Alleged bribery, corruption and bad administration which reportedly plague the Health Ministry, has resulted the influx of substandard drugs and medical devices to the country.
Secretary All Ceylon Medical Officer’s Association Dr. Jayantha Bandara said that the continuous decline in budgetary allocation to the health sector over the years added with the corruption within the Ministry was severely affecting the country’s free health service.
“While the unnecessary expenditure at the ministry has not decreased the senior officials in the government turn a blind eye to all corruption that is taking place when drugs are purchased. In order to get a good commission Health Ministry officials keep on purchasing substandard medical equipment, quality failed and low efficacy drugs which has cost the country dearly. Although these purchases have not benefited the people, the officials involved in the Health Ministry are highly profited through this deals,” the sources alleged.
According to Dr. Bandara, Sri Lanka’s total expenditure on health as a percentage of the Gross Domestic Product (GDP) is 3.7 in year 2000 which has declined to 3.2% by year 2010.
“The World Health Organization (WHO), Central Bank and World Bank statistics shows that the Sri Lankan Government has systematically reduced finance allocated for the health sector. According to WHO statistics global expenditure on health as a percentage of the GDP in 2000 was 8.2% and this has increased to 9.2 by 2010, although in Sri Lanka the numbers have come down sharply,” said Dr. Bandara.
Lack of drugs in Hospitals
Dr. Bandara meanwhile said that according to reports, majority of the people in Sri Lanka do not take medicine for their sicknesses due to lack of money.
“Due to less budgetary allocation for medicine there is a shortage of drugs and medical supplies in government hospitals. People have to spend money for medicine out of their pocket. WHO in its reports says that if a country spends more than 30% out of pocket from the total health expenditure it shows that the country’s health sector is inefficient. In year 2000 the global average of out of pocket expenditure on the total health costs was 21.8% which was a healthy sign and it has dropped further to 20.5% in 2010 which is very good.
‘But in Sri Lanka, the average out of pocket expenditure in 2000 was 44.7% and the figure has gone up to 45.7% in 2010 which shows that our health sector is inefficient and people spend more for health from their earnings. When our people do not have the means to spend on medicine they prefer not to take medicine.
‘This is evident clearly in rural areas. Unlike in urban areas, rural folk depend on free medicine and as a result of drug shortages in government hospitals the doctors ask the patients to buy the prescribed medicine from private pharmacies. Other than a very few, majority of the patients do not buy the medicine from outside as they do not have means for this,” Dr. Bandara added.
According to Dr.Bandara, the government is to allocate 7% for the Health Ministry out of its total budget of Rs.1800 billion.
“In every country, more funds are allocated for health and education where as in Sri Lanka, the governments kept on reducing the health ministry allocation,” Dr.Bandara alleged.
He further claimed that though Rs.101 billion has been allocated as Health Ministry recurrent expenditure from the total health budget, it is still not enough to provide the necessary drugs and medical supplies.
“Because of commissions from every medical purchase, those involved purchase substandard drugs and medical supplies. As a result on many occasions we have had to make local purchase if the expiry date of drugs and medical supplies have lapsed. Meanwhile Rs 38.5 billion out of the total health budget has been allocated for capital expenditure,” Dr.Bandara alleged.
According to Dr.Bandara, per capita health expenditure in Sri Lanka for the years 2000, 2006, 2009 and 2010 was US $ 33, 62, 71 and 82 respectively.
“In our neighbouring country Maldives, the per capita health expenditure for year 2000, 2006, 2009 and 2010 was US $ 132, 245, 355 and 490 respectively. In Malaysia, for the same period the per capita health expenditure was US $ 128, 259, 316 and 367. In Cuba the figures were US $ 166, 362, 651 and 583 while in the US for the same period the figures were US $ 4703, 6719, 7790 and 8233. This clearly shows how much low Sri Lanka has allocated for health for the citizens of this country comparing to our closest neighbours Maldives and Malaysia,” Dr.Bandara alleged.
Non-implementation of the Senaka Bibile Drug Policy
Meanwhile, Dr Bandara accused the Health Ministry for its failure to implement the Senaka Bibile Drug Policy which has created a drug mafia in the country. “Without the drug policy we have no control over the in-flow of sub-standard medicine to the country,” said Dr.Bandara, who is also the National Organiser of the Prof.Senaka Bibile Commemorative Association.
In the absence of a drug policy in the country according to Dr.Bandara, patients have to spend lot of money to purchase the drugs that are prescribed by brand names by the doctors.
Meanwhile, President All Ceylon Nurses Services Union, Gamini Kumarasinghe said that if the government implemented Bibile Drug Policy as promised, the country could have saved billions in foreign exchange and helped patients to purchase best quality drugs at an affordable price.
Health Minister Maithripala Sirisena accepted that there is a drug mafia in the country and it has sabotaged his attempts to introduce a price control mechanism for pharmaceuticals. Why should the Health Minister get scared of a mafia and why couldn’t he take action against them using the ministerial powers. We as trade unions challenged the minister then to name the members of this mafia group and take immediate action against them. We were confident that the minister would neither reveal the names of those who are involved in this sabotage nor would take action against them as most of the mafia group members are his own ministry high ranking officials,” Kumarasinghe said.
Failure to implement the drug Policy which was formulated 42 years ago by Prof Bibile has reportedly caused the influx of quality-failed and low efficacy drugs to the country.
“It is the Technical Evaluation Committees (TEC) and the Tender Boards that should take the sole responsibility for purchasing substandard medical equipment to hospitals. We have seen TEC overlooking high standard medical equipment which is higher in price but best in quality with low cost substandard equipment. All this high standard medical equipment comes with a guarantee period but the substandard equipment do not have a guarantee period.
‘We can name the machines that went out of order within a few months after purchasing. Once we called the supplier to ask how to operate a certain machine. To our surprise neither the agent nor any of his technical staff members knew how to operate it and they had to read us out the manual details. This shows that the health ministry has purchased machines from a company who has never sold machines to hospitals,” Kumarasinghe alleged.
According to Kumarasinghe, although the Minister once promised that drugs have to be prescribed by its generic name and not by its brand name, it was never implemented.
Kumarasinghe further said, if the Bibile drug policy is implemented, there would be no need for the health department to import 11, 000 varieties of drugs to the country by brand names although the country needs around 1, 000 varieties of drugs under generic name.
“At present the health ministry imports more than 11, 000 varieties of drugs. If the drug policy is implemented there would be no need to import drugs under brand names but from its generic names. Other than the drugs and devices that cannot be manufactured in the country, all others have to be manufactured in the country. We have to import only the raw materials. Then the public will get quality medicine for a cheaper rate. There will be a price control on all pharmaceuticals,” he added.
According to Dr.Bandara, the National Drug Quality Assurance Laboratory (NDQAL) comes under the Medical Supply and Technology Division of the Health Ministry which can check the quality of all drugs that are imported.
“The SPC Chairman once stated that 90% of the required drugs are imported from India has no quality assurance since we have no facilities to check the quality of these medicines. The NDQAL’s role should be to check the sample from the manufacture and give the approval to import the medicine and then to carry out a random check before the stock is shipped. Once the stocks are brought to the country another random check has to be done before they are distributed and to check once again if there are any complaints from the public. Knowing that this procedure is not followed India keeps on exporting sub-standard quality failed drugs to Sri Lanka,” Dr.Bandara alleged.
He further stated that failure to carry out Chemical Analysis and quantitative analysis of the imported drugs, the doctors who prescribe these drugs have no clue whether these drugs contain the active ingredients or not.
“Sometime we do not know whether the medicines we prescribe are really medicine as we do not carry out chemical and quantitative analysis,” he added.
The Sunday Leader October 20, 2014