Healthy supply chain
3 April, 2021, 7:20 pm
World Health Organization introduced the six-building block concept of healthcare delivery. (WHO-Manila meeting 8/2008).
Apart from leadership and governance, healthcare workforce, healthcare finance, health information and research, services delivery, we note medical products/technology block in that listing: In isolated developing countries in the Western Pacific such as Fiji, the pharmaceutical and medical consumable supply chain is at imminent risk of falling apart due to a wide range of natural and man-made barriers.
Traditionally, as part of the British Empire, purchasing in its territories was by UK Crown agents, supplies had to be ordered in bulk and advanced orders placed for surface shipment.
This concept has continued in some of our neighbouring territories even today at great expense to the nation and individual patient.
With immense progress in the past 30 years, high standard generic medication and medical consumables available at shorter notice and air freight transfers possible from the non-traditional sources, the scales need to be rebalanced.
India is home to several large generic manufacturers.
China and Korea are now leaders in medical technology, equipment and reagents production.
The supplies do not have to be via Crown or other agencies in Australia or New Zealand and direct deals can be made to measure, with manufacturing houses.
One can seriously bypass the crown and other agents and save a staggering sum, which in-fact works synergistically in healthcare financing matrix.
The question of “standards” will surface, but with 50 of the US pharmaceutical market originating in India, why are our systems not being proactive about such source identifications when items come off the patency period?
If EU, US, UK, Australian standards are applicable, then it beats me why we are being sticklers to archaic UK standards only.
Interestingly India has overseas and Indian pharmacopeia compliance ratings and I see no reason why if an item is EU certified, why are we in the Pacific are not looking at the cost differentials and being sensible to purchase within the national reach of overseas standard items i.e if it’s OK for the Europeans or the Australians, then why are we not purchasing that?
Transporting the supplies, safe storage, keeping track of expiry dates and recycling items at the divisional and sub-divisional levels (Inter-hospital transfers of rapidly need items, substitution, whilst regular supplies are awaited) are all measures very much do-able but sadly not practiced as often.
With internal migration, rapid urbanisation (Fiji 57 per cent) the need for regular annual quantification of needs in the supply line remains mandatory to optimise distribution.
With great difficulty in 2013 this exercise was undertaken by divisional medical officers who had to be pushed hard enough to optimise the data set, address the requirements in their divisions but unfortunately the supply chain restructure was not implemented due to executive changes at the ministry headquarters.
Why is this low-lying fruit not being followed through?
We cannot afford ignorance and lack of oversight.
We cannot afford incompetent civil service bureaucracy: fearful of “change” as it remains a proactive move, rather than reactive to constant supply chain shortages/outages.
One cannot have a mediocre “the procurement section of a pharmaceutical and technology line in any country, when clinicians need progressive introduction of new services especially those items coming off the patency listing globally with affordable costings.
Workforce reviews are long overdue and their position descriptions rewritten.
Why are tertiary qualified personnel redeployed into general policy planning areas of work when overseas training in pharmaco-economics were undertaken to address pharmaceutical management specifically.
One should not hold the public at ransom any more with workforce inefficiency.
Taxpayer funding and health policy requires that there are sufficient funds for post warranty service agreements of highmedium quality technology equipment, yet machines remain unserviced.
When Fiji’s MRI and CT scanners are down for over 12 months recently, the question was why?
Similarly, why was the Automated Cytology Analyser purchased in 2013 (To raise cancer screening to over 50,000/ annually from 20.000) still in need of maintenance 12 months down the line with reagents out of stock whilst private laboratories flourish with specimens redirected from the public system at great cost to and disservice to taxpayers.
These are answers not addressed by a mediocre system.
The Healthcare Workforce is the other block (WHO) which is in need of strengthening, rightsizing truly, for improved outcomes.
There is need for greater client focus and a compassionate work ethos.
A constantly variable, changing leadership, poor governance structures, a poorly motivated workforce make the difference in any healthcare delivery system.
If the negatives are addressed, provided the health financing, information is timely and research based, positive change will be inevitable.
The supply chain can be rightsized and upgraded, the service delivery to our Pacific peoples improved as we face the noncommunicable crisis and climate change impacts.
- Dr Neil Sharma is the former health minister. The views expressed are the author’s and not of this newspaper.