Procurement of medicines: Cure is worse than disease

Sri Lanka’s once-lauded health sector is in dire crisis. In addition to losing qualified medical staff in numbers, hospitals have run out of essential medication. Now, using the cover of urgency—one of the oldest tricks in the corruption playbook—the Health Ministry is procuring hundreds of medicines under the Indian credit line (ICL) bypassing regulation.

But the depletion of medication developed over at least one year. The authorities know it. They also well know that the dollar deficit was just part of the problem. And foisting unregistered, unevaluated medication from walk-in pharmaceutical firms hanging around the Health Ministry’s corridors sniffing for deals is not a solution. It is the start of a new and dangerous trend.

In June 2022, the Auditor General issued a special report on pharmaceuticals shortage (having assessed the situation up to May that year) in Government hospitals. It determined that reasons for the health sector catastrophe included a lack of coordination among relevant offices, outdated computer systems, and, dangerously, a sheer disregard for procurement schedules. In short, they were late.

These were deep-rooted, identified flaws. And procurement could’ve been speeded up within the regulatory framework had there been an interest to do so. The path taken, however, was to elevate a difficult situation to emergency proportions and eliminate, of all things, oversight.

The Health Ministry’s excuse for popularising unsolicited proposals—procurement without competitive tenders—in the medical sector is that, when it called for bids, the pharmaceutical industry did not come forward. But the devil’s in the detail. Companies are already owed billions in arrears. And it was hinted to them that there was no guarantee of timely payment, even under the ICL.

Professional medical associations vehemently oppose the Health Ministry’s attempts. Among other things, they are alarmed that a large number of drugs for which waivers of registration have been given are nonessential and non-lifesaving (including Paracetamol). Several others are available in adequate quantities. Why then is Sri Lanka borrowing money on interest to procure nonessential drugs when so many more are listed as critically required?

This process also helped expose defects in the National Medicines Regulatory Authority, the gatekeeper. Waivers were granted freely, ignoring the Medicines Evaluation Committee. The politically-appointed officials accompanied the Health Minister to India on the invitation of one of the shortlisted drug suppliers. There are within the NMRA other interest groups that control authorisations.

The system needs a thorough overhaul. That needs strong Presidential intervention of which the hallmark must be the clear absence of corruption. Public health is at stake.