The Ministry of Health has come under fire over expired medicines stored in health facilities for years, at a time when the country is facing inadequate supply of drugs in some government referral hospitals, crippling health service delivery.

Health experts say the expired drugs are a result of poor procurement plans by government officials, something that has denied patients in government hospitals much needed treatment.

READ: Officials blamed for shortage of medicines

Rwanda Today could not, however, establish the cost of the expired drugs to the government by press time.

The 2012 Auditor-General’s report on the management of state finances, which was released recently, also cites mismanagement of public funds and failure to recover funds embezzled by government officials.

ALSO READ: Key ministries engage in blame game as drug shortage persists

Auditor-General Obadiah Biraro, says the expired drugs currently held in stores, had not yet been destroyed as pharmacies awaited instructions from the ministry.

The report raises serious concerns over the quantities of expired drugs in Camerwa, King Faisal Hospital and district pharmacies and the delay in disposing of them, which is necessary to avoid environmental and health hazards.

“At the national level, there are cases of slow movement of drugs — held by Camerwa and King Faisal Hospital — that had expired but had not been disposed of by the time of the audit,” the Auditor-General’s report states.

Dr Aflodis Kagaba, the executive director of Health Development Initiatives, told Rwanda Today: “We have expired drugs in the country because we don’t have proper planners.

“There is even a greater risk involved because patients can be exposed to these drugs due to neglect or malice. Besides, we spend a lot of money on these drugs.”

Awaiting incineration

Information gathered during the audit at King Faisal hospital shows that much of the expired drugs destroyed in July 2012 had been in stores for several years. At Camerwa, drugs which expired way back in 2010 were still being kept in the stores, awaiting incineration. 

The report however notes a positive initiative from the ministry, which is making efforts to increase the number of incinerators in the country. 

According to the audit report, the structures to house the latest incinerators acquired are under construction through a joint venture agreement signed with the Ministry of Defence two years ago.

But while the construction was expected to be completed by April last year, the works were still ongoing at the time of the audit in April this year and the incinerators had not been installed. They were delivered by the supplier in May 2011 but are yet to be put to good use due to government bureaucracy.

The ministry argues that it needs to co-ordinate with Rwanda Environmental Management Authority to ensure that expired drugs in health facilitates across the country are handled with due care and disposed of with urgency to avoid contamination and arising health risks associated with exposure to the same.

The Auditor-General recommends that the process of installing another incinerator should be expedited to increase the existing capacity for disposal of medical waste and other disposable hazardous material.

The report further indicates an unsupported expenditure of Rwf1.2 billion, compared with Rwf5.9 billion in the previous year, while some Rwf849.5 million was lost in wasteful expenditure such as bounced cheques, penalties and fines, and payments for goods not delivered.

Why expired drugs

The problem of expired drugs arose because of the change in demand for particular medicines and lack of authentic information about the required quantities required during procurement.

According to the environment authority, the 2011 guidelines for mainstreaming climate change, adaptation and mitigation in the health sector, as well as management of medical wastes – including toxic and infectious wastes, liquid waste and solid materials – were to be taken seriously with the usage of appropriate incinerators.

Afraid that the destruction would cause air and water pollution and spread infections, the government had to embark on plans to build modern infrastructure that would house advanced incinerators.

The Treasury allocates 16 per cent of the national budget to health, with a bigger fraction spent on the establishment of facilities and importation of medicine.

Central bank statistics show that the country’s spending on healthcare imports dropped by 14 per cent to $114 million in January to November last year from $133 million in the same period in 2011.

The volume of imports however increased by 26.4 per cent, to $34 million tonnes.