A recent CAG report tabled in the legislative assembly
has brought to light some serious lapses in the procurement processes
for equipments and supplies in J&K Health Department, and has also depicted
gross negligence and apathy on part of the officials in ensuring quality and
safe medicine to patients that can be gauged from the fact that 50.95 lakh
sub-standard tablets, capsules and injections had been given to patients in
hospitals. CAG report has also revealed acute deficiency of drugs and
disposables for testing in healthcare institutes. Such lack of proper mechanism
is resulting in supply of substandard medicines to the patients that is highly deplorable.
Need of the hour is to
streamline procurement of medicines on scientific and professional lines
alongwith their foolproof quality testing leaving no room at all for any
compromises on the quality of medicines being supplied to patients. There is
need to establish state-of-art warehouses in each district besides central
warehouses in Srinagar, Leh and Jammu divisions so as to ensure round-the-clock
availability of medicines in all health facilities of the state. To ensure this
dedicated transportation facilities, adequate funding, sufficiently trained
manpower are also needed besides a systematic centralized procurement and
decentralized distribution of medicines. JKMSC is functioning in the state in
absence of proper procurement policy framework, lack of drug storage facilities
in all districts and divisions of the state, lack of dedicated transportation
facilities, non-availability of qualified and adequate manpower trained
specifically in supply chain management, paucity of funds, lack of adequate drug
testing facilities and deficiency of drug sampling procedures. All this has led
to inefficiency of the JKMSC and has paved way for failure of the whole system.
Therefore there is need to streamline the entire system on scientific lines and
organize all their activities in a systematic manner in tune with international
standards and guidelines. In absence of such a fool proof mechanism JKMSC will
continue to fail in its objectives of making standard quality medicines
available throughout the year without any stock-outs in all health facilities
of the state.
While the spirit with
which JKMSC was established is admirable, the way it is functioning is unwarranted
and needs some serious thinking. No such corporation can be a success unless it
is fully autonomous, fully transparent, free of corruption and functions on
well established principles of pharmaceutical supply chain management.
Government needs to engage suitably qualified and adequately trained personnel
for the purpose of drug procurement, demand estimation, quantification,
pre-qualification and post-qualification procedures. It needs to fulfill all
necessary pre-requisites like state-of-art warehouses, dedicated
transportation, qualified manpower, adequate funds, sophisticated quality
testing facilities, regular inspections of retail outlets and frequent drug
sampling in order to bring the JKMSC back on track and fulfill its objectives.
Existing medicines management and supply chain systems have many gaps and
shortcomings with lack of resources and well documented policy framework.
Urgent steps are needed to assess the functioning of the public distribution
system for medicines for bridging up the gaps and rectification of
shortcomings. Priority needs to be accorded towards developing well-qualified
manpower, suitably trained in medicines management and pharmaceutical supply
chain. Various national standards suggest that drug quality should be assessed
as compliance with pharmacopoeial specifications concerning a
drug’s identity, purity, potency and other characteristics
like uniformity of the dosage form, bioavailability and stability.
Establishment of a comprehensive Quality Assurance system involving both
surveillance and testing of drug quality, including both technical and
managerial activities, helps in ensuring quality of the products. Basic quality
assurance procedures like visual inspection, labelling carried out by a
qualified pharmacist can easily be adopted at facility level. JKMSC must not
rely completely upon the insufficient govt. drug testing facilities available
in the state. It must empanel accredited private drug testing laboratories on
the lines of Tamil Nadu Medical Services Corporation and send coded samples to
them for testing after carrying out due process of their validation. Meanwhile
govt. needs to accord top priority to augmenting drug testing facilities in the
state on modern lines by installing state-of-the-art sophisticated equipments
and mobile testing vans laced with all the modern gadgetry required to test
drugs on the spot in far flung areas.
Government needs to promulgate a robust drug procurement
policy and implement the drug policy in letter and spirit that has already been
approved by the state assembly four years back. It is highly negligent on part
of the government that even after the lapse of four years drug policy is still
awaiting implementation because of which poor patients are suffering for want
of good quality medicines at government health facilities of the state. In this
regard government needs to take following measures towards improving the drug
procurement and distribution mechanism of the state:
§
There
is an immediate and dire need to uplift the existing health care infrastructure
of the J&K state, with involvement of more qualified human resource and
better health facilities. Urgent steps
are needed to assess the functioning of the public distribution system for
medicines for bridging up the gaps and rectification of shortcomings. Priority
needs to be accorded towards engaging well-qualified manpower, suitably trained
in medicines management and pharmaceutical supply chain procedures.
§
Improved
availability of affordable essential drugs, vaccines and other health care
products depends on effective medicines management and logistic systems to move
essential commodities down the supply chain to the service delivery point and,
ultimately, to the end user. An effective policy framework for medicines
management is desired for providing the health care system with a road map for
continuous improvement in pharmaceutical supply chain.
§
Inappropriate
and inefficient medicine procurement system leads to sub-optimal use of
resources with poor value for money. So far centralized procurement and
decentralized distribution of medicines was not being practiced in the state.
However recently J&K Medical Supplies Corporation (JKMSC) that was
constituted way back in 2013 has started its procurement activities by issuing
its first ever Notice Inviting Tenders. It needs to be further strengthened and
made more dynamic with adequate
funding, trained manpower,
modern infrastructure laced
with MIS, state-of-art warehousing and cold chain
transportation facilities. Recently news reports appeared in the local press that
first ever state level Essential Drugs List (EDL) has been customized and the
same consists of a total of 1200 medicines. Such a huge list kills the basic
aim and objectives of formulating an Essential Drugs Lists since a concise list
would have allowed concentration of all efforts vis-à-vis medicines management
activities as well as limited resources on a small number of drugs leading to
better results in terms of conservation of resources, large volume of purchases
and consequently greater availability of essential medicines. Having 1200 drugs
in EDL literally means including almost all drugs available in the market which
would hardly translate into any tangible benefits for the patients. If the
essential list finalized by JKMSC consists of 1200 drugs, it need correction as
the essence of EDL lies in limiting the number of essential drugs based on
individual facility/societal needs.
§
There
is a need to develop state-of-art
warehousing and cold
chain transportation facilities
at all district headquarters
along with Management
Information Systems for
real-time verification of stocks at district levels. Moreover JKMSC in itself
needs to follow national and international guidelines for developing its
standards governing medicines management practices and use of drugs.
§
Various
national standards suggest that drug quality should be assessed
as compliance with pharmacopoeial specifications concerning a
drug’s identity, purity, potency and other characteristics
like uniformity of the dosage form, bioavailability and stability.
Establishment of a comprehensive Quality Assurance system involving both
surveillance and testing of drug quality, including both technical and
managerial activities, will immensely help in ensuring quality of the
medicines.
§
Medicines
management and supply chain management is a highly technical and
professional activity that can only be achieved 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 exclusively for medicine management activities at any of the
government health departments of J&K state like Departments of Health,
Family Welfare, Medical Education, Provincial Medical Stores or Govt. Medical
College, Srinagar that are adequately trained to serve the purpose.
§
Therefore
appropriate measures need to
be taken in the forms of decisions, actions particularly for proper selection,
quantification, forecasting, procurement, distribution and use of medicines to
make the supply chain more efficient. Moreover disbursement of funds should
also be sufficient and timely to cater to the needs of individual hospitals
across all levels of care. All
the activities related to medicines management and supply chain need to be
carried out in accordance with standard guidelines and good practices involving
only qualified and professional manpower. Evaluation of supply chain should be
carried out regularly to monitor the performance. Health facility specific
policies and procedures with SOPs should be developed and adhered to for better
compliance with existing standards.
In conclusion
appropriate measures need to be taken in the forms of decisions, actions
particularly for proper selection, quantification, forecasting, procurement,
distribution and use of medicines to make the supply chain more efficient.
Moreover disbursement of funds should also be sufficient and timely to cater to
the needs of individual hospitals across all levels of care. Scattered and
sparse budgetary allocations for medicines available with individual hospitals
need to be pooled at the central level for optimal utilization of available
resources resulting into more efficient procurement since centralized
procurement and decentralized distribution has been found to improve access to
medicines in all settings. All the activities related to medicines management
and supply chain need to be carried out in accordance with standard guidelines
and good practices involving only qualified and professional manpower.
Evaluation of supply chain should be carried out regularly to monitor the
performance. Facility specific policies and procedures with SOPs should be
developed and adhered to for better compliance with existing standards.
(Author teaches at the Dept. of
Pharmaceutical Sciences and can be reached at ishaqgeer@gmail.com)
