Prime
Audit registers regional imbalance in drug supply
National Medical Stores workers sort medicines set for distribution to public health facilities. PHOTO | FILE
What you need to know:
- Delays in drug delivery have led to persistent stockouts, increased disease burden, and potential loss of lives across hospitals.
A new audit has ranked Mbarara Regional Referral Hospital as the facility experiencing the least delays in receiving government drugs while the Kampala-based Naguru Regional Referral Hospital, experienced the highest delays.
This information is contained in a new value for money audit report by the Office of the Auditor General (OAG) on the measures put in place by the Department of Pharmacy and Natural Medicines under the Ministry Of Health in the provision of pharmaceutical services in Uganda.
The report captures three-year trends in the delivery of Essential Medicines and Health Supplies (EMHS) to four regional referral hospitals of Naguru, Mbarara, Mbale and Masaka.
Drug delivery in the country is done by National Medical Stores (NMS) based on six-order cycles from the hospitals, according to the report. The audit shows delays (counted as days) that each hospital experienced over the three financial years of 2019/2020, 2020/2021 and 2021/2022.
Our computation of data from the report showed that Naguru hospital, which is about 44 kilometres away from the NMS base (main drug store) in Entebbe, experienced the highest delays in receiving drugs with a cumulative of 289 days over the three years.
Naguru hospital was followed by Masaka hospital, which experienced cumulative delays of 248 days in total, Mbale hospital (177 days) and Mbarara hospital, which is located some 290 kilometres away from Entebbe, had the least cumulative delays at 68 days.
Response from NMS
Asked why some hospitals are receiving experiencing more delays than others to receive EMHS, Ms Sheila Nduhukire, the NMS spokesperson, said: “The challenges for that period were well documented, that is to say, delayed releases from Ministry of Finance.”
Ms Nduhukire added: “You will recall the minister tabled a detailed report on the floor of Parliament highlighting the impact of the delay in releasing operations funds for that period.”
The report indicates that although delays in drug delivery have been high, they generally worsened in the 2021/2022 Financial Year across the country with Naguru and Masaka hospitals experiencing cumulative delays of three months over the six order cycles that year alone. This was too high when compared to the previous Financial Year, 2020/2021, where Naguru and Masaka hospitals experienced cumulative delays of 2.5 months and six days, respectively.
However, Mbarara Hospital, in the 2020/2021 Financial Year, experienced cumulative delays of one day and Mbale Hospital, four days that year. In the 2021/2022 Financial Year, cumulative delays in Mbarara hospital were higher, at two months, while in Mbale hospital stood at three months.
“The audit team used a sample of regional referral hospitals (because of the high patient load and the specialised services offered) to compute the delivery lead time by NMS and the analysis indicated that the delivery lead time was beyond the standard delivery lag time of 30 days for some regional referral hospitals which translates into further delays in the delivery of EMHS,” the report reads.
“….whereas NMS made efforts to deliver EMHS to regional referral hospitals in a timely manner, there were some delays ranging between 1 to 87 days [per order cycle] over the years despite the fact that regional referral hospital orders were within the required order deadlines,” the report reads.
It continues: “The longer delivery lead times were attributed to the Covid-19 pandemic outbreak where priority was given to procurement and distribution of covid-19 vaccines. In addition, the longer lead times were as a result of delayed release of funds by Ministry of Finance, Planning and Economic Development (MoFPED).”
According to the OAG, the failure to deliver EMHS as per the delivery schedules translates into persistent stock out of these drugs at health facilities meant to satisfy the health care needs of the population.
“This may ultimately lead to loss of lives as well as increase the disease burden hence stretching the country’s pharmaceutical systems and budgets,” the report reads. The report also indicates that the delays in receiving medicines were not unique to regional referral hospitals, but were experienced by all public facilities such as health centres and general hospitals.
The management of the Health Ministry, in their response to the OAG, said: “National Medical Stores (NMS) was already engaged. This is well noted but as noted in the report during the period under review we had Covid-19 and most of our efforts were channelled to the distribution of Covid medicines and related supplies but also NMS experienced some operational challenges due to late access of funds.”
But the OAG in their recommendation, said the accounting officer of the ministry should engage NMS and MOFPED for any possible options in ensuring timely delivery and distribution of EMHS to all health facilities in the country to minimise stock outs and meet the health care needs of the population.
“Develop an emergency response strategy in terms of procurement and delivery of drugs/ vaccines so that any future response to emergencies does not affect the normal cycle delivery schedules for EMHS to health facilities in the country,” the report reads.
