Understanding the Systems that Influence Distribution Channels for Drugs in Uganda
In his own words, the director of National Medical Stores (NMS) Mr. Moses Kamabare said “the stores are full of drugs to the point that I am asking my suppliers to hold future deliveries as I try to work out stocks from the system”. Reading the NMS Director’s statement and considering the regular drug stock-outs in the country makes one wonder who is fooling the other. This is an indicator that someone in the system is incompetent in managing their job of furnishing the correct data to the relevant authorities. This article intends to examine the pros and cons of the nature of the system that NMS uses in procuring the drugs for Ugandans to avoid stock outs.
By Bukenya Denis Joseph*
Coordinator – Human Rights Research Documentation Centre (HURIC) Kampala, Uganda
Understanding the Systems that Influence Distribution Channels for Drugs in Uganda for Better Inventory Procedures
Access to medicines is a fundamental right to health in both patients and health workers as they both play a major role in the fulfillment of the right to health. The patient is the end user and mostly said to be on the demand side of the supply chain. Health workers being the intermediary in this vehicle of the rights based approach should also be accorded the attention they deserve as the protagonists of access to medicines.
It is impasse as to what happens when the demand for medicines versus the supply chain of essential medicines causes denial of essential medicines to patients. This will curtail the attainable standards of health recommended by the WHO guiding principles on access to medicines. This then begs the question of blame on who is responsible for the citizenry access to medicines. Owing to the foregoing, we borrow a leaf from the shortfalls of the Ugandan supply chain of medicines.
In his own words, the director of National Medical Stores (NMS) Mr. Moses Kamabare said “the stores are full of drugs to the point that I am asking my suppliers to hold future deliveries as I try to work out stocks from the system” (Abusharizi, 2012). Reading the NMS Director’s statement and considering the regular drug stock-outs in the country makes one wonder who is fooling the other. This is an indicator that someone in the system is incompetent in managing their job of furnishing the correct data to the relevant authorities. It could be a deliberate move by individuals in the system so as to increase clientele for their private clinics. You cannot rule out the fact that the system is too porous to furnish the right information to the medical stores at NMS. It is also worrying that instead of looking for more funds from the Ministry of Finance to improve the NMS stocks, money is sought to conduct disposal of expired drugs. That will be a discussion for another day. This article intends to examine the pros and cons of the nature of the system that NMS uses in procuring the drugs for Ugandans to avoid stock outs.
The Uganda National Medical Stores (NMS) is run on a pull and push system. There are persistent drug stock-outs in the country due to failed deliveries. Many a time we have instances of facilities in Uganda receiving deliveries that were not on their demand lists. Meaning that the suppliers are forced to push stocks out of their stores hence the paradox of who is to blame. It is estimated that at least $ 550, 000 worth of antiretroviral and 10 million antimalarial drugs does reportedly expire in the NMS warehouses (Department of Pharmacy, 2010). May be we need more competent managers to avert the calamity that befalls the tax payers’ money in Uganda. According to the WHO report on distribution as a barrier to access to medicines, published in 2012, it categorically states that the last mile is achieved when the patient gets his medicine in time given the distance covered meaning that regardless to whether the distances travelled to the facilities that distribute the required drugs are near to the consumer or far, a person should be able to access the required medicines on arrival to a designated premise.
In regard to our distribution channels under the push and pull system, the pharmaceutical supply system comprises of 3 major players that is one national medical store and two private non-profit organizations engaged in the system of distribution of drugs in the country and in Africa at large. Uganda has a centralized medical store that manages the distribution and allocation of the medicines to the patients with the main goal of ensuring that the last mile which is the distance to the last customer (patient) is achieved in a timely manner and in the right proportions and conditions for consumption.
To a certain extent, the push system of supply of medicine is based on projected or predicted demand. In this system there is often a failure to correspond with the actual or consumed demand; this inaccuracy causes sizable dent in the distribution chain of drugs in Uganda hence the excesses in the register. That couples with the associated required storage space as the main causes for this. However, there are some advantages to this system; for instance there is only the worry of absence of an inventory, customer satisfaction and government predictability in supply unlike the pull system that can be manipulated to suite individual’s evil motives. Considering the issue of predictability, the government plans its finances ahead of time in regard to the actual procurement and storage (WHO, 2015)
The two systems seem to complement each other in regards to the encumbering short falls. In the pull system of the supply chain, there is elimination of the excesses in the inventory in the distribution and procurement is only effected on the signals given. The signals are prompted by demand; the pull strategy, also allows for a single piece flow or a one-piece flow system. This eliminates the bulk buying, the need for batch sizes, and a lot of products bought since only one product at a time is being worked which is a time-saving procedure. The single piece flow system additionally cuts unnecessary expenditures such as the need for space caused by excess inventory due to overstocking. This method also allows for reduction in the costs of labor associated with space requirement and stock handling significantly. Disadvantages to the pull strategy do however exist like falling subject to over demand which results in an excess in actual customer demand, hence bringing about shortage of supply and inability to meet customer demand. Eventually we shall have customer dissatisfaction.
Considering all in the above, it is advisable and prudent to operate under a hybrid of the two supply systems. This is what Uganda has tried to do over time although for political reasons; many of the authorities in the management of the system will be heard eloquently saying that Uganda is working under the pull system. They would love to show Ugandans that the system is accommodating of all views. To be more specific and realistic, it is very difficult for any entity run these systems on one pure system, be it the pull or push system. In the nutshell, there are several shortfalls in the Ugandan system where change is long overdue. All has to be precipitated by the various advocates through critiquing and pointing out the challenges in the system. There will be a need to weed out all the bad elements that are crippling the system hence an impediment to access to medicines.
The government of Uganda needs to ensure a speedy and timely access of essential medicines as required by the citizenry through streamlined inventory channels that represent the correct data. This will be made possible through:
- Training of health workers, store managers on issues of record keeping and inventory management in regards to the demands and inventory of medicines in each health center; this training should focus mainly on inventory (order placement and stock taking) to remove the chaotic drug overstock at main warehouses given that even minimal technical training can confer a completive advantage in the labor market.
- The government should implement a reward system for its workers in places that are hard to reach and very remote in demographic with incentives such as children education, proper housing developments and also better salaries to reduce on labor turnover.
- There should be a stock in and out monitor meant to characterize the data of stocks from different regions and the trends should be analyzed for purposes of effective monitor. As time goes by, it will help us to reduce on the cost of inventory monitoring. This will further reduce the inconsistences by putting into consideration the unique peculiarities that exist at the different health facilities.
- It is also recommended that national medical stores involve stakeholders at every stages of medicines and supplies planning, especially the district health officers, who are the final consumers facing entities in the supply chain.
- Finally, the government should adopt a revolving drug fund system, in the form of ‘Special Pharmacies and drug stores’ to enhance availability of essential drugs in public health facilities and thus improve the quality of health care.
Abusharizi, P. (2012, May 9). Do We Really Have Drug Shortage ?Retrieved December 22nd, 2017, from http://www.cehurd.org/2012/05/do-we-really-have-drug-shortage
Department of Pharmacy, M. U. (2010, May 9th). Expiry of medicines in supply outlets in Uganda. Bull World Health Organ. 2010 Feb; 88(2): 154–158, 1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2814474/
WHO. (2015, December Tuesday). Essential Medicines and Health Products. Retrieved January 23rd, 2015, from www.who.int: http://www.who.int/medicines/areas/access/supply/en/index5.html