The gatekeeper of a healthy nation

By Sarah Hannan

Purchasing and supplying medical instruments, pharmaceuticals, and surgical items for an entire country cannot be as easy as walking into the pharmacy and buying medicine for a prescription. The Medical Supplies Division (MSD), under the purview of the Ministry of Health, Nutrition, and Indigenous Medicines, is tasked with storing and distributing the medical supplies required for the government hospitals, healthcare institutes, and private sector pharmacies.

Functioning as the central medical storage for 26 regional medical supplies divisions at district level, the supplies are stored among 18 bulk warehouses at the MSD main building, three bulk warehouses at Angoda, five bulk warehouses at Colombo 6, one warehouse at Digana, and one warehouse at Welisara.

The Sunday Morning spoke to MSD Director Dr. A.T. Sudharshana to understand the functionality of his institute and the importance it plays in running the health sector of Sri Lanka smoothly. We also questioned him as to why, from time-to-time, there seemed to be reports of drug shortages for certain prescriptions.

“This building has been standing strong since it was constructed in the mid-80s. While we are still functioning on semi-automated and manual systems at present, the transition to a fully-automated system is scheduled to be completed by 2022. Even at present, we handle close to 16,000 medical supplies, including pharmaceuticals, surgical dressings, X-Ray films and chemicals, ECG and EEG paper ink, surgical items, laboratory items, and stationery, for the healthcare sector at an estimated cost of Rs. 45 billion,” he said.

All estimations, consolidations, and order placements are managed through the Medical Supplies Management Information System (MSMIS) which was initiated at a cost of Rs. 225 million and has a recurrent cost of Rs. 118 million per annum. The MSD is also looking at an expansion project of the MSMIS to strengthen the medical supplies chain, covering divisional hospitals and Medical Officers of Health that are maintained under provincial review of the Regional Medical Supplies Divisions (RMSD). The MSMIS expansion project is estimated at Rs. 934 million and once completed will cater to 670 hospitals and institutions by 2020.

No room for delays

“The MSD cannot afford to have delays in calling for estimates, consolidating the orders, and placing the purchase orders with the State Pharmaceutical Corporation. Our staff works all seven days to ensure there is no delay in the required medical supplies being dispatched.”

According to Dr. Sudharshana, most of the delays are caused at the tender awarding stage, evaluation process, and procurement process which contribute to a lengthier lead time. Yet, once the request is entered in the MSMIS, the MSD promptly works on placing the order and fulfilling the supply requirement. He further noted that the team continuously discusses reducing lead time at whichever level possible, and at times orders buffer stocks, call in for early estimations, early ordering, and early delivery to maintain a constant supply.

“Periodically, the pharmaceuticals that are prescribed by the consultants change and then the other medical supplies that are used at the hospitals change. To maintain international standards and local standards, we have to then place orders for these new medical supplies. These requirements are submitted to us through the consultants and relevant colleges, and our quality team also evaluates these requirements to ensure that the required supplies would be up to standards when ordered.”

Supplying to the demand

The MSD maintains two supply lines: For state-owned hospitals which are classified as line ministry hospitals and provincial hospitals. The provincial hospitals have their own drug therapeutic committee meetings where they decide their medical supply needs and prepare estimations. The manually-prepared estimation is then sent to the RMSD, who accommodates requests from about 30-40 institutions for the province.

“The RMSD consolidates the estimations from all these institutions and hospitals and enters it into the MSMIS. Our target is to provide access to the MSMIS to all the hospitals that are manually preparing estimates by 2020. Once the MSD receives these estimations, our stock control officers consolidate an itemised estimation to send across to the State Pharmaceuticals Corporation, who is the authorised government procurement agency.”

However, if there is an urgent requirement to fulfil a shortage of a certain drug, the medical institution or hospital has the right to locally purchase the required medicine for which the MSD would later reimburse the cost. Based on the level of the hospital, disbursed allocations for emergency drug purchasing is Rs. 500,000 onwards.

Meanwhile, the MSD has also assured a buy-back guarantee of five years for all the registered suppliers; at present, there are 15 local manufacturing companies that are registered as suppliers with the Ministry of Health through the National Medicine Regulatory Authority (NMRA). Out of these local manufacturing companies, the State Pharmaceutical Manufacturing Corporation is the biggest supplier who is assigned to supply 80 essential medical supplies to the MSD.

Emergency requirement supplies

Even at 12 noon, the loading/unloading bay was busy. Many supply stocks were delivered and prepared for dispatching.

On a brief walk towards the bay, The Sunday Morning observed that fresh supplies which were packed in April were waiting to be dispatched to required hospitals and health institutes across the country.

“Following the bomb blasts, we thought of preparing emergency situation supply boxes which include everything that a first responder would have to have in hand to treat people they rescue on the way to the hospital. Furthermore, with the inclement weather that is setting in, we are also geared to provide required supplies in a moment’s notice,” one of the MSD staff members informed. She hurried into the stores to look at more requests before we could catch her name.

The MSD has its own fleet of 46 vehicles that are dispatched to RMSDs across the country, and according to the OIC Security, at least 75 dispatches take place per day. “The frequency of dispatches increase at times of crisis, and the hospitals would also send in hired lorries or vans to collect stocks. All vehicles need to have a valid gate pass along with the order papers. If not, no medical supplies are dispatched.”