Tuesday, May 9, 2017

#Uganda to stop sending medicine, supplies to rural parts of country @GlobalFund @StateHouseUg @RuhakanaR @KagutaMuseveni


Ugandans seeking free treatment at public health centres should brace for harder times following revelations that the government is to freeze delivery of drugs and medical supplies to the facilities.
Our investigations show that the decision, separately confirmed by the National Medical Stores (NMS) that procures medicines and medical supplies on behalf of the government, is a result of a protracted row between Finance ministry and NMS over Shs68b.
This newspaper has learnt that NMS last Financial Year incurred Shs68b loss due to depreciation of the Ugandan Shilling and follow up budget cuts, but the Finance ministry reportedly provided only Shs27b, creating a Shs41b gap.
If the dispute is not resolved soon, officials say there will be a stock-out of essential drugs and supplies --- among them Hepatitis B vaccines, antibiotics, medicines to treat psychiatric problems and mama kits --- at all health centres II, III and IV across the country.
A mama kit package, given to expectant women, contains a one-metre piece of cotton cloth (baby wrapper), one baby soap, a pair of gloves, a piece of cotton wool, small gauze, cord ligature, and a metre of polythene sheet which is used on the delivery table. NMS says it needs Shs3.49b to supply the kits to all regular, military and Uganda Prisons health facilities.
Drugs such as paracetamol (panadol) and morphine, a narcotic pain reliever and anti-inflammatory agent, Hepatitis B vaccines as well as surgical items such as gloves and cotton gauze will not be provided.
Mr Moses Kamabare, the NMS general manager, said they require Shs68b “to balance the books” before it’s too late and that they had notified Finance minister Matia Kasaija and Secretary to Treasury Keith Muhakanizi about the impending adverse ramifications of any delay.
“People are dragging their feet on this matter because they have not yet understood the magnitude of the crisis we are going to have in health centres if we do not get money for medicine and other sundries,” he said, adding: “If you don’t release money for roads, there will be no roads.
Similarly, if you don’t release money for NMS, there will be no medicines. This is the moment of truth…we will not give any medicine to any health centre II; we will not give any medicine to any health centre III in Uganda; we will not give any medicine to any health centre IV in Uganda, and we will not give any mama kit to anybody in Uganda.” The 3,000-plus facilities in parishes, sub-counties and counties serve in progressive manner as the first-line centres, and or referrals, in the chain of healthcare provision. A dearth of medicines and supplies at the units will force healthcare seekers to flood district health centres that, for unexplained reasons, will not be affected.
In spite of the grim picture Mr Kamabare painted, both Mr Muhakanizi and the Health ministry Permanent Secretary Diana Atwine, said the matter will be sorted in time and Ugandans should not panic.
“Action has been taken; I have said action has been taken and the ministry of Finance has written to NMS,” Mr Muhakanizi said, without elaborating.
This newspaper understands that the impending crisis stems from a difference of opinion between officials over a Shs68b shortfall in the NMS budget triggered by the depreciation of the Shilling in the 2015/16 Financial Year and follow up budget cuts.
Government ministries, departments and agencies budget in Uganda Shillings but buy on the international market in United States dollars, meaning a rise in the exchange rate reduces the actual amount of dollars, and subsequently the volume of items, that can be purchased. There is also a dispute over Shs8b meant for procurement of Hepatitis B vaccines for the people in 39 badly-hit districts, mostly in eastern and northern Uganda. Although Parliament last year approved Shs11b in supplementary budget for Hepatitis B vaccines, the Ministry of Finance released only Shs3b to NMS.
In a June 21, 2016 letter to NMS, the deputy secretary to Treasury Patrick Ocailap cited resource constraints. NMS protested and even petitioned Parliament and the President’s Office, without success, to rein in the Finance gurus. Hepatitis B is a viral infection and major global health problem and attacks the liver and can cause both acute and chronic liver ailments, according to the World Health Organisation.

The row over the Shs68b has been running for months. For instance, Mr Muhakanizi on August 17, 2016 wrote to Mr Kamabare informing him that the ministry had secured a loan of $83.5m (Shs292b) from Trade Area Bank (PTA Bank), a trade and development financial institution in Africa, to clear the funding gap.
Mr Muhakanizi requested for copies of the procurement contracts and quarterly invoices for the payments made to enable the bank reimburse the government.
NMS reportedly shared the documents with Mr Muhakanizi on September 13, but he did not release the money for medicines and other critical sundries for the affected health centres.
Health minister Jane Ruth Aceng, the political overseer of NMS, declined to discuss the impasse.
Dr Atwine, however, gave assurances that “there will be no crisis”. “Since he (Kamabare) said the Shs27 billion has been funded already, we shall find the remainder; you don’t have to worry,” she said.
Mama kits are supposed to be provided at public health facilities at no cost --- a relief to particularly the rural population --- because they are essential items in combating maternal mortality. However, some health workers at some health centres ask recipients to pay.
MPs on the Health committee have concern that maternal mortality in a country where, according to official statistics, about 16 women in Uganda die every day while giving birth is likely to worsen if NMS is unable to distribute the 500,000 mama kits needed annually.
Vaccines for immunising babies, anti-retroviral (ARV) drugs and medicines for treating Tuberculosis and malaria will, Mr Kamabare noted, be available “because their funds are ring-fenced.”
Ministry of Finance, NMS row
The row over the Shs68b has been running for months. For instance, Mr Muhakanizi on August 17, 2016 wrote to Mr Kamabare informing him that the ministry had secured a loan of $83.5m (Shs292b) from Trade Area Bank (PTA Bank) to clear the funding gap. Mr Muhakanizi requested for copies of the procurement contracts and quarterly invoices for the payments made to enable the bank reimburse the government. NMS reportedly shared the documents with Mr Muhakanizi on September 13, but he did not release the money for medicines and other critical sundries for the affected health centres.
How Uganda’s healthcare works
The country’s healthcare delivery system is designed in such a way that referral is progressive from the lowest-tier facility, in this case a Health Centre II, available at the parish level.
Health Centres, categorised into levels II to IV, cover geographic areas ranging from villages to counties, with varying population of 1,000 for level II to 100,000 for level IV.
Their functions also differ, with Heath Centre II focusing on prevention and health education while Health Centre IV covers prevention, cure, rehabilitation, and emergency surgeries. Above them is a district hospital, the apex public health facility for a population of 500,000.
Regional Referral Hospitals typically cover two million people, providing select specialist care and outreach services.

The national referral hospitals --- Mulago and Butabika --- serve the whole country, but ideally for cases referred by regional referral hospitals. These provide comprehensive specialist care, research and training, in addition to other roles. However, the crisis at the lower units directly clogs hospitals some of which have been described by Opposition leaders as “sick” as a result of poor staffing and inadequate infrastructures.
DAILY MONITOR

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