Shortages: Auditor General’s report sheds light on many ills in health sector

By Saman Indrajith

The expenditure on medical supplies in the first quarter of 2022 was only Rs. 12.4 billion, a sharp drop from 2020 and 2021, the Auditor General’s Special Report on Procedures taken to avoid the Shortage of Pharmaceuticals in government hospitals by 13 May 2022, has revealed.

The amounts spent on medical supplies during the year 2020 and year 2021 were Rs. 83.5 billion and Rs. 73.6 billion respectively.

The actual quarterly average expenses on medical supplies in 2020 and 2021 were Rs. 20.8 billion and Rs. 18.4 billion respectively, the report has said.

The number of pharmaceutical items used in hospitals as Vital, Essential and Non-essential is 1,146; the number of surgical items is 8,648; the number of laboratory items is 3,900 and the number of the X-ray items is 44.

By 13 May, the number of Vital and Essential drugs out of stock in the Medical Supplies Division and hospitals was 190 and 51 respectively. Besides, 2,724 and 2,156 Vital and Essential surgical items were out of stock in the Medical Supplies Division and hospitals respectively at that time.

The number laboratory items and X-ray items out of stock in the Medical Supplies Division and hospitals was 850 and 18 respectively.The report says the future annual requirement is estimated by the respective hospital authorities based on the consumption and the remaining stocks, and sent to the Medical Supplies Division 13 months prior to the month in which the supply is required.

In the process of procuring medical supplies, the Medical Supplies Division has to send orders to the State Pharmaceutical Corporation for the procurement of estimated items with a supply period of 11 months.

The report has stated that the National Drug Quality Assurance Laboratory was established under the National Medicine Regulatory Authority to assist in the process of verifying the standards of procured medical supplies. Cabinet approval was given, on 15 October 2009, for the five-year Development Plan from 2010 to 2015, which was prepared at a cost of Rs. 410 million to develop the infrastructure and human resources of the National Pharmaceutical Quality Control Laboratory with a view to increasing the number of laboratory tests to check the quality of medical supplies.

According to the Manual on Management of Drugs, pharmaceuticals should be stored in well-ventilated spaces at specified temperatures. The Medical Supplies Division should maintain a secure stock for three months, and in addition to regular checks by a staff officer, sample testing should be done for the confirmation of the accuracy of drug storage and accounting.

The Auditor General’s report has said a number of other factors have contributed to shortages––poorly maintained computer system, lack of proper coordination and coordination between the Medical Supplies Division, the Ministry of Health, the State Pharmaceutical Corporation of Sri Lanka and the State Pharmaceutical Manufacturing Corporation of Sri Lanka, lack of regular monitoring, and progress of orders issued to the State Pharmaceutical Corporation of Sri Lanka and noncompliance with the procurement schedule.

The AG has found that the Medical Supplies Division submitted lists of orders for the respective year to the State Pharmaceutical Corporation of Sri Lanka through MSMIS or PRONTO computer system with a lead time of 11 months, but the corporation had not immediately commenced procurement process for those orders and the procurement was delayed until written copies of the order list were received by the corporation.

It took more than 18 days to send the written copies of the orders to the Import Division of the State Pharmaceutical Corporation, and since procurement had only begun thereafter, part of the supply period of 11 months had elapsed. Pharmacists and senior officials in the Medical Supplies Division placed the order through the computer system, but there had been a delay in sending written documents., the Auditor General has said.

Although 41 orders out of 90 for eight vital items and essential items were issued by the computer system to the State Pharmaceutical Corporation of Sri Lanka in the first two months of the year, it had taken between 18 days and six months for the Import Division of the State Pharmaceutical Corporation to receive the written copies of the order lists, the report found.

This shows that there is a lack of coordination among the Medical Supplies Division, Ministry of Health, State Pharmaceutical Corporation of Sri Lanka and State Pharmaceutical Manufacturing Corporation, which are mainly involved in the management of medical supplies, the Auditor General has observed in his report.