Dear Editor,

I write with respect to the Daily Observer’s lead story of July 14, “UNHEALTHY, Audit uncovers several inefficiencies at Ministry of Health”. While the story correctly reflects the findings of the audit and the proceedings of the Public Accounts Committee of Parliament that considered the matter, there is a statement which is attributed to Permanent Secretary Dr Jean Dixon, which could convey the wrong impression.

The permanent secretary did report to the PAC that the delays experienced by Health Corporation Limited in filling orders for pharmaceutical and medical sundries from the regional health authorities/health facilities resulted in purchases being made from private suppliers at higher cost than would have obtained from HCL. In these instances, HCL would still provide the drugs to the RHAs/facilities at a later date as they became available because there was no cancellation of the original order. The point that she made about the ministry paying twice was within this context as the RHAs/facilities would no longer need these drugs, having already bought them from private suppliers. However, having filled the order, the ministry would be obligated to pay Health Corporation Limited.

The Ministry of Health finds the recommendations of the Auditor General’s Report useful in advancing the development of the pharmacy service in the public sector. The purchase of pharmaceutical and medical sundries represents the largest budgetary allocation after wages and compensation. It is also the area that has experienced the largest increase in budgetary allocation over the last three years, moving from just over $1billion in 2007/08 to $3.7 billion in this fiscal year.

Some interventions of the ministry began before the audit was carried out and were informed by our own internal assessment of the pharmacy service and a report that was done by a Drug Serv Advisory Group that was established by the permanent secretary to assess the state of the service and make recommendations to improve the offerings.

A major development in recent times has been the integration of Health Corporation Limited and National Health Fund which took place April 1, 2011, based on a policy directive of the government. This has paved the way for the systematic development of the service. NHF is required to prepare a proposal within six months of the date of integration which will see the seamless movement of pharmaceutical preparations from the warehouse to the patient. The key areas that are to be covered in the proposal are:

(1) The development of an inventory system that tracks the drugs from the warehouse to the patients.

(2) The arrangements to transport items from the warehouse to the health facilities;

(3) Public/private partnerships recommendations.

(4) Recommendations for infrastructural development to support the efficient and effective operation of the pharmacy service.

In the meantime, a number of interventions have been made in response to the audit to address the areas of infrastructure, procedures for drug financing and resource mobilisation.

The development of the infrastructure requires an immediate investment. A provision is made in this year’s budget to expand bed space and to undertake some work to address the physical layout of hospitals. Some of the funds will be used to address infrastructure for the pharmacy service.

The ministry is also streamlining the procedures for allocating resources to NHF for the purchase of drugs. The Ministry will pay NHF directly and NHF has been instructed to establish accounts with all hospitals and each parish. This will avoid the situation that existed in the past where outstanding payables became difficult to manage. The health facilities and parishes will place orders directly to the NHF rather than through the regional health authorities in order to reduce delays.

The management of resource mobilisation, including pharmaceutical gifts, has been centralised with the ministry assuming direction and control of allocating these resources. This will reduce the incidence of expired drugs in the system.

Finally, the ministry intends to recommend a process of cadre rationalisation as one way of attracting pharmacists to the public health sector. This would give the ministry the opportunity to recruit more pharmacists at higher levels of the cadre and improved remuneration.

Sandra Graham

Director, Policy, Planning and Development

Ministry of Health

Kingston