- NAO flags lack of basic storage compliance
- Says routine audits not done
Inadequate storage facilities within the Medical Supplies Division (MSD) to unload nearly 41 containers dispatched by the State Pharmaceuticals Corporation (SPC) recently has once again raised questions about the efficacy and capacity of the State medical apparatus.
This, in the backdrop of the public health system grappling with an acute shortage of medicines, among other issues.
The MSD plays a crucial role in ensuring the accessibility and distribution of medicines and surgical equipment within the State healthcare system. Functioning under the Ministry of Health, Nutrition, and Indigenous Medicine, it bears the responsibility of executing, controlling, monitoring, and supervising the comprehensive procurement, order, receipt, supplier payments, storage, and distribution processes. This oversight is expected to guarantee the fulfilment of all medical supply requirements across the public health system.
According to details available to the public from the Ministry of Health, the obtained medical supplies are stored within 31 premises owned by the MSD. These supplies are then transported to individual hospitals as needed through Regional MSD (RMSD) stores, utilising MSD-owned trucks for transportation.
The revelation of improper medicine storage emerges in a context where the country lacks proper and advanced laboratory facilities to comprehensively test medicine quality. Currently, medicinal drug testing relies on documentation provided by manufacturers and local suppliers registered with the National Medicines Regulatory Authority (NMRA).
In this context, medical experts assert that inadequate storage could lead to compromised quality of medicines and medical equipment, emphasising that medicines and medical equipment constitute the backbone of the country’s healthcare system. Consequently, improper storage not only undermines their effectiveness but also poses potential risks to patient well-being.
Government Medical Officers’ Association (GMOA) Spokesman Dr. Chamil Wijesinghe charged that the apparent reason for inadequate storage within MSD was the organisation’s inability to distribute effectively.
“There can be no supply overflow because hospitals are struggling due to shortages. This is clearly a result of distribution issues. The supplies should be distributed daily to the required locations. Although an online system exists, it is not functioning properly. The system was created to provide real-time data on the availability of medicines throughout the country,” he stressed.
Dr. Wijesinghe further noted that medicines should be stored in accordance with international standards to maintain their quality.
Meanwhile, Association of Health Professionals (AHP) President Ravi Kumudesh, speaking to The Sunday Morning, highlighted that the shortage of storage space exposed the mismanagement within the Health Ministry, particularly in a context where the entire system was grappling with a severe shortage of medicines across the country.
“If there had been no shortage, we could have attributed this to the overflow of supplies. However, what we are witnessing is corruption and mismanagement. The storage facilities should have been tailored to each hospital’s requirements. Presently, 41 containers remain outside MSD stores, unable to unload consignments. The medicine procurement process must be revisited and amended to prevent corruption,” Kumudesh emphasised.
NAO highlights MSD shortcomings
Amidst these concerns, unsettling mismanagement and malpractices have come to light in a recent audit report issued by the National Audit Office (NAO) on the MSD.
Medical supplies, distributed to 27 RMSDs located throughout the island from the MSD stores, have been redistributed to hospitals and health centres under Provincial Councils by these divisions.
Observations have revealed that 61 items of medical supplies, costing Rs. 11.30 million and meant to be stored at a temperature below 25 degrees Celsius, have been stored between 27-38 degrees Celsius at four RMSDs.
Additionally, nine items of medicines costing Rs. 4.09 million have been stored in open spaces and corridors outside hospitals in Anuradhapura due to inadequate space at the Anuradhapura RMSD. Medicines that should have been stored below 25 degrees Celsius at 10 hospitals in the Northern and North Central Provinces have been found stored at temperatures between 34-36 degrees Celsius.
Moreover, three medical items costing Rs. 65.37 million, meant to be stored below 25 degrees Celsius, have been stored at temperatures exceeding 25 degrees Celsius at the medical supplies sub-store located in Digana, Warapitiya, belonging to the MSD.
It was also noted that the required temperatures have not been maintained in stores owned by the MSD. The physical verification carried out on 3 March 2017 indicated that 23 items of medicines costing Rs. 104 million, labelled externally to be stored at temperatures below 25 degrees Celsius, had been stored between 29.6-32.7 degrees Celsius over periods ranging from 13 days to 730 days or two years.
Among these, some medicines had been intended for sensitive organs such as eyes and others had been medicines required for kidney diseases and caesarean surgeries.
The maintenance of medicinal drug stores at the MSD, from which medical supplies are provided to all Government hospitals along with the RMSDs, is crucial to ensure the quality of medical supplies. Failure to maintain proper temperatures may expose patients to various risks, as revealed by the NAO.
Certain medical supplies purchased by the SPC have been transported to the MSD, deviating from recommended temperatures. The Medical Supplies Division has also stored these stocks in normal stores to prevent medicine shortages and due to the inadequacy of space in cold stores. Although these stocks had been taken over by the MSD with a view to reimbursing them if damaged, failure to store medicines at specified temperatures could affect their quality.
According to the Manual on Management of Drugs, medicinal stores should be periodically inspected by managerial staff and proper storage and accounting of medicines should be ensured through test checks. However, apart from the annual stock verification by the Stock Verification Unit of the ministry, no other checks have been carried out, it is learnt.
With the exception of the Kotikawatta stores, action has not been taken to obtain insurance coverage against fire and theft for other stores. Additionally, sufficient attention has not been given to protecting stocks valued at approximately Rs. 9,544 million and stored in 31 store complexes belonging to the MSD as of 31 December 2016.
As the quality of medical supplies declines due to inadequate storage within the relevant temperature range, it is recommended that tender samples and samples obtained from medicine purchases be stored until the stock is exhausted after issuance to hospitals. A standardised storing system with sufficient capacity, ventilation, light, and acceptable temperature limits is crucial to protect the quality of medicines. Attention must also be paid to the security of stocks.
Lack of suitable testing facilities
Despite spending billions of rupees annually on importing medicines, Sri Lanka lacks a standardised laboratory for quality testing. The only designated laboratory for medicine quality testing, situated at the NMRA, is reportedly 30 years old and in a state of disrepair. As of now, several machines are inoperative and efforts to secure international certifications have been rejected due to necessary changes in the laboratory setup.
This deficiency in testing facilities has raised concerns among health sector experts about the protocol used by both the Government and private sector to verify the quality of imported medicines. Recent incidents of quality failures have led to the blacklisting of a pharmaceutical company that had supplied medicines for years. In a separate case, a pregnant woman’s death reportedly resulted from complications linked to a medicinal drug administered during surgery, which prompted a product withdrawal.
No medicines
When contacted by The Sunday Morning, Health Minister Keheliya Rambukwella said that the 41 containers consisted of medical and clinical equipment and did not contain any materials that could get spoiled.
He explained: “For two of such items, it needs a container and that takes up a lot of space. At the moment, we are giving priority to medicine and pharmaceuticals. We have had this issue for the last five to six years. I spoke to the Fisheries Minister and they had some space in Wijewardena Mawatha. We got another property from Iranawila. The problem is now sorted.”
The Minister reiterated that the items inside the containers were not prone to spoiling as they were merely equipment.
Rambukwella emphasised that this information was misreported by one union and the stocks had nothing to do with pharmaceuticals.
When queried further, Rambukwella assured that the Government possessed ample space to store all medicines in a high-quality manner while emphasising that the storage issue concerning medical equipment had also been successfully resolved.
He clarified that while there was indeed an issue regarding the storage of medical equipment, this problem did not extend to medicines that were perishable or sensitive to storage conditions.
He asserted that the Government had taken steps to ensure the proper storage of all medicines and pharmaceutical products, guaranteeing their quality and safety.