Drug Rationing: The Perilous Reality for Rural Kabale

Susan Mbabazi, a 27-year-old mother of 3 children from Kituba parish in Kabale district felt frustrated when her lastborn child, only 7 months old came down with Malaria.

She rushed the child to Kamukira Health Centre IV in Kabale district to get medication. At the hospital, she says, she was given an incomplete malaria doze and instructed to buy the rest from outside.

She tried to get the medicine from a pharmacy, but couldn’t afford its price. And days later when she noticed that her child was improving, she relaxed and abandoned the essential treatment.

After two weeks, however, her daughter came down again with severe signs of Malaria and was returned to Kamukira health centre, where she had to undergo fresh treatment.

Mbabazi, who has been using the same health centre for antenatal services, delivering, immunization and general treatment says nearly every time she comes to the facility she doesn’t receive the full doze of medicine and is told to top it up from private clinics.

“Traveling on a bodaboda to get here alone, is too costly for me. So sometimes if the child is not very sick, I stay home,” she said

Ivan Mubaginzi, a medical officer at Kamukira Health centre who also serves as the Principal Medical Officer of Kabale Municipality says the drug rationing challenge (Taking less of the medicines prescribed by a medical officer for a given disease) is common with the patients in the area.

“I don’t know if it is ignorance or poverty but when patients come here and we write them medicine that they should buy to complete the dose, they never buy it. They only depend on what we have given them which is improper because by the time I prescribe a dosage for you, I know it’s what you need for the disease to completely be cured” he said


He added “Particular diseases are cured by a combination of drugs. If I prescribe three different drugs and you only take two or even one, there is no chance that the disease will be healed.”

Dr. Mubaginzi says sometimes the hospital runs out of drugs because of the big numbers of the patients especially the outpatients that they receive on the daily.

“We receive around 150-250 people every day. This health center is mainly supposed to serve the Kabale Municipality people and may be referrals from health centers 2 and 3. However, we receive people from all other areas who come here because in most cases, we normally have drugs. Sometimes, people come from the main Kabale referral hospital because there are no drugs there. This can be overwhelming for the staff and of course the drug stocks” he said

Owing to the large number of patients thronging understaffed and often under-stocked health centres around the country, Uganda has over the decades suffered a chronic challenge of drug shortages.

There have been numerous reports of recurrent stock-outs of essential drugs such ARVs and anti-malaria medicine.

The latest Ministry of Health STOCK STATUS REPORT that came out late last year, indicates that  “most reproductive health commodities including condoms are stocked out at National Medical Stores except Misoprostol (an abortion pill).”

The report also warns of projected stock out of Emergency Contraceptives by end of November 2018 and Microlut by end of November 2018.

Besides the drug stock outs, Dr Mubaginzi says health centres such as Kamukira continue to face other challenges like break down of medical equipment such as the ultrasound scan, x-rays which are supposed to be at every health centre iv.

The hospital also lacks an ambulance, a mortuary, a proper equipped maternity ward and housing for staffs

“If we had an x-ray machine here, it would allow us to make quick diagnoses and treatment for non-communicable diseases that are currently on the raise in this area. Sometimes when we send patients to go and do scans, and they never come back or they come back when the disease has worsened. We also need a caesarean centre so that we can start helping our expectant mothers from here” he said.

Jaqueline Katushabe, another mother we found at the facility who hails from Kijurera village, Bukora parish in Kabale district said the biggest challenge that is facing the people in her area in terms of health care is the poor mobile network and lack of health services at the lower levels like the health centre IIs, which forces most of them to walk long distances to health Centre IVs or the Kabale main hospital.

“I am here to get my child immunized against measles. At the health centre II and III, they only do this once in two months which does not match with my child’s days so I have to come this side. It is a long distance which I have to cover on foot but I have nothing to do since I do not have money to take a Boda Boda” she said

Katushabe further said that the poor network in Kijurera has also been a big hindrance to services access.

“Phones are useful especially when there is an emergency like a pregnant woman who wants to be rushed to a hospital to give birth or someone gets seriously sick. Because of the poor network in the area, you cannot call a Bobaboda person or even a relative to come to your rescue, this is a hindrance to us” he said.



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