Figure 1

Morphine supply and blockages within the Ugandan regulatory framework. Blockages in morphine flow: key. District Hospital has to obtain permission from MOH for every order and take this to JMS. National Medical Stores currently re-structuring and lacks capacity and drug inspectors. Mission hospitals and NGOs have to obtain morphine via District Hospital pharmacy and depend on the co-operation of the pharmacist/dispenser. Pharmacy may be slow in re-ordering. Local health centre/hospice level, drug cupboard may not be adequate, record books may be missing, there may be staff turn over resulting in loss of know-how.