The Auditor General’s report on Uganda’s regional hospitals has revealed troubling inefficiencies in drug management, particularly at Jinja Referral Hospital, which has stored 16 bags of expired medicines for over eight years.
This finding is part of a broader issue involving the mishandling of expired drugs across major hospitals, including Fort Portal, Moroto, Mubende, Soroti, Lira, Entebbe, and Mbale, highlighting gaps in Uganda’s health system.
According to the Public Accounts Committee (PAC) chaired by Muwanga Kivumbi, the report reviewed the drug stock balances of essential medicines at various hospitals. It uncovered significant discrepancies in drug management, with many hospitals either failing to record expiry dates or quantities of expired drugs. In Jinja’s case, the expired drugs have remained since 2016 without proper records of their quantity or types.
Section 1.1.1 of the Memorandum of Understanding (MoU) between the Government of Uganda (GoU) and the National Medical Stores (NMS), requires the Ministry of Health to coordinate periodic collection and disposal of expired medicines. This process should be done in collaboration with the Ministry of Local Government and NMS. However, NMS was found to have failed to collect these expired drugs despite receiving notifications from several hospitals.
“Fort Portal did not provide the value of their expired drugs nor a budget for their disposal. Mubende had 2,322kgs of unvalued expired drugs sent to NMS for destruction, while Moroto had expired drugs worth UGX 9,063,085 stored alongside viable medicines. Jinja, Entebbe, and Soroti had no records of the types, quantities, or expiry dates of expired drugs,” Kivumbi noted during the interaction with officials from the Ministry of Health on Monday.
In the same report, Hospital administrators cited the non-collection of expired drugs by NMS as a primary cause for this backlog, along with the supply of short-shelf-life drugs, incomplete laboratory reagents, and the failure to provide crucial components necessary for the use of certain medicines. Mubende Hospital, for example, received an oversupply of short-expiry medicines, including critical ARVs and TB treatments, leading to their eventual expiration.
Kivumbi condemned NMS for its failure to act and emphasized the potential dangers of mixing expired drugs with usable stock. “The non-separation of expired drugs from livestock is a violation of Chapter 8.2 of the Ministry of Health Essential Medicines and Health Supplies Management Manual (EMHS) 2018. This practice not only prevents the proper estimation of lost value but also poses a significant health risk if expired drugs are accidentally dispensed,” he said.
The Public Accounts Committee has recommended strict measures, holding NMS accountable for their failure to collect expired medicines and suggesting reprimands from the Secretary to the Treasury. Additionally, it called on hospital accounting officers to create separate storage facilities for expired drugs to avoid further mishandling.
National Medical Store in question
Section 2.3 of the Uganda EMHS Management Manual 2018 requires all health facilities to prepare procurement plans to manage hospital inventory however, the report revealed that in the Auditor General’s interview with the Management of several RRs and SHIs revealed that they on several occasions experienced drug stockouts resulting into lack of several essential, vital and necessary drugs like Losartan-H tablets, Amlodipine, Gauze, Blood transfusion sets, Cannulas G24, G22, Examination and Surgical gloves, Ferrous Salufate + Folic Acid, Plaster (Zink Oxide) adhesive and Jik, Atesonate Inj, Oral Morphine, Artesunate Injection, Medroxprogesterone Acetate, Aciclovir cream, Lansoprazole among others.
Stockouts varied across hospitals for instance; Butabika had stockouts between 64-372 days, Lira between 4-69 days, and Arua 28-182 days while UHI suffered stock-outs of over 1,000 days with Digoxine Inj for congestive heart failure missing for 1,210 days, Atesonate Injection for malaria treatment 440 days and Oral Morphine a pain reliever for 174 days. Also, 2 out of the 8 sampled medicines were not received from NMS as per the order.
The Accounting Officers commonly attributed the anomaly to delayed deliveries by NMS, an overwhelming number of patients, a mismatch between supply and demand by NMS, nonresponse by responsible authorities including MOH, NMS to communications by Accounting Officers, and inadequate annual budgetary allocation to medicines and specialized services e.g Moroto had O.86Bn Out of 1.28n, Fortportal had only UGX1.3 Bn.
According to Muwanga Kivumbi, NMS breached Section 2.3 of the Memorandum of Understanding between the Government of Uganda and NMS, which recommended that the Accounting Officer of NMS should be held liable and be reprimanded by the PSST for non-delivery of essential medicines, medical supplies and for ignoring the hospitals, needs assessment schedules.
They also proposed that the government should ensure adequate budget allocations and timely release of funds for medicines and medical supplies and should be exempted from budget cuts.
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