Procurement of ‘surplus’ hepatitis C drugs baffles health authorities

Updated May 21, 2019

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Medicine was purchased at a cost of Rs1.5 billion for 180,000 patients visiting 17 teaching hospitals of the province. — AFP/File
Medicine was purchased at a cost of Rs1.5 billion for 180,000 patients visiting 17 teaching hospitals of the province. — AFP/File

LAHORE: Health authorities have ordered a probe into purchase of hepatitis C medicines which are allegedly over and above the requirement of the patients registered with Punjab’s major state-run teaching hospitals.

The medicine was purchased at a cost of Rs1.5 billion for 180,000 patients visiting 17 teaching hospitals of the province under the project titled ‘Establishment of Hepatitis Clinics and GI Departments in tertiary care hospitals in Punjab’ in July 2018.

The issue surfaced when the programme provided excessive medicines to the teaching hospitals of the province.

On finding heads of these hospitals reluctant to keep the medicines which were more than their requirement, medicines meant to be used by 85,000 patients were dispatched to the Primary & Secondary Healthcare (P&SHC) department for consumption in small-scale hospitals, an official told Dawn.

As the procurement of the medicines was made by the project run by Specialized Healthcare & Medical Education (SH&ME) Department, their distribution to the hospitals controlled by the P&SHC put a big question mark on the purchase process and the planning of the initiative, he said.

The medicines supply to the small-scale hospitals in the districts, including the district headquarters hospitals, controlled by P&SHC becomes more questionable as these facilities had no capacity to treat hepatitis C patients because of lack of diagnostic labs, PCR and consultants.

The official said the heads of the teaching hospitals complained to the health authorities that huge stock of the medicines might go waste, showing their inability to consume the drug before its expiry in March, 2020.

The authorities later got alarmed when it transpired that the programme had purchased medicines according to the estimated population and the prevalence of the hepatitis C in Punjab, instead of buying the drugs as per the demand of the number of patients registered with the government hospitals.

The official correspondence between some teaching hospitals, health authorities and the programme head in this respect also shows the alleged negligence and the potential risk of wastage of the medicines, resulting in loss to the exchequer.

Instead of referring the matter to any investigation agency like the Anti Corruption Establishment (ACE), the health authorities formed a committee headed by King Edward Medical University Vice Chancellor Prof Khalid Masood Gondal to probe into the ‘surplus procurement of medicines’.

Interestingly, the probe committee head is said to be a class fellow of the programme’s project director Prof Ghiasun Nabi Tayyab as both of them graduated from KEMU in 1986. Secondly, according to the professors’ seniority list of the health department, both have equal status.

The probe was ordered when a procurement officer took up the matter with the health authorities, pointing out that the medicines purchased for the teaching hospitals could not be distributed to those run by the P&SHD and sought an impartial inquiry into the matter.

He raised several pertinent questions, including violation of PPRA rules on procurement process.

“The authorities must take stock of the circumstances leading to purchase of medicines by the Project ‘Establishment of Hepatitis Clinics and GI Departments in tertiary care hospitals in Punjab’, the procurement officer recommended.

He sought evaluation to know whether the demand was generated keeping in view the number of registered patients.

The official also recommended evaluation whether the procurement was properly planned and the process complied with Punjab procurement rule 2014.

The official correspondence in this respect also reflects gravity of the situation.

A letter (copy available with Dawn) sent by the programme management to the Government Teaching Hospital, Ghulam Mohammadabad, Faisalabad, revealed some ‘unrealistic instructions’ when it asks it to reach out to the community, find hepatitis C patients and distribute the medicine in accordance with the prevalence of the disease.

Written on Feb 18 this year, it was a reply to a letter in which the MS of the Faisalabad hospital had shown reservations over supply of surplus medicines.

“It is understandable that the patients may not be coming to the hospital for various reasons to get themselves treated, but as a national cause, it is important to reach out to all in the community who are ignorant of the infection and its consequences and bring them in loop for the management of their disease,” it reads.

“However, if the authorities still feel the medicine is over and above the needs of people of Faisalabad, then I shall be happy to receive [the drugs] back”, says programme head in the letter.

The MS, in his fresh letter on May 3, again requested the programme head to recall the surplus medicines of 4,000 patients sent to his hospital.

“The medicine for 4,000 patients is surplus in the hospital and it is feared that it will expire”, reads the MS letter.

A similar situation was reported in the Mayo Hospital, Lahore, which informed the health authorities that the programme had provided them surplus medicines of 9,000 patients against the registered number (1,100) a year back and it might go waste if not recalled and used anywhere else before the expiry date.

Similarly, out of the total medicines meant for 15,000 patients provided to the Government Teaching Hospital, Mozang, a huge quantity is still lying unused.

Nishtar Hospital Multan has also refused to keep the medicines which were more than the requirement of the registered number of patients.

Clarifying his position, programme head Dr Ghiasun Nabi rejected the allegation of surplus purchase under the project of establishing hepatitis and gastroenterology units for 17 autonomous institutes of Punjab.

He said the procurement was made keeping in view the demand of the hospitals and the prevalence of the disease.

He said in view of the high prevalence of hepatitis B and C in the community, it is a project of immense public importance falling in line with sustainable development goals 2030 and directions given by WHO to all its member countries.

“The number of purchased medicines was perfectly in line with the short-term and long-term strategy to control hepatitis and “finding the missing millions” in the community is a challenge,” Prof Ghias said.

He said it would be worthwhile to point out that approximately 7.5 million patients of hepatitis were present in Lahore, 3.5m in Multan, 3.6m in Bahawalpur, 3.1m in Rahim Yar Khan, 1.2m in DG Khan, 1.7m in Sahiwal, 6.6m in Faisalabad, 3.1m in Gujranwala, 1.8m in Sargodha, 1.4m in Gujrat and 3.9m in Rawalpindi as per a study published by a senior doctor, Dr Huma, in 2008.

Approximately, 80,000 registered patients were documented and forwarded to the project office by planning and development wing of the health department, he said.

Published in Dawn, May 21st, 2019