Gov’t Delays Threaten Health in Countryside

Two years after donor complaints forced reform, the  Mini­stry of Health’s prescription drug procurement remains mired in delays and miscommunications that last year resulted in a shortage of several key drugs.

Health workers fear a similar shortage will happen again this year.

Drugs that were supposed to arrive by the end of 2002 in the Central Medical Store—two cavernous warehouses in Phnom Penh that are the first stop for all donated and purchased prescription drugs—weren’t even ordered until November or December of that year, an adviser to the Ministry of Health said recently on the condition of anonymity.

Instead of being ready for delivery to the provinces at the beginning of 2003—the way the process is supposed to work—the drugs trickled into the country in batches throughout the year.

As the year wore on, provincial health departments and NGOs scrambled to cover their shortages, and donors chipped in by footing the bill for emergency shipments of key drugs.

“You can imagine what happens when there’s no drugs. I don’t need to tell you that,” said Chroeng Sokhan, deputy director of the Health Ministry’s Depart­ment of Drug and Food, in an interview earlier this year.

To shore up its depleted stocks, the ministry and several NGOs organized an inter-district sharing program midway through the year, transferring surpluses to areas where drugs were running low.

The National Center for Tuber­culosis and Leprosy Con­trol ran out of ethambutol, one of four key drugs used to control tuberculosis, in March last year, and stocks of two more, isoniazid and streptomycin, were dangerously low by midyear, according to a chart supplied by the Japan International Cooperation Agency, which supports the national TB program.

“We had some difficulty managing the drug shortage,” said center director Dr Mao Ten Eang. He said that a rise in TB cases also contributed to the drug shortage.

JICA spent $600,000 on an emergency order of those three drugs that arrived in June. The drugs ordered with money from the national budget, expected to arrive in early 2003, didn’t arrive at the Central Medical Store until mid-September.

From 1996 until 2001, all the contracts to supply the nation’s drugs were awarded to one company—Sokimex—which then subcontracted with smaller drug companies to furnish the medicines, ministry officials said.

But in 2001, donors and NGOs sent a letter to the government, condemning the monopoly and requesting that the government switch to an open bidding pro­cess. It did so the following year.

While NGOs heralded the switch to a nominally more transparent process, the companies supplying the drugs say that the process still has more than a few kinks to work out.

“It looks nice, but in effect—you can go back and look at the records—the last two years were the worst two years since the monopoly started in 1995,” said an executive at one drug company that supplies the Ministry of Health, who asked not to be named.

When the monopoly was in effect, suppliers only had to deal with Sokimex, the executive said. Now, they are stuck in the communication gap between the ministries of health and finance, both of which seem to change deadlines, prices and their minds on a whim, the executive said.

According to the Health Mini­stry adviser, procurement contracts were supposed to have been finalized by May or June 2003, giving suppliers at least six months to produce the drugs. But the contracts were not awarded until the end of the year.

Drug procurement is “a chronic problem,” said Kuyseang Te, director general of administration and finance at the Ministry of Health. “The procurement of drugs is not as simple as you think.”

He acknowledged that there have been delays in the ministry’s evaluation of bids and subsequent awarding of contracts.

The delay, said several sources close to the Ministry of Health, has been exacerbated by the political deadlock, which has slowed communication between the ministries of health and finance.

The Funcinpec-led Ministry of Health needs its budget from the CPP-led Ministry of Finance before it can release bids, and then has to submit contracts to the Finance Ministry for approv­al.

By this time of year, contracts should be arriving at the Finance Ministry for review, said a finance official who reviews the documents. So far, nothing, he said.

Observers said that the political deadlock has slowed progress at both ministries.

“Because the government is not in place, people are not taking full responsibility for what they are doing,” said the Health Ministry adviser. “Right now they’re just going, as opposed to working.”

At JICA, which has pledged to provide $1 million in TB drugs every year for the next three years, health workers were cautious about the drug situation this year.

“I’m afraid it will happen again. I hope not, but it depends on the political situation,” said Masaru Iizuka, project coordinator with JICA’s tuberculosis control program.

Chief adviser Dr Kosuke Okada added, “It’s such a mystery, how things happen here.”

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