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Find a financial cure for drug shortages
Author: Samuel Opio Acuti, Member of Parliament, Kole North. PHOTO/FILE/COURTESY
What you need to know:
- ... short of a financial cure for drug shortages at the macro level we shall not be treating it but only managing its symptoms!
In the Daily Monitor of February 1, 2023 it was reported that hospitals had run out of essential drugs and supplies.
The minister of Health in her statement on the floor of Parliament on February 1, 2023 blamed the drug shortages on delays by Ministry of Finance Planning and Economic Development (MOFPED) to release the needed funds.
According to the Public Finance Management Act , regulations of 2016, release of funds are supposed to be done by the 10th day of the first month of each quarter. MOFPED indicated to have complied with this with Shs6.369 trillion having been released in the third quarter by December 29, 2022 almost two weeks earlier.
However, it is important to note that this was release of expenditure limits and not release of funds and therefore does not equate to receipt of money into the respective government entity accounts. Finance basically turned on the pump to fill the financial resources into the tank but it did not open the tap for the resources to flow out.
For this to happen, additional processes need to be undertaken in the IFMIS (Integrated Financial Management) system in which the accounting officers login and make accounting warrant requests.
These then have to be approved from the finance side and once done, again invoices raised in the system and approved for payments to be effected into the accounts.
This is where the blockages lie within the IFMIS pipeline. At times the IFMIS system is unavailable and the accounting officer fails to login. On other occasions the approval times delay. The cycle time from release of expenditure limits to receipt of funds can at times take upto one month as indicated by the minister of Health in her statement on the floor of Parliament.
In it she stated that in quarter one of financial year 2022/23 the NMS budget whose expenditure limits were released in July, had the funds received in August 2022 and those released in October similarly received a month later in November 2022.
Drug distribution however doesn’t follow the same pattern of finance release since it is continuous and not periodic. Therefore, at any one time the funds should be in the NMS accounts including the money for distribution.
In addition, only availing funds for purchase of drugs without funds for distribution equates to providing the food without the fire to cook it. For payment of salaries, MOFPED’s approach could work since salaries are paid at the end of the month. However, for drug distribution you need the money at the start of the month since some health facilities receive their supplies monthly while others get theirs every two months. A review of this financial system is therefore needed for drugs.
The second major issue is that our per capita expenditure on health and subsequently drugs is still very low as per World Bank statistics.
Uganda spends just $32.1 on health per person much lower than its neighbours Kenya that stands at $83.4, Rwanda at $ 51.4 and Tanzania at $40.34. Countries such as US are unmatchable at $ 10,921. If figures on NMS budget were to be used then Uganda spends just $3 per capita (per person) on medicines out of the $32 on health. This translates to just one dose of antimalarials, one course of antibiotics and a few tablets of paracetamol.
Budgetary increases are required but they shouldn’t be generic but focusing on specific areas such as antibiotics, antimalarials, theatre and emergency drugs, hypertension, mama kits and diabetic drugs where shortages are most common.
In conclusion, short of a financial cure for drug shortages at the macro level we shall not be treating it but only managing its symptoms!
Samuel Opio Acuti, Member of Parliament, Kole North.
