Shortcomings in the Management of Medicines at the Ministry of Health and Its Hospitals

·        Episode No. ( 16 )

·        The patients' cry..!

·        No sustainability in providing essential medicines, and their quality, in the Ministry of Health and its hospitals!

·        This is what the "Performance Audit" report of the State Audit and Administrative Control Bureau (SAACB) made clear in its annual report for 2024, on the effectiveness of the procedures of the Ministry of Health and its hospitals for 2022!

·        The Bureau reached many findings of shortcomings in the procedures adopted by the Ministry of Health and its affiliated hospitals in the management of medicines, and among these substantive observations that led to such shortcomings in medicines management...the following:

·        First: Planning and estimating needs for medicines

1-     There is a weakness in measuring the indicators related to medicine availability and the share of government spending on them, and consequently, the data available in the Ministry's reports do not reflect the true situation regarding medicine availability in public hospitals,

2-     Weakness in the process of determining medicine needs in hospitals, manifested in estimating needs without a documented, unified, clear basis to rely on, due to the absence of procedural templates, which led to a mismatch between actual demand volume and the estimated demand volume!

3-     The medicine needs were not estimated during 2022, as the estimated needs for 2021 were adopted.!

4-     There is a decline in the availability of some essential medicine items, which led to these medicines being purchased directly by hospitals, and among the main reasons for that is incomplete supply by suppliers due to high indebtedness

·        Second: Availability of medicines:

5-     There is a clear and major imbalance in medicine balances, especially in some emergency departments, due to discrepancies between book balance and actual balance , caused by improper issuance of balances, and the absence of a physical inventory by the Ministry, which may lead to misuse of medicines!

·        Third: Control and recording of medicines

6-     Weak compliance with recording medicines and medical stores on patient files at Palestine Medical Complex, especially the Emergency Department, due to insufficient staff working on recording these medicines!

7-     Weak follow-up by pharmacy departments regarding medicine dispensing from departments in hospitals, their recording on patient files, and the control of medicine inventories!

8-     There is a defect and shortcoming in providing the conditions and circumstances of medicine and medical consumables stores in some hospitals, in terms of inadequate store size and unsuitability of the location in terms of ventilation, which affects the quality of medicines!

·        Fourth: Purchasing medicines from petty cash advances

9-     There are shortcomings in direct purchase procedures from petty cash advances, especially regarding procedures for comparing suppliers, the existence of purchase committees, and the lack of unified templates for conducting the comparison process that document procurement procedures,

10-            There is an additional cost resulting from purchases from petty cash advances for items whose price exceeds the price listed in the central medicines tender , and the difference between the direct purchase cost and the purchase cost if bought at the tender price was calculated for a sample of direct purchase operations in a sample of hospitals, and the financial impact for this sample amounted to 286,940 shekels!

·        Fifth: Accumulated debts on the Ministry and hospitals

11-            Government hospitals' failure to pay the amounts accumulated against them and the carrying forward of these debts into subsequent years, due to nonpayment in full of medicine and medical supplies purchases from petty cash advances, amounted to about six hundred and forty-six million on the Ministry for medicines and its branches as of 12-11-2023, with an increase of 30% over 2022, and 52% over 2021!

12-            A large share of the petty cash advances is spent on purchasing medicines, where the share of medicine and medical supplies purchases from petty cash advances reached 84% at Palestine Medical Complex, for example!

13-            There is a decline in the debt repayment rate, where the percentage paid from petty cash advances on medicine purchases and previous supplies and debts in Palestine Medical Complex, (for example), was only 10% of the advance value for medicine purchases and debts, which is a very low rate!

·        The Bureau recommended the necessity of improving indicators for measuring medicine availability and spending on them, adopting precise mechanisms for estimating needs, controlling balances, recording consumption on electronic files, in addition to organizing direct purchasing processes, adhering to the central tender prices, and putting a practical plan to stop the accumulation of debts! ....The Ministry affirmed its commitment to taking these recommendations.