Labelling drugs is the solution to shortage
Mar 17, 2009
<b>By Hamis Kaheru</b><br><br>I thank Dr Sam Okuonzi for highlighting some of the problems National Medical Stores (NMS) encounters in carrying out its mandate to procure, store and distribute essential drugs to public health facilities.
By Hamis Kaheru
I thank Dr Sam Okuonzi for highlighting some of the problems National Medical Stores (NMS) encounters in carrying out its mandate to procure, store and distribute essential drugs to public health facilities.
In his article, “Drug shortage is due to inefficiency in NMS†(the New Vision, February 25), he highlighted deficiencies in legislation and undercapitalisation. These are external factors over which NMS has no control. Efficiency is the ratio of output as a percentage of input, and if one is given few resources and he/she produces little, that person is efficient. Therefore, it may be erroneous to say that NMS is inefficient as suggested in the headline. Perhaps Dr Okuonzi meant ineffectiveness imposed by factors outside NMS for which it cannot be blamed over drug shortages.
My earlier article to which Dr Okuonzi responded was meant to clarify two issues. First, that shortage of medicines in public health facilities is not a result of non or delayed delivery of medicines by NMS. Secondly, that NMS is not the primary source of medicines for public health facilities.
Although Dr Okuonzi asserts that, “NMS remains the primary source of drugs for public facilities,†official figures indicate the contrary. The Annual Health Sector Performance report, presented by the health ministry, shows that in the last financial year (2007/8), sh47b was allocated for drugs to public health facilities.
Out of this money, sh17.4b (37%) was for drugs under Credit Line programme. NMS supplies primarily under the credit line. This means NMS is not the primary source of drugs as Dr Okuonzi asserts, and should not be blamed for shortages.
Also out of the sh47b, sh10.4b went to national referral hospitals (Butabika and Mulago), but no medicines were bought from NMS by these hospitals. Yet there is evidence of acute shortages of medicines in Mulago Hospital and a patient can hardly get Panadol free of charge. The question is: Did these hospitals buy the drugs? And if so, why did they opt not to buy from the biggest source (NMS) or even the second biggest source Joint Medical Stores? In fact over the last two years, Mulago Hospital did not buy any of their medicines from NMS and shortages there cannot be blamed on NMS.
Dr Okuonzi concurred with me that drug shortage is partly due to theft by health workers. However, he seemed to rely on poor remuneration to defend colleagues who engage in this unethical behaviour. All health workers are underpaid and if each of them is trying to compensate by stealing supplies, then theft is the major cause of shortages. This is why the Government thinks embossment is the solution. With embossment, Ugandans will decide whether they should pay for supplies they are supposed to get free. If they decide not to pay for them, these drugs will be available at health facilities – unless health workers throw away the drugs which I believe they will not. Therefore, nobody should underestimate the impact of embossing.
If we say it is okay for health workers to steal drugs because they are underpaid, what of the money allocated to districts under the primary healthcare (PHC) programme? PHC funds comprise 60-70% of a district’s funds for drugs. The same people who are underpaid are the ones who control the PHC money. Isn’t it easier for unethical district health officials to divert the PHC money and then somehow account for it than having to steal the drugs delivered by NMS? When PHC funds are diverted, the shortage is greater than if NMS does not supply the 30-40% under the credit line. When this diversion is in addition to stealing of physical drugs delivered by NMS, the impact is much bigger.
On undercapitalisation of the health sector, Dr Okuonzi was spot-on. But while increased funding is necessary, the immediate solution is streamlining the flow of the available resources meant for providing medicines to the population. The Ministry of Finance does not send the money for buying drugs to NMS as is the case with other public utility companies. The money is sent to the health ministry which sometimes does not pay NMS in time as evidenced by the unpaid bills owed by MoH to NMS.
We think guaranteeing money directly from the Ministry of Finance (as it is done for suppliers of water and electricity) would be a good start. On whether funding provided by the Government for buying drugs is adequate, I maintain that without diverting PHC funds and rampant theft of drugs, the more than sh100b per year that the Government provides can be enough to provide medicines to every patient in a public health facility.
The figures quoted by Dr Okuonzi would probably be required to provide all the necessary essential medicines for every Ugandan because they are based on per capita. However, not every Ugandan goes to a government health facility. I am referring to that Ugandan who has to walk for a kilometre or more to go to a government health facility and cannot find essential medicines. Moreover, there is no guarantee that if the Government provides the $40 per capita, health workers will not divert all of it or a substantial part of it! Therefore, the way forward is to compel all public health facilities to buy drugs from sources which emboss their products.
NMS believes the current debate in the public domain is probably not how much more the Government needs to provide for health facilities to have adequate stocks but rather how much the Government must put in so that when all the thieves have taken their loot, there remains sufficient supplies for the patients that report to these facilities.
The writer is the public relations officer of National Medical Stores
I thank Dr Sam Okuonzi for highlighting some of the problems National Medical Stores (NMS) encounters in carrying out its mandate to procure, store and distribute essential drugs to public health facilities.
In his article, “Drug shortage is due to inefficiency in NMS†(the New Vision, February 25), he highlighted deficiencies in legislation and undercapitalisation. These are external factors over which NMS has no control. Efficiency is the ratio of output as a percentage of input, and if one is given few resources and he/she produces little, that person is efficient. Therefore, it may be erroneous to say that NMS is inefficient as suggested in the headline. Perhaps Dr Okuonzi meant ineffectiveness imposed by factors outside NMS for which it cannot be blamed over drug shortages.
My earlier article to which Dr Okuonzi responded was meant to clarify two issues. First, that shortage of medicines in public health facilities is not a result of non or delayed delivery of medicines by NMS. Secondly, that NMS is not the primary source of medicines for public health facilities.
Although Dr Okuonzi asserts that, “NMS remains the primary source of drugs for public facilities,†official figures indicate the contrary. The Annual Health Sector Performance report, presented by the health ministry, shows that in the last financial year (2007/8), sh47b was allocated for drugs to public health facilities.
Out of this money, sh17.4b (37%) was for drugs under Credit Line programme. NMS supplies primarily under the credit line. This means NMS is not the primary source of drugs as Dr Okuonzi asserts, and should not be blamed for shortages.
Also out of the sh47b, sh10.4b went to national referral hospitals (Butabika and Mulago), but no medicines were bought from NMS by these hospitals. Yet there is evidence of acute shortages of medicines in Mulago Hospital and a patient can hardly get Panadol free of charge. The question is: Did these hospitals buy the drugs? And if so, why did they opt not to buy from the biggest source (NMS) or even the second biggest source Joint Medical Stores? In fact over the last two years, Mulago Hospital did not buy any of their medicines from NMS and shortages there cannot be blamed on NMS.
Dr Okuonzi concurred with me that drug shortage is partly due to theft by health workers. However, he seemed to rely on poor remuneration to defend colleagues who engage in this unethical behaviour. All health workers are underpaid and if each of them is trying to compensate by stealing supplies, then theft is the major cause of shortages. This is why the Government thinks embossment is the solution. With embossment, Ugandans will decide whether they should pay for supplies they are supposed to get free. If they decide not to pay for them, these drugs will be available at health facilities – unless health workers throw away the drugs which I believe they will not. Therefore, nobody should underestimate the impact of embossing.
If we say it is okay for health workers to steal drugs because they are underpaid, what of the money allocated to districts under the primary healthcare (PHC) programme? PHC funds comprise 60-70% of a district’s funds for drugs. The same people who are underpaid are the ones who control the PHC money. Isn’t it easier for unethical district health officials to divert the PHC money and then somehow account for it than having to steal the drugs delivered by NMS? When PHC funds are diverted, the shortage is greater than if NMS does not supply the 30-40% under the credit line. When this diversion is in addition to stealing of physical drugs delivered by NMS, the impact is much bigger.
On undercapitalisation of the health sector, Dr Okuonzi was spot-on. But while increased funding is necessary, the immediate solution is streamlining the flow of the available resources meant for providing medicines to the population. The Ministry of Finance does not send the money for buying drugs to NMS as is the case with other public utility companies. The money is sent to the health ministry which sometimes does not pay NMS in time as evidenced by the unpaid bills owed by MoH to NMS.
We think guaranteeing money directly from the Ministry of Finance (as it is done for suppliers of water and electricity) would be a good start. On whether funding provided by the Government for buying drugs is adequate, I maintain that without diverting PHC funds and rampant theft of drugs, the more than sh100b per year that the Government provides can be enough to provide medicines to every patient in a public health facility.
The figures quoted by Dr Okuonzi would probably be required to provide all the necessary essential medicines for every Ugandan because they are based on per capita. However, not every Ugandan goes to a government health facility. I am referring to that Ugandan who has to walk for a kilometre or more to go to a government health facility and cannot find essential medicines. Moreover, there is no guarantee that if the Government provides the $40 per capita, health workers will not divert all of it or a substantial part of it! Therefore, the way forward is to compel all public health facilities to buy drugs from sources which emboss their products.
NMS believes the current debate in the public domain is probably not how much more the Government needs to provide for health facilities to have adequate stocks but rather how much the Government must put in so that when all the thieves have taken their loot, there remains sufficient supplies for the patients that report to these facilities.
The writer is the public relations officer of National Medical Stores