The Maltese health system was not functioning properly under a Nationalist administration. It is not faring any better under the Tagħna Lkoll lot now. The Johns Hopkins University Report, which cost the taxpayer €1.3 million, has been kept hidden and secret by both administrations.
This report puts its fingers on many flaws.
I will limit myself, however, to just one of the many problems: out-of-stock medications.
Many a time government, especially under the previous administration, has blamed as one of the main causes for out-of-stock medications the agents who are the local representatives for the relevant pharmaceutical companies.
A bit strange: normally agents want to sell as much as possible and try to do their best to ensure their medications do not fall out of stock. So they normally try to deliver on time once an order has been placed to be able to sell as much as possible.
The way the Central Procurement and Supplies Unit (the department responsible for placing the orders) calculates the orders needed, as well as when they are needed, is still very medieval and primitive.
When medications are delivered by an agent to CPSU, the whole lot goes to a central storage place. The store at Mater Dei then requests the amounts it deems necessary, and transfers these stocks to pharmacies (outpatient pharmacy, POYC, and so on) based on the orders that these place. Eventually, the medications are then dispensed to the patients.
CPSU calculates the consumption for a particular medication based on the movement of stock of this medication from the CPSU central storage to the store at Mater Dei. This is an unreliable and fickle way of estimating the amounts that need to be ordered from the agents. Apart from the timing of the orders, the way the orders are placed is not based on any particular criteria.
Government will not have the funds to purchase newly produced medications, even if these are life-saving drugs
So the way the calculations are made goes this way: for most products, a six-month stock is kept. When the stock falls to a four-month supply, CPSU places an order estimated to be adequate for four months with the agent.
The order usually takes two months to arrive from abroad, as the agent does not risk keeping stock at his end, since there is no assurance from CPSU about the size of the order that will be placed. Hence, four months of stock arrives at CPSU when it is holding a two-month stock, thus topping up to a six-month stock. At least, that is what is supposed to happen in theory.
However, basing one’s calculations for the orders that need to be placed on the movement of stock from the CPSU store to the Mater Dei store is a very unreliable way of doing things, for a number of reasons.
Of course, in reality this is a convenient way for the Health Department to save money by not budgeting for the real amount of medications needed. The consequence is that pensioners earning a pittance are forced to fork out the money themselves.
This is totally immoral: when shortages of essential medication persist the government should be obliged to refund all money spent by pensioners and others on the ‘out of stock’ medicinals.
Back to good practices, the best way of calculating consumption would be from the quantities dispensed directly to patients in pharmacies. One of the key problems preventing this from being implemented is the lack of a comprehensive IT system that tracks stocks from the time they arrive at the CPSU stores until when they are dispensed to patients.
Having a proper IT system in place would alleviate the out of stock situation substantially.
Another reason for out of stock medicines may be that certain agents may occasionally not supply an order as government owes them a substantial amount of money. Yet another reason is that an order is not placed by CPSU as the Health Department simply does not have enough funds. In the past years, the money allocated to the Health Department for the purchase of medications has been roughly maintained at the same level. Naturally, the 2010 amount would clearly not be adequate for 2014, and hence this needs to be a chief consideration in the drafting of every budget.
Also, the present government declares it is fully committed to resolving the out of stock situation but clearly does not even have the funds to do this with regard to the medications it currently gives out free of charge. It is therefore evident that government will not have the funds to purchase newly produced medications, even if these are life-saving drugs or drugs that can make a real difference to patients’ lives.
A case in point is Gilenya. This is an innovative medication for multiple sclerosis. Both the previous government and this government have been promising for a long time to make the medication available to multiple sclerosis patients. However this promise has not so far been fulfilled.
Gilenya is the first oral formulation for multiple sclerosis, since all other medications are injectables which the patient generally self-administers. More importantly however, it is far superior to the treatments currently available through our health service.
In conclusion, the real issue in resolving these problems is a lack of adequate funding. Lack of adequate funding to pay agents for the orders they would have delivered. Lack of funding to place the necessary orders. Lack of funding to put in place an adequate IT system. Lack of funding to be allocated specifically for the purchase of newer, more effective and innovative, at times life-saving medications.
Though it is clear to one and all that the government does not have an unlimited amount of funds to be shared by the various ministries, I strongly believe that, with an ever increasing ageing population, the Health Ministry’s financial needs should be prioritised and the funds necessary for the well-being of suffering people should be allocated.
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Arnold Cassola is chairman of Alternattiva Demokratika.