Waste and need

It’s best said in French: plus ça change, plus c’est la même chose – the more things change, the more they stay the same – but no language can quite convey or dispel the disappointment that comes with the knowledge that this is indeed the case in the public health sector. As if the drug bond fiasco were not enough, the 2017 Auditor General’s Report, which was tabled in Parliament last month confirmed more than revealed that millions of dollars’ worth of expired drugs were strewn throughout the public health system.

Given the state of the storage of drugs and medical supplies, as referenced in this column on October 25, 2018, it is unsurprising that the Audit Office’s physical verification exercise found expired drugs. What is also not surprising is that last year’s discovery mirrored 2016, 2015, 2014, 2013, 2012, 2011 and on and on throughout the last administration, and likely the one before that as long as state audits were done. And where audits were not done, it’s not that the problem did not exist – just that it was not highlighted.

Hundreds of millions of dollars in expired drugs equates to waste. If the drugs were purchased, then it’s money that could have been used elsewhere; if they were donated, then the donors’ time and money were not valued, and those too could have been otherwise employed – Guyana is far from the most needy country in the world.

According to the report, the checks which unearthed the expired drugs were conducted at the Diamond Diagnostic Centre and health centres in regions Three, Four, Seven, Eight and Nine as well as at the Ministry of Public Health’s Materials Management Unit (MMU) warehouse at Diamond. It stated too that in several cases no cost could be put to the expired drugs as they would have been sent to the regions from the MMU without the costs attached. And that, while remarkably asinine, is not the height of incompetence. No that was reached a long time ago, because while millions of dollars of drugs expire and have to be dumped each year, every day in every part of the country citizens lament that hospitals and health centres do not have the medicines for their ailments.

But patients are not the only ones who complain.

In June 2013, the Sectoral Committee on Social Services, which is made up of parliamentarians from both sides of the House, visited the Leonora Cottage Hospital and the West Demerara Regional Hospital and found quantities of expired drugs in both. In the former, they were discovered in a jumble of cardboard cartons dumped in the morgue, while patients complained that basic drugs like painkillers, decongestants and antibiotics were not available. 

And later that same year, when the Auditor General’s Report for 2012 was laid in Parliament, it had stated that 327 items of stock valued at $208,090 million were lying expired and, in effect, unusable in the then Ministry of Health’s bonds and warehouses.  Moreover, the ministry could offer no satisfactory explanation for this.

In March 2017, the Sectoral Committee on Social Services visited the New Amsterdam Public Hospital and heard that there was a shortage of drugs used to treat chronic non-communicable illnesses such as diabetes, hypertension and thyroid disease. Part of the problem appeared to be drugs not being issued on schedule by the MMU.

The next month, the parliamentary committee was at the Diamond Diagnostic Centre where the same tale of woes was repeated. This time a doctor also voiced his frustration that patients were unable to fill prescriptions at the centre for much-needed drugs like insulin, among others, but had to take them elsewhere and spend thousands of dollars.

In April this year, nurses at the Linden Hospital Complex staged a sit in because their requests for medical supplies from the MMU were not forthcoming or not in sufficient quantities.

Then in June this year, Region One (Barima/Waini) Chairman Brentnol Ashley told this newspaper that the shortage of drugs was putting a strain on the region’s health care services. He said that drugs used to treat malaria, well known to be endemic in the region, were not available and patients had visited his office to complain that they tested positive for it but were given no treatment because there was none. In addition, he complained that although the region’s budget for drugs and medical supplies was $80 million-odd for this year it was not receiving its quota from the MMU. Last year, he added, the budget was $70 million and the region received less than half of that.

One would think that it doesn’t take a rocket scientist to grasp what the problem is, but perhaps that is what is needed in the Ministry of Public Health.

Aside from that it is obvious that the drugs that are needed are not being purchased in adequate amounts; medications which are not as needed are being purchased and then left to go bad and there seems to be no urgency in fulfilling requisitions made by hospitals and clinics. What is also clear is that there is and has long been some kind of management snafu in the MMU.

Whatever it is, it needs to be fixed. Minister of Public Health Volda Lawrence should have been on top of this a long time ago. Her predecessor, Dr George Norton had said in 2015 while the APNU and the AFC were in opposition that cutting waste spending and ensuring accountability were among the coalition’s plans to fix the health sector. This was after lamenting that the ministry had destroyed $280 million worth of expired drugs in 2014.

It is 2018 and citizens are still waiting for the end to wasteful spending and the beginning of the accountability promised. In the meantime, poor people who depend on the so-called free health care suffer as the unconscionable practices continue.