Counterfeit and substandard medicines pose significant risks to our health because they may contain incorrect ingredients, have incorrect dosages, or may lack active ingredients entirely. The presence of fake drugs continues to be a major challenge in the pharmaceutical industry, particularly in rural areas, as reported by Ismail Bategeka.
According to the World Health Organisation (WHO), substandard products are those that do not meet quality standards and specifications, often due to poor manufacturing practices or inadequate quality control.
Falsified medical products deliberately misrepresent their identity, composition, or source. These products are often created and distributed with the intention of deceiving consumers for financial gain.
Substandard and falsified medical products pose significant threats to public health globally. They can be ineffective at treating the illness, as they may contain incorrect ingredients or incorrect dosages. They can even be directly harmful to patients if they contain contaminants or toxic substances. They may be indirectly harmful through increased risk of antimicrobial resistance.
Masindi Town, once known for its quiet streets and thriving markets, is currently facing a deadly invasion from medicine bottles and blister packs lined neatly on some shelves in drug shops. From behind the brightly painted doors of the pharmacies, fake, expired, and substandard medicines, smuggled from the Democratic Republic of Congo (DRC) through porous points in neighbouring Buliisa District, are slipping into clinics and roadside stalls.
In a small rented room in Kijura cell, 29-year-old Jane Afisa clutches a faded photo of her three-year-old son, Brian. Tears well in her eyes as she remembers the day she lost him to malaria.
‘He developed a fever and was vomiting. I rushed to a nearby pharmacy and bought anti-malarial drugs. I gave him the full dose. However, his condition worsened progressively. By the time I took him to Masindi (General) Hospital, it was too late,’ she laments.
A postmortem, performed by the hospital, later revealed that the drugs Afisa had given her son were counterfeit and expired. ‘I thought I was saving my child. I did not know that I was killing him, instead,’ she says.
The drugs were probably brought in through Waaki Landing Site on Lake Albert, smuggled in as part of an underground supply chain from the DRC.
According to the 2024 Annual Crime Report, the Directorate of INTERPOL intercepted traffickers on seven occasions, in which eight suspects were arrested and charged in court.
Four of the suspects were sentenced to fines between Shs10m and Shs20m, one case was dismissed, and one case is still pending in court. On May 6, 2025, five districts bordering the DRC signed an agreement aimed at curbing cross-border crimes.
At the time, Gen Taban Amin, the deputy director general for Special Operations in the Internal Security Organisation (ISO), said the deal would stop cross-border theft of vehicles and livestock, and smuggling, among other crimes.
According to Titus Musiime, Buliisa District’s health officer, records at Buliisa General Hospital indicate that in the last two years, there has been a 20 percent rise in drug-resistant infections.
‘We have many patients who come back after completing the treatment cycle, complaining that the drugs did not work. When we perform laboratory tests, we discover drug resistance. We think this is linked to substandard and fake medication, especially common with antibiotics,’ he says.
According to the National Drug Authority (NDA) Annual Report 2024-2025, there has been a 21 percent increase in adverse drug reactions (ADR) compared to those received in 2023-2024, mostly from antibiotics, painkillers, and even life-saving anti-malarial tablets. In Bwijanga Sub-county, Moses Kabagambe, a 45-year-old farmer, still walks with difficulty after suffering complications from fake antibiotics. After he developed an infection in a wound on his leg, he went to a local drug store.
‘The attendant gave me capsules, which he said would clear the infection. After a few days, my leg began swelling. I was running a high fever. I could not walk. I almost lost my leg,’ he recalls. The doctors informed Kabagambe that the capsules had no active ingredient at all, only starch and colouring.
Smuggled drugs At Runga Landing Site in Buliisa District, small boats cross from the DRC, ferrying fish, fruits, and other items to Wanseko Market. This trade forms the livelihood of several families in the area.
Some locals, though, claim that besides the goods, the boats also ferry drugs, because they are not always inspected at the official customs point.
‘Some traders hide medication inside boxes of deodorants, fuel containers, and other goods. They pass through ungazetted points at night. From Buliisa, they load their merchandise onto trucks or boda bodas to Masindi, Hoima, and beyond,’ says Nicholas Aliganyira, the chairperson of the district health committee.
Along the way, the drugs are repackaged to look like genuine brands, complete with fake seals and expiry dates. In Masindi District, apart from drug shops, fake medicines also circulate openly in informal markets.
On market days, tablets and syrups are spread out on tables alongside vegetables, soap, and sugar.
These tablets include antibiotics, painkillers, and anti-malarial. Some medicine packages have faded labels and missing leaflets, while others are repackaged into small plastic bags.
The common denominator is that the drugs are cheap. Several pharmacists admit that they are struggling to detect these counterfeits.
‘The profit margins in this business are small, and the demand is high. If someone gives you a box of amoxicillin at a cheaper price than the market price, it is tempting.
However, we later discover that some of the drugs do not work,’ says an owner of a drug shop on Station Road in Buliima town council, who asks not to be identified.
These small, mostly unregulated outlets are the last stop in the long journey of the fake drugs. From here, tablets and syrups of unknown quality find their way into people’s hands without checks.
Health workers say that this is where the real danger lies. Dr Alex Felix Ruhuhura, the acting Masindi district health officer, explains that counterfeit medicines can turn a simple illness into a severe health condition.
‘When counterfeit medicines are used for diseases such as malaria, tuberculosis, or HIV, they cause treatment failure, drug resistance, and sometimes death. They also waste resources because patients pay for drugs that do not work and then pay again for proper treatment,’ he says.
For Dr Ruhuhura, the solution starts with creating awareness. People need to know that cheap drugs sold in unlicensed shops are risky.
‘Sometimes wholesalers set very low prices for the drugs they are selling. We do not have the equipment to test the medication before we buy it. Communities, local leaders, and regulators must work together to stop this hidden trade before it claims more lives,’ he notes. Without laboratory equipment, many pharmacies rely on visual checks, which counterfeiters are masters at dodging.
Government reaction
However, the National Drug Authority (NDA) insists that there are no fake drugs in the country. Instead, Abiaz Rwamwiri, NDA’s public relations manager, cautions residents living on the shores of Lake Albert against using drugs from unlicensed traders. ‘We do not have fake drugs. The challenge is that some patients misuse drugs by failing to follow the prescribed dosage, and when treatment fails, they wrongly assume the drugs are fake. Residents and refugees should seek medical care from government health facilities, which are well-stocked with drugs approved by NDA,’ he says.
Besides smuggled drugs coming from across the border, drug shops are also selling expired drugs that have the government seal. Dr Warren Namara, the director of the State House Health Monitoring Unit, says sometimes, the expired drugs are often stolen instead of being destroyed.
‘The drugs are then repackaged and sold, posing a danger to patients. In the 2024/25 Financial Year, equipment and medicines worth about half a billion shillings have been recovered, with several cases currently in court. We have embossed our medicines with clear distinguishing marks, to the extent possible,’ he says.
According to the Parliament Watch, in July 2021, the Cabinet withdrew the Anti-counterfeiting Goods Bill, 2015 from Parliament, stating that there were other laws that can address the gap.
The Bill had been introduced to combat the importation and sale of counterfeit products on the domestic market.
Health officials are urging the government to increase inspections, strengthen border security, and provide drug-testing kits to district hospitals and major pharmacies.
Scope of the problem
Substandard and falsified medical products are a significant global health problem, impacting millions of people and compromising health systems worldwide. These products can be found in all countries, impacting all types of medical products, including life-saving treatments such as vaccines, antibiotics, and cancer therapies.
In 2017, the World Health Organisation estimated that one in 10 medicines in low- and middle-income countries failed quality control tests. The economic burden is also substantial, with billions of dollars lost annually due to ineffective treatments, increased healthcare costs, and loss of productivity.
The issue of substandard and falsified medical products is pervasive and challenging to address due to sophisticated falsification techniques that are difficult to detect and insufficient national resources to respond effectively.
This problem significantly undermines health systems, erodes trust in healthcare, and results in financial losses for both patients and legitimate industries.
The rise in online sales through unauthorised sites has further exacerbated the issue, allowing falsified products to reach consumers more easily. Tackling this problem necessitates robust legal frameworks, regional and international cooperation, heightened public awareness, and stronger enforcement measures.