Important note: Information in this article was accurate in 2007. The state of the art may have changed since the publication date.
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New Vision (Kampala) - September 16, 2007
Elvis Basudde
Albert Kalangwa, the acting head of stores, marketing and operations, said arrangements to destroy the drugs are in the final stages. Among the items to be destroyed include Ngabo condoms.
The director general of Health Services, Dr. Sam Zaramba, said the drugs have expired over many years and have been collected from different districts, as well as private pharmacies. "There are many reports on the shortage of ARVs in Katakwi, Pallisa, Rakai, Soroti, Hoima and Luweero districts," Richard Sserunkuuma, the national coordinator of Positive Men's Union, said. He was addressing people living with HIV/Aids during a workshop in which they complained about the expiry of ARVs in store, accusing NMS and the Ministry of Health of negligence.
The workshop was held at the National Forum of People Living with HIV/Aids Networks of Uganda offices in Mengo recently. Sserunkuuma said as a result, the number of people accessing ARVs had declined. But Kalangwa said NMS is not entirely to blame for the expiry of the drugs.
He said their role is to store drugs and distribute them according to instructions from the Ministry of Health. The World Health Organisation (WHO) procures ARVs through the sponsorship of the Global Fund.
"If NMS was procuring the items, we would take responsibility for what is happening. We find ourselves in an embarrassing situation storing what we did not want to procure," he said.
Kalangwa added that the lack of coordination between NMS, WHO and the ministry, contributes to the wastage. He said WHO and the health ministry procured ARVs without consulting medical stores and when the drugs expired, NMS had to explain.
Zaramba said expiry of a negligible quantity of procured drugs of between 5% to 10%, will always occur, however well you may compute. He explained that some of the expired drugs at NMS are donations from different partners and not WHO, adding that most ARVs have a short shelf-life and the majority have a span of two to three years.
Zaramba said by the time the drugs were procured and arrived in the country, most of them had lost six months. Zaramba said most of the drugs that expired were paediatric preparations for children, which were donated by different partners.
Children preparations have a shorter shelf-life, since they are solutions, and they expired before more children were recruited to consume them. He, however, accepts that there was a computing error and negligence in the way adults' ARVs were handled by NMS, resulting in their expiry.
"The bulk of the drugs that caused the sucking of NMS key staff were those that were mistakenly not given out to the users. Human error apart, the computer was giving front expiry dates (still ahead) when actually the dates on drug box tags were close," he said.
"The first batch of drugs we got into the country with support from WHO was in March this year, and the stock is almost
getting finished. But the alleged drugs expired in September 2006.
So, none of the drugs we have procured have expired," Dr. Frank Lule, the national professional officer for HIV/WHO stressed. He said the order to procure ARVS using Global Fund is for $13m (sh22,750m) and their mandate to procure is for one year, ending this month.
After which, WHO will hand over the procurement to the Government. "These are the variables which, if you go wrong in one of them, leads to stock wastage, mainly through expiry," Kalangwa says.
He explained that the process of incineration has to start with investigations, after which a procedure recommended by the Public Procurement and Disposal of Public Assets follows because they would be disposing of public property.
They had to involve external stakeholders in the disposal, like the National Drug Authority, which regulates drugs in Uganda. They had to involve the Uganda Revenue Authority since a lot of money is being written off the books of NMS, the National Environment Management Authority since the incineration has an impact on the environment, and the Police for safety.
They also have to recruit a service provider to transport the items to the incineration point and destroy them.
Zaramba said they have harmonized the entry and exit of the drugs in the stores after quantifying what is needed to be brought into the country at regular intervals.
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