Solving the out-of-stock medicines situation “will take time”. Photo: Darrin Zammit Lupi

The procurement system in place and the management of medicines and medical devices by the Government has to be completely revamped, a study suggests.

This was imperative to solve the perennial problem of out-of-stock medicines, says the investigative report, published yesterday by the Office of the Ombudsman.

The report identifies a raft of problems stifling the multi-million-euro procurement process, ranging from a 10-month-long tendering process to manual stocktaking, lack of funds and bad prescribing habits by doctors.

Although a number of initiatives taken in the past years were aimed at improving the service to the public, including the introduction of free medicine and the Pharmacy of Your Choice initiative, the situation of drugs that were out of stock got worse.

While the Government spends more than €70 million a year to supply free medicine to its hospitals and more than 100,000 outpatients, the investigation found about 10 per cent of all free medicinal products were out of stock in February alone, including four life-saving drugs and 59 classified as ‘vital’.

The cumbersome tendering process in use is one of the main problem areas, with each tender taking about nine months to be adjudicated.

According to the report authored by Health Commissioner Charles Messina, the Government procures about 1,300 different medicinal products and hundreds of items as medical supplies.

A total of 4,551 different tenders were issued last year: 1,499 for drugs and 3,052 for equipment.

The report points out that the unit responsible for coordinating and adjudicating tenders – the Central Procurement and Supplies Unit – cannot physically cope with such a number and is understaffed. Lack of expertise also hinders the adjudication process.

Mr Messina suggests the Government should start issuing tenders every three years and not annually, as happens now, staggering the process and making it less bureaucratic.

Stocks also need to be monitored better because, according to the investigation, there is no holistic system and it is almost impossible to monitor the level of stocks.

“Since the procedure to check stocks is still done manually and at irregular intervals, it is not surprising that items will go out of stock, especially due to the increase in demand,” the report states.

At Mater Dei Hospital, by far the largest consumer, stock replenishment is done every week by the nursing officer of each ward but the room where the medicine is kept is not used solely for their storage and is accessible to all the staff in the ward, the study notes.

Apart from drastically increasing the client base of free medicine, the Pharmacy of Your Choice system, introduced a few years ago, is complicating the stocktaking exercise.

While outpatients can now obtain free medicine from their hometown rather than going to Mater Dei, the report notes that “since there is no holistic IT system, and since medicines have to be supplied to all 209 pharmacies in the scheme, it is extremely difficult to keep track of stock availability and consumption patterns, which are dynamic and constantly changing”.

The way medicines are prescribed by doctors was also criticised.

“Prescribing habits need to be audited”, the report insists. “It seems that a good number of doctors prescribe the quantities as dictated by the patients who seem to want to hoard just in case there would be an out-of-stock situation.”

Mr Messina suggests that a team of doctors, including retired ones, should be appointed to examine such prescribing habits.

Speaking to Times of Malta, Mr Messina said, although solving the out-of-stock medicines situation would take time, it could be done if the right decisions and reforms were introduced.

“I feel it is of utmost importance that the Central Procurement Supplies Unit staff should have the mentality of availability stocks rather than ‘out of stock’ and works towards that goal so that, as far as can be achieved, no medication will be out of stock.

“It is, however, acknowledged that this is a mammoth task that requires finance, systems and resources,” Mr Messina said.