UGANDA: Drug supply chain problems trigger shortages
KAMPALA, 3 September 2008 (PlusNews) - Uganda's health ministry has been scrambling to stave off a nationwide shortage of antiretroviral drugs (ARVs) that could jeopardise the lives of tens of thousands of HIV-positive people.
Health officials said an inefficient drug procurement system, sporadic drug donations and a shortage of qualified pharmacists have left thousands of patients in danger of running out of essential medicines such as malaria medication and ARVs.
The government has ordered a supply of ARVs from foreign suppliers to offset the current shortage, and government sources said the drugs had arrived this week.
In the past two years, the local media have regularly raised the alarm over essential drugs expiring and having to be destroyed by the National Medical Stores (NMS), the main supplier of government drugs.
In Uganda, sub-district hospitals and health centres place orders for drug purchases with district health officials, who requisition the drugs from the NMS and the Joint Medical Stores.
"But there is inefficiency ... NMS may take 60 days instead of 30 to process and deliver an order to the district, but there are also problems of poor warehousing at the district level, inefficient transportation and distribution, as well as inadequate support supervision," said Dr Mshialla Maghanga, a lecturer at the faculty medicine at Gulu University in northern Uganda.
NMS officials have attributed the delays to poor forecasting of drug requirements as well as a low budget allocation for medicines. Health accounts for 10.6 percent of Uganda's national budget, which is below the 15 percent commitment to health made by African Union heads of state in Abuja, Nigeria, in 2001.
The government has 57 hospitals, 179 health centres and 989 other medical facilities around the country; past shortages have been attributed to the rapid scale-up of ARV distribution over the past few years.
"Even when we get the medicines there are no right people to dispense them," said Martin Oteba, acting assistant commissioner-in-charge of pharmaceuticals at the ministry of health.
He said Uganda's public sector had only 350 qualified pharmacists, while the country needed at least 14,000 to effectively serve its 30 million people. "Most of the pharmacists work for just about two years and go abroad or into private practice; the supply of drugs is affected by lack of continuity. The tools are there, the system is in place but there are no people to implement them."
 The tools are there, the system is in place but there are no people to implement them | Oteba noted that seasonal diseases and epidemics, such as the recent hepatitis E outbreak in northern Uganda, often attracted a lot of drug donations from development partners during the emergency, but once the outbreak had subsided the medicines might seldom be used and expired in the NMS.
Looking inward
In an effort to boost local production, the ministry of health has also placed its first order for ARVs from Quality Chemicals, a new ARV-manufacturing plant in the capital, Kampala.
Using drugs from the new factory has proved problematic in the past because major donors have tied their HIV grants to specified external drug manufacturers, so the government has been forced to earmark separate funds to buy drugs from Quality chemicals.
The factory, which began producing generic ARVs and malaria medication in 2008, has not received a licence from the UN World Health Organisation (WHO) but has been granted one by Uganda's National Drug Authority.
The ministry of health has also started local production of artemisia, the plant species from which the active ingredients in Coartem, recommended by WHO as a first-line malaria treatment, are derived. Malaria accounts for up to 40 percent of annual out-patient hospital visits and kills an estimated 320 Ugandans daily.
About 130,000 people living with HIV in Uganda have access to ARVs, roughly 42 percent of the total who need them.
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