Tuesday, December 31, 2013


OUR TARGET IS TO HAVE UNIVERSALSUPPLY OF ESSENTIAL MEDICINES SAYS, NATIONAL MEDICAL STORES GENERAL MANAGER (GM)MOSES KAMABARE It has been a long 20 year innovative and progressive journey for the National Medical Stores,(NMS) which was created in 1993 by the National Medical Stores Act to address the gaps in the delivery of medicines and medical supplies which had been experienced under the Central Medical Stores. To reflect on this long journey from scratch to becoming an African model, Moses Sserwanga interviewed Mr. Moses Kamabare the National Medical Stores General Manager. Below are excerpts; Qs:It's 20 years since National Medical Stores was set up in 1993. Can you briefly give use the history of NMS . MK: The National Medical Stores (NMS) was born out of the Central Medical Stores which used to be a department under the Ministry of Health. That department used to be under the Chief Government Pharmacist who apart from taking care of the quality , procurement , storage and distribution of medicines, was also in charge of registration of pharmacists in the country. The Chef Pharmacists was also responsible for policy formulation and as you can see that was a lot ofwork as the demand grew. In 1993 government decided that they take away the functions which were not core to the Ministry of Health headquarters and thus created the National Medical Stores under the National Medical Stores Act of 1993 with the mandate of procurement, storage and distribution of medicines and medical supplies to all government health facilities . The other entities which were created are the National Drug Authority to take care of the quality of medicines and medical supplies and the Pharmacy Council to take charge of professionals i.e the pharmacists and their regulations. The Ministry of Health remained with the core function of resource mobilization, coordination and policy formulation. That’s how NMS came into existence on 3rd December 1993. Qs:What are some of the fundamental reforms that have propelled the rapid transformation of National Medical Stores.In other words what are NMS’ major achievements in the last 20 years ? MK: NMS has been at various levels of discharging it’s mandate under the NMS Act. One of the fundamental reforms we have undertaken is the publication of a national medicines and medical supplies delivery schedule to ensure proper planning and accountability; To ensure that all government hospitals and health facilities at all levels never run out of drugs and other medical supplies throughout the year. We also withdraw from the private sector and concentrated on government health facilities to ensure steady and predictable supply of medicines and medical supplies. The second reform has been the re-centralization of funds for procurement, storage and distribution of medicines and medical supplies at NMS. The third major innovation has been the firm decision to emboss all medicines and medical supplies we deliver to government hospital and health facilities at all levels to stop the wanton pilferage of the medicines. There was a huge problem of stealing government medicines from government health facilities for sale on the open market and left government health facilities without medicines. We have now largely stopped that problem . With embossment of medicines the health workers and the public are put on notice that such medicines and medical supplies are not for sale. The other major reform has been the creation of a new innovative last line delivery system- which is delivering the medicines beyond the District Health Offices up to the individual heath facilities. We have also built a strong management team and staff that is clearly focused on the delivery of the mandate that is given to us. We have rebranded to inform the people we serve about our mission and vision which are; Vision: To have a population with adequate and accessible quality medicines and medical supplies. Mission: To effectively and efficiently supply essential medicines and medical supplies to the public health facilities in Uganda. Qs: What in your view have been the major bottlenecks in distribution of drugs to the Ugandan people? And how have you overcome these bottlenecks? MK: The challenges have been at different levels. First there has been a challenge of having enough qualified health workers to do proper selection and quantification of medicines and medical supplies in time to last them for the duration that is in the published delivery schedule. The second challenge is the health workers at the various health facilities not placing in timely orders to NMS to ensure timely delivery of drugs. The road network which slows down the medicines delivery system is another bottleneck. We have also previously had a big challenge in the procurement processes .Being a government entity we procuremedicines and medical supplies according to the Public Procurement and Disposal of Assets (PPDA) law which didn’t recognize the special nature of medicines procurement. We need more flexibility in the procurement of medicines because at times thereare emergencies. You have to save lives. For the bad roads that’s beyond our control . However, through our seven regional Customer Care offices in Central, Soroti, Gulu, Fort Portal, Mbarara, Hoima and Mbale we are training and reminding the health workers to place their orders in time according to the delivery schedule. We are also planning to open up another regional customer care center in Arua this financial year. We have also proposed to government to amend the PPDA law to cater for the special circumstances in medicines and medical supplies procurement. Parliament has already amended the PPDA Act and put in place special procurement of medicines and medical supplies regulations to fasten the process and ensure timely delivery of medicines and medical supplies to all government health facilities. What remains now is gazetting the regulations. We are determined to eliminate any form of stock outs in government health facilities. Because of the fast procurement processes we are reducing on the lead times in the procurement circle from the previous four-six months to now under two months. With the new regulations, we will be able to get in what we need on emergency within one day. Qs: What do you envisage to be the major challenges going forward and what plans do you have to deal with those challenges? MK : The major challenge going forward is the perception among Ugandans that every illness has a pill to swallow. Many illnesses don’t need medicines. A lot of the medicines people swallow are not necessary .Published literature shows that out of every 100 reported cases in health facilities 75 of them should not be in the health facilities. The 75 cases are presenting conditions which would have been prevented. This means that people are focusing more on cure, rather than prevention of diseases. Why should 100 people report cases of malaria and yet such cases should have been prevented through use of mosquito nets .Why should 100 boda-bodas end up at Mulago causality ward together with their clients and yet they could avoid accidents by behaving responsibly on the roads ,following traffic regulations and wearing helments? Why should 100 mothers be at the risk of dying while trying to bring forth a life when 75 of them shouldn’t be at the health facility only if they had used family planning methods and spaced children. By taking care of our health through preventive measures Uganda would attain the Millennium Development Goal 4 in just two years. Basic hygiene like construction of toilets, vaccination against polio, measles can do quite a lot to better Uganda’s health sector. We need to focus more on prevention than cure. We need to re-program the minds of Ugandans; to engage all of us to deal with the causes rather than the effects of ill health and disease. This calls for a lot of public education and awareness and we need to focus more resources in that direction. Qs.:where do you see NMS in say the next 5-10 years from now? MK: I can see the NMS in a new and bigger home; with big storage space having modern equipment . We need a bigger warehouse to serve the country better. We also plan to set up two big regional warehouses to decongest the center and take our services nearer to the people. We also want to see NMS which is better understood by the people-that we are part of the solution and not a problem . Qs: Are there any key individuals , partners you would like to recognize for standing with you to make National Medical Sources one of the best performing government agencies? MK: I would like to recognize central government and President Museveni who created NMS and has been at the center of all the reforms we have undertaken including the recentralization of funds for medicines and medical supplies. This has reduced on the theft of such funds at the lower levels and led to increased and steady supply of drugs to all government health facilities. We also recognize the political and technical leadership in the Ministry of Health who continuously guide us for better service delivery. DANIDA has been our biggest partner and we are grateful for their support. Others are USAID, CDC, UNFPA, Global Fund, WHO,UNICEF , government agencies like National Drug Authority (NDA), PPDA, Medicines Unit, Auditor General’s office ,civil society; we work with them closely because they ensure that we deliver on our mandate better . Qs:What has inspired you to do this job? MK: There was work to be done and Uganda has given me a lot. I felt obliged to give back to my country; that really inspired me to serve. But above all, I had to serve my God by giving service to His people. When I was outside of NMS I had a feeling that the debate on availability of medicines had been narrowed down to insufficient funding and ignored many other facts of governance and innovation and I felt I would contribute in re-directing the debate. When I see more medicines in government health facilities I believe that contributes to saving life and it makes my stay at NMS worthwhile . Qs.When you sit back and reflect , is there anything you would have done differently. In otherwise ,do you have any regrets? MK: The only regret I have is that the debate about which direction our health system should take should have come much earlier. We went with the flow to concentrate on the supply side which was okay but should have been handled concurrently with the demand side and by now we would have achieved the universal availability of essential medicines and other medical supplies . In other words we must continue in our effort to solve the problem of waste which is largely motivated by corruption,negligence andcommercialization of health services. Take for instance a case where health workers are used to prescribing more than four types of medicines for a simple medical condition/disease yet in other jurisdictions which are better than us, prescription of more than two types of medicines is a rare occurance. This is total waste. Imagine how much medicines is wasted and if utilized rationally it would serve many more people. These are the issues we need to deal with going forward. Qs. what advise do you give to the Ugandan people and the health practitioners about availability of drugs in all health centers across the country? MK: Health workers should improve on the medicines and medical supplies inventory management to ensure proper planning ,make timely orders according to the NMS delivery schedule because its known throughout the year. Health workers should also give rational prescription of medicines to stop wastage . To the general public they should know that the medicines and medical supplies made by government through NMS to all government hospitals and health facilities across the country are not for sale. The medicines are embossed and if seen in the private sector people should report to police or to us here at NMS. Your last word MK: I wish every Ugandan very good health. And whenever you think of medicines and medical supplies in government facilities always remember NMS is your major partner and is part of the solution to get you the medicines you need. ENDS

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