Drug shortages turn clinics into death traps

It began quietly—missing drugs deliveries, empty shelves—but today, Uganda’s healthcare system is facing a full-blown crisis that many health experts say was entirely predictable.

Months after the suspension of USAID operations by the Donald Trump administration, the fallout is being felt far beyond political discussions. In Uganda’s crowded health centres, patients living with HIV, children battling infections, and newborns awaiting vaccinations are finding out life-saving medicines and basic supplies have simply disappeared.

TLD (combination of tenofovir disoproxil fumarate/lamivudine/ dolutegravir), a cornerstone HIV medication used by 80 per cent of Ugandan HIV/Aids patients, is running out fast.

The situation worsened further on Friday, April 25, 2025, when TLE (combination of efavirenz/lamivudine/ tenofovir), another critical drug used for patients with underlying health issues such as diabetes and renal disease, was reported out of stock in many facilities. Children living with HIV are also at risk.

Abacavir, one of the few available paediatric HIV medicines, is dwindling on the shelves – all a direct consequence of the USAID suspension. Meanwhile, with USAID-supported Management Sciences for Health (MSH), the organisation that monitors and strengthens HIV drug supply chains, closing its Ugandan operations in February, there is hardly a systematic early-warning mechanism to alert health authorities to stockouts.

“The situation is desperate,” said a healthcare worker at a rural health centre VI. “We have patients we simply can’t help anymore.”

Uganda’s ministry of Health now estimates it needs over Shs 600 billion to cover the critical gaps left behind by USAID’s departure. Yet officials warn that even fresh injections of cash cannot immediately undo the deeper structural dependencies exposed by the collapse of donor support.

For years, Uganda’s health sector relied heavily on programmes such as the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), USAID, Global Fund and Global Alliance for Vaccines and Immunisation (GAVI).

PEPFAR’s future, though funded through September 2025, also remains in balance, since it missed key congressional reauthorization in the USA and is engulfed in political woes of its own back home. The crisis extends beyond HIV care.

Tuberculosis drugs, another essential health service, are also reportedly in dangerously short supply. Some health centres could not even conduct early childhood vaccination programs on time—not because of a lack of planning, but because there were no basics such as gloves and syringes.

Even private health facilities are caught up in the shortage, as many depend on public supply chains managed by the National Medical Stores (NMS) and Joint Medical Store (JMS), both of which are now running short. Long-suspected procurement issues within NMS—masked for years by steady donor inflows—have been laid bare.

When contacted for comment, National Medical Stores (NMS) spokesperson Sheila Nduhukire declined to address the crisis directly. Instead, she asked for specific details about which clinics had reportedly run out of drugs.

The stakes are especially high for Uganda’s 1.4 million people living with HIV, who represent three per cent of the national population. Nearly one million of these individuals rely on daily antiretroviral therapy to stay alive. For them, adherence to a strict drug regimen is not optional—it is essential to prevent resistance, treatment failure and, ultimately, death.

At many government HIV/Aids clinics, the fight for dwindling TLD supplies plays out every morning. Patients arrive early, hoping to secure the last available packs of medication.

“The scramble for the temporarily available TLD is real,” one clinical officer said. “But the problems go much deeper. Even basic tuberculosis drugs—which are crucial because TB is a common opportunistic infection in people with HIV—are out of stock.”

The shortages have crippled routine medical services. “Now, even things like gloves and syringes are not in stock,” he said.

“In fact, we couldn’t carry out our routine children’s vaccination campaign against diseases like measles this month because there were simply no supplies. We’ve been told to wait for the next quarterly release of funds.”

All this highlights the devastating consequences of delayed government disbursements, and it is unfolding against a backdrop of political controversy. Uganda’s Parliament has been widely criticised for allocating Shs 100 million each—totalling approximately Shs 53 billion—to 529 members of parliament for “monitoring” government programmes.

Meanwhile, millions of ordinary Ugandans are left to queue at collapsing clinics without access to even the most basic health services. At Mulago national referral hospital, as The Observer has witnessed, unobserved, the situation is equally grim.

Cancer patients who are supposed to receive free surgeries are now being asked to pay between Shs 5 million and Shs 7 million. Those unable to afford the fees languish in the wards for weeks without treatment, while wealthier patients are scheduled for life-saving surgeries within a day.

The healthcare system’s erosion extends to basic inpatient care. In Mulago, nurses were seen demanding small informal payments before administering intravenous medications, moving patients from the theatre, or even finding a patient’s file, forcing families already burdened by poverty into impossible choices.

“After my expensive but successful surgery at Mulago, I went to the Cancer Institute thrice for review and on all days the staff ‘couldn’t locate my file’, until someone told me to give the clerks Shs 10,000. My file immediately resurfaced,” a cancer patient told The Observer.

Uganda’s health crisis is no longer simply about medicine shortages; it has become a matter of life and death. The human cost—measured not only in statistics but in lost lives and crushed hopes—is mounting daily.

Health workers, many of them frustrated and helpless, continue to serve on the front lines. “We are helpless too,” said the doctor at the health centre VI.

“We took an oath to save lives, but how can we do that without gloves, without vaccines, without basic medicine?”

It is no longer a surprise for patients in government facilities to be asked to go and buy surgical blades, gauze, gloves, etc, by health practitioners trying to do their job under strenuous circumstances. For families across Uganda, the wait for government intervention grows more desperate by the day.

Supplies that could save lives often cost less than a simple meal in a city restaurant—yet they remain out of reach. As the country struggles with competing priorities, citizens are increasingly asking: How can leaders justify billions in political spending when healthcare centres are starved of basics?

For now, the queues outside Uganda’s undersupplied hospitals and clinics grow longer. The country’s ongoing health crisis paints a stark portrait of inequality, where survival is becoming less about need and more about privilege.

Speaking to The Observer, Dr Sarah Zalwango, acting director of Public Health Services and Environment, denied there was a shortage of HIV drugs in government facilities. She noted that Kampala Capital City Authority (KCCA) health centres remain well stocked with HIV medications, alongside other essential medicines.

“We provide HIV patients with medications that can last a minimum of two months,” Dr Zalwango said. She added: “I am yet to confirm, but it could be private facilities—those that previously accessed HIV drugs through funding from the now-disbanded USAID programme—that are experiencing shortages.”