Fixing health: Where are the supplies?
A key observation in the recently released audit reports of the regional health authorities is that there is a grave lack of supplies in all hospitals.
Not only disposables but also instruments needed to carry out procedures. This has forced health workers to, sometimes dangerously, reuse disposables and improvise in order to get by.
The ill informed have immediately began ostracising the workers for this practice rather than focus on why they are forced to do so in the first place.
In addition, the doctor is legally culpable for any adverse events that occur when they reuse single-use materials. Their malpractice insurance and the attorney general will not come to their defence if a lawsuit should arise, and these 'McGuyvers' will be left on their own.
These concerns become moot when you have a patient in front of you who will die if you don't reuse the only instrument that you have available.
The health-care worker is unfairly put in a catch-22 situation, where he/she is torn between Samaritan principles and fear for his/her own future.
But why is there no regularity in the supplies of disposables and why is it that we don't have enough instruments with which to work?
REVIEW SUPPLY CHAIN MANAGEMENT
I have long called for a review of the supply chain management. For it is difficult to imagine that there can be a shortage of much-needed supplies when, on many occasions, they are locked away in warehouses.
The persons who are in charge of supplies clearly have no idea of what is a reorder point or the importance of auditing supplies. On many occasions, there has been a shortage of supplies that are instantly rectified once there is a crisis. It simply means that there was a manufactured shortage caused by the bureaucracy.
A former employee of the Ministry of Health once told me that it took 28 steps to get a cheque to clear imported supplies. Hopefully, some things have improved since then, but the situation is still far from perfect.
What is not said in the audit reports is the frequency with which we change first-line antibiotics in hospitals because the pharmacies keep running out of stock. Frequent stock-taking and timely reordering would go a long way in solving this problem.
This is not as simple as it seems, however, there is a chronic shortage of pharmacists in the public system. Only a fraction of the available pharmacist posts are filled and with the throngs of patients clamouring for their medications, the workers are preoccupied with dispensing rather than checking what is in stock.
There is no computerised inventory and so we are left with no antibiotics or enemas from time to time.
The persons in charge of ordering the soaps, hand towels and disposable supplies for the operating theatres and wards will tell you that whatever they order, the amount is half what is requisitioned when the supplies arrive.
The stores' managers will, in turn, defend this practice by stating that they get limited supplies from the regional health authorities (RHAs) and they have to make do with what they have until the next ordering cycle.
FAILURE OF RHAs
The regional health authorities get a supplies budget from the Ministry of Health (MOH) and are responsible for the procurement and distribution to the hospitals and clinics under their jurisdiction.
If what the central MOH officials say is to be taken as fact, then they are not aware of the extent of the problems with supplies in the regions. This would attest to the already obvious lack of communications between regions and with the central ministry.
If this is true, then the regional health authorities have failed in addressing the primary reason for the creation of these entities in the '90s.
A perennial criticism of the MOH at that time was that it was difficult to get supplies and react timely to challenges affecting the hospitals and clinics.
The regional health authorities were supposed to be the solution, as they would bring the decision-making and day-to-day management closer to the ground.
The previous problems experienced with supply chain management should have been a thing of the past. However, this has not been seen.
There have been rumours of suppliers not being paid and the flitting from one supplier to another as bad credit relationships have resulted in the breaching of contracts and irking the suppliers.
Sustained injection of cash
A sustained injection of cash would help to solve these problems. But it still leaves the question as to why there are supplies in warehouses while the ground staff is left wanting.
The managers are found wanting in this regard. It is egregious to have patients suffering and health-care staff putting their lives on the line because incompetent managers cannot get supplies to those who need them.
There needs to be a complete overhaul of the supply chain with employment of computerised inventory tracking.
Sustainable financing of the health sector is a must if we are to get the quality of care expected in the 21st century. As for those who have presided over this disaster of a supply chain. That is the subject of another discourse.
- Review the supply chain structure and reduce bureaucracy.
- Computerised inventory control with electronic reordering and tracking.
- Have dedicated inventory control staff in pharmacies.
- Conduct needs assessment audits of various hospital departments and provision of supplies based on expected usage.
- Conduct performance evaluation of supply chain managers and retraining or replacement, where deemed appropriate.