Concerns have been raised over the decision by the Health Ministry to allow State hospitals to purchase medicines from the local market when the required medicine is not available in the warehouses of the Medical Supplies Division (MSD) of the ministry.
The decision was taken as a solution to the ongoing severe shortage of medicines in the country. Several factors have affected this shortage, including the change of officials at the National Medicines Regulatory Authority (NMRA) and the ban on emergency purchases of medicines.
Shortly after the Covid-19 pandemic lockdowns and the country’s return to normalcy, Sri Lanka experienced a severe economic crisis driven by extreme shortages of foreign exchange, resulting from reduced foreign exchange earnings due to Covid-19 and poor economic policy decisions made by the former Government.
This has caused the unavailability of a large number of medicines at State warehouses. As a solution to address these extreme shortages, the Government resorted to emergency purchases, which later became mired in controversy due to concerns about the quality of the medicines imported on an emergency basis.
To prevent extreme shortages of medicines as a result of the delay in importing medicines following the sudden ban on emergency purchases, the Ministry of Health has permitted hospitals to purchase any medicine as per their requirements.
Health Ministry Secretary Dr. Palitha Mahipala said that while emergency purchases were temporarily suspended, a hospital-level programme was addressing the non-availability issues across the country. Necessary ministerial permissions have been granted for this initiative, ensuring patient interests are prioritised. He said that necessary steps would be taken to purchase and supply medicines if any non-availability issues were reported.
NMRA concerns
Nevertheless, as reported by The Sunday Morning last week, the NMRA has raised concerns over the Health Ministry’s recent decision to allow State hospitals to purchase medications that were in short supply, claiming that there was no monitoring of those purchases by the authority.
NMRA Chairman Dr. Ananda Wijewickrama emphasised that such unregulated purchases bypassed NMRA oversight, potentially compromising public health. While Dr. Wijewickrama acknowledged that the NMRA’s concern only arose should hospitals acquire unapproved medicines, he pointed out instances in 2023 where emergency purchases had led to the acquisition of unregistered medicines, prompting a temporary halt in the process.
LP process
Local Purchase (LP) is a facility given for institutions to purchase the most urgently required life-saving medical supplies. It is an emergency facility given to consultants to cater to the urgent need of patient care and should not be exercised as a regular function.
As per the manual issued by the Health Ministry, the LP process should always reduce the morbidity and mortality of the patient, reduce out-of-pocket expenditure, or reduce the hospital stay, thus benefiting the economy of the country.
The head of the institution and the MSD are required to take full responsibility to make this process transparent. The LP process exercised at an institution must strictly adhere to this manual and the latest other appropriate national procurement guidelines with amendments. Heads of institutions should always ensure that patients receive the best quality medical supplies that outweigh the benefits compared to the cost.
As stated in the manual, the local purchases should be done only via NMRA-registered suppliers and NMRA-registered pharmacies. Since LP is done to acquire urgent medical supplies, the purchaser should consider stock availability, delivery schedule, and lead time to receive the ordered medical supplies.
The institutional Drugs and Therapeutic Committee (DTC) must monitor the LP trends of the institution and the National Drug Therapeutic Committee should monitor the national LP trends. It is the duty of the institutional DTC to monitor the LP trends and report to the higher authorities. The MSD is responsible for increasing the availability of such supplies after careful analysis of the existing and expected trends.
As further highlighted in the manual, purchasing should be done for the medical supplies that are either unavailable at the MSD or are unobtainable from the existing stocks at the MSD/Regional Medical Supplies Division (RMSD). All LP requests should be made by a consultant and must accompany an urgent requirement. LP can be done for both inward patients and outpatients.
However, any inpatient for whom an LP request is made must be registered in the institution (preferably with a Personal Health Number [PHN]) and all outpatients requiring local purchasing must be registered in the national health system with a PHN.
LP can be done by the State Pharmaceuticals Corporation (SPC) at the national level (e.g. due to delaying main tenders, supply chain issues, emerging and reemerging diseases, unforeseen changes in consumption patterns, etc.) based on the request of the MSD, RMSD at the regional level, or institutional level by each institution. It is stated in the manual that the LP process should be exclusively done through the Medical Supplies Information Management System (Swastha).
NAO revelations
In such a backdrop, the National Audit Office (NAO) has revealed that when the receipt of medicines ordered from the SPC by the MSD was delayed, urgent local purchases were made.
As such, it was observed that four types of medicines costing Rs. 50.73 million purchased in this manner had failed in quality in 2016. Accordingly, it was further observed that action was taken to encourage the attempt by the Government to supply medicines to the public without a shortage by purchasing medicines even at a high cost.
The Kurunegala Teaching Hospital had purchased medicines valued at Rs. 9.80 million as emergency purchases (Local Purchase) in 2021. Accordingly, nine items of medical supplies were purchased beyond the estimated price in the computer data system during the emergency purchases of that year and the price variance of those supplies had ranged from 24 cents to Rs. 2,461.
Further, the value of the medicines that had been purchased beyond this estimated price was Rs. 7.84 million and if the medicines were purchased at the estimated price, its value would have been Rs. 2.64 million.
When the stock of medicines in the warehouse is over, the requests made by the wards and units of the hospital are taken by the pharmacists to the national office as a result of non-provision of proper stocks by the MSD as per the annual medicines estimate.
Further, due to the delay in giving the necessary approval for local purchases, there are variances in prices when purchasing fewer quantities of medicines on a credit basis. Most of these medicines are life-saving and antibiotic medicines and the purchases have been made following the stipulated procurement procedures.
Need for immediate solutions
When contacted, Government Medical Officers’ Association (GMOA) Spokesman Dr. Chamil Wijesinghe said the Government should immediately find a solution to the existing medicine shortages and that expensive local purchases should be avoided.
“When medicines are purchased locally, there is no cut-off and hospitals tend to purchase the medicines that are available in the market. Ideally, the process should be streamlined,” he said.
Similarly, All Ceylon Nurses’ Union (ACNU) President S.B. Mediwatta stressed that the local purchases were similar to emergency purchases, allowing more room for corruption.
“When the hospitals are allowed to purchase medicines, it can lead to corrupt practices. This happens occasionally. Since there are a number of medicines that are in short supply, the process will be complicated,” he said.
All attempts to contact Health Minister Dr. Ramesh Pathirana and Ministry Secretary Dr. Palitha Mahipala proved futile.