The Min­is­ter of Health's de­c­la­ra­tion of ir­reg­u­lar­i­ties in the Chron­ic Dis­ease As­sis­tance Plan mer­its se­ri­ous con­cern and im­me­di­ate in­ves­ti­ga­tion.Ac­cord­ing to Dr Fuad Khan, more than 600,000 pre­scrip­tions are be­ing served un­der the pro­gramme an­nu­al­ly, an over­whelm­ing fig­ure for a pop­u­la­tion of 1.3 mil­lion.

Most trou­bling was the high in­ci­dence of "stock­outs," the de­ple­tion of drugs be­cause of de­mand. Ear­ly in­ves­ti­ga­tions sug­gest that peo­ple are col­lect­ing their month­ly al­lot­ment of these dis­ease man­age­ment drugs more than once a month, which points to the pos­si­bil­i­ty of an or­gan­ised plan to steal drugs from the CDAP sys­tem.

The Health Min­is­ter has an­nounced plans to in­tro­duce a smart card sys­tem to man­age pre­scrip­tions and will ap­point a steer­ing com­mit­tee to en­sure greater ef­fi­cien­cy and ac­count­abil­i­ty.It seems that he should, af­ter a more com­pre­hen­sive re­view of the way that the drug dis­pen­sary pro­gramme is be­ing man­aged, be ready to call for a crim­i­nal in­ves­ti­ga­tion in­to what seems to be a sys­tem­at­ic pil­lag­ing of drugs des­ig­nat­ed for chron­i­cal­ly ill pa­tients with­out the re­sources to ac­quire them on their own.

The CDAP project was in­tro­duced in 2003 to help cit­i­zens with a range of chron­ic dis­eases get ac­cess to cost­ly pre­scrip­tion drugs free from charge.The pro­gramme now makes 51 drugs avail­able to man­age a range of dis­eases, from di­a­betes and asth­ma to car­diac ail­ments, men­tal de­pres­sion and high blood pres­sure.Orig­i­nal­ly planned to serve the needs of per­sons 65 and over, CDAP is now dis­pensed un­der the man­age­ment of NIPDEC Phar­ma­ceu­ti­cal at all pub­lic health in­sti­tu­tions and 280 phar­ma­cies across the coun­try.

In April 2013, NIPDEC re­port­ed that it served 681,969 unique pa­tients with just short of 5.5 mil­lion pre­scrip­tions.The lead­ing ail­ments are hy­per­ten­sion (384,489 pa­tients), car­diac dis­ease (335,254 pa­tients) and di­a­betes (266,115 pa­tients).The project, one of the great suc­cess­es of the pub­lic health sec­tor, is, with­out a trace of hy­per­bole, a life sav­ing in­ter­ven­tion in the gov­er­nance of this coun­try.

Which makes what's hap­pen­ing with­in CDAP not on­ly crim­i­nal, but im­moral on a scale that de­mands fo­cused and spe­cif­ic at­ten­tion. This is a par­tic­u­lar­ly per­ni­cious crime, since any­one try­ing to steal the type of drugs of­fered by CDAP is al­most cer­tain­ly plan­ning to sell them.Since the mar­ket in T&T for stolen drugs that are al­ready avail­able for free is like­ly to be ze­ro, is this med­ica­tion is be­ing traf­ficked else­where in the re­gion?

CDAP drugs may not be recre­ation­al, but they are ex­pen­sive, and the mar­ket for them is like­ly to be quite des­per­ate.As a first step, the Min­is­ter of Health should take spe­cif­ic steps to re­view the ex­ist­ing sys­tem, en­sur­ing that the drugs that are be­ing of­fered to the pub­lic are prop­er­ly reg­is­tered and screened for use and then iden­ti­fy abus­es and in­stances of theft.

Should il­le­gal ac­tiv­i­ty with­in CDAP be found, Dr Khan must pur­sue crim­i­nal pro­ceed­ings against any­one found guilty of steal­ing CDAP med­i­cines.Their ac­tions threat­en the avail­abil­i­ty of med­ical sup­plies, but the vi­a­bil­i­ty of a sys­tem that is one of the few in Gov­ern­ment that can boast that it saves lives each day.