Apollo Muhairwe is head of Uganda's National Drug Authority, or NDA. He says Uganda imports 80 percent of its medicines, so the NDA works both inside and outside the country to ensure quality. "Through the official ports of entry, we have a presence there, at customs,” he said in an interview at his office in Kampala.
“And then before the people import the medicines, they seek authority from us. And not only must they import medicines from authorized places -- which we have gone there and inspected -- but also, in the case of A.R.V.'s [antiretrovirals] and TB's and anti-malarials, even though we have checked the factories and evaluated the dossiers of the manufacturers, when the medicines come to the ports of entry, they must be analyzed batch by batch in our quality-control laboratory."
If someone tries to import a substandard or fake drug lot, Muhairwe says, the NDA’s laboratories can detect it through its sample testing program. "We have not done a study on the extent of counterfeiting, so I cannot tell you it is 10 percent or 90 percent, but from the quality assurance mechanism that we have put in place, and the results we are getting in the lab, we are confident that the medicines which are available to the population are safe, of good quality and efficacious. When we pick samples and bring them to the lab, the extent of the problem seems to be minimal.
Yet in a poor country like Uganda, there simply aren't enough licensed pharmacies to serve everyone, Muhairwe notes. And so poor and rural people "self-medicate," buying medicines where they can find them, and taking them as they choose. That's also a prescription for encouraging drug resistance -- a problem that experts say won’t be solved anytime soon.