Ot­to Car­ring­ton

Se­nior Re­porter

ot­to.car­ring­ton@cnc3.co.tt

Health Min­is­ter Dr Lack­ram Bo­doe says the Gov­ern­ment is work­ing to ad­dress sup­ply chain and dis­tri­b­u­tion chal­lenges af­fect­ing the avail­abil­i­ty of med­ica­tion un­der the Chron­ic Dis­ease As­sis­tance Pro­gramme (CDAP), main­tain­ing that while short­ages may oc­cur at in­di­vid­ual fa­cil­i­ties, pa­tients should still be able to ac­cess med­ica­tion else­where with­in the pub­lic health sys­tem.

“The re­sponse I’ve had so far is that al­though you might have short­ages here and there, there’s al­ways the op­por­tu­ni­ty in any par­tic­u­lar RHA to try and source the drug if it’s not avail­able at one health cen­tre,” Bo­doe said.

He ex­plained that phar­ma­cists across the re­gion­al health au­thor­i­ties (RHAs) have been in­struct­ed to con­tact neigh­bour­ing health cen­tres and phar­ma­cies when­ev­er a pre­scribed med­ica­tion is un­avail­able.

“Some­times it’s avail­able at an­oth­er health cen­tre. The phar­ma­cists have been in­struct­ed that if, at their par­tic­u­lar phar­ma­cy, there is a short­age of a par­tic­u­lar drug, it is in­cum­bent up­on them to call around with­in the re­gion and find out if it’s avail­able at an­oth­er phar­ma­cy.”

Bo­doe ac­knowl­edged that the min­istry con­tin­ues to face sup­ply chain chal­lenges.

“It might be a dis­tri­b­u­tion is­sue, and it’s re­al­ly a sup­ply chain is­sue as well, which we are ad­dress­ing.”

He said among the ma­jor is­sues con­fronting the min­istry since he as­sumed of­fice were short­ages of health­care per­son­nel and en­sur­ing a re­li­able med­ica­tion sup­ply.

How­ev­er, two phar­ma­cy as­so­ci­a­tions rep­re­sent­ing pri­vate CDAP providers say the sit­u­a­tion ex­tends be­yond dis­tri­b­u­tion alone, al­though they dif­fer on where the great­est prob­lems lie.

As­so­ci­a­tion of Phar­ma­cist Owned Phar­ma­cies pres­i­dent Justin See­lal said short­ages of sev­er­al es­sen­tial med­ica­tions have per­sist­ed since late last year.

“I think it’s a two-fac­tor ap­proach. They have been out of stock for a lot of med­ica­tion since prob­a­bly De­cem­ber of last year.”

She said ro­su­vas­tatin, losar­tan, am­lodip­ine and met­formin were among med­ica­tions dif­fi­cult to ob­tain.
She said phar­ma­cies con­tin­ue sub­mit­ting req­ui­si­tions but sup­plies are fail­ing to ar­rive.

“We’re go­ing in­to Au­gust, the eighth month of the year. The lo­gis­tics are so bad from NIPDEC that we can­not get med­ica­tion de­liv­ered from Ch­aguara­mas to parts of the coun­try.”

She said the short­ages are forc­ing pa­tients who de­pend on free CDAP med­ica­tion to pur­chase drugs pri­vate­ly.

See­lal es­ti­mat­ed that her phar­ma­cy alone serves be­tween 300 and 400 CDAP pa­tients every month, adding that ap­prox­i­mate­ly 20 phar­ma­cies with­in her as­so­ci­a­tion are fac­ing sim­i­lar dif­fi­cul­ties.

“When you mul­ti­ply that across our mem­ber­ship, these are pa­tients who are leav­ing the pub­lic sys­tem be­cause they’re not get­ting med­ica­tion. They come to us and when we tell them they have to pur­chase it, that be­comes dif­fi­cult for them.”

While she ac­knowl­edged many of the med­ica­tions are avail­able through pri­vate sup­pli­ers, she ar­gued, “The med­ica­tion is avail­able in the coun­try and it’s avail­able for pur­chase, but we’re not get­ting any de­liv­ered from the pub­lic sec­tor to ful­fil the needs. You have one com­pa­ny buy­ing out the small­er sup­pli­ers, so con­sumers ac­tu­al­ly have few­er op­tions.”

Pri­vate Phar­ma­cy Re­tail Busi­ness As­so­ci­a­tion pres­i­dent Glen­wayne Su­chit agreed that dis­tri­b­u­tion is part of the prob­lem but said the larg­er is­sue was the sup­ply of med­ica­tion from phar­ma­ceu­ti­cal dis­trib­u­tors.
Su­chit said the chal­lenges in­volve dis­tri­b­u­tion, ad­e­quate sup­plies reach­ing NIPDEC and the abil­i­ty of dis­trib­u­tors to pro­vide suf­fi­cient quan­ti­ties af­ter de­layed gov­ern­ment pay­ments.

He re­vealed that gov­ern­ment ten­ders for CDAP med­ica­tions were on­ly award­ed re­cent­ly, fol­low­ing months of un­cer­tain­ty. For May and June, he said two CDAP med­ica­tions were un­avail­able, while met­formin al­so ran out dur­ing Ju­ly.

“The ten­ders have been put in­to the com­pa­nies, but the dis­trib­u­tors are the pri­ma­ry rea­son for some of the short­ages.”

Un­like See­lal, Su­chit said many of the sup­ply dif­fi­cul­ties stem from out­stand­ing debts in­her­it­ed by the cur­rent ad­min­is­tra­tion.

“This Gov­ern­ment in­her­it­ed some sig­nif­i­cant debt owed to the dis­trib­u­tors, and the dis­trib­u­tors couldn’t keep sup­ply­ing un­less they got pay­ment.”

He said the sit­u­a­tion has be­gun im­prov­ing as pay­ments have re­sumed.

“For the last four months, from April to now, the Gov­ern­ment has start­ed to pay every­body — dis­trib­u­tors, in­clud­ing the phar­ma­cies. We got pay­ment this month and we got pay­ment last month.”

Su­chit ex­pressed con­fi­dence that some med­ica­tions now in short sup­ply would re­turn dur­ing the Au­gust cy­cle.
He al­so ex­plained that when­ev­er med­ica­tion be­comes avail­able, pub­lic health in­sti­tu­tions re­ceive pri­or­i­ty over pri­vate CDAP phar­ma­cies.

He added, “The min­is­ter is not wrong in say­ing that it’s part­ly a dis­tri­b­u­tion prob­lem. That is part of the prob­lem. But sup­ply­ing from the dis­trib­u­tors is the ma­jor prob­lem be­cause they use the sup­ply as lever­age to get pay­ment.”

He not­ed that while pa­tients re­main frus­trat­ed when med­i­cines are un­avail­able, many phar­ma­cists have ob­served grad­ual im­prove­ments in the sys­tem.
“Every­thing is op­er­at­ing and run­ning much bet­ter than pre­vi­ous­ly, but still not sat­is­fac­to­ri­ly. It will take some time.”