( Human rights , Commercial, Land and Environment lawyer, Media,Communications Consultant and trainer)
Tuesday, December 31, 2013
20 YEARSOF INNOVATION AND TRANSFORMATION AT NATIONAL MEDICAL STORES
20 YEARSOF INNOVATION AND TRANSFORMATION
AT NATIONAL MEDICAL STORES
Following decades of anarchy characterized with mismanagement of public resources government health facilities were not spared either. Government hospitals and health centers sufferedchronic stock-outs of medicines and medical supplies. The Ugandan people were not only left without drugs but would walk long distances to get whatever little that was left by the thieving bureaucrats..
But 20 years after the introduction of the National Medical Stores (NMS) ,all government hospitals and health centers are not only receiving constant supply of drugs, measures have been put in place to ensure that medicines and medical supplies delivered to are not stolen and sold on the open market.
Embossment of all drugs and medical supplies to government health hospitals and health centers IVs, IIIs and IVs, is one of the key innovations that have been undertaken by the leadership of NMS to stop the wanton pilferage of drugs. “ It has come at the displeasure of many but we had to do it to stop the vise of health workers stealing drugs and other medical supplies . All medicines and medical supplies are now embossed with a seal ‘Uganda Government Not For Sale’. The health workers and the general public is accordingly put on notice . If anyone are got selling such embossed drugs they are prosecuted ,” Mr. Moses Kamabare the General Manager of the National Medical Stores says.
Embossment of medicines and medical supplies is not only the major innovation that has been undertaken at NMS. The institution has also come up with the Last Mile Delivery system for medicines and medical supplies to ensure that medical supplies reach the end user at all government health facilities across the country. Before this particular innovation,medicines and other medical supplies used to be delivered at the District Health Offices which had no capacity to delivery to the health facilities. This meant that many government health facilities would be without drugs for long periods of time .some drugs would even expire before they were delivered to the health facilities.
“The situation was dire and we had to carry out fundamental reforms in our delivery system. So, now we take the medicines and medical supplies direct up to the health facilities . This means all government health facilities can get supplies from NMS in time and account for all the deliveries we make.
In order to make the system more user friendly we publish a medicines and medical supplies delivery schedule which is intended to make the delivery of drugs predictable throughout the year .This system does not help in ensuring timely delivery of medicines and other medical supplies but it also ensures effective management of our stock so that health facilities don’t run out of medicines,” Kamabare says.
"The situation before the establishment of NMS I must say was s pathetic. There were no medicines to supply and the public largely relied on the private sector for the provision of drugs. But that has since changed. Government is now in position to supply adequate essential medicines to all the hospitals and health centres across the country" Kamabare, explains.
In 1993 the then Central Medical Stores (CMS), run by the Chief Pharmacist in the Ministry of Health was responsible for all aspects of medicines. At the time, CMS was the regulatory body in charge of ensuing quality of drugs and licensing of pharmacists among other regulatory functions and also the procurement and distribution of medicines to government health facilities.
However, in 1993 the government created the National Medical Stores under the NMS Act of 1993 as an autonomous body to deal with the growing demand for medical supplies in the country while the regulation of medicine quality and premises went to National Drug Authority (NDA).
The new law mandated the NMS to procure, store and distribute medicines to all government facilities in the country.
"Government medicines are supplied to all government hospitals and all health centres across the country on time and should be given to all in needfree of charge. We now have enough stock of medicines and we are distributing medicines to all government hospitals and health centres on a routine basis against the ordersmade to us by the health facilities. I cannot understand why Ugandans keep being cheated when they go to government hospitals and they have to pay for any medicine given to them.
No one should lie to Ugandans that government has no medicines or that there is a government health facility without medicines because of NMS,” Kamabare
"The problem of supply of adequate medicines has been solved. All government medicines are embossed and clearly marked "UG" and "NOT FOR SALE”. All that the health facilities have to do is to ensure that they properly quantify their needs,send their orders to NMS in time and ensure that they only prescribe for patients the essential medicines as provided by the Ministry of Health through the Uganda Clinical Guidelines. There are some quarters within government who thought that we could not emboss our medicines. That it was too costly. But we have done it and at zero cost. So any person who tries tosell medicines marked "NOT FOR SALE', even if it’s a health worker, is a criminaland should be arrested immediately and handed over to police,”Kamabare added.
Government had originally decentralised the supply of drugs and 70% of the money meant for purchase of medicines was directly being sent to the districts and hospitals. This created problems as it was difficult even for auditors to ascertain that the money was used for the intended purpose.
“The money would get 'lost' along the way and health centres and hospitals were left without medicines to give to patients. Even for NMS that had to borrowits working capital from banks and pay interest on it, the resultant mark-up on the medicines to cover our operational costs was upto 35%.Now this mark-up hascome down to 10%.This means that even with no increase in budget for any given health facility, its purchasing power increases by 25%,more than anyincrease any government sector could ever get on its budget! The situation where money for medicines would be sent to health facilities/districts had to be reversed. Now all procurement, storage and distribution of medicines for government health facilities are done by NMS,” he says.
With the reforms at NMS, which five years ago had a stock range of 60 items (types of drugs) with a 44% availability rate, it has now grown to register a stock range of 2,400 (different types of medicines and medical supplies at NMS is at 88%) .
“And we are targeting 90% availability rate for all the drugs .We need to first demonstrate to Ugandans how much more we can achieve with the resources available to us before we can ask for more.
The Ministry of Health together with NMS and other stakeholders have made an innovation of a "Basic Kit". The kit contains the basic medicines which are supplied to all Health CentreIIs and IIIs across the country. The Kit is revised every year tomake it relevant to the people. NMS supplies the kits and other medicines once every month to all government Health CentreIIs and IIIs. Under same innovation the Health Sector Review report for 2012-2013 shows thatnotably, there was increased access to maama kits to82% of mothers delivering in public health facilities.
The NMS delivery schedule,is shared with all customers and other stakeholders and delivers all medicines up to the lowest health centres. This system termed as the "Last Mile Delivery" hasreduced on the long delivery times it would take the supplies to move from thedistricts to the health facilities especially in the rural areas.
Improved performance Score card
• Expanded storage capacity at NMS warehouse in Entebbe which has led to better planning, appropriate procurement and timely distribution of medicines.
• Reduced stock-outs of essential medicines and medical supplies at all government health facilities.
• Low incidence of expired drugs and other supplies because of procuring only"the suitable" medicines and the use of the 'First Expiry First Out' system.
• Timely delivery of medical supplies to health facilities due to a transparent and improved delivery system.
• Improved financing. Due to the transparent system, government and other development partners are now able to see better how funds for medicalsupplies are utilised. This has attracted increased financing and confidence in our services.
• The image of NMS and that of government facilities is steadily improving regarding medicine availability in public health facilities.
• Improved range of medicines and medical supplies from 350 to more than 2400 today.
• Introduction of a night shift to take care of increased workload.
• Ensuring that all medicines and medical supplies for government health facilitiesare duly embossed.
The writer is a communications .media and legal consultant
Based in south sudan
I’m a Development Communication ,Media and Legal Consultant specializing in good governance and development communication . I’m also a human rights, Commercial and Environment lawyer. I have served as Editor at Saturday and Sunday Monitor and Advocate of the High Court with 10 years of
governance and development consultancy work;16 years of reporting and editing and 11 years of providing legal advocacy services, respectively.
I have initiated and participated in capacity building programmes as
a Promoter of good governance and rural development communication , peace and respect for human rights in war affected areas . I have worked as a Trainer, Presenter, Rapporteur and Resource person at different fora. I have written widely about issues of media and communication ,law reform ,human rights, gender balance,public policy , national development , good
governance and the rule of law and environmental protection in Germany and Uganda.