8 January 2018

Uganda: 76% of Hospitals Fail to Account for Medicines - AG Report

Photo: Daily Monitor
(File photo).

76 percent of districts and municipal councils failed to account for over Shs 4.5 billion dispensed for health supplies and medicines in 2016/17, the auditor general's report reveals.

An audit exercise into management of medicines and health supplies at the districts also exposed malpractices including drug stock outs, explaining the current poor health services in the country.

Auditor general John Muwanga and his team, audited districts and municipal councils' financial statements for district hospitals and health centre IVs. The audit focused on the procedures, processes, tools and documentation used to manage medicines and health supplies.

The report observed that unaccounted for medicines and health supplies may lead to rampant medicine stock-outs which hamper service delivery.

The auditor general advised accounting officers to ensure that all the necessary records for the items are properly maintained, monitored and any variances investigated and that optimum amount of medicines and health supplies are available at health facilities at all times.

Some of the district hospitals that failed to account for the funds include Mpigi health centre IV in Mpigi district, Kyazanga health centre IV in Masaka district, Mityana hospital, Kabuyanda hospital in Isingiro district, Buzibwera and Buyamba health centres in Mbarara district and others.

The others are Ovujo health centre III on Maracha district, Anaka hospital in Nwoya district, Pajule health centre IV in Pader district, Aduku health centre IV in Apac district, Bukwo hospital in Bukwo district, Nsinze health centre IV in Namutumba district and others.

Persistent stock-outs

The audit report also highlights persistent stock-outs of the 11 essential medicines that are supposed to be at hospitals and health centers at all times as per the ministry of Health and World Health Organisation (WHO) guidelines.

The essential or tracer drugs and supplies include Artemether, Lumefantrine, HIV determine test strips, malaria rapid diagnostic tests (RDTS), oxygen, blood, surgical gloves, Oxytocin, safe delivery kits/mamakits and others.

The report found that mama kits were out of stock for 320 days at most hospitals and Coartem drugs used for treatment of malaria was out of stock for 285 days.

The report noted that the e stock-outs may be a result of failure by National Medical Stores (NMS) to supply drugs in the quantities ordered by health centres and lack of reliable information on drugs usage and stocking positions.

Muwanga warns that the stock-outs erode patient confidence in the health sector which leads patients to explore inappropriate and expensive alternatives of health care. He advised accounting officers to liaise with NMS to ensure continuous optimum stock of medicines and health supplies.

Expired medicines

The audit revealed that expired medicines and health supplies were found in 40 health facilities across the country. The report attributes the expiry of the drugs to a possibility of excess stocking of slow moving drugs.

"The cost of destruction of expired drugs is high and there is a risk of them getting redistributed back to the market. The entity should liaise with NMS to ensure that expired or damaged stock is destroyed in accordance with the regulations." said Muwanga.

Under staffing

The auditor general also notes that out of 118 health facilities, 98 (83%) were experiencing high rate of under staffing ranging from 80% in Kalisizo hospital in Rakai district to 9% at Iganga Hospital.

The audit report says that in 38 districts and municipal councils, the under staffing included critical positions in medicine management. It attributed the under staffing to limited wage bill and ban on recruitment. Some of the key positions without staff include pharmacist, stores assistant, dispenser and others.

That, according to auditor general under staffing overstretched the available staff beyond their capacity, creates job-related stress to the fewer staff and negatively affects the level of public service delivery to the community.

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