Expired drugs valued more than $34 million were discovered at the Diamond Diagnostic Centre and several Health Centres in Region Four, according to the 2017 Auditor General’s report, which also reported similar findings albeit on a smaller scale at health centres in regions Three, Seven, Eight and Nine.
“Physical verification exercises conducted on drugs and medical supplies at Diamond Diagnostic Centre and four of the twenty-two Health Centres revealed that there were forty-four instances where expired drugs with an approximate value of $34.501M, were found at these locations,” the report, which was tabled last month in the National Assembly, said. Instances where drugs were discovered being stored under less than ideal conditions were also highlighted in the report.
Though the Region Four Administration informed that it has disposed of all expired drugs and is awaiting certificates from the Food and Drug Department, the Audit Office recommended that it puts systems in place to monitor the expiry dates of drugs in stock to ensure that “wastage and loss through expiry is reduced.”
The report explained that for 2017, the sum of $620 million was budgeted for the procurement of Drugs and Medical Supplies under Health Services Programme (Line Item 6221) for Region Four. The Regional Administration spent $2.960 million and issued an Inter-Departmental Warrant for $617 million to the Ministry of Public Health (MoPH) for the ministry to procure drugs and medical supplies on behalf of the Regional Administration.
According to the report, the Inter-Departmental Warrant was issued on November 21st, 2017, to the MoPH for $617 million, while a Financial Return was received indicating that the full amount was spent.
Like in 2016, the report noted that there was a recurring situation whereby drugs and medical supplies although received by the Regional Administration did not include the cost on the documentation that accompanied the deliveries. As a result, it could not be determined whether full value was received for the sums warranted to the MoPH.
In response, the region indicated that it is still awaiting the cost of the drugs from the MoPH so as to reconcile same with the Region’s receipt of drugs.
It was recommended by the Audit Office that the Regional Administration puts systems in place to reconcile supplies received with the drugs list initially submitted, and obtain the cost of the drugs and medical supplies from the MoPH so as to reconcile the value of the drugs and medical supplies received with that of the sum warranted to the MoPH.
Region Three
Under the heading ‘Stores and Other Public Property’ for Region Three, the report states that physical verification exercises were conducted on drugs and medical supplies at the West Demerara Regional Hospital and the Leonora Diagnostic Centre along with six health centres within the region.
It was observed that at the Leguan Cottage Hospital, there were 215 items of expired drugs on hand that related to both 2017 and prior years that were “being stored in boxes in the same room as drugs that were being dispensed for public consumption.”
At the Zeelugt and De Kinderen health centres, there was a small quantity of expired drugs on hand. However, at both Health Centres, drugs were stored in a room that did not have a serviceable air conditioning unit, the report said.
“Hence, a cupboard was provided for storage of the drugs at Zeelugt Health Centre but it was explained that the drugs are being stored at the top of the cupboard so as to prevent any damage from over-heating,” the report said.
It also said that at the Versailles Health Centre, a small quantity of expired drugs was evident, while drugs that were stored for public consumption were in a cupboard that was very congested and had no labels to differentiate the different type of drugs on hand. Additionally, the drugs stored at this location, were in a room that was also occupied by the Medex, who reported that since “the room has no air condition unit and both the electrical point and the stand fan were out of order, at certain times of the day the room becomes very hot and that is not the ideal condition under which drugs should be stored.”
In response, the Head of Budget Agency indicated that a letter was sent to the Food and Drugs-Government Analyst Department for the expired drugs to be destroyed, and for the necessary corrective actions to be taken.
As a result, the Audit Office recommended that the Regional Administration undertake a survey to determine the realistic needs for pharmaceuticals and other medical supplies at these institutions and to ensure the proper storage of drugs and medical supplies in order to reduce losses through expiration or improper storage.
Regions Seven and Eight
In Region Seven, a physical verification of drugs and medical supplies at Bartica Hospital revealed thirty five instances of expired drugs, valued $1.285 million.
The region, in response, indicated that action would be taken to dispose of the drugs and the Audit Office has recommended that systems be put in place to monitor the expiry dates of drugs in stock to ensure the reduction of wastage and loss through expiry.
The report said, too, that physical verification exercises conducted on drugs and medical supplies at Mahdia Hospital in Region Eight, found sixty-eight instances where drugs had expired. No values were attached to those drugs.
The region explained that no costs were attached because none was received from the Materials Management Unit (MMU) but efforts would be made to dispose of the expired drugs.
The Audit Office recommended that the Regional Administration put systems in place to monitor the expiry dates of drugs in stock.
Region Nine
In Region Nine, a physical verification based on an examination of the 2017 records of the Lethem Regional Hospital revealed thirty instances of expired drugs with quantities in the range of 540 to 30,100 that were stored in a bond in the hospital’s compound. Similarly, for the year 2016, physical verification exercises revealed 113 instances of expired drugs, the report said, while adding that none of the recommendations made in regards to this issue in the 2016 report were implemented.
The Region, in response to these fresh findings, said action would be taken to dispose of the expired drugs.
The Audit Office again recommended that the Regional Administration put systems in place to monitor the expiry dates of drugs.
Meanwhile, among the unsatisfactory features noted during the validation exercises conducted at Camp Street and the MMU Diamond Warehouse were the detection of expired drugs.
“A list of 185 expired items was generated from the Management Accounting Computerised Software [MACS] system as at December 2017. While 139 items were valued at $108.553M, forty-six items had no value attached to them, due to the absence of pricing information from the Warehouse Management System,” the report said.
It noted that a similar problem was detected in 2016 and it has not been fully resolved
The report said that a list of 134 expired items, with a total quantity of 660,877 units, was generated from MACS system as at August, 2016. However, the value of the expired items could not be determined, due to the absence of pricing information from MMU Diamond Warehouse. Physical checks carried out in August and September, 2017, revealed that twenty-two items had differences when compared to the expired drugs and medical supplies listing provided by the warehouse.
MoPH, in response to this observation, indicated that it is moving to have longer shelf life of drugs from suppliers so as to reduce large number of expired drugs. “In addition, the system will be first-in first-out and to have weekly reports on the stock level and expiration of drugs from the date of manufacture,” the ministry assured.
During the validation exercises at the two locations, it was also discovered that Bin Cards were not updated promptly to reflect the items issued, resulting in the inaccurate reflection of the balances on hand for each item; in fourteen instances, the items selected for verification could not be traced to their listed locations; instances were observed where loose items of stock were not stored in boxes and in some instances the boxes were placed on the floor and the receiving bay was clogged during the validation exercise, which is contrary to the Warehouse Standard Operating Procedures.
The MoPH, in response, indicated that it is currently conducting refresher sessions with the storekeepers to ensure proper stores management is upheld. It also noted that the receiving bay was clogged due to the increased deliveries made by suppliers and this should be resolved with the completion of the extension of the MMU bond. It also said the MMU is currently working to update MACS with all the prices from 2018 backwards.
The Audit Office recommended that the Head of Budget Agency puts measures in place to ensure that the records at MoPH facilities are reconciled periodically in order to identify and account for differences and to have all records updated in a timely manner. The Audit Office also recommended that the ministry undertake a country-wide survey to determine the realistic needs of pharmaceutical and other medical supplies in order to reduce losses through expired drugs.
