Statement _ Medicines and patients' Food in hospitals

7/24/2019 Statement _ Medicines and patients' Food in hospitals

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Malawi Government

STATEMENT BY

THE MINISTER OF HEALTH

HONOURABLE DR. PETER UMPALUME! MP

IN THE NATIONAL ASSEMBLY

ON

MEDI"INES AND PATIENTS# FOOD IN HOSPITALS

$%r&FEBRUARY! $'()

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Mr. Speaker, Sir, it gives me great pleasure and honour to present to the August

House, on the following issues; medicines and patients food in our hospitals.

In my statement, Mr.Speaker, Sir, I will report on the current status and I will

also highlight what my Ministry is doing as a response.

Mr Speaker, Sir, allow me to start with the drugs issue.

STATUS OF ESSENTIAL MEDI"INE * HEALTH SUPPLIES +EMHS,

AND PHARMA"EUTI"AL MANAGEMENT "HALLENGES

Mr S-eaer! Sir! allow me torief this August house on the !"ssential Medicine

# Health Supplies situation$ in the country.2


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I would like to present the availaility of medicines y specifically addressing

three topics%

&. 'he financing

(. )onsumption rate of those finances and

*. Actual availaility of medicines

(. T/e Finan0in1

Mr Speaker, Sir, In +une last year, this house approved a rug -udget allocations for istrictand )entral Hospitals of &/,///,///,///.// and 0,123,*0/,4&1.// respectively

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'herefore, for the first 1 months 5+uly 6 ec (/&07, 4,288,140,*02 was the comined drug

udget for 9uarters & and ( i.e. 0,///,///,/// and (,288,140,*02 for the istrict and

)entral Hospitals respectively.

:ovt disursed 4,*03,/48,334

A total of 2!%34!'25!442.'' was paid y MoH 5*,&3(,/4/,2*/.//7 and uarterly advance funding for the period & st +uly to *&st

ecemer (/&0 as detailed in 'ale & elow

Table 1. Payments by MoH and NLGFC

Date Re0ei

-t No.

MOH NLGF" Total

26/10/15 (*3 1*&,14/,2*0

)%(!)2'!6%3

(8?&&?&0 (8& &,031,/(0,8 (!34)!'$3!5

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&0 (3

*/?&&?&0 (8( (,133,333,3

33

$!)44!444!4

44

*/?&&?&0 (8* 2*0,***,*

**

6%3!%%%!%

%%/8?/&?&1@ (88 &,031,/(0,8

&0

(!34)!'$3!5

(3

Total %!(4$!'2'!6

%'

5!()2!''5!(

)2

2!%34!'25!4

42Note* this cheque relates to Quarter 2 but was collected in January 2016

lease note that while the decision to change the funding model for the drug udget wasmade in 9uarter &, the actual payments y MoH and


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'otal drugs sold and delivered to all pulic hospitals y )MS' during the period under

review amounted to 4,408,&83,*4/.(3 out of which drugs worth 1,/*0,44/,80*.22 and

&,4&2,*42,3&1.8& were delivered and invoiced in respect of istrict and )entral Hospitals

respectively.

Bhile the overall drug udget utiliCation was at 32.3D, istrict Hospitals eEceeded their

udget y (/.4D and )entral Hospitals underutiliCed their udget y *3.1D as detailed in

'ale ( elow.

Di7tri0tHo7-ital7

"entralHo7-ital7

Total

-udget 57 0,///,///,/// (,288,140,

*02

4,288,140,*0

2

eliveries 57 1,/*0,44/,808 &,4&2,*42,

3&1

4,408,&83,*4

/

Fariance 57 5&,/*0,44/,80

87

&,&(1,(31,88

(

3/,0(0,322

Fariance 5D7 5(/.4D7 *3.1D &.&D

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etails of deliveries of drugs to istrict and )entral Hospitals and analysis of udget

utiliCation are provided in the AnneE 'ale *.

I8 I am to 79mmari7e! Mr S-eaer Sir! t/e &ata on Finan0in1 an& 0on79m-tion

are 7a;in1 t/at t/e amo9nt o8 mone; t/at ;o9r /o97e a--rove& 8or &r917

8or t/e 8ir7t ) mont/7 +M2.6


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rug stock availaility at the central 5)MS'7 level averaged 1/D during oth 9uarters &

and ( of the (/&0?(/&1 financial year.

'he low stock availaility was due to delays eEperienced in receiving medicines and

medical supplies ought with support from the epartment for International evelopment

5=I7 which were eEpected in the first >uarter ut shipments started arriving towards the

end of ecemer (/&0.

)MS' floated maGor procurement tenders in 9uarter & and contracts with suppliers were

signed in ecemer (/&0 and +anuary (/&1. eliveries under these tenders are eEpected in

9uarters * and 8. elays in concluding the tenders also affected stock availaility in oth9uarters & and (.

'he >uarterly advance payments to )MS' have assisted in giving confidence to that 'rust

therey improving its cash flow to enale not only to float tenders that are eEpected to

improve stock availaility ut also pay its suppliers within due dates.

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As stated aove, once the >uarterly advance payments are regulariCed, it is eEpected that

)MS' will have predictale cash flow proGections which assist in meeting its oligations and

improve drug stock availaility in 9uarters * and 8.

Dr91 Availa


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also see an improvement in the availaility of medicines used to treat the most

common illnesses that plague the countrys population.

At facility level we find that average stockout rates for tracked tracer items is

6>. 'his places availaility at aout 4$>of facilities that reported in the period.

'his is a decline from the doule digit stockout rate the system eEperienced a

year ago.

?/at are t/e 0riti0al item7 t/at 8a0ilitie7 are 7/ort o8

At central medical level, the maGority of shortages relate to antiiotics especially

the more powerful ones that should treat the narrow range antiiotic resistance

cases i.e. those that are resistant to commonly used antiiotics.

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At primary health care level, the maGority of cases relate to antiiotics 5narrow

range7 and anti malarial talets.


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from +ulec (/&0. A rough estimate of items ordered vs items delivered for

central hospitals stand at */D for MCuCu, (/D for )H and 81D oma.

Mr Speaker sir this may eEplain in part why central hospitals utilised only */D

of their udget.

Bhilst running stock availaility at */D y volume re>uirements is not a ad

thing in itself, this leaves us vulnerale should there e hiccups in the upstreamsupply chain. 'o increase stock availaility the logical solution is to )MS'

more finances so they have a lot more resources at their disposal.

Dr91 T/e8t an& 8ail9re to a00o9nt 8or &r917

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Mr Speaker sir, you have heard reports of drug theft cases all of which involve

ministry of health staff, e it clinicians, nurses or pharmacists. I want to report

that over the last 1 months, the ministry received reports of (2 drug theft cases.Mr Speaker sir, the ministry has taken a tough stand against drug theft and I have

no regret to report that all of them were suspended without pay. 'he maGority of

these cases are in court and frankly I dont see any possiility of these people

eing reemployed in the ministry again.

=urther Mr Speaker sir, we received reports of over consumption of malaria

drugs in &/ of our facilities. In some of these cases, consumption was 4 times

more than the reported malaria cases. Such huge anomalies can not e eEplained

y simply reconciliation errors considering that the maGority of these facilities

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were visited previously . 'he ministry suspended all staff involved in these

facilities on full pay pending audit. I am pleased to report that the audit was

completed last week and depending on their report further action may e takenagainst these individuals.

Mr Speaker sir, the ministry is of the opinion that the (2 cases of drug theft

reported last year are a tip of the iceerg. In order to unravel all drug related

theft, I instructed the ministry to set up a special unit 5you may call it the special

ranch7 to lead the fight against drug pilferage. Mr Speaker sir, the ministry is on

the verge of setting up this unit. 'his unit will sensitise the community on how

they can Goin the fight against drug theft, strengthen supervision of health

facilities, investigate all drug cases and prosecute hot cases. Jes , Mr Speaker,

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this unit will have its own lawyers to prosecute cases so we dont overurden

other government agencies. Be are eEpecting to receive K&.8m from

development partners to finance this unit. Be owe it to the neEt generation toleave the ministry of health in a etter state than we found it and we remain

resolute to do that. 'his is the time and we are the people that must end the theft

of medicines in our hospitals. Be in the ministry of health we are and will

continue to deal with this issue as per laid out government regulation. 'he days

where such people would e transferred to other facilities are gone.

T/e P/arma0; an& Me&i0ine7 Re19lator; A9t/orit;

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Mr Speaker sir you may recall that we have een talking aout a new ill with

stiffer penalties for those caught stealing medicines. Be have amended the ill

and we have also aligned it with international standards so the oard will nowecome a regulatory authority. 'he ill was resumitted to the Ministry of

+ustice and )onstitutional Affairs for drafting. Be are optimistic that the ill will

e taled at the neEt sitting of parliament.

FEEDING OF PATIENTS

Mr S-eaer! Sir! an& Hono9ra


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situation of food for patients in our hospitals has een a suGect of media deate

over the past few weeks.

A few days ago, I contacted the istrict Health Lfficers to give me an update on

the current status of food for the patients in our hospitals. I further asked them to

provide hospital ed occupancy as well as their food udget allocation so we can

compare the food situation with numer of in patients and the allocated money.

=rom the reports that we have received, most hospitals are at present providing

patients with ( meals a day. 'he ideal is, of course, three meals a day. Aout 02

percent 5&8 out of (87 of districts provide ( meals a day to their patients and *2

percent of them 53 out of (87 provide * meals a day

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ow I want to draw your attention to the analysis as detailed in the attached

"Ecel sheet.

?/at are we &oin1

&. As a Ministry we want to know the eEact amount hospitals spend

on food on a regular asis. =or that reason I have asked all HLs18


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to report to me monthly on how much they have spent on patient

food and on what items. 'his will help us map the est

interventions.

(. 'he Ministry of Health has received and will e receiving funds

from certain evelopment artners 5s7 in respect of new fund

called the Health Services +oint =und 5HS+=7. 'he HS+= is a

funding mechanism designed to receive funding from multiple s

and uses elements of :overnment systems 5such as planning,

udgeting, procurement, reporting7 ut maintains a parallel funds

flow with strong fiduciary and procurement oversight and controls.

It is designed as a means to efficiently and securely channel

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funds to approved, priority government udget lines? activities;

reduce fragmentation of support; and strengthen government

fiduciary and related systems, as long as s deem it not feasileto use alternative mechanisms for channelling funds that are more

fully integrated with :overnment financial systems.

'hese funds have and will take off pressure which some of our

HLs were facing in terms of paying for utilities, fuel for

amulances and Service


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*. As a Ministry, we have intensified monitoring of eEpenditure in our

facilities so that we can detect misuse and the usual disciplinary

action can e taken.

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the resources we have and under the ale leadership of our State resident, His

"Ecellency rofessor eter Arthur Mutharika, :overnment is committed to do all

that is necessary to ensure that we deliver and guarantee >uality health servicesconsistent with improving the >uality and life eEpectancy of all Malawians.

Mr Speaker Sir, and Honourale Memers, I thank you all for your kind

attention.

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A""S

'ale *.

DRUG BUDGET

ALLO"ATION AND

"ONSUMPTION FOR @ULY

TO DE"EMBER $'(3

$'(3() Ann9al

B9&1et

Total invoi0e7 @9l; to

De0em


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khota ota HL *82,21(,*((.&4 &38,204,222./3 01

tcheu HL *3/,428,/43.(8 *8/,*&1,4(/.41 24

tchisi HL (&0,/*2,00(.4/ &4&,223,8*0.&3 2/

edCa HL 804,130,82/.&0 (23,2*(,(88.// 1*

Salima HL */0,/08,83&.24 &**,&&&,404.30 88

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eno HL (&2,0/&,(&8.(8 &1&,010,/&&.31 48

sanGe HL (80,4&*,*02.1& &*(,3/&,/4&.08 08

oma HL 804,&14,882.31 &24,13(,//1.3* 8&

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"ENTRAL HOSPITALS

amuCu )entral Hospita &,244,*8*,*&8.// 43&,&08,130.24 8(

9ueen "liCaeth Hospital &,32/,233,8&3.// 8/*,03&,/21.2( (/

oma )entral Hospital 28/,///,///.// &2&,28&,*43.(* ((

oma Mental Hospital &2&,304,*84.// 0(,0&4,2&/.1( (3

MCuCu )entral Hospital 2/3,&0/,1*1.// (23,(4*,38*.24 *1

TOTALS 3!)64!%3'!2().'' (!2(6!%26!4().5( %'

GRAND TOTALS (3!)64!%3'!2().'' 2!235!(54!%2'.$4 54

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Documents

Statement _ Medicines and patients' Food in hospitals