As a result of the depletion of foreign exchange reserves in the country, the Sri Lankan health system is heading towards a critical situation due to the lack of medicines and medical consumables. Doctors, including the strongest trade union of Sri Lankan doctors – the Government Medical Officers’ Association (GMOA), have been warning the authorities regarding this crisis for many months. However, currently, the situation is rapidly reaching a tipping point, threatening the whole of Sri Lanka’s healthcare system.
The Sri Lanka Medical Association (SLMA), the national institution which brings all medical specialities together, conducted a media conference on 9 February 2023, focusing on this looming issue. SLMA President and consultant community physician Dr. Vinya Ariyaratne chaired the conference. SLMA President Elect and consultant physician at the National Institute of Infectious Diseases Dr. Ananda Wijewickrama, Faculty of Medicine, University of Colombo Senior Professor in Pharmacology Prof. Priyadarshani Galappatty, and Sri Lanka College of Anaesthesiologists and Intensivists President Dr. Anoma Perera shared their experience. The conference was moderated by Dr. Pramitha Mahanama.
The following are excerpts from the media conference.
SLMA’s stance on the crisis situation
Dr. Vinya Ariyaratne spoke about the current situation of lack of medicines, consumables, and laboratory reagents, and explained the SLMA’s involvement. “The SLMA foresaw this issue in early 2022 and warned then-President Gotabaya Rajapaksa of this impending crisis in writing last April. Further, the SLMA has guided doctors at each level of the hospital through the professional colleges regarding the management of patients with minimally available medicines and consumables.”, said Dr. Ariyaratne.
“In general, the drug management cycle includes many complicated aspects and should undergo critical steps such as supplier selection, quality testing, technical evaluations, and the lengthy procurement process before the prescription. Hence, legislations are in place to assure both the quantity and quality of medicines, reagents, and consumables. Further, the SLMA has taken all possible measures through the inter-collegiate committee to inform and guide the authorities to the correct path. Furthermore, the SLMA requested donations from alumni residing all across the globe, to get down essential medicines as a temporary measure to battle the crisis,” explained Dr. Ariyaratne. He concluded his speech by insisting that it is essential to consider this crisis situation as an emergency and stressed the need for immediate action in this regard.
Steps taken through the SLMA Medicinal Drugs Committee
Senior Professor in Pharmacology Prof. Priyadarshani Galappatty explained the actions taken through the SLMA Medicinal Drugs Committee. The committee reviewed the current situation in detail and made critical recommendations to the Ministry of Health in January 2023. The review detected deficiencies related to drug ordering. “Due to the current foreign exchange crisis, the previous practices in drug purchasing cannot be applied. Currently, the medicines are purchased through an Indian credit line. Hence, it is mandatory to manage it stringently”, said Prof. Galappatty. She insisted on the need of purchasing only essential medicines, which are recommended by clinical experts, as they had identified several incidents of non-essential medicines being purchased. Along with their suggestion, the Ministry of Health has initiated coordination between clinical experts, the National Medicines Regulatory Authority (NMRA), the State Pharmaceutical Corporation (SPC), and other relevant stakeholders, and has recommended conducting weekly meetings to regularly monitor the situation related to critically essential medicines.
“Donations of medicines have helped immensely in continuing healthcare services during these critical times. However, we are required to focus on essential medicines when accepting donations as well. Regarding medicinal drugs, quality is a crucial requirement. Especially, the logistical quality standards, such as transport and storage temperatures, are critical in assuring medicinal quality. There have been several occasions where the donated medicines had expired and additional funds had to be utilised to have them destroyed”, explained Prof. Galappatty. In critical emergency situations, unregistered medicinal brands may also have to be purchased. However, the quality of these medicines should also be ascertained and the Medicinal Drugs Committee issued recommendations on this regard to the relevant authorities.
Critical drug stock levels
Sri Lanka College of Anaesthesiologists and Intensivists President Dr. Anoma Perera discussed the current situation on drug availability. “While some medicines are in critically low supply, some medicines are simply not available”, Dr. Perera highlighted. “This situation is extremely critical. At present, the stocks of many anaesthesia and pain management medicines have completely depleted in the Medical Supplies Division (MSD). This situation critically affects emergency surgeries, ICU care, and even maternal care by jeopardising caesarean surgeries. If the current situation is not managed properly, these services are at risk of collapse,” Dr. Perera emphasised. She further highlighted that this critical situation is not only limited to the Government sector but also affects private-sector hospitals. Hence, this is a crisis affecting all economic strata equally.
“The responsibility falls on all of us, including patients and the public. Do not waste prescribed medicines; know your illnesses; and control all preventable conditions,” Dr. Perera advised the public. Further, she revealed that there is a severe shortage in the stocks of antibiotics as well.
The essential requirement of regulation
Consultant physician at the National Institute of Infectious Diseases Dr. Ananda Wijewickrama exposed certain irregularities related to ordering and procuring medicines, which had occurred in the recent past. He emphasised the importance of regulating the ordering of medicines during these critical circumstances.
“Highlighting the medicine crisis, two Cabinet papers had been submitted by the Health Minister in October and December 2022. The first Cabinet paper was for purchasing 36 types of medicines from an unsolicited supplier called Savorite. This request had been granted Cabinet approval with conditions of the Ministry of Finance insisting on the assurance of the quality of medicines and to consider prices before purchasing. Another Cabinet paper had been tabled in December for the purchasing of more than 20 medicines, and thanks to the media, this attempt to purchase drugs from a blacklisted company was subsequently halted,” Dr. Wijewickrama revealed.
“According to the NMRA act, there are certain legal provisions with regard to purchasing unregistered medicines which are considered lifesaving medicines. However, the list of medicines which has been submitted for purchase through the Indian credit line contains non-essential medicines, such as certain types of topical creams. It was revealed that approximately 80% of the medicines recommended to be purchased from the Indian credit line are not registered in Sri Lanka, and thus, their quality standards have been assessed. Further, some of these listed medicines are not essential medicines and some are medicines that have already been removed from use. These issues have been highlighted and conveyed to the relevant authorities, and we have insisted that only the most essential medicines are purchased from this precious credit line,” explained Dr. Wijewickrama. Furthermore, he mentioned that according to health authorities, the current funding through the Indian credit line and donations from international funding agencies are adequate to purchase essential medicines for two years, if managed properly. Dr. Wijewickrama appreciated the active involvement of the media in communicating accurate messages to the public and for being attentive and raising awareness about irregularities.
(Dr. Charuni Kohombange is a media committee member of
the Sri Lanka Medical Association)