10 May 2011

Hire Coca-Cola to run the National Medical Stores

In recent weeks, Uganda news stories have been inundated with harrowing tales arising from hospitals and other health facilities in the country. A man strips naked in Buyende District to protest lack of basic health commodities in government health facility. Police halt burial of mother who died during delivery in Nakaseke District. And why did she die? According to the medical superintendent, Dr. Emmanuel Mukwaya, Nakaseke hospital had run out of essential drugs, et cetera, et cetera. The constant tenor in these stories are stock-outs of drugs, and, “we have not been supplied by the National Medical Stores (NMS)”.
Currently, the NMS has distinguished itself by deflecting all criticisms directed at it by blaming all and sundry but itself for any faults attributed to NMS. May be their spokesperson is very hardworking; but, I believe that that these complaints should offer the NMS the opportunity to pause, reflect, and ask themselves, “is there something we are not doing right?”
This reflection should reveal to the NMS that their current chain supply system is deeply flawed and faulty. The centralized system is a hangover from the previous model of healthcare delivery, which has generally been discarded by the MoH in favor of decentralized sub-systems. To illustrate rather starkly, if (God forbid!), fire guts the NMS at Entebbe, then what happens?
Accordingly, the NMS must accept that the centralized system they are using makes it difficult for the NMS to understand and respond to the peculiar needs of her customers. If NMS had Regional Medical Stores (RMS), each would be adapted to the socio-cultural nuances and needs of each region and can respond quicker when a need arise; for example, in case of a massive disaster like major accidents, floods, fires, disease epidemic, etc. This would, therefore, free the hand of the NMS to do other neglected duties like training, support supervision, quality assurance, and long-term planning.
Additionally, given the poor road network in the country, having Regional Medical Stores would enable the NMS to deploy smaller vehicles and even motor cycles to supply even the remotest health units in the villages. The NMS can learn a lot from the supply chain system of Coca-Cola. Coca-Cola has the big monster trucks for supplying its regional depots in various part of the country. From these depots, medium sized trucks are deployed to supply the mini-depots located in smaller towns and trading centers. From these mini-depots smaller vehicles, the modified tuk-tuk motorcycle, hand-pushed carts, and even the humble bicycles are deployed to transport the product to the final retailers. That is why, when I visit my grandmother in Obangangeo, Achaba sub-county Oyam district, she sends a child to a nearby shop, to buy me a bottle of Coca-Cola. All my life, the shop-keeper has never reported, “I am out-of-stock of Coca-Cola products”.
Furthermore, the NMS has this habit of blaming the In-Charges of health units for delaying or providing them faulty drug orders; the Regional Medical Stores could solve this problem because the managers of the Regional Medical Stores would be near enough to develop working relationship with the various in-charges under their jurisdiction and help them in the management of drugs orders.
In conclusion, the NMS has initiated many reforms which, sadly, have not resulted to customer satisfaction. There is need, therefore, for the NMS to make responsiveness to customer needs their core objective by decentralizing the management of NMS to the various regions of the country in order to address this persistent complaint.

Patrick Odongo (B.Sc Public Health; Dip. Clinical Medicine and Community Health)

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