Do what’s right

Nothing to sing about

After more than a year of chronic drug shortages, the prime minister has asked the health minister for a report on the problem. I’m surprised. Hospitals throughout the country have been facing a serious shortage of drugs for more than a year. The problem has been widely reported and analyzed by the media. The  opposition party questioned the government during the 7th session of the Parliament. And the National Council questioned the government during the 8th session.

So I’d have thought that the prime minister would be well aware of the problem. I’d have thought that would have discussed it thoroughly in the cabinet, and that he would, in fact, have already decided how to address the problem. It looks like I am wrong. The prime minister still does not seem to understand the extent of the drug shortage problem. That’s why he’s only now asked for a “comprehensive report”.

The pubic, however, has a fairly good idea about the extent of the drug shortage problem. That’s because most people, at one time or the other, and especially the poor, have suffered because of the shortage of drugs in our hospitals. That’s also because the media have done a remarkable job in keeping us informed about the problem. Here, as an example, are links to stories that just one of our newspapers, Kuensel, has published on the issue of drug shortages.

Yes, a heart patient has died. The health ministry has defended itself, claiming that the heart patient had died because of other complications. But her parents insist that she died because she didn’t have medicine. They insist that their daughter died because of the shortage of drugs.

The health minister has not accepted responsibility for the death of the heart patient. But, like it or not, he has to accept responsibility for the overall drug shortage. Like it or not, he has to accept responsibility for the suffering caused to countless patients throughout the country. Like it or not, he has to accept that he is unable to solve the drug shortage problem, a problem that emerged during his watch.

The prime minister should read the health ministry’s report that will, no doubt, blame ACC and RAA and DRA and suppliers and others for the perennial drug shortage. But he should also read what the media has reported, consistently and conscientiously, during the last year. And he should listen to the many stories of suffering that patients have had to endure.

And then he should do what’s right: ask the health minister to step down.

Health on drugs

Causing suffering

The Health Ministry has admitted that they have a problem: they have not been able to maintain an adequate supply of drugs to our hospitals. As a result, patients have had to postpone or even forgo medication. And doctors have been forced to direct their patients to private pharmacies, which, many times, have also been frustratingly out of drugs.

Worse still, the Health Ministry has admitted that they still do not know how to resolve the drug shortage issue, a problem that has reached chronic proportions during the past year. So they’ve announced that, as an interim measure, they will send officials to buy drugs directly from manufacturers in Bangladesh.

I suspect that the officials who’ll be going to Bangladesh will be mainly, if not entirely, ministry personnel, most of them from the Drugs, Vaccines and Equipment Division (DVED). If that is so, that could very well be the problem – a central agency unable to keep up with the growing and changing needs of referral hospitals in general, and the Jigme Dorji Wangchuck National Referral Hospital in particular.

DVED is the Health Ministry’s central procurement agency. They buy, stock and distribute drugs and equipment to hospitals throughout the country. That’s a lot of work, work that just gets more complicated as more people use the health system. Between receiving orders for drugs from individual hospitals to supplying them with the drugs is a logistical nightmare that includes compiling and approving orders from the field; tendering and awarding procurement contracts; receiving, verifying and storing drugs; and finally, distributing them to every hospital and clinic, throughout the country. And all that must be done within the framework of the government’s tight financial rules and regulations.

DVED’s centralized operations have served the nation’s health system faithfully till now. But the health system has changed drastically since the establishment of referral hospitals. And DVED would now find that procuring and delivering drugs to the new and growing referral hospitals is an increasingly difficult and complex matter, especially when their main task is still to service all the other hospitals throughout the country.

So it’s time to decentralize procurement, at least for referral hospitals, and definitely for JDWNR hospital. And why would JDWNR hospital be able to do a better job? Incentives.

When drugs run out, hospital staff take the flak. They are the ones who interact with patients every day, and the ones who, as far as patients are concerned, are at fault if hospital services are not adequate. So it is in the interest of hospital staff – nurses, doctors, technicians and administrators – to ensure that drugs, especially essential ones, are always available. Ministry officials, including DVED staff, cannot, and will not, share the same levels of concern.

So decentralize drug procurement. Allow JDWNR hospital to acquire drugs without having to deal with the bureaucracy of the ministry. Otherwise, be prepared to face more serious drug shortages, more frequently.

In fact, decentralize equipment procurement too. And all personnel matters, including training. And finance. And administration. Make the nation’s biggest and fastest growing hospital fully and truly autonomous. That way, hospital staff would feel a sense of control, a sense of ownership, a sense of purpose. And that would drive them to realize their full potential and to achieve their vision.

But the Health Ministry must regulate them. And make them fully accountable. That way, services would improve, drug shortages would drop, and the health sector’s biggest disease – widespread corruption – would finally be contained for proper treatment.

Photo credit: Kuensel