[e-drug] Donated fluconazole stolen in Uganda (cont)

[kibumba@yahoo.com]

E-drug: Donated fluconazole stolen in Uganda (cont)
---------------------------------------------

In reference to publication of Sunday 09/29/2002, "Donated 
fluconazole stolen in Uganda" .

Uganda is a country occupying 24,000 km2 of the planet earth and has 
a population of about 23 million people. 1.9 million of these 
Ugandans are HIV positive. The country is administratively subdivided 
into 57 districts. In a bid to take services closer to people, the 
districts are further sub-divided into health sub-districts. The 
Monitor and The Newvision are the two major daily newspapers in 
Uganda. We also have an organized system of public purchasing of 
drugs and medical supplies and the main procurement body for the 
entire nation is a corporate body that was established by law. 
Authorized private procurement arrangements do exist. Currently 
because the Uganda Government abolished cost sharing in public health 
units, all Ugandans are supposed to receive medicines free of charge.

Despite of all the efforts, Ugandans oftentimes complain about 
failure of the public health system to supply drugs to sick people 
who seek treatment countrywide.

Paul Onapa in his letter to editor of The Monitor newspaper (Aug 20, 
2002) described a complaint to this effect. He stated that Mulago 
hospital (national referral hospital) medical staff should save 
patients the burden of filling prescriptions of drugs that are not in 
the hospital. He also explained that such medicines are present in 
private clinics, which are run by the medical staff.  Add to this a 
top-page story in The New Vision of Sept 24, 2002. This story titled, 
"HIV / AIDS drugs for needy stolen", sheds more light than any other 
related media reports on the problem of moral decay amongst Ugandans, 
and how deep corruption has permeated this country.

Some Catholic priests who are supposed to be examples in deed, speech 
haven't been spared by the habit of stealing (The New Vision 
editorial, Sept 23, 2002). Displayed at all levels of the Ugandan 
society, stealing now occurs at the church, and health professionals, 
according to media reports, recently siphoned AIDS tablets for the 
needy. US giant Pharmaceutical Company -- Pfizer Inc donated the 
tablets to Ugandans through the public health system. These tablets 
differ from the usual fluconazole on the Uganda market.

My major worry in this particular case where Diflucan tablets, were 
siphoned from public health set-ups to private-for-profit clinics and 
pharmacies, is the police may have arrested the wrong people. Many 
health professionals working in private pharmacies don't purchase 
medicines or other medical supplies. This is why the police or courts 
of law can at best justly use staff they arrested to determine 
retrospectively, the chain of distribution of the stolen medicine. 
And perhaps the actual thieves who could be working within the public 
sector will be netted.

There is another side of the story. Some AIDS patients, being 
'corrupt' used to get free Diflucan tablets from public health 
facilities. Explaining that they were dying anyway and lacked food 
and swissgarde products (brands of food supplements that are usually 
consumed by HIV/AIDS patients in Uganda), these unfair Ugandans 
begged private pharmacies to purchase their medicines (Diflucan 
tablets). Obviously private pharmacies procure medicines for re-sale 
and so they started selling the Diflucan.

Apart from the above observations on the general lack of morals, 
there are three lessons to learn from the Diflucan saga.

Firstly have special packaging, labeling for drugs that are supposed 
to be received free of charge. This is not only possible given the 
arrangement, extent of public medicines and medical supplies 
purchasing capacity of a whole nation, but it is also a weapon 
against dishonesty.

Secondly subject to audit the records of drugs issued to patients and 
quantities supplied and records of expected number of illnesses for a 
given period. How can you explain the absence of a clear record of 
drug issues to patients? Not just that, but how can you explain the 
consistent existence of strategic numbering of patients? A patient 
numbered 2000 should realistically follow one numbered 1999. In 
patient registers of some public health facilities you will find a 
person numbered 1999 followed by one numbered 3000. This is a clear 
strategy designed to fleece drugs supposed to be used free of charge 
by about 1000 Ugandans. Besides engineering records at health units, 
how can we explain fraudulent record keeping at drug and medical 
supplies stores located at district or health sub-district levels?

Thirdly have good quality burglar proofed stores at district, health 
sub-district levels, and for private wholesale and retail pharmacies 
and drug shops (The New Vision Sept 23, 2002 Page 9: "Thugs raid 
Kasese health unit")

In conclusion, as well as in work places, corruption has permeated 
all corners of the Ugandan society; the church hasn't been spared. A 
reformation in the church will reverse this trend: But as we wait for 
a transformation to happen, let us put in place all manner of 
safeguards, including legislation, against abuse of office that comes 
as a result of moral degeneration. Guarding us is a basic role that 
our Government is going to exercise.



George Kibumba, MPS
Teaching Assistant, Clinical Pharmacy, Makerere University,
P.O.BOX 7072, KAMPALA, UGANDA
e-mail: kibumba@yahoo.com
Mobile: 256-071-81 54 28

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