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Severe shortage of essential pharmaceuticals: Health sector faces risk of collapse 

16 Apr 2022

  • 5 life saving and 200 essential drugs in short supply
  • Call to prioritise medicines and healthcare above others with $ fund allocation
  • Health Ministry debt a stumbling block to import supplies
By Maheesha Mudugamuwa The national healthcare system is now on the verge of collapse due to a severe shortage of essential and lifesaving pharmaceuticals and devices.  There is a shortage of nearly 200 essential medicines and five types of life saving pharmaceuticals around the country, The Sunday Morning learns. Medical experts predict that the shortages will get worse in the coming weeks unless the Government allocates necessary funds for pharmaceutical imports.    Shortages loomed at the beginning of this year when pharmaceutical importers limited imports due to a drastic increase in costs with the devaluation of the rupee against the dollar while urging the Government to increase prices. Nevertheless, even after the Government adjusted the prices as requested by the importers, shortages remained as imports were limited due to the acute shortage of foreign exchange reserves in the country.  To avert a medical catastrophe, the medical community sought international donors to assist the country to bring down essential life saving medicines and other medical equipment in order to save lives. The experts also warned of an emergency in the healthcare sector with the Government officially announcing that the country would be defaulting on external debt last week. Low foreign exchange reserves could make the situation worse as importers continue to face difficulty in opening Letters of Credit (LCs). They believe that the healthcare sector should be prioritised in a crisis like this as people cannot wait for medicines, unlike in the case of fuel or gas. Prioritise healthcare According to Government Medical Officers’ Association (GMOA) Executive Committee Member Dr. Prasad Colombage, there is a severe shortage of medicine to treat heart diseases, medicine and equipment for premature babies, and medicine for cancer, which is very difficult to obtain.   He said there was a shortage of five types of life saving drugs throughout the country and shortages of more than 200 other essential medicines. Dr. Colombage stressed that the healthcare sector should be prioritised in an emergency like this as all other sectors could wait, but not medicine, especially when it came to medicines that were essential to save lives. Therefore, he stressed that the Government should direct all funds to the health sector until the shortages were met. “We can stay without fuel and we can stay without gas, but we will have to end our lives if we lose medicine. This is a time when we as doctors are very helpless,” Dr. Colombage said. He went on to say that it had become imperative to focus only on essential surgeries, as the equipment and materials were very limited. Urgent remedial measures needed The Association of Medical Specialists (AMS) too has urged the Government to take urgent remedial measures to avert a major crisis in the health sector. In a letter written to former Health Minister Keheliya Rambukwella, the AMS informed that there was a shortage of essential drugs, surgical items, anaesthetic medications, and reagents required for essential investigations in Government hospitals. These shortfalls vary from centre to centre and such shortages severely impair the provision of optimum patient care services in Government hospitals, putting the lives of helpless patients in danger. “As the apex organisation representing all the medical specialists in Sri Lanka, with more than 1,300 members, we are deeply concerned about the current crisis situation that we are facing,” the AMS stated in the letter. Bad policymaking According to Academy of Health Professionals (AHP) President Ravi Kumudesh, the current crisis faced by the healthcare sector is due to the bad policy decisions taken by the Ministry of Health as well as the Government. He stressed that all decisions regarding medicines and other essential health supplies required for this year should have been planned and allocated before December last year, but policy decisions were not made at the right time and the health service was dependent on arrogant policy decisions that were under the control of a few. “Patients in this country have had to face a health service crisis due to the delay in essential decisions being made in the last two to three years and the economic crisis. We have repeatedly informed the Ministry of Health about the dangers of such a situation and the Ministry should take responsibility for not paying any attention to it,” he lamented. He highlighted that the debt owed by the Ministry of Health had exceeded Rs. 12 billion. The debt owed by the Ministry for equipment maintenance alone is Rs. 5 billion. “Many companies have decided to suspend supplies due to debt. We still do not have a way to talk about debt consolidation or price controls or spending cuts.” According to the AHP President, at present there is a serious shortage of about 40 essential medicines in the health service and as he stressed that if this situation were to continue for another month, that number could be around 150. “Laboratory tests must be restricted due to the lack of reagents and chemicals. Some investigations have already been stopped. If left without a solution for a month or two, most investigations may come to a halt. Also, timely maintenance is recommended for equipment such as CT scanners, MRI scanners, linear accelerators, and some laboratory instruments as well as ventilators,” he added. As Kumudesh elaborated, the country cannot just rely on the Indian Line of Credit (LoC) for pharmaceuticals as about 80% of the drugs are not being imported from India. “Streptokinase, anti rabies serum, tenecteplase, and some anticancer drugs, antibiotics, analgesics and even anaesthetics are hard to find. Also, the lack of regular medication for Non-Communicable Diseases (NCDs) can become a long-term problem,” he stressed. Worsening situation Meanwhile, All Ceylon Nurses’ Union (ACNU) President H. Mediwatte stressed that what they feared the most was whether the shortages would worsen due to the current economic and political crisis in the country, with most tender boards currently inactive. He said: “The drug shortage is not a new problem; it was there through the year. But now the situation has worsened due to the shortage of foreign exchange.” Mediwatte urged the Government to take immediate steps to at least provide essentials as soon as possible. “The situation in hospitals around the country is the same, especially those at provincial levels. When the national hospitals are facing shortages, imagine the situation in rural hospitals where most people go to obtain basic medical treatment?” he stressed. A matter of money As per the World Bank (WB) analysis on Sri Lanka’s economy, the trade deficit widened to $ 8.1 billion in 2021 from $ 6 billion in 2020 as a rising import bill offset the increase in export earnings, despite import restrictions on non-essential goods. Declines in remittances (22.7%) and tourism receipts (61.7%) are estimated to have further widened the current account deficit to $ 3.2 billion (or 3.8% of GDP) in 2021. The Government mobilised external financing from bilateral partners, including a financial assistance package from India worth $ 1.4 billion in January 2022 to pay for essential imports and boost foreign exchange liquidity. A further $ 1 billion support from India was signed on 17 March 2022. However, official reserves at $ 2.3 billion in February 2022 (equivalent to 1.3 months of imports) remain low relative to foreign currency debt service, estimated at $ 5.6 billion from April to December 2022 (including domestic instruments issued in foreign currency). Net foreign assets of the banking system declined to $ -4.9 billion in December 2021, showing escalating foreign exchange liquidity shortages.  After keeping the exchange rate broadly fixed at around 201 LKR/USD for seven months, the CBSL floated the currency on 7 March to stem reserve losses. By the end of March, the currency had depreciated by 46%. The Sunday Morning learns that the total estimated funds needed to bring down the required pharmaceutical products for the next six months is $ 132 million. The country’s pharmaceutical market is estimated to be worth $ 400 million per year. Extremely dangerous When contacted, All-Island Private Pharmacy Owners’ Association (ACPPOA) President Chandika Gankanda said around 25% of the total medicines in Sri Lanka were now out of stock and the shortage would get worse in coming weeks. “As we get records everyday from the pharmacies around the country, there is an extremely dangerous shortage of essential medicines. The shortage has now affected around 25% of medicines. As an example, the antibiotic syrup for children is now out of stock. Likewise, many drugs are out of stock,” he stressed. “We warned about this four months ago. Now the Government sector is facing a crisis. The situation in the private sector is also the same. We don’t get stocks as the importers have cut down imports. The Government raised the prices when the dollar rate was at Rs. 255 but now it has increased to Rs. 320. Earlier, the Finance Ministry assured a weekly increment based on dollar rate. But with the changes made there, the discussions were stalled. Even if the prices are revised, the shortage will remain due to the foreign exchange shortage,” he stressed. Health Ministry stance The Ministry of Health has stated that there is a shortage of some drugs and equipment in certain Government hospitals and that plans are afoot to manage the shortage and ensure an uninterrupted supply of drugs and equipment. A shortage of supply of certain drugs occurred due to the delay in opening Letters of Credit (LCs) in time amid the difficulty in finding foreign currency, the Health Ministry said, contradicting a statement issued by the Government Information Department last week claiming that there was no shortage of medicines and surgical equipment. “Several solutions have been identified to that effect and they are being implemented,” the Ministry said.  One of them is to open LCs under the Indian LoC facility and order drugs and equipment. The second is the $ 10 million fund received from the World Bank to buy pharmaceuticals. In addition, the Ministry has started discussions with the World Health Organization (WHO) and Asian Development Bank (ADB). At the same time, a request has been made to international agencies, foreign nationals, and Sri Lankan expatriates to make donations or provide essential drugs. The Ministry stated that it had already received positive responses in that regard. When contacted by The Sunday Morning, Production, Supply, and Regulation of Pharmaceuticals State Ministry Secretary Dr. R.M.S.K. Rathnayake said there was a shortage of several essential medicines that were required in low quantities.  “Those are usually in short supply even during normal days. Some of those drugs we need only around five or 10 for the entire year. Therefore, importers are not coming forward to bring down those items,” he added. Dr. Rathnayake stressed that stocks of most items were reaching low levels and therefore it was important to secure them as soon as possible. Meanwhile, the State Ministry in a letter seeking donors stated that it was utilising the maximum local production capacity and had also initiated utilising the Indian LoC to the maximum effect to purchase medical supplies for Sri Lanka. “But due to the prevailing foreign reserves crisis, it has been extremely difficult to maintain the supply chain of most life saving drugs which are not produced in Sri Lanka and cannot be imported through the Indian LoC,” it stated in the letter.   

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