• Misuse of emergency purchases squanders millions of rupees
• 294 medicines purchased under emergency procurements
• Rs. 30 b spent annually by Treasury on emergency purchases
• NMRA issued WOR on 750 meds last year, 500 meds get WOR this July
• Emergency meds purchases to address State sector shortages: Rambukwella

Revelations regarding the emergency procurement of medicines and medical equipment by the Ministry of Health have raised a host of questions among health sector experts, with some alleging that the country is losing money due to mismanagement and malpractices within the health sector management.

The mismanagement issues range from questionable procurement practices to concerns about inadequate oversight and accountability, resulting in financial drain and hindering the effective delivery of healthcare services.

This revelation has not only cast a shadow over the financial integrity of emergency procurement but has also raised fundamental questions about the allocation of resources and the prioritisation of public health needs. 

Stakeholders are now demanding a thorough investigation and a reassessment of the procedures and mechanisms governing emergency procurements within the health sector to ensure optimal utilisation of funds and resources and to regain public trust.

Misuse of emergency procurement system

Against this concerning backdrop, a source close to the matter at the Ministry of Health has disclosed information regarding the approval process for emergency purchases. Approvals have been granted for the procurement of even common painkillers like paracetamol under the guise of emergency needs.

The source revealed that this misuse of the emergency procurement system had led to the squandering of millions of rupees on medicines that did not genuinely necessitate immediate procurement.

This revelation underscores a deep-seated issue within the management of emergency procurement processes, raising questions about the appropriateness of the approvals and the fiscal responsibility associated with the utilisation of public funds.

The fact that basic, readily available medications are being acquired through emergency procurement procedures raises concerns about the effectiveness of the system in place and calls for urgent reforms to ensure that public resources are allocated judiciously and responsibly, especially in critical sectors like healthcare. 

The need for enhanced transparency and accountability in the emergency procurement processes within the health sector is now more pressing than ever.

Costly emergency purchases

Recent statistics released by the Health Ministry indicate that a total of 294 medicines were procured through emergency purchases as of last week. An estimated Rs. 30 billion is being expended annually by the Treasury for emergency acquisitions.

Experts argue that these substantial funds could be more effectively utilised in procuring medicines of superior quality, rather than the current scenario where emergency purchases often result in the acquisition of subpar medicines at inflated prices.

Speaking to The Sunday Morning, Government Medical Officers’ Association (GMOA) Spokesman Dr. Chamil Wijesinghe shed light on the issue of wasteful spending. He emphasised that the country suffered significant financial losses each year due to emergency purchases, leading to the acquisition of medications of inferior quality at higher costs.

Dr. Wijesinghe stressed the importance of redirecting funds from emergency medicine imports towards high-quality European medications, expressing deep concern over the misuse of emergency purchases. He urged a shift away from routine emergency purchases, advocating instead for a streamlined procurement process that would ensure timely orders and better financial utilisation.

Highlighting the risks associated with emergency purchases, including corruption and concerns about product quality, particularly through the use of Waiver of Registration (WOR), Dr. Wijesinghe revealed alarming figures. 

He noted that last year alone, the National Medicines Regulatory Authority (NMRA) had issued WORs in approximately 750 instances, and, by the end of July this year, the number had already reached 500.

In the realm of pricing, Dr. Wijesinghe pointed out the substantial markup on medicines acquired through emergency purchases, which often reach three to four times the original price. He emphasised the urgent need to address this issue and to promote a more financially responsible and transparent procurement process within the healthcare sector.

NMRA Act

Section 109 of the National Medicines Regulatory Authority Act serves as a pivotal framework defining the terms ‘emergency’ and ‘special circumstances’ with precise clarity. These definitions pave the way for crucial actions in the import and distribution of essential healthcare items such as medicines, medical devices, or borderline products. 

The primary objective is to swiftly respond and effectively manage critical situations, emphasising actions aimed at saving lives, controlling outbreaks, addressing epidemics, and handling national emergencies.

In essence, this section of the act embodies a careful balance between facilitating prompt actions for public health welfare and maintaining strict regulatory oversight. It underscores the necessity for importers to exercise a heightened sense of responsibility and transparency throughout the process.

The act elaborates that such permissions for importation may be granted under two specific circumstances.

Firstly, it may be initiated in response to a formal request from the Ministry of Health, reflecting a centralised approach aligned with the Government’s healthcare strategy. Secondly, it can be triggered by a request from an individual or organisation, subject to a recommendation by the Ministry of Health, ensuring a collaborative and consultative decision-making process.

Crucially, the legislation emphasises the pivotal role of the importer in ensuring accountability and effective management of the imported healthcare items sanctioned under Section 109. The importer is entrusted with the task of adhering to defined reporting procedures, providing routine reports to the authority. These reports are crucial for monitoring and evaluating the appropriateness and impact of the emergency imports, aligning with the principles of transparency and oversight that are fundamental to the act’s broader objectives.

Discrepancy in implementation 

Meanwhile, Association of Health Professionals (AHP) President Ravi Kumudesh expressed concerns about the apparent discrepancy between existing rules and regulations and their actual implementation within the Health Ministry. He highlighted that despite the presence of well-defined rules, they often seemed ineffective when it came to the conduct of Health Ministry officials.

Kumudesh pointed out a common issue, where tenders for essential medical supplies frequently experienced delays due to various reasons. These delays can extend the procurement process by up to six months or more. Such prolonged timelines can lead to genuine shortages and potentially emergent situations. He attributed this mismanagement to the Health Ministry, urging a streamlined approach to tackle these delays and ensure a more efficient procurement system.

He also highlighted the urgent need for the Health Ministry to reevaluate and expedite its procurement procedures, especially in critical situations where timely acquisition of medical supplies was essential for public health and safety. He emphasised on the necessity for a more effective and responsive tendering process to prevent potential shortages and ensure a well-functioning healthcare system.

Minister’s reassurances 

When contacted by The Sunday Morning, Health Minister Keheliya Rambukwella clarified that the ministry allowed emergency medicine imports to address shortages in the State sector. 

“These medicines are approved by reputable institutions like the World Health Organization (WHO) to ensure their quality. The emergency procurement process takes around three months, emphasising the need for swiftness to prevent shortages,” he said. 

He reiterated that in terms of finances, $ 200 million, from a $ 1 billion credit facility by the Indian Government, and Rs. 3,000 million had been allocated for essential medicine imports, covering 95% of the necessary financial arrangements. 

The ministry prioritised timely procurement to meet current requirements and assured that all imported medicines met quality standards approved by these reputable institutions, he added.

When contacted by The Sunday Morning, State Pharmaceuticals Corporation (SPC) Managing Director Dinusha Dasanayake said the entire emergency purchase process was carried out by the Ministry of Health, while the SPC merely placed orders as per requests made by the Medical Supplies Division (MSD).

“We are not a party to deciding what to order on an emergency basis. It is entirely the responsibility of the Ministry of Health,” he reiterated.

Alleged insulin shortage 

In response to claims by a group of health experts and pharmacists regarding a shortage of insulin in the country, the Ministry of Health has firmly denied these allegations. The ministry has reassured the public that there are sufficient supplies of insulin available and that the distribution process is ongoing without disruption.

Health Minister Keheliya Rambukwella, speaking to The Sunday Morning, stated that the insulin shortage had been resolved and that the country currently possessed ample stocks. “We have received stocks and the process of distribution is ongoing,” he confirmed.

The ministry’s statement aims to allay concerns and emphasise that it is actively managing the availability and distribution of critical medical supplies such as insulin to ensure the wellbeing of those relying on this essential medication.

Last month, medical experts warned the Health Ministry of a potential severe shortage of insulin in the coming months, posing life-threatening situations for patients reliant on the drug. It was alleged that the last tender for insulin supply had been awarded at Rs. 650 per vial, a four-fold increase from the previous tender at Rs. 150, due to a supplier claiming a lack of raw materials for production.

Despite the arrival of stocks, health sector unions predict it may take an additional three months to stabilise supplies. Insulin is critical for individuals with diabetes, and the emergency tender was necessitated to address supply gaps from previous orders, State Pharmaceuticals Corporation (SPC) Managing Director Dinusha Dasanayake clarified, speaking to The Sunday Morning on an earlier occasion.

Additionally, when contacted, Association of Health Professionals (AHP) President Ravi Kumudesh affirmed that the previously reported shortages of insulin had been successfully alleviated. Hospitals now have sufficient and adequate supplies of insulin, providing reassurance regarding the availability of this crucial medication.

Meanwhile, The Sunday Morning has reliably learnt that despite the arrival of adequate insulin supplies in the country, there is a reported shortage of insulin syringes in State hospitals. The Health Minister, however, denied these allegations, stating that the ministry was in the process of distributing the stocks and working to ensure a smooth supply chain for both insulin and syringes.