Hands-on minister gets shock in clinic

By John Njoroge & Molly Lister

Health State minister Kakooza’s fact-finding mission reveals why drugs seem to be missing in hospitals

Sitting in a health centre in western Uganda in a T-shirt, jeans and open-toed shoes, State Minister of Health James Kakooza witnessed a nurse send a patient to a pharmacy located outside the hospital to buy doses of quinine instead of getting the drugs free from the hospital.

Kakooza identified himself, to the shock of the hospital employees, and ordered the hospital administration to open its stores.  He found quinine in stock.

This was the first of a solo fact-finding mission to find out why drugs seem to be missing in hospitals.Is it an inadequacy of funds, misuse of funds, problems of administration or procurement? Kakooza explains.

After my recent experience, I have come to the conclusion that the biggest problem is theft of drugs. The theft is mainly orchestrated by medical workers in our public hospitals.

Since beginning his quest, the newly appointed State minister for Health has visited health facilities in over 26 districts in Uganda.  The revelations are alarming.

Unscrupulous doctors, medical officers, nurses, medical superintendents and hospital store keepers in government health facilities and within the National Medical Stores (NMS) are involved in stealing medicines meant for free distribution in government hospitals, he says.  They, in turn, divert the drugs to their own private clinics and pharmacies and sending patients to these outlets to purchase their medication.Â

Even more shocking, the minister learnt, is the revelation that some district health officials are deliberately under-procuring drugs to cause a shortage thus creating a vacuum for private clinics and pharmacies to supply the missing drugs at a fee.Â

The government of Uganda gives 30% of the total financial obligation to primary healthcare, to the National Medical Store. The remaining 70% is sent to the districts depending on their needs, emergencies and disease prevalence. Half of this money is meant for procurement of antenatal drugs, drugs for diseases like malaria, dysentery, vaccines and the likes.

Despite these efforts, corruption, greed and incompetence are frustrating the availability of these much-needed drugs.  Top on the list is rampant conflicts of interest. It is emerging that some of the management committees sent from the districts to monitor the procurement and distribution of drugs have private pharmacies. A good number of them end up diverting some supplies to personal entities, thus starving government health units.Â

While speaking to journalist recently on the subject, the World Bank country chief, Kandiresan Kundavi is quoted to have said that “the recent public expenditure review estimates that government losses were close to Shs30 billion due to absenteeism [and] 93 per cent of the drugs procured by the National Medical Stores did not reach their intended recipients.”

Further exacerbating the situation, doctors’ wages in Uganda, at Shs 600,000 per month, are some of the lowest paid in the region. They are rarely given the opportunity to improve their careers because they are rarely transferred to other parts of the country and the possibility of a pay-raise is nearly impossible.  These working conditions are coupled with lack of modern medical amenities and acute congestion in hospitals. According to a report by the World Health Organisation (WHO) in 2008, the doctor patient ratio stands at 1:24, 000. Doctors under such conditions are often tempted to either leave the country in search of better pay or go into private practice.Â

Kakooza’s surprise attacks uncovered that in many cases, doctors do not totally abandon government hospitals but exploit poor the administrative mechanism by diverting drugs to their private clinics. Many of them now stand involved in professional misconduct.

They are known to recommend patients who visit government health facilities to seek further medical treatment from their own private health facilities at a fee. In many cases, it has become the order of the day for these doctors to divert drugs in public hospitals to earn extra money.Â

The problem with doctors,” Kakooza explains, “is quite serious especially in national referral hospitals like Mulago. It’s totally unethical but we cannot do much about it. Uganda has very few doctors who we do not want to reprimand as per now for fear that they will leave. The ministry has however been monitoring them closely and have identified those that are involve in misconduct. Once the capacity is built, they will be disciplined.”

He has drafted a proposal to see all the drugs procured by government marked to prevent them from being sold. Even though this proposal, coupled with mass sensitization, would prevent diversion of drugs, it may not be effective without superior supervision. Beatrice Byenkya, the chairperson of the African Parliamentarians Network Against Corruption, told AllAfrica.com that labeling the drugs alone was not enough saying that other loopholes in the delivery chain need to be addressed. The WHO has also echoes this problem in its numerous annual reports on Uganda’s health care system.