Guide · Uganda

Expired drugs: how a clinic loses money on a shelf

Nobody buys medicine intending to throw it away. Expiry is not bad luck and it is rarely carelessness — it is what happens when the stock record and the shelf stop agreeing with each other.

The scale of it in Uganda is not a secret. National Medical Stores has reported losses running into tens of billions of shillings from expired supplies, and audits have found expired stock sitting on the same stands as live medicines at facility level. If it happens at that scale with dedicated stores staff, a clinic with one lockable cupboard and a busy dispenser is not going to escape it by trying harder.

What actually causes expiry in a small facility

Nobody knows what is on the shelf. If the only way to answer "how much amoxicillin do we have?" is to go and look, then nobody looks until something runs out — and the slow-moving items behind the fast-moving ones are never seen at all.
Newest stock at the front. A delivery goes on the shelf where there is room, which is usually the front. The older tins move back and age out. This one habit probably causes more expiry than any other.
Ordering by feel. Without consumption figures, orders are sized by memory of the last stockout, which reliably overshoots on the items that scared you and undershoots on the ones that quietly matter.
Expiry dates recorded once and never looked at again. A date written on a stock card in January is invisible in October unless something puts it in front of a human.
Donations and emergency buys. Stock that arrives outside the normal process often arrives with short dating and no record.

The four habits that fix most of it

First-expiry, first-out — physically. Not a policy on a wall: the shortest-dated tin goes at the front of the shelf when it is received. If the arrangement is right, the dispenser cannot get it wrong.
Move the record at the moment of dispensing. Not at the end of the day, not in a catch-up session on Friday. A stock figure that is accurate at 5pm and fiction by Wednesday is worse than none, because people trust it.
Look at what is expiring, on a schedule. Monthly, not when someone remembers. Anything within about three months either gets used, gets moved to where it will be used, or gets planned for.
Order from consumption, not from fear. Once you can see what actually moved in the last three months, ordering becomes arithmetic.

The cheapest version of this

If you are on paper today, do not start with software. Start with two things: put the shortest-dated stock at the front on receipt, and write the card at the moment of dispensing. Those two habits, done consistently, recover more money than any system will, and they are also what makes the medicines section of your HMIS 105 report truthful rather than reconstructed.

Where software earns its place

Software helps with exactly one thing here, but it is the thing that fails most: keeping the record true without anyone having to be diligent.

In CareBoon, stock moves when a prescription is dispensed — that is the only way stock changes, so the figure cannot drift from what actually left the shelf. Each drug carries its earliest expiry on the shelf, and expired stock is blocked from being prescribed or dispensed rather than merely flagged. There is an expiry watch list, and when a doctor prescribes, the assistant prefers an equivalent that expires sooner where one is clinically appropriate — using up the stock that would otherwise die.

What it will not do: it cannot tell you what is physically on your shelf if nobody records a delivery, and it cannot arrange your cupboard. A system makes an honest record easy to keep. It does not make it optional.

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