New Vision (Kampala) - November 21, 2006
Mariam Nalunkuuma

Cases of drug expiry are inevitable and not limited to ARVs. When we have large quantities of drugs with low uptake, the shelf life of the drugs comes to an end and they expire.

There are specialised drugs we must always stock in preparation for disease outbreaks. If the outbreak does not come, they expire. For example we have bird flu drugs and rabies vaccines. But they are not being taken. They will inevitably expire. Sometimes a new drug comes on to the market to replace the already existing one. If we have the old drugs in the stores, we have to abandon it and go with what is on the market and it expires. Change in national equipment policy also leads to expiry of drugs at our stores. The change in malaria drugs from HOMAPAK to Coaterm will cause an expiry of over 10 million doses. But the Government has intervened over this matter and we hope it will be resolved.

These drugs expected to expire in December, why can't you sell them on open market now?

We cannot, and more so, ARVs. It is a policy issue. We only distribute and deliver drugs to accredited centres. To deliver ARVs we must get instructions from the Aids Control Programme (ACP). We cannot distribute ARVs anyhow. So are you just looking on as more ARVs expire in the stores? ACP has to enrol more HIV patients to access drugs from the accredited centres. When the uptake of the drugs increases, the drugs won't expire in our stores. As for these ARVs about to expire next month, the Ministry of Health has contacted some organisations like Joint Clinical Research Centre (JCRC) to take up some of them and JCRC has actually taken some of the drugs. We expect more organisations to come for more.

What do you do with the expired drugs?

We quarantine them and then seek the Board's approval to destroy them. We have to obtain permission from the National Drug Authority (NDA), NEMA, URA, Public Procurement and Disposal of Public Assets. We then take the drugs to Nakasongola and destroy them.

How can you explain the consistent shortage of drugs at health centres when we are burning drugs?

Many health sub-districts do not follow the schedules provided. And when a centre does not make its order in time, it means the drugs will not be processed for delivery within the delivery cycle. So the centre has to wait until the next cycle. Another reason for shortages is that some health facilities do not have the capacity to quantify their needs. They, in most cases, ask for drugs which cannot take them through the next delivery period. There are also budgetary constraints from the health centres.

They make orders according to the budget allocations from the district. Centres cannot order beyond their budgets.

How does the system work? As NMS, we follow the Public Procurement and Disposal of Public Assets (PPDA) regulations when procuring drugs. But we base on monthly consumption of the public facilities and plan procurement of drugs for three years. And depending on the need, we keep adjusting the plan. At the beginning of every year, we produce a delivery schedule indicating when the health facilities should have their orders ready at NMS. We are usually strict to ensure the health centres meet the deadlines which enables us deliver effectively and efficiently. We then move across the country every two months to dispatch drugs, apart from HIV/AIDS drugs which we distribute monthly at the 260 accredited health facilities. The health facilities are aware of our schedules, so we expect them to plan and make orders to enable them get the drugs in time. We cannot deliver what health facilities have not asked for and what is not in their demand. We also have credit line items system in which over 110 items are identified as basic and essential to which we ensure 100% availability of such items to the health centres. If a health facility does not determine its needs efficiently, then there will be shortage at the health centre. It seems the personnel at lower health centres do not have the capacity to adequately quantify the needs of their facilities. That is why there are possible shortages in some health centres. What time does this take? We deliver drugs for health centre II, III and IV to district stores through the District Director of Health Services (DDHS). It is then the responsibility of the districts to ensure health facilities receive the drugs they ordered for. We do not follow delivery of the drugs to lower health centres. In view of the expiry scandals, how can NMS improve its systems? The Joint Health Review Mission resolved that the ministry of health undertakes a study to provide those answers. But in the meantime, districts should ensure drugs are delivered to the lower health facilities fast enough and government should provide funds to districts in time. What is the mandate of the NMS? NMS was established by the Parliamentary Statute No.12 of 1993 with the statutory mandate of efficient procurement, storage and distribution of drugs and medical supplies throughout the country. We are a corporate body, commercial in nature, but charged with the social responsibility of providing essential, affordable, quality and efficiently distributed medical products. Where do you buy drugs from? Suppliers and manufacturers registered with the NDA. But we also receive drugs from donors and such drugs are under the third party programmes of the Ministry of Health. They are procured for distribution free of charge, but are brought to NMS for storage and distribution on instruction from the donors. What are the challenges of NMS? Our biggest challenge is the third party products. We never know how much and what type is to be procured. They do not plan with us, so they procure drugs in large quantities constraining our storage capacity and leading to wastage and expiries, for which NMS is blamed.

But at a joint health review mission, the health sector has agreed to have a harmonised plan for the products. We are also heavily indebted by the Government which owes NMS over sh11b. We are supposed to work as a commercial entity and compete with private sectors. But we cannot operate without flexibility. We are not enjoying independence and autonomy because we are regulated.

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