Coartem child dose is six tablets and adults 12
Mar 29, 2009
<b>By Hamis Kaheru</b><br><br>I wish to correct some misleading information in the article titled, “Drug shortage hits Uganda†(Saturday Vision, March 21) to avoid unnecessary alarm in the public.
By Hamis Kaheru
I wish to correct some misleading information in the article titled, “Drug shortage hits Uganda†(Saturday Vision, March 21) to avoid unnecessary alarm in the public.
The article says the adult malaria patient is being treated with “coartem for children†because doses for adults are not available at National Medical Stores (NMS). This creates the wrong impression that coartem for adults is different from that for children and, therefore, adults are receiving under-dose or wrong treatment.
What people call coartem meant for children is just a packaging of six tablets. Each of the tablets is of the same strength whether it is for children or for adults. The only difference is the number of tablets the adult or child takes.
The dose for the child is six tablets (one pack) while that for an adult is 24 tablets. Because the Government had imported the six-tablet packs in excess and had a deficit of the 24-tablet packs, it was agreed by the Ministry of Health, through a circular to all health professionals that instead of having expiries of the six-tablet packs, they should give four packs to adults, which is equivalent to 24 tablets. So while a child patient is given one pack, an adult is given four packs of the same tablets. Health professionals should know this better. But if the technical people in that workshop could not explain such a simple issue, NMS wishes to set the record straight.
Coartem, like ARVs, is centrally procured by the ministry. NMS does not procure coartem. We only receive it on behalf of the ministry and distribute it to health facilities as and when it is available. Therefore, stock-outs should not be blamed on NMS in case these items are not available to us. However, stock-outs in health facilities are mainly a result of lack of complete and timely orders to NMS, poor quantification by health facilities and theft of medicines once they get to the health facility.
These problems cannot be remedied through decentralisation of procurement but by all the players in the supply chain of medicines, putting the patient before anything else.
The article quoted participants as saying it can take up to 60 days instead of 30 to process and deliver an order to the district. According to a Memorandum of Understanding signed between the Ministry of Health and NMS in 2002, NMS is required to deliver medicines to districts once every 60 days.
However, we have taken it upon ourselves to deliver every 30 days — without additional resources from the Government. Otherwise our performance would still be rated at 100% if we were following the target given to us by the Government of delivering once every 60 days.
On our own initiative, we are delivering to a possible extent, every 30 days because our focus is the patient who needs the medicines and health facilities may not accurately quantify their needs for the entire 60 days. It is true that if a particular drug is not available at NMS, we issue a certificate of non-availability so that districts or health facilities can procure them from elsewhere. But reports that NMS sometimes fails to issue the certificates is history. We have configured our Management Information Systems in such a way that once we receive an order from a district and put it into our system, the Proforma invoice that goes to the district and is the basis of preparing the Local Purchase Order (LPO) by the district comes out at the same time with the certificate of non-availability. It is difficult for NMS to comprehend how a health facility would receive a Proforma invoice without the certificate of non-availability, when the two documents come out of the system at the same time.
The public has a right to know that there is a new NMS in place with a new management and different ways of doing things.
The best way for researchers, activists and any other person to have up-to-date information is to contact authorised officials at NMS and also involve us in their public discussions.
The writer is the public relations officer of the
National Medical Stores
I wish to correct some misleading information in the article titled, “Drug shortage hits Uganda†(Saturday Vision, March 21) to avoid unnecessary alarm in the public.
The article says the adult malaria patient is being treated with “coartem for children†because doses for adults are not available at National Medical Stores (NMS). This creates the wrong impression that coartem for adults is different from that for children and, therefore, adults are receiving under-dose or wrong treatment.
What people call coartem meant for children is just a packaging of six tablets. Each of the tablets is of the same strength whether it is for children or for adults. The only difference is the number of tablets the adult or child takes.
The dose for the child is six tablets (one pack) while that for an adult is 24 tablets. Because the Government had imported the six-tablet packs in excess and had a deficit of the 24-tablet packs, it was agreed by the Ministry of Health, through a circular to all health professionals that instead of having expiries of the six-tablet packs, they should give four packs to adults, which is equivalent to 24 tablets. So while a child patient is given one pack, an adult is given four packs of the same tablets. Health professionals should know this better. But if the technical people in that workshop could not explain such a simple issue, NMS wishes to set the record straight.
Coartem, like ARVs, is centrally procured by the ministry. NMS does not procure coartem. We only receive it on behalf of the ministry and distribute it to health facilities as and when it is available. Therefore, stock-outs should not be blamed on NMS in case these items are not available to us. However, stock-outs in health facilities are mainly a result of lack of complete and timely orders to NMS, poor quantification by health facilities and theft of medicines once they get to the health facility.
These problems cannot be remedied through decentralisation of procurement but by all the players in the supply chain of medicines, putting the patient before anything else.
The article quoted participants as saying it can take up to 60 days instead of 30 to process and deliver an order to the district. According to a Memorandum of Understanding signed between the Ministry of Health and NMS in 2002, NMS is required to deliver medicines to districts once every 60 days.
However, we have taken it upon ourselves to deliver every 30 days — without additional resources from the Government. Otherwise our performance would still be rated at 100% if we were following the target given to us by the Government of delivering once every 60 days.
On our own initiative, we are delivering to a possible extent, every 30 days because our focus is the patient who needs the medicines and health facilities may not accurately quantify their needs for the entire 60 days. It is true that if a particular drug is not available at NMS, we issue a certificate of non-availability so that districts or health facilities can procure them from elsewhere. But reports that NMS sometimes fails to issue the certificates is history. We have configured our Management Information Systems in such a way that once we receive an order from a district and put it into our system, the Proforma invoice that goes to the district and is the basis of preparing the Local Purchase Order (LPO) by the district comes out at the same time with the certificate of non-availability. It is difficult for NMS to comprehend how a health facility would receive a Proforma invoice without the certificate of non-availability, when the two documents come out of the system at the same time.
The public has a right to know that there is a new NMS in place with a new management and different ways of doing things.
The best way for researchers, activists and any other person to have up-to-date information is to contact authorised officials at NMS and also involve us in their public discussions.
The writer is the public relations officer of the
National Medical Stores