After immense public and media outcry over the spurious drugs debacle
and after four years of sustained lobbying and persistent advocacy by Civil
Society Forum, Government of J&K has finally risen to the occasion and decided
to constitute J&K Medical Supplies Corporation (JKMSC) with an aim to
centralize and ensure the supply of standard quality drugs and other medical
supplies to healthcare centres in the state. Proposed Corporation shall
function under the chairmanship of Chief Minister, with Ministers of Health and
Medical Education serving as its Vice-Chairmen. It
may undertake procurement,
testing, storage and distribution of human drugs, medical equipments &
devices, surgicals & sutures, kits and reagents to the government health
institutions of the State. Constitution and other modalities
of the Corporation are at present being finalized for getting it approved by
the state cabinet.
This is truly a welcome decision that if executed in a proficient manner
shall pave way for an effective implementation of the approved Drug Policy
besides streamlining the terribly deranged drug procurement mechanism of the
state. While this initiative needs to be applauded and encouraged by one and
all, there are several issues and challenges confronting the proposal whose
redressal assumes importance for accomplishing the dream of this Corporation in
a timely manner and for making it a roaring success. Some of these issues at
hand and challenges ahead that have the potential to mar the prospects of realization
of this government proposal are discussed here with a sole intention of overcoming
all possible hurdles and paving way for an unhindered functioning of the
proposed Corporation.
Standard Operating
Procedures (SOPs)
First and foremost issue is that in relation
to procurement of drugs and other medical supplies, the approved Drug Policy of
the state just mentions that the existing
procurement mechanisms of drugs & supplies shall be improved with a view to
ensure timely availability of quality drugs, however it does not put forth any discrete policy framework before the upcoming
corporation as required for tendering, supplier selection, ordering, pre-qualification,
post-qualification, resource allocation, quality assurance, distribution etc.
Therefore there is urgent need to chalk out a comprehensive and robust drug
procurement policy framework for the state so that there are “Standard
Operating Procedures” available to the Corporation that can serve as its
guiding roadmap and devise modalities for its day-to-day functioning. Due to
some mutual differences between two erstwhile ministers of Health and Medical
Education over the constitution of this Corporation, the procurement part had
been left incomplete in the approved drug policy of the J&K state. Unless
this deficiency is duly addressed well in time, there will always be a scope
for gratification practices and bending of rules for some illegitimate gains. Strong
lobby of the drug mafia that has successfully scuttled any moves to establish a
drug procurement corporation in the past may once again attempt to sabotage the
establishment or working of this Corporation which needs to be fought out with firm
conviction through strong policies and stringent procedures.
Warehousing and
Transportation
Second big
challenge confronting the upcoming JKMSC is to have
adequate, state-of-the-art warehousing facilities for drugs and other medical
supplies both at divisional and district levels in the state alongwith sufficient transportation laced with cold chain facilities. Madhya
Pradesh government’s centralized drug procurement policy of 2004 failed on
account of non-availability of adequate drug storage and transportation
facilities at district level and consequently they had to revert back to
decentralized procurement in their revised drug policy of 2009. Therefore it is
extremely important to have warehouses with enough storage space, fitted with
heavy duty racking system to avoid wastage of space alongwith pallets,
hydraulically operated hand-trolleys and pedestrian controlled electric
stackers to handle the medicines scientifically and efficiently. An earlier
draft of the drug policy prepared in 2009 had mentioned that the government
shall establish modern warehouses at divisional and district levels under the
proposed J&K Medical Supplies Corporation keeping in view the state’s
topography, climatic conditions and issues of accessibility and that the
capacity of warehouses/stores would be in line with the actual requirement to
ensure constant supply of drugs to all healthcare institutions of the state. Surprisingly
this provision was dropped in the final draft approved by the state cabinet. Therefore
if the govt. has decided to procure drugs centrally and then distribute to
various district level hospitals, this clause needs to be incorporated into the
procurement part of the policy.
Skilled manpower
trained in procurement
Procurement and supply chain management of medicines is a
highly sophisticated and professional activity that can only be satisfactorily
and successfully undertaken by suitably qualified, adequately trained,
sufficiently skilled manpower both at managerial and ground level. At present
no executive or administrative staff is available in sufficient numbers at any
of the government departments including Departments of Health, Family Welfare,
Medical Education, Provincial Stores or Drugs Control that are amply trained to
serve the purpose of the upcoming Corporation. Therefore need of the hour is to
create sufficient vacancies in the proposed Corporation for such staff, arrange
capacity building workshops for the existing staff of Provincial Medical Stores
and impart sufficient training to them regarding modalities of modern drug
procurement in tune with international standards and norms. Many international
Universities conduct summer schools in Pharmaceutical Procurement and Medicines
Management from time to time. Government needs to identify and appoint the
managerial staff for the proposed Corporation on priority basis and depute the
same to these training courses for gaining required expertise so that they can
serve the Corporation better and in an effective manner on their return. Given
the impact of procurement activities on the operation and effectiveness of
health services, it is essential that these activities be performed by trained
staff only using sound procedures. Main activities of drug selection, quantification,
procurement, quality assurance, storage and distribution must exclusively be
carried out by graduates and post-graduates in Pharmaceutical Sciences, who are
best suited and well trained for this purpose.
Integrity and
transparency in tendering
Most of the apprehensions and skepticism of common masses
in relation to the functioning and success of the proposed Medical Supplies
Corporation are linked with the degree of integrity, openness, transparency and
efficiency of procedures adopted for awarding tenders to the drug suppliers
that will in turn decide the standards of quality of drugs and equipments
procured by the Corporation. Majority of people fear that undue political or bureaucratic
interference may mar the prospects of such transparency in tendering and
procurement and that may in turn bleak the chances of success of this
Corporation. In this regard state government needs to display its writ and
throttle any such overt or covert moves to undermine the fairness of the
tendering practices. Proposed Corporation has to be an absolutely autonomous,
open and constraint-free body with full decision-making powers devoid of any undue
political or bureaucratic influences. In this regard JKMSC needs to follow the
footprints of Tamil Nadu, Kerala and Rajasthan Medical Services Corporations
and ensure transparency in all its dealings. Full authority and autonomy needs
to be vested upon its Managers and Board of Directors in making their
decisions. No transfers of its managers should be allowed under statutes for a
specified period unless there are any proven accusations of impropriety. Transparency
and integrity will be the benchmark and the key litmus test for the success of
this Corporation that alone will decide its future progress. If it succeeds, it
makes history and if it fails it fails forever.
Financial/budgetary allocations
Besides divisions for procurement, storage and
distribution of drugs and other medical supplies, JKMSC must have a separate
department of Quality Control where an in-house QC Laboratory equipped with all
sophisticated equipments, staff and infrastructure required to test the quality
of drugs, should be a established. Therefore besides sending drug samples for
testing to government and empanelled private laboratories, Corporation should itself
be able to carry out in-housing Quality Control of some of the supplies on
urgent basis. To fulfill this and other needs of the Corporation, it must
receive sufficient and liberal finances from the govt. through plan as well as
non-plan budgetary allocations. Since healthcare has to be on top of all
priorities of any government, no stone should be left unturned to ensure
adequate monetary support from internal as well as external resources for
smooth functioning of the Corporation. It has come to the fore that inadequate
funding has over the years left govt. drug testing laboratories of the state in
shambles which in turn has resulted into large scale resentment among masses
regarding govt. apathy towards these vital institutions. Therefore there should
be no dearth of funds at any stage that may impede effective functioning of the
proposed Corporation.
Conclusion
An effective procurement process ensures the availability
of the right drugs in the right quantities, at reasonable prices, and at
recognized standards of quality. Effective procurement is a collaborative
process between the procurement corporation, suppliers, an appropriate
management system, and committees which make decisions as to which drugs to
buy, in what quantities and from which suppliers. In order to put the existing derailed
drug procurement system back on track, government has to move several extra
miles at a brisk pace and take bold decisions in making this entire concept a
grand success. Let our healthcare not fall prey to corrupt practices prevalent
elsewhere and let this sector at least be spared from the monetary lust of
human kind. States like Tamil Nadu and Rajasthan have shown how this model can
be made a success despite all odds; we just need to replicate their success in
our own small world.
No comments:
Post a Comment