Can we really prevent drug theft in Uganda Hospitals?
Apart from counterfeiting, theft of government of Uganda drugs and health supplies poses a growing problem to the health care system and is not just an emerging but a full blown vice. Uganda is in no isolation with other countries in regard to theft of medication and health supplies. Malawi, Italy and DRC canâ€™t go without mention.
Increasing flows of this threatens health service delivery and therefore, deserves address. A report from the United States Presidentâ€™s Malaria Initiative (PMI) highlighted some of the ways through which malaria drugs are trans-continentally diverted in Africa (PMI, 2012). This includes illegal diversion which does occur when the genuinely approved health products, intended to be used in a specific country or region, are intercepted and sold else elsewhere. This can also occur during transit within a country, from manufacturer or supplier to the designated national ware house, in this case, National Medical Stores or during transit from main warehouse to the designated government health facilities.
These supplies and drugs can possibly be stolen from the national warehouse as well. What is really alarming, among other things, is where such big volumes, as is in the report, do come from. Itâ€™s no doubt that such an investigation is suggestive of drugs being stolen from the pharmacies or dispensing units at these government premises, and that false accountability has been also presented for some good time as a cover-up. Otherwise, how else would one end up with big quantities, if not obtained at the top supply level? Where is the gap? At pharmacy or dispensing unit level, scams that can potentially be committed by whoever is operating from there, in the name of man eateth where he worketh, in order to conceal their theft potentially do include:
1) Short filling prescriptions and pocketing the rest of the medication
2) Opening packages and replacing and gluing the seal.
3) Filling prescriptions for deceased patients
4) Unauthorized early refills Are there any measures in place, such as cameras or computer systems to mitigate the above?
I guess literally none for the vast majority of the government health premises. Anyway, why is a pharmacist like me bothered about this? Does it lie in my sphere of concern? Yes, of course.
These drugs and health supplies, out of the donations and tax payersâ€™ money, are availed by the Ugandan government to treat most of the diseases that commonly kill or accelerate the death of Ugandans of all ages. Malaria, the immunizable diseases and HIV, among others are some of the leading ones and itâ€™s disheartening that some people siphon these drugs and health care supplies required for their personal gains. This is because the immediate consequence is stock-outs in these health units, thereby worsening the disease burden and adversity of health outcomes. From left, right and center, we heavily condemn this.
However much it has not been to the maximum requirement as per the actual need in the government health premises, some credit is given to the ministry of health and the government at large for their efforts to ensure that at least some drugs and health supplies are made available. Siphoning of the little available drugs really adds salt to the wound. At some point in time, some regional referrals completely run out of basic pain killers like paracetamol. It could have been part of those drugs made to disappear. In recognition of this issue, I acknowledge the tireless efforts of the media entities: NBS and B.B.C. for unearthing the lucrative unlawful business of extracting and selling drugs meant to be availed to Ugandans free of charge. This was a landmark investigation piece. It has elicited wishes and rants in sections of some Ugandans. Not being new, itâ€™s so sad that it took a lot of time to capture the attention it deserves from the general public and regulatory bodies.
In 2004, it was as worse to an extent that 78% of the drugs were not reaching the intended facilities Despite the awareness of the relevant authorities: National Medical Stores, Health Monitoring Unit, Ministry of Health, and relevant professional bodies about theft and diversion of drugs and health supplies in public health facilities, it is clear that enough is not being done to curb down this vice. Should we say the implementation of relevant laws, policies, and strategies by these bodies is inadequate? And if so, where is the missing link? Fingers have been pointed and blame games set in high gear. The fact is it is not a one manâ€™s show to create results. It takes team work to make a dream work. The different professionals and regulatory bodies are being held accountable, and the current government regime was not spared. Often outbursts are usually made on certain tribes or regions in Ugandan, but this left no one. Among others, pharmacists were highlighted in this investigation by B.B.C and NBS.
This was in regard to whoever was being found behind the counter or in charge of drugs at the units captured. The question of whether they are actually qualified pharmacists or not does not take away the role of pharmacists in ensuring the existence and practice of the highest practicable standards and levels of integrity, diligence and accountability in drug and health supplies chain. For matters of clarity, just like the Secretary of The pharmaceutical society of Uganda has already put it, the named subjects, thought to be pharmacists are not and have never been pharmacy students or registered pharmacists. One of the major challenges we are facing as a country is many people disguising in job descriptions they are not meant or trained to do, leaving no one accountable. They either lack the required training or the integrity. For instance, not all the current 65 government hospitals have at least a pharmacist attached to them, on top of being the professionals that should be handling restricted drugs. The government has not done enough to recruit pharmacists into these facilities to fulfil the mandate.
What adds salt to the wound is that the currently employed heath workers are paid pea nuts and as a result, some choose to join private practice whereas some resort to theft of drugs and health supplies for their welfare. Are the other health workers and health professionals aware of this vice? If so, what have they done about it? With community crimes, a vast majority of people fear or hesitate to run to police due the thinking or mind-set that these criminals are â€œconnectedâ€ and thus, no serious appropriate penalties will be administered. In the same way, should we say that scenarios of drug theft in these government health premises are noticed, but matters are just pushed under the carpet because of statements like: â€œIâ€™m connectedâ€ â€œIâ€™m big and I know big people?â€ The later phrases are highly suggestive of the existence of a strong and big network, from the askari to the top. Potential whistle blowers probably always choose to keep quiet in the fear of the â€œbig fat cats.â€ Braveness is yet another vaccine needed to be given to everyone recruited into the health care system or to any other Ugandan.
What can be done? Should we go on to treat the symptoms and ignore the cause? Just as mentioned before, this is the work of all stake holders involved in the supply and use of government drugs and health supplies. There is a need to strengthen the monitoring and evaluation tools for the purpose of improving the quality collected and its consumption. Computerising the system and installation of cameras can serve us good in minimising the paper-based approach and obvious drug pilferage at dispensing units. With the above, random inventory check must be intensified so as to identify any missing items. In order to hasten tracking of the drugs, the government must continue labeling the drugs with unique features to enable patients recognise if sold to them yet supposed to be provided for free in public health facilities, and therefore, be the whistle blowers. Political will must be part of the recipe if any measures are to really work out. Any culprits must be apprehended without interruptions by know who.
This has partly fuelled the vice, in the name of â€œIâ€™m connected; Iâ€™m big and I have a team of big people.â€ Welfare of health workers and professionals must not be taken for granted. As reported by Ferrinho and colleagues, most health workers or professionals that do get involved do sell these stolen items as well in their private clinics and pharmacies with an aim of boosting their incomes (Ferrinho et al, 2004). Literature review highly suggests that incentives, benefits and competitive salaries would actually curb down theft by employees (Ronald, 2009). Living standards of health workers and professionals need to be improved.
References 1. Ronald, J. B. L., 2009. Research Companion to corruption in Organizations.. Edward Edgar Publishing. 2. Ferrinho, P., Omar, M. C., de Jesus Fernandes, M. Blaise, P., Bighahlo, A. M., Van Lerberge, W., (2004). Pilfering for survival: How health worker use access to drugs as a copying strategy. Human Resources for Health 2:4. Elsevier Publishing Inc.: London. This was developed and put together by the following pharmacists Dr. Musa Ssemanda Dr. Musa Mukalazi Dr. Richard Mukundane Dr. Ashiraf Mpuuga Dr. Henry Mugerwa Dr. Richard Mugenyi Dr. Benjamin Ahabwamukama