Purchasing, Storing and Dispensing Medicines in the Military Medical Services for 2020

-        Episode No. 5

●      The stock balance of most categories of drugs dispensed to patients in the Military Medical Services was zero.....(Inventory of the main drug warehouse of the Military Medical Services for 2020. By the State Audit and Administrative Control Bureau (SAACB) in Palestine.!

●      A report by the State Audit and Administrative Control Bureau (SAACB) on the processes of purchasing, storing, and dispensing medicines in the Military Medical Services for 2020 showed worrying observations that must be followed up, and that violations and mismanagement in the pharmaceutical sector must be curtailed. The laxity and indifference in fully performing the burdens of public responsibilities and duties, which emanate from the lines of the SAACB’s report, constitute a real dilemma for public work in some centers of responsibility in the governmental sector, where the phenomenon of lack of accountability and poor performance prevails....!

●      We list below some of the observations the SAACB recorded in the referenced report:

●      The report showed that there is no specific law regulating the work of the Military Medical Services according to defined mechanisms and approved methodologies, nor is there an internal regulation and procedural manuals in force in the Medical Services. In addition, there is no approved mechanism or system for staff distribution and job occupancy conditions in the centers and directorates for general practitioners, specialists, nursing, pharmacists, and others.

●      The report added that there is no approved organizational structure and clear job descriptions for the Military Medical Services to define the special competencies, tasks and responsibilities of each position…

●      As for the process of estimating drug needs in the Military Medical Services, the report stated that it is carried out manually, according to the annual consumption of the clinics affiliated with the Military Medical Services and the historical data available to them from previous years!

●      In addition, the report shows that drug balances in the governorate pharmacies do not appear at the central warehouse, which makes it impossible to know the balance and quantities of drugs available at a given moment or to determine the reorder point for purchasing and managing medicines in the Services...!

●      The report continued, pointing out that the pharmacies affiliated with the Services do not determine their needs in the monthly report issued to the central warehouse, but instead rely on a paper form showing the actual balance available in the pharmacy..!

-        From visits to some Military Medical Services pharmacies in the governorates and inventorying some categories, it was found that a large number of medicines are not available in the pharmacies, especially drugs for chronic diseases. There is also no coordination between the Ministry of Health and the Military Medical Services regarding drug procurement through joint tenders between them. Instead, the Services are informed to provide the General Supplies Committee with their drug requirements for review, approval and inclusion in the joint tender with the Ministry of Health, where more than 400 drug items are dealt with in the joint tender, the value of which amounted to 2,143,587 dollars and 148,138 shekels.

-        As the report stated, it was noticed there were delays in issuing and awarding the tender to the companies ...!, which led to a severe shortage of medicines in the Military Medical Services, and the 2021 tender was not issued, and when the main drug warehouse was inventoried, most items had a zero balance..!

-        In this regard, the report explains that the Military Medical Services did not adhere to the essential drug list.. (the drugs shared with the Ministry of Health), but instead adopts a special drug list in addition to the list shared with the Ministry of Health.!

-        There is no legal basis on which the Military Medical Services rely in the process of private purchasing, and rather the purchase process is conducted as it was in the past, during the days of the Palestinian revolution, and the private tender of the Military Medical Services deals with 145 drug items, whose value amounted to 6,979,128 dollars, representing 74% of the value of drug purchases in the Medical Services for 2020/2021.

-        The report continues on this matter, explaining that despite providing a large number of drugs to treat chronic diseases in the joint tender, the Military Medical Services provide additional drugs to treat the same diseases through their own private tender, and there is no mechanism explaining how and why this list of drugs was chosen, and in many cases some items of these drugs are not available in the pharmacies..!

-        The value of direct purchases amounted to 316,248 shekels in 2020, representing 3% of the value of the Medical Services’ drug purchases.

●      As for the storage and dispensing of medicines, the SAACB report indicates that there is no segregation of duties and work distribution among the staff in the warehouse, where the employee performs receiving and handing over as well as dispensing, and the warehouse does not meet the required level for storing medicines according to the specifications and standards for drug warehouses.

●      The report also indicates that in the case of reordering medicines, inventory showed that 466 types of medicine out of 600 had a zero balance, i.e., 69% of the drug items provided by the Military Medical Services, and there is a large shortage in drugs used to treat chronic diseases, such as cardiovascular and arterial diseases, hypertension, kidney diseases and others,

-        It was also noted that medicines were dispensed and medical reports were accepted and renewed by specialist doctors from outside the Services, and the extent of the patient’s need for the drug is not reviewed and examined in cases where it was prescribed by a specialist physician outside the Military Medical Services system, and according to the Medical Services Institution’s opinion, this is due to a severe shortage of specialist doctors and the unavailability of physicians in some specialties within the Medical Services.!

-        The report shows randomness in the distribution of prescription notebooks among Military Medical Services staff, where they are distributed to pharmacists and not kept solely by physicians..!

●      As for the pilot electronic program for dispensing medicines in the Military Medical Services, there is no clear system for reporting deaths that occur to holders of chronic files or to any beneficiary of health insurance services at the Military Medical Services, nor for linking with the relevant authorities.

-        The report reveals that the program currently available in the directorates does not show the available and dispensed drug balances, so the central warehouse management supplies the drug if it is available with them and makes decisions on drug allocation among the different pharmacies...

-        The report also states that this program does not include a clinical audit mechanism; when dispensing medicines there must be a pharmacy management screen to approve dispensing and another screen for the physician, and the system does not include a report to follow up on dispensing drugs outside the diagnosis or where the diagnosis does not match the dispensed drugs!

●      Regarding the condition of the Services’ buildings and facilities, the SAACB report points to the weak infrastructure of pharmacies in some governorates in terms of buildings and the poor and unsuitable environment for storing medicines, in addition to severe overcrowding, especially at the time of dispensing chronic drugs to patients at the Military Medical Services’ General Administration premises, which is a rented building that is very small and severely overcrowded, as it contains all Service departments in addition to the central warehouse..!