Is the National Medical Stores (NMS) to blame for the glitches in the supply of medical products in Uganda? “It is not our problem,” says NMS General Manager Moses Kamabare while responding to an array of questions we put to him Thursday after giving a talk on the state of affairs at NMS.
Although there is general consensus of improved delivery of medicines in the country, complaints still abound of drug stock outs or insufficient supplies and expiry of medicines in health centres, among others.
But according Mr Kamabare, these problems are arising as a result of other key players failing to play their part, in what he summed up as “the key challenges we are facing as NMS,” which in term gives them bad publicity “for other people’s failures.”
The failure to align procurement plans with order cycles, especially by upstream health facilities (General Hospitals to National referrals), is one of the major problems affecting efficiency in the availability of medicines.
“They give you a procurement plan saying this is what we need, you procure those products, when a cycle order comes which is calling things off, it is talking of something different,” said Kamabare (pictured above) . “So if you give us in your procurement plan that every two months you will for example require 500 doses of Coartem, we procure, and when a cycle order comes someone says I want 1000. So where do you want us [NMS] to get the other 500?” He further argues that “for the fault finders,” the reference point here should not be the cycle order but the procurement plan.
Also, well aware of the changes in disease burden, Kamabare explained that NMS gives a flexibility of 20 percent above and 20 percent below the procurement plan.
Asked how the apparent lack of competency by facility managers to make proper orders could be fixed, Kamabare said there must be deliberate effort by Government to increase the numbers of trainees in pharmacy at degree as well as diploma level and dispensers, in order to help health facilities and districts make the correct procurement for medical supplies.
Another challenge blamed for some of the reported lack of medicines, especially at lower health facilities is politics, according to Mr Kamabare.
“Politicians wake up and create a Health Centre. They tell us we have sat in the council and decided to create a Health Centre 2. We say thank you but there is no budget for you,” Kamabare disclosed adding that lately, NMS has instead been asking districts presenting such requests to get a certificate of approval from Health ministry because of the financial implications these facilities present.
Irrational and over prescribing by health workers is yet another challenge blamed for the reported flaws in the chain. Kamabare explained: “A client tests positive for malaria, there is Coartem in stock and a health worker prescribes Halfan. And the patient thinks there no antimalarial yet what is not there is Halfan but the Coartem is there. So health workers prescribe what they clearly know is not there but always available in a drug shop close to the health facility and cause artificial shortages in the process.”
Similarly there are situations where health workers are unnecessarily prescribing more than what patients need in what the NMS chief referred to as polypharmacy (the use of four or more medications by a patient). Mr Kamabare asked health workers right from the lowest facilities to referral hospitals to follow the health ministry clinical care guidelines. Compliance with the guidelines, he alleged, is below 10 percent.
And, regarding the needs of the specialised facilities like the health and cancer institutes at Mulago, only increased funding will be the solution to their problems, according to the NMS manager.
NMS employee prepares stock at the Entebbe warehouse
Article by Kakaire Ayub Kirunda
Credits also go HPPM staffers Dr S. Kiwanuka, Dr E. Ekirapa-Kiracho, Dr Peter Waiswa, Mr Chrispus Mayora, Mr David Walugembe and Mr Moses Tetui for contributing questions
The seventh cohort of our certificate course in health services management has graduated with counsel to the trainees to make use of the learned skills in order to improve service delivery.
While officiating at the pass out at the weekend, the Kibuku District Health Officer Dr. Ahmed Bumba said he believes in people using the acquired knowledge before adding more. “A certificate today, work for some time, diploma next and work for a while before aiming for the next qualification. And I would like to urge you as managers to serve diligently.”
Dr Bumba said he has been challenging health workers from his district who have attended the course to demonstrate that they benefited from this course by doing some things differently from the way they used to.
“I have pushed many in-charges to do one or two things differently; whether it means maintaining and arrival book, doing an analysis of the book and acting on the findings of the analysis or making sure that the duty roaster is well maintained or making sure the drug orders are on time or doing performance monitoring of the workers,” he added.
Speaking on the same occasion, Prof. Freddie Ssengooba, the HPPM head of department said the course adds value to frontline health workers who hardly get management training during their training.
“Having knowledge on budgets, accountability, reports of service delivery and many other functions are very important especially at a time when health workers are under attack from all corners,” said the professor, imploring the trainees to make use of the acquired skills to improve themselves and their places of work.
(R-L) Course Coordinator Dr Vincent Kawooya, Prof. Freddie Ssengooba and Dr Ahmed Bumba performing the award giving ceremony
Thirty of the 43 successful candidates in the seventh cohort were sponsored by MakSPH’s Maternal and Neonatal Implementation for Equitable Systems (MANIFEST) study, which aims at improving maternal and newborn indicators in the districts of Kamuli, Kibuku and Pallisa.
MANIFEST also sponsored 30 health workers in the 6th cohort, ten from each of the three districts, and the same number is being sponsored in the 8th cohort which will come to a cumulative number of 90.
The journal Global Health Action has published a nine article special issue titled Newborn Health in Uganda based on finding from the Uganda Newborn Study (UNEST) which was housed under HPPM.
UNEST was a community randomized trial which evaluated an integrated care package linking homes, health centres and hospitals and involving visits during pregnancy and the postnatal period at home by a designated member of the village health team. The study was carried out in the Iganga-Mayuge Demographic Surveillance Site in eastern Uganda.
The UNEST results demonstrate that these home visits in pregnancy and soon after delivery were possible to achieve, and that life-saving behaviours could be improved by this interaction. Breastfeeding practices, skin-to-skin care immediately after birth, delaying a baby’s first bath, and hygienic care of the baby’s umbilical cord stump were higher amongst the families receiving home visits compared to those that did not receive them.
Importantly, these home visits were pro-poor, with more women in the poorest households, who are at most risk of encountering difficulties in access to care, receiving an early home visit after delivery when compared to the wealthiest families.
EU Ambassador Launches Policy Analysis Strengthening (SPEED) Project
The Head of the European Delegation to Uganda has launched the Supporting Policy Engagement for Evidence based Decisions (SPEED) for Universal Coverage project saying evidence is paramount to solving Uganda’s health problems.
Ambassador Kristian Schmidt said delivery of universal services usually comes with quality issues and urged SPEED partners to ensure that they give government sound policy advice in the area of universal healthcare coverage.
Mr. Schmidt also urged the Ugandan Government to work with SPEED to conduct some policy analysis on the controversial plan to export health workers to Trinidad and Tobago, especially at a time when the country is struggling with a big gap in human resources for health.
SPEED Director and Principal Researcher Prof. Freddie Ssengooba said solving health challenges was not the sole responsibility of the Health ministry but other sectors have to play a complementary role, hence the need for all round health policies.
SPEED is a 3.9 million Euro 5 year partnership supported by EU to improve policy analysis and policy influence at MaKSPH. This initiative will broadly be addressing UHC and systems resilience in Uganda institutions that are specialized in health policy and systems research, economic policy analyses, social science research, national planning, and advocacy for health rights. The contribution of this partnership will range from engaging decision makers in forums that enhance shared learning, shared vision of UHC goals, and collaborative decision making.
Other partners include ITM from Belgium and the Human Sciences Research Council of South Africa. In Uganda the Partner Institutions are: Makerere University School of Public Health (as the lead), Economic Policy Research Centre, National Planning Authority and Uganda National Health Consumers Organization.
Future Health Systems and Africa Hub partners will be participating at the ResUp MeetUp Symposium and Training Exchange in Nairobi from 9 to 12 February 2015, which will bring together members of the ResUp MeetUp community to share learning and best practice, and build capacity for research uptake. Kakaire Ayub Kirunda (Makerere University School of Public Health, Uganda) and Shibaji Bose (Indian Institute for Health Management Research, Kolkata) will be co-facilitating a training session on media engagement to influence policy.
Nasreen Jessani (Johns Hopkins Bloomberg School of Public Health, USA), Mabel Nangami (Moi University, Kenya) and Richard Ayah (University of Nairobi) will be delivering training on how to use issue briefs as effective and practical tools to highlight issues and provide practical solutions.