The much-vaunted public health sector in Kerala is in the throes of a crisis. Its inherent malady manifests in the form of shortage of drugs and frequent break down of critical equipment. Though the health minister and chief minister repeatedly claim that the State has a robust healthcare sector, the ordinary people, who depend on government hospitals for their health needs, are a worried lot.
Of late, the functioning of the government hospitals has been hit following a shortage of drugs and equipment. The delay in procurement of drugs has derailed the distribution of medicines to hospitals, which is expected to take months to get back to normal. The authorities had been denying that there was a shortage of medicines, but has now reluctantly admitted that the drug stock in the State is inadequate. The shortage is affecting the ordinary people, who are dependent on government hospitals for their medical needs.
Why drug stocks run out
Most government hospitals have run out of necessary medicines, including antibiotics, and testing facilities even as fever cases have been increasing by the day. The normal, effective functioning of these hospitals have been affected by the three-month delay in initiating the tendering process for procuring medicines.
The tendering process was to be initiated in November and completed by March. The delay has derailed the functioning of the hospitals, and indications are that it would take months to restore normalcy.
The Kerala Medical Services Corporation Limited (KMSCL) is spending Rs 30 crore more than the previous years to procure medicines this year. In its May 21 editorial, Malayala Manorama pointed out the depleted stock of medicines in warehouses and hospitals. The authorities, who had then claimed that enough stock was available, are now admiting to the delay in procuring medicines.
Normally, KMSCL used to distribute medicines by early April after completing the tendering process in March. The Corporation, however, finalised the tender for procuring 754 essential drugs and 85 specialty medicines for the 2022-23 financial year only by May 12.
Litigation bogs down drug suppliers
The distribution is not likely to be smooth since cases are pending in courts in other States against Unicure Remedies and Health Biotech, two pharma firms that have bagged the lion's share of the order. The courts' verdict in these cases will be crucial for KMSCL.
Of the 754 essential drugs, these two companies came first in the tendering process for providing 120 drugs. If the KMSCL decides to go ahead with the purchase order issued to these firms, the Corporation should convene a meeting of its Board of Directors.
Meanwhile, drugs for fever, diarrhoea and lifestyle diseases — which require continued medication — are not available in government hospitals. Patients are now forced to buy expensive life-saving drugs from private chemists.
In most public health centres, patients are asked to buy the capsules for vapor inhalation from private players. The stock of antibiotics, and drugs for blood pressure, diabetes, and heart conditions have depleted. Anti-rabies vaccine, sterile surgical threads and pain killers are almost over. Paediatric syrup and tablets are not available.
After-effects of a ban
The Chhattisgarh Medical Corporation has banned Unicure Remedies for four years, which adversely affected Kerala. The company had won the contract for providing 77 drugs, used for treating several diseases, including diabetes and heart ailments, to that State.
KMSCL had banned one drug by Unicure after it was found to be sub-standard. The Chhattisgarh Medical Corporation banned the pharma firm, pointing out that it had not revealed the ban imposed by Kerala while participating in the tendering process.
Unicure has approached a Chhattisgarh court against the ban, but the final verdict is yet to come. If the verdict goes against the firm, it will have an impact on Kerala, since it will have to go for a
re-tender to procure drugs from some other company. It will add to the existing woes of the State.
Changing policies, dragging processes
One of the reasons for the delay in procuring medicines is a directive to change the KMSCL's tendering process. The central government has ordered the States to procure drugs through its Government e-marketplace (GEM) portal. The directive forced the officials to study each issue and convince the authorities of the problems that would arise while moving to GEM. This caused the delay.
Additionally, the major issue was that GEM portal has firms whose credibility is under question. The GEM initiative does not consider the profit of the pharma firm. It also does not ensure the quality of the drug or mandate a caution deposit.
KMSCL has several examples to point out the lack of credibility and quality of purchases made over GEM. One of the directives was to procure equipment from the Emergency Covid Response Package (ECRP) only through the GEM portal. Based on the directive, the State made a bulk purchase of ventilator beds, of which 40 per cent failed in meeting the required quality standard.
About half of the beds distributed to Manjeri and Ernakulam medical colleges and the general hospital in Kochi, were too sub-standard to be used.
GEM portal has empanelled pharma firms, which quote the price when a demand is raised. The buyer state, however, has no means to test the quality of the equipment it wants to purchase. Once an order is placed, 75 per cent of it will be delivered immediately.
A section of KMSCL officials have been frowning at this immediate delivery. They strongly believe that it will lead to the distribution of sub-standard equipment and drugs. Currently, the authorities have decided against procuring drugs through GEM.
The AMC tangle
The orthopantomogram (OPG) of the Ernakulam general hospital has been out of order for the past three months. Its repair cannot be carried out since the annual maintenance contract (AMC) has been awarded to a new firm, Cyrix Healthcare. Earlier, Kirloskar Technologies was responsible for its maintenance. The change in AMC necessitated the authorities to prepare a fresh list of equipment that has to be included in the contract.
Spare parts were easily available when Kirloskar Technologies was maintaining the equipment. The OPG machine needs five spare parts, and two of them have to be imported. Till the spare parts are made available, dental patients will have to get x-ray done at private laboratories.
Wanted: A radiologist
The Tribal Specialty Hospital at Kottathara has four scanning machines, but no radiologist to operate them. The hospital is the only healthcare centre available for the tribespeople of Attappady, where deaths of pregnant women and infants are frequent.
The hospital is yet to create the post of a radiologist. It was reported that most deaths in Attappady could have been avoided if proper diagnosis was made during pregnancy. However, no steps have been initiated based on these reports.
The lack of facilities here have been forcing pregnant women to travel to the district hospital at Palakkad or the medical college at Thrissur for treatment.
In Palakkad hospital, the x-ray machine has conked and another one which was donated to the institution is not being used. Meanwhile, a move to purchase a Rs 43-lakh machine is in its final stage.
Shortage of doctors has affected the functioning of the Endoscopy Department at Thrissur Medical College Hospital. Of the two doctors, one has been transferred to Kottayam.
Medical equipment needs timely fixing
It has been reported that more than 10 per cent of medical equipment procured at a cost of Rs 235 crore are developing technical issues almost daily, rendering them useless.
Though AMC has been awarded, non-availability of spare parts often delay the repairs by about two months.