Why the drug procurement process for public hospitals needs saving

Public hospital drugs are not open for sale on the open market. Yet, due to a lack of oversight, they are. One such case was caught in Chattogram in January 2023.

The availability and affordability of medicines are crucial for the health and well-being of people, especially the poor and vulnerable. According to the World Health Organization (WHO), access to essential medicines is a human right and one of the core functions of a health system. 

However, many countries, including Bangladesh, struggle to provide adequate and quality medicines to their populations due to various factors such as insufficient funding, inefficient procurement systems, weak regulatory mechanisms, irrational use of drugs and corruption. 

In Bangladesh, where public hospitals are critical in delivering healthcare to millions of citizens, a streamlined and transparent procurement process for drugs is paramount. 

The healthcare system in Bangladesh comprises a network of public and private healthcare providers. Public hospitals are managed and funded by the government and serve as a significant healthcare access point for the majority of the population, particularly those with limited financial means. 

To guarantee the availability of essential drugs and to ensure equitable access to healthcare, it is imperative to have a well-regulated procurement system in place. As per Article 15(a) of the Constitution of the People's Republic of Bangladesh, adequate and affordable healthcare services are a fundamental obligation of the government in Bangladesh. 

The Public Procurement Act 2006, and other relevant laws, and policies regulate and govern the procurement process in the country. Under the 2006 Act, public procurement is defined as the acquisition of goods, services and works by public entities using public funds. The Act applies to all government ministries, divisions, departments, autonomous bodies and public corporations. 

Public hospitals fall within the purview of this Act as they are funded by public funds and are considered public entities. Beyond the Public Procurement Act, several other laws and regulations impact pharmaceutical procurement for public hospitals such as the Drug Control Ordinance 1982, the National Drug Policy 1982, the Pharmacy Act 1954, the Drug (Control) Rules 1946 and the Health and Population Sector Program (HPSP).

The health policy of Bangladesh was published in 2011. It has 19 goals and objectives, 16 policy principles, and 39 strategies to guide the development of the health sector. 

The policy also adheres to several international declarations on health, such as the Alma Ata Declaration, the World Summit for Children, the International Conference on Population and Development and the Beijing Women's Conference. 

However, there is still a gap between policy and practice in Bangladesh. The health sector needs more investment, innovation and integration to overcome the challenges of drug procurement and ensure access to quality medicines for all. 

In 2023, an Anti-Corruption Commission team from Naogaon district conducted an operation at Patnitala Upazila Health Complex due to allegations of corruption. The storekeeper and head clerk were found to have embezzled government funds and committed other irregularities. They created vouchers, inflated prices, and purchased medicines at lower cost from external sources instead of the contracted organisation.

A 2020 study surveyed 120 public hospitals in Bangladesh and found that 72% experienced medicine shortages. The main causes were insufficient budget, delayed procurement, inadequate supply, poor storage, irrational prescribing and dispensing and pilferage. Most hospitals lacked a functional drug committee, standard treatment guidelines and a computerised inventory system.

In addition, one of the main challenges in the procurement process is the lack of a centralised and coordinated system that can ensure a timely and adequate supply of medicines to public hospitals. 

Currently, there are three main sources of drug procurement for public hospitals: the Directorate General of Health Services (DGHS), the Directorate General of Drug Administration (DGDA) and the Central Medical Stores Depot (CMSD). Each of these agencies has its own procurement procedures, budgets and suppliers, which may result in duplication, inefficiency and wastage of resources. 

Moreover, there is no clear mechanism for monitoring and evaluating the performance and accountability of these agencies.

Another challenge is the lack of transparency and accountability in the procurement process, which may increase the risk of corruption, fraud and other unethical practices. 

According to a recent study by Transparency International Bangladesh (TIB), the procurement process in public hospitals is influenced by various factors such as political pressure, personal interests, bribery, nepotism and favouritism. There are many irregularities and violations in the procurement process, such as manipulation of tender documents, collusion among bidders, overpricing, substandard quality and delay in delivery.

A third challenge is the lack of quality assurance and pharmacovigilance systems for the procured medicines. Although the DGDA is responsible for ensuring the quality and safety of medicine in Bangladesh, it faces several constraints such as inadequate human resources, insufficient laboratory facilities, weak regulatory enforcement and a lack of coordination with other agencies. 

As a result, there is a high possibility of substandard, spurious, falsified or counterfeit (SSFFC) medicines entering the public health system. These medicines may pose serious threats to the health and safety of patients and may undermine the trust and confidence in the public health system.

However, procuring drugs for public hospitals in Bangladesh is a crucial part of the public health system that needs immediate improvement. This can be achieved by establishing a centralised, integrated procurement system to coordinate and harmonise the activities of various agencies involved in drug procurement and distribution. 

Additionally, implementing e-procurement systems, strengthening both internal and external audit mechanisms, promoting the public disclosure of information and encouraging the participation of civil society organisations would help. It's also important to strengthen quality assurance and pharmacovigilance systems by increasing human and financial resources, upgrading laboratory facilities, enforcing regulatory standards and improving coordination among stakeholders.

Zannatun Tahura is a student of the Department of Law and Human Rights at the University of Asia Pacific.

Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard.