Dear Editor,
APNU+AFC’s MP, Ganesh Mahipaul, has no moral authority to talk about medicine shortages. His APNU+AFC government between 2015 and 2020 caused the expiration of more than $10B worth of medicines. He ought to reserve his outrage to demand criminal charges against those of his colleagues who were in charge.
The present medicine and medical supply shortages is a consequence of a broken supply chain system that the present government inherited from the previous government. In August 2020, there was a greater than 80% shortage in the health sector. In the six months since then, this shortage has been considerably lessened and the government is hoping to eliminate shortages by June, 2021. By December 2020, the overall shortages were reduced to less than 55% and presently down to about 30%. We expect to reduce this down to 0 to 5% by end of June 2021. Because of lengthy tendering and international procurement, and the COVID-19-related shipping delays, the stabilization period is lengthier than we had hoped.
Let us be clear: even though the country expended more money between 2015 and 2020 ($35B) than it did the previous 23 years ($30B), the country suffered from chronic medicine shortages since 2015. Single-sourcing of medicines and medical supplies were rampant, Guyana significantly overpaid for medicines, sometimes as much as 3 to 5 times the international reference price, and Guyana had an expiry problem. In August, 2020, Guyana had to dump more than $1B worth of medicines and medical supplies. In spite of monthly disposal of expired medicines since then, the MMU continued to have mounting expired medicines and medical supplies. Two weeks ago, the Ministry of Health completed a total physical audit of the MMU and verified that more than 75% of the physical space within the MMU consisted of expired medicines and medical supplies. The MoH is actively disposing of more than $1B of expired supplies so far. It is estimated that over the last five years, between $5B to $10B of expired medicines have been disposed of.
Even for those supplies that are still active, a significant amount are of very short shelf-life. In addition, the modern warehouse management information system (MACS) was never kept up-to-date. Make no mistake, this scandalous situation is one that is criminal. Shortages have been caused by previous mismanaged and corrupt procurement transactions and by mismanagement of the MMU. In August 2020, the MMU was totally dysfunctional, with expired medicines and medical supplies filling up the MMU in Diamond. At the time, less than two weeks of the PPP assuming office, the MoH had to dispose of supplies totaling almost one billion dollars ($1B) in order to create space for newly delivered medicines. Once these expired medicines are disposed of, the MMU at Diamond will be virtually empty.
The government has already made significant progress in meeting the needs of the health sector and we expect that by June 2021, the medicine and medical supplies situation will be stabilized, moving from 80% shortage in August 2021 to 0 to 5% by June 2021. At present, there is an emergency selective tender (10 selected suppliers) that has been evaluated and the MoH is awaiting an award to begin the procurement of a two-month supply of medicines and supplies. There are also two open tenders – one for a four-month supply and one for a further 10-month supply. We are hoping that with the rapid delivery from the two-month supply, we will attain some stability in the supply chain.
In determining these orders, initially, we had to work blinded because the warehouse management system was corrupted, with inaccurate information. We were forced to complete a physical count in the MMU at Diamond and in all the warehouses in the ten regions. We have finalized this tedious exercise and have now restored the accuracy of the warehouse information system. The new tenders will allow the MMU to restore the system whereby all supplies in the regional health sector are provided directly by the MMU.
One of APNU+AFC’s MPs, Ganesh Mahipaul, shamelessly highlighted medicine shortage at the West Demerara Public Hospital and charged that the government is deliberately creating medicine and medical supplies shortages in the public health sector in order to force the government to single-source medicines and medical supplies. This is reckless, irresponsible and a total fabrication. Indeed, the government has disposed of almost $3B in expired medicines since August 2020. This is criminal and warrants an investigation. While APNU+AFC almost exclusively single-sourced medicines, the PPP has not single-sourced essential medicines since it assumed office. The present emergency procurement is a selective tender, with ten suppliers asked to bid. The other tenders are all public tenders. Soon after the PPP assumed office, it was discovered that there was a critical shortage of PPE for the COVID-19 response. The government then embarked on a two-prong procurement process – first it requested local suppliers to supply what they had in country and then proceeded with a selective tender for the remaining needs. Thus, the government has not single-sourced any medicine and has no plan to single source any supply.
Before 2015, almost 100% medicines and medical supplies for the public health sector in the ten Regions of Guyana were supplied by the Ministry of Health’s Materials Management Unit (MMU). Since 2015, the ten Regions were forced to procure most of what they needed through single-sourcing because the MMU consistently failed during 2015 and 2020 to meet the needs of the health sector. In August 2020, the MMU supplied less than 20% of the health sector needs, with the regions scrambling to procure medicines and medical supplies in order to provide adequate services to the people. This situation led to chronic medicine and medical supply shortages. The situation by August 2020 was nothing short of scandalous. Not only were medicines in short supply, but virtually all the priority medicines were at zero stock levels. These medicines included anti-retroviral medicines for HIV, TB medicines, insulin and metformin for diabetes, critical hypertension medicines, critical medicines and supplies for the operating theatres, anesthetics for dental services, HIV test kits, chemistry reagents for the laboratory and many others.
Single-sourcing was rampant throughout the five years of the APNU/AFC administration. In the five years, virtually all the medicines were procured through single-sourcing of medicines and medical supplies. One order in 2017 was placed multiple times so that the government was forced to defer deliveries into 2018, 2019 and 2020. Budget allocation in 2018 and 2019 were used to pay for the mistaken multiple orders placed in 2017. The last persons that ought to be talking about medicine shortages are APNU+AFC leaders and MPs. Ganesh Mahipaul’s brazen charges that the PPP is deliberately causing shortages in order to revert to single-sourcing is clearly intended to distract from the criminal mismanagement of the MMU that has led to the accumulation of billions of dollars’ worth of medicines. While patients are suffering without access to medicines, the MoH is forced to dump expired medicines as a result of APNU+AFC allowing medicines to expire.
Yours faithfully,
Dr. Leslie Ramsammy
