The Ministry of Health and An-Najah University Hospital in Palestine in 2019

- Among the sectors mentioned in the State Audit and Administrative Control Bureau (SAACB) report for 2019, which included violations and transgressions, was the social and cultural services sector, and the Ministry of Health was one of the many centers that, in some of its execution of responsibilities, violated instructions and exceeded the laws and decrees regulating its activities. The Bureau’s report presented the results of its audit and examination of three topics falling within the scope of work and responsibility of the Palestinian Ministry of Health during the years 2017 through 2019.

- We will list the content of the violations below, but I wish to clarify in the context of these episodes that the Palestinian citizen, when reviewing the substance of the State Audit and Administrative Control Bureau (SAACB) report regarding the general state of public work and public funds in some centers, is struck by panic and anxiety—especially when following, for example, the content of the report about the state of the Palestine Hospital in Cairo. I was shocked by the scale of the destruction of public funds in that hospital; the Bureau’s observations about it will appear in a third episode on my page. I also felt betrayed by the collapse of a Palestinian medical-scientific edifice located abroad as a result of neglect, indifference, and lack of a sense of responsibility by some of the staff and by the Ministry of Health and the Palestinian Red Crescent Society. The situation revealed by the Bureau’s 2019 report of violations by the Ministry of Health—especially regarding laxity in the matter of medical devices and various other matters, and especially concerning Palestine Hospital in Cairo—takes you back to days we lived decades ago. The mere naming of any public place with the word "Palestine," such as the hospital, is enough and worthy of keeping the Palestinian flag flying proudly, as it should be at the forefront of scientific and service development in the world. What the Bureau’s report revealed—the clear, watchful eye for the Palestinian people—is an insult to the reputation of every Palestinian and an offense to the Palestinian oath taken to be faithful in serving the Palestinian people, faithful over its properties, using all capacities and expertise and the developments of modern sciences in the world so that these Palestinian edifices would be creative in their uses and ranked among the foremost institutions in the world. But… what the report displayed of multiple violations, including the existence of patients’ files scattered on the floor in Palestine Hospital in Cairo, warns of the dangerous condition of this Palestinian medical edifice, and the Palestinian Red Crescent Society’s responses to the Bureau’s report—which will appear in the third episode—are insufficient; its response stated positively that “the association’s reply was positive, as the recommendations contained in the report were adopted to correct and address them”!!

- A response in general terms as noted above does not halt the deterioration occurring in the condition of Palestine Hospital in Cairo, nor does it disclose clarity about the manner or method of remediation, nor even how those responsible for the state of this Palestinian medical edifice will be punished!! And now to the second episode:

·      First: Audit of medical devices for the years 2017 and 2018

- The Bureau carried out a compliance audit of medical devices for the years 2017 and 2018 to verify the soundness of procedures followed by the Ministry of Health in the management of medical devices. It found that there are no systems or instructions regulating all work procedures for medical devices. It also noted delays in studying specific needs for medical devices, in obtaining necessary approvals, and in procurement procedures, in addition to the existence of unused devices in some hospitals and medical centers. The Bureau’s report also revealed that the Ministry of Health had not conducted studies and statistics regarding medical referrals linked to shortages of medical devices, whereby patients are referred outside the Ministry of Health to have tests performed on these devices despite their existence within the Ministry, which led to an increase in the medical referral bill. Regarding the licensing of medical devices, the Bureau’s report showed that a member of the Biomedical Engineering Unit was not included in some hospital inspection committees for the purpose of licensing.

- The Bureau’s report revealed that the presence of unused medical devices in some Ministry of Health centers led to referring patients outside the Ministry’s facilities and increasing the medical referral bill. The report also revealed the absence of a training program by the Ministry for engineering staff, in addition to the lack of future plans for training. There is no training provided to staff operating medical devices—technicians, nurses, and doctors—on using the devices, on how to preserve them, and on performing their periodic maintenance. The Bureau’s report also pointed to the absence of a comprehensive and integrated database of medical devices and the facilities that manufacture, supply, or distribute them, along with approvals and prices for these devices. In addition, there is no consistency between the number of medical devices according to central warehouse records and the records held at hospital warehouses.

- The Bureau’s report showed that storage conditions for medical devices at the Palestine Complex and Beit Jala Hospital were poor, without safety measures, and that the size of the warehouse did not correspond to the volume of devices stored. The Bureau’s report also revealed missing medical devices in the Physical Therapy Department at Rafidia Hospital, without any action taken against those responsible for the safekeeping of those devices. In addition, spare parts are not recorded in the HIS system, and the Ministry of Health has not taken effective measures regarding maintenance of complex medical devices through maintenance by Ministry crews; rather, maintenance of these devices is performed by purchasing maintenance services from the private sector. Moreover, preventive maintenance is not carried out by the various maintenance crews.

- The Bureau’s report also revealed that some devices exceeded their useful life for long periods and that preventive maintenance was not performed. There is also no dedicated record for each medical device.

- The Bureau’s report explained that some medical devices became nonfunctional due to misuse by staff operating them, and such faults are outside warranty coverage, which leads to the Ministry of Health bearing the costs of repairing these devices and to delays in providing services to citizens.

- The response of the entity (Ministry of Health) to the above report was positive, stating that a number of measures had been identified to address the observations contained in the report.!!

·       Second: Ministry of Health: A report on the Ministry of Health’s purchase of medical devices and their donation to An-Najah National University Hospital.

- The Bureau followed up on a complaint regarding the Ministry of Health’s purchase of medical devices and donation of them for the benefit of An-Najah National Hospital, including: the magnetic resonance imaging device (MRI): the Bureau’s report revealed that on 14-8-2012 a letter was sent to the Japanese government by the Prime Minister to allocate 7 million shekels to purchase an MRI device for An-Najah Hospital. On 6-11-2013 the tender was awarded at a value of 5,614,636 shekels, and the device was installed in the hospital in 2015. The report uncovered that there is a dire need for the mentioned device within Ministry of Health facilities, where patients were referred to perform tests on it outside the Ministry’s centers, while the audit teams at the State Audit and Administrative Control Bureau (SAACB) did not find evidence that the Ministry’s supply of the MRI device to An-Najah Hospital from the amount allocated to the Medical Equipment Development Project in Palestine contributed to reducing the state treasury’s medical treatment bill—especially as the prices agreed between An-Najah Hospital’s administration and the Ministry of Health for the MRI device match the prices at other private hospitals and do not provide preferential rates for the Ministry.!

- The Bureau’s report also revealed that on 20-11-2013 the Ministry donated two Blood-Apheresis devices to An-Najah National Hospital (one of which is functional and the other requires maintenance), noting that the two devices are not available in Ministry of Health facilities and that there was a dire need for them. The devices remained in the Ministry for nine years without being operated. The Ministry trained a number of its staff to work on the devices in Turkey, Lebanon, and Hadassah Hospital, and purchased the materials necessary to operate the devices; nevertheless, they were not operated and the training and necessary operational materials were not utilized....!

- Regarding the legality of the donation, the report stated that the donation or granting of medical devices constitutes a violation of Article 43 of the Supplies Law No. 9 of 1998, since the donation of the devices was made by the Minister of Health rather than by the Council of Ministers, which is the competent authority for donations. It noted that donations are usually made for supplies surplus to needs and unfit for use.

·      The response of the entity (Ministry of Health) to the above report was unjustified, as the Ministry stated that the donation was made based on the approval of the Prime Minister and the Minister of Health at the time!!

·      Date: 31-10-2020