Guyana’s Pharmaceutical Industry is one that has been marred by perceptions and instances of corruption, delayed delivery of drugs, disorganization, overpricing, abuse of sole-sourcing provisions and a total disregard for rules and regulations. In short, it was a conundrum of chaos!
In the past, only selected companies were able to benefit from the procurement of drugs and pharmaceutical supplies for the nation. This was not a perception but a fact that has been spoken on at length by many of Guyana’s most prominent and respected politicians.
Prior to the May 11, 2015 General and Regional Elections, Vice Chairman of the Alliance For Change (AFC), Khemraj Ramjattan, asserted that once the Coalition (APNU+AFC) won the presidency, the practice of sole-sourcing of pharmaceuticals would be banished, save the cases where it is actually seen as a necessity.
His comments in this regard would, of course, follow a series of concerns over the years as it relates to the Health Ministry’s continued sourcing of drugs from the New Guyana Pharmaceutical Corporation Limited (New GPC) without using the proper national procurement rules and regulations. This was done irrespective of numerous commitments to cease this practice. New GPC has been supplying the bulk of the medical supplies for the nation for over 14 years.
The APNU and the AFC had also spoken to the pre-qualification requirements for the supply of drugs, which both parties said were changed to such an “unreasonable” extent that it forced only one person or company to qualify for the supply of pharmaceuticals. That company was the New GPC. Under the revised criteria for the pre-qualification of suppliers of drugs and medical supplies, the bidders must demonstrate a profit earning of $1 Billion (US$5 Million) and net assets worth US $2.5 Million.
One of the Ministry’s criteria is that maximum score would be given to those who paid $50 Million in corporate taxes annually. The company with 50 or more employees and warehousing capacity of 30,000 square feet in the city would also get an edge. New GPC is, however, the only entity in Guyana with a storage facility of that size. According to the revised pre-qualification criteria, maximum points will also be awarded in the evaluation process to the applicants who have been supplying the Public Health Ministry for over six years without any negative reports.
THE PRESENT AND THE CHALLENGES AHEAD
Under a new administration, much of this has changed. More than 18 companies can now bid for drug and pharmaceutical contracts. But this fresh wind of change will bring with it its own problems. As the Ministry of Public Health seeks to move forward with the improvement of the drugs and pharmaceuticals system, it will interface with a number of challenges; one being collusion.
In fact, the collusion between moles in the public health system and a few crooked suppliers of pharmaceuticals is what led to the Minister of Public Health, Volda Lawrence, taking a controversial route a few months ago in the procurement of emergency pharmaceuticals for the Georgetown Public Hospital Corporation (GPHC).
The Minister made the following remarks in an effort to correct misleading comments in some sections of the Guyanese populace. The misguided comments, she said, were in relation to certain documents which were leaked, giving the false impression that the medical facility attempted to purchase pharmaceuticals from Ansa McAl Trading Limited through sole-sourcing.
The Public Health Minister emphasized, nonetheless, that the Guyanese company was one of the four companies from which these emergency supplies were procured. The other entities included New GPC, Health 2000 and Chirosyn Discovery.
The Minister of Public Health said that other companies were not a part of this process due to ongoing probes into their late/ non-delivery of emergency pharmaceuticals for which they were contracted to procure for GPHC during 2016. She said that some of these pharmaceuticals were due for more than half of the year.
As such, she explained that this escalated the issue of drug shortage at the hospital. She explained that moves were made to fast track the purchase of these drugs so as to reduce damaging effects on patients due to the shortage of some critical drugs. “This influenced the decision to seek the green light from the National Procurement and Tender Administration Board (NPTAB) for Ansa McAl to provide medical supplies at a cost of $605 Million.”
Lawrence explained that Ansa McAl is one of only two companies in Guyana that can provide the cold chain storage necessary to maintain the integrity of a wide range of drugs which are crucial to the health sector in Guyana.
“Ansa McAl not only air-freighted the drugs (this helped spike the cost to import the items) for the public health sector, but also donated four refrigerators to GPHC to store the emergency supplies at the internationally acceptable temperature of 2 to 8 Degrees Celsius. No other company in the history of the institution has provided cold storage facilities at the hospital, even though at least one of them (NEW GPC) was the sole supplier of pharmaceuticals to the institution for over 20 years.”
The Public Health Minister shared that the medical supplies for Guyana was sole-sourced from that company for billions of taxpayers’ dollars. During that period, she said that GPHC used ice packs to store these sensitive drugs at the facility because the main refrigerator was in poor condition and unable to maintain the exact temperature for the pharmaceuticals, thereby jeopardizing their effectiveness, strength and integrity. Lawrence stressed that she was unwilling to jeopardize the subdivision and the lives of citizens. As such, she did what she felt was necessary.
The matter has since come in for investigation by the newly established Public Procurement Commission. A report from this body has since been laid in the National Assembly.
As it continues to highlight the loopholes within the system, the Ministry of Public Health is also making moves to address the quality of drugs being imported by some suppliers. Senior officials within the Ministry of Public Health said recently that emphasis is being placed by some critics on the cost of the pharmaceuticals being purchased. However, none is being placed on the quality of drugs imported for the health sector the officials stressed.
In this regard, they asserted, “Most of the pharmaceuticals imported are generic drugs from third world countries which, in many cases, are not produced under international standards.”
The Public Health officials said that many of the manufacturers are not certified with the International Organization for Standardization (ISO) while others are not approved by the World Health Organization (WHO) for the treatment of certain diseases. There is even an ongoing investigation into “inferior or bogus” medical supplies which were provided to GPHC by a popular local supplier.
The matter is being investigated by the Food and Drugs Department. The Ministry noted, however, that this is not the case with all suppliers of drugs. In this regard, the officials cited that the drugs imported by ANSA McAL Trading Limited are from internationally renowned manufacturers who are both ISO certified and whose pharmaceuticals can be verified by checks on the WHO website.
AN ACCOUNTABLE SYSTEM
The Public Health Minister has said that when it comes to the future of health in Guyana, efforts will be made to have a system that is accountable and transparent. She added that the system needs urgent and massive overhaul as she found that several procurement officials are not only unqualified for the job, but also unwilling to obey the rules, which unfortunately leads to chaos within the health sector.
Therefore, “there will be slippages and the loopholes will be many,” Lawrence said. The slippages, Lawrence stated, still exist “because health is a rewarding industry and a lure for dishonest folks and venal firms. Hence, many have fallen victim to the allure of dishonest gain.”
“Without a shadow of a doubt, this shortage is man-made and designed to rob the nation of pharmaceuticals and cash… But I am not for sale,” Lawrence said.
The Public Health Minister said that the engineered shortage of drugs in the system meant that drugs that should have been in stock since 2016 to cater for demands in the first quarter of this year were no longer available. She stressed that this has dire implications to the tender process for drugs. She said that she is bracing for a fierce fight from suppliers and stiff staff opposition because they now feel helpless by the fresh wind of change that is brewing in the direction of the nation’s health care system.
The fresh wind of change, she said, has brought open tender; a proper procurement policy which includes computerization of data, storage of vital pharmaceutical drugs under globally accepted conditions and the placement of pharmacists in wards of the GPHC.
In addition, the Pan American Health Organisation and World Health Organisation (PAHO/WHO) are lending their support in an effort to help develop a proper and accountable public health system. PAHO/WHO is helping to shape policy directions in the areas of purchasing, distributing, storing and monitoring the depletion levels of pharmaceuticals at the GPHC.
Furthermore, Lawrence said that the current difficulties in the public health system are compounded by its inability to forecast forthcoming needs correctly due to its dependence on a pen and paper system which is rarely updated.
Lawrence wants this ended immediately and has promised new measures to accomplish this. The first step was taken recently when she met with several delinquent suppliers at her Brickdam, Georgetown office. “The policy and standards will be rigorously applied to guarantee the safety of the Guyanese people who are my priority,” she asserted.