! I have shared before that accessing a bad drug is as bad as having no access at all! These interventions are a manifestation of NDA’s commitment to protecting the public health and strengthening the drug supply chain. Health risks are like security concerns, they affect all of us squarely and require our joint efforts to keep all of us safe.

The writer is the public relations manager, National Drug Authority