Findings by the Budget Monitoring Unit of the Ministry of Finance have revealed that the majority of people who go to government health centres for malaria drugs are not patients. They are mainly 'speculators' who keep the medicine in their homes for fear that they will fall sick when the medicine is no longer available at the health centre.
The study indicates that in Rukungiri District alone, only 4,000 out of 20,000 people per month who get free malaria drugs at public health centres are genuine patients. This means that Uganda loses 16,000 doses of anti-malarials every month per district. Consequently, many genuine patients will not get treatment and probably die of malaria - part of the 300 daily deaths. Understandably, health workers in rural health centres give out the medicine to everybody who asks for it because they lack facilities to carry out blood tests.
The study confirms what many in the health sector have heard before but probably could not figure out the magnitude of the problem. Ruhaama and other border areas such as Bukwo and Gulu also have other unique challenges. They have to attend to patients from neighbouring countries like Rwanda, Kenya and Sudan.
"We know that the medicines are meant for Ugandans but you cannot send away a patient because he is not Ugandan. That would be rude and unethical," a health worker in Ruhaama County, Ntungamo District, noted. Giving medicine to non-patients and non-citizens means that stocks meant to last two months are exhausted in a few days, leading to an outcry of shortages from those who seek treatment afterwards. Malaria is the most common disease in rural areas and Coartem is the recommended effective medicine.
The solution lies in compulsory screening of all those who claim to have malaria. Beginning next month, National Medical Stores (NMS) will start distributing Rapid Diagnostic Test (RDT) kits to every health centre alongside routine supplies. NMS intends to use part of the Shs90b from Global Fund to supply malaria RDTs free of charge. It is hoped that if those who feign sickness are cut out, almost every genuine patient might have access to free anti-malarial drugs.
Going by the study in Rukungiri, if 16,000 doses of Coartem are lost in every district per month, then about 1.6 million doses are lost countrywide every month. Then how many genuine malaria patients go to public health centres in the same period and fail to get Coartem? Are they more than 1.6m people? Whatever the numbers, it is clear that shortage of malaria drugs in the country is largely artificial and the RDTs should change this.
The kit is easy to use; it requires a simple prick on a finger for a blood sample to be dropped on the kit for it to show the appropriate colour that tells the status of the patient - the same way the pregnancy rapid test kits work. The RDTs should not only lead to shorter queues at public health centres but also enable the stocks to last longer, probably until the next delivery in two months time - thus significantly bringing down malaria deaths.
However, the public should also play their part in ensuring that the supplies denied to those who have been feigning sickness do not get out of the health centre to private clinics through other means.
Mr Kaheru is the public relations officer, National Medical Stores