Joachim Buwembo
25 July 2008
opinion
Uganda's minister of finance must henceforth budget for the disposal of expired drugs because the phenomenon will remain with us for quite a while. But as we agonise over spending an unbudgeted Shs800m this year to destroy expired drugs in the custody of the health ministry, we at least expect Dr Ezra Suruma to include the item in next year's expenditure so there is no distortion in the 2009/10 budget.
Of course there would be no massive expiry of drugs in the pharmacies if we borrowed the skills of village shopkeepers who have mastered the management of various stocks in their stores.
Drive out to any small shop 20 or more kilometres from Kampala and observe the shelves. Some items which are common on the city supermarkets will never feature in the village shop. You will not see bottles of Listerine mouthwash for example in a shop in Mpigi town. The shopkeeper knows that he would probably only sell one bottle in a year if he stocked the stuff.
His neighbour who runs a bar will not have the green Tusker bottle so popular in Kampala and makes the consumer's wallet Shs3,000 lighter without knocking him out quickly. But he will have plenty of the bigger bottles with higher alcohol percentages. But even these will not compete favourably against the hard liquor sold by Ms Beere Ddene in the narrow street behind the shops.
These upcountry stockists have learnt over time which commodities move at what rate and this helps them know what to bring in what quantities. If they were in charge of running the National Medical Stores (NMS), there would be less or no expired drugs on the nation's hands demanding hundreds of millions of shillings to dispose of.
But are such capabilities non-existent with our modern pharmacists? Do they not know which diseases occur more frequently than others? Do our medical people, for example, not know that more cases of malaria are reported at health centres than say, erectile dysfunction?
Of course they do. Then why should a clinic have impotence drugs and no anti- malarials? The answer to this complex question is quite simple. The professionals have little or no say in the decision making. The procurement process is influenced by the suppliers who help the managers to decide which drugs to stock.
These are the drugs which are about to expire in some store and an official is persuaded that they must be bought by Uganda. If somebody queries the purchase and delays payment, this means payments for the more needed drugs will also be held up because the supplier is in touch with some people who provide the funds for some essential purchases. The rest does not require a genius to figure out.
So malaria is very common and it kills more people than any other disease; destroys more lives worldwide than the AK-47 and terminates more pregnancies than most of us can imagine.
But the suppliers and their friends in managing our medical stocks are impressed. Logically then, we would be more keen on stocking malaria drugs.
But the real world, or Uganda does not work that way. That is why when the ministry of health outlawed the Fansider and chloroquine drugs for treating malaria and declared the new policy of using combination therapies (ACTs), it took three years for government itself to secure the drugs like Coertem. Reason? Millions of free dollars provided by donors to buy the ACTs were lying unutilised in Geneva because officials concerned did not have any incentive to pursue them.
After all, malaria kills mostly the poor people who can't afford expensive treatment. Even if we import the Coertem and divert it to private clinics, it won't sell as fast. Actually, ACTs have been available in private clinics for a few years but even the health workers mostly prescribed them for expatriates, the rich and people on medical insurance schemes.
So we really have only two options to deal with the problem of drugs expiring in government medical stores: Either budget for their disposal every year or get a village shopkeeper to manage the medical stores for us.
The writer is a veteran journalist
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