1. MAYUGE DISRICT FACT FINDING MISSION ON STOCK OUT OF ARVS
Date: 10/9/2015
Compiled by: Namuzimbi Cissy PM
Introduction
The district has 13 sub counties with only 7 ART sites. Mayuge H/C 111 is a high volume Health
Facility with over 2330 PLHIV ever enrolled into care but of these about 1100 are active clients.
The health center is serving sub counties of Bukatube, Manyiro, Makuutu and Mayuge T/C
Originally, this was a TASO site which was later put under government when TASO withdrew.
This health center has been experiencing drug stock outs since August 2015 and the problem was
reported by the linkage facilitator and follow up was done by NAFOPHANU Programme
Manager in the district. The Programme Manager interviewed the Team Leader Mr. John
Gambani at Mayuge Health Center 111, Mr. Balidawa John and Paddy Babolana, the Linkage
Facilitators at the facility.
Missing drugs
The H/C started experiencing stock of Septrin (960mg, 120mgs) 3 weeks ago when they
received an insufficient order from NMS. According to the Team leader at this H/C the
missing drugs include Septrin (960mgs, 120mgs), EFV (600mgs, 200mgs), Attripla,
AZT/3TC/NVP. They also received 9 packs of test kits out of the 35 ordered for. Each
pack has 100 test kits but these are not enough given the fact they have outreaches at
landing sites and an eMTCT programme.
Testing kits. Only 9 packs were delivered out of 25 ordered for
Problem analysis
Delayed supply by NMS in the previous quarter. The order made in May was delivered in
June 2015.
2. Insufficient supply from NMS. There was a variance of what was ordered and what NMS
supplied. Septrin and Dapson were not supplied despite the fact that they had ordered,
195 doses of Efeverenz were supplied out of 387 ordered
The Septrin that was supplied was under essential medicines which means it was for the
general community not specifically PLHIV. Each clinic day, the facility needs 4 tins of
septrin
NMS did not supply the health center with a certificate of non available for missing drugs
as was the case before and up to now there has been no explanation from NMS for the
insufficient order
This facility was initially under TASO but when TASO left, there was no other service
provider to take over so it is solely a public health facility.
Generally, the district has problems of limited access to ART services with only 6 sites.
There has been a lot of advocacy from PLHIV but the process is slow at national level
because it has budget implications. This affects utilization of services as narrated by the
linkage facilitator Balidawa John.
“Even when drugs are there, some people fail to come due to long distances”
Interventions to address the problem
- The H/C has been borrowing from nearby Health Centers. However, some of these
centers like Wabulungu H/C 111 are also affected by the stock out since 15th July ( EFV
600mgs, TDF/ 3TC/EFV and Septrin 960mgs.
- Patients have been given doses for only week while some are sent away without drugs
- They used the 200mgs EFV which was in supply to make doses for adults but at the
moment this is also finished
- Patients buy their own Septrin and dapson. In the last order these were not supplied
- For patients on Attripla, they have been using a combined dose of 3TC, TDF and EFV
which increases the pill burden. Right now, this is also out of stock
- An emergency order has been written and will be delivered to NMS on 9/9/2013
Effects of the problem on PLHIV
- Resistance to the drugs due to interrupted adherence
3. - People are likely to be switched to second line drugs which are more toxic and expensive
- High transport cost as patients have to move to the health center all the time to look for
the few drugs available. Patients come from sub counties of Bukatube, Manyiro,
Makuutu and Mayuge T/C which have no ART sites.
Conclusion
This was a problem that arose due to inefficiencies in the supply chain management process
which are highlighted mainly in poor coordination at national level and lack of proper channels
for communication.
Mayuge request sent to NMS in May 2015
