I’ve had the privilege of being invited recently to give talks in Vietnam, Singapore, Malaysia, Indonesia and Myanmar. It’s heartening to note the marked improvement in these countries’ health care delivery despite budgetary challenges.
The common denominator I saw in these countries is that their citizens learned from their setbacks in the past, and came up with systems to make sure they got the biggest bang for their buck.
In short, they thought of ways and means to prioritize their health needs, allocate the budgets, and come up with a system of implementation that can assure effective delivery of the necessary services and medicines, avoiding wastage. They ensure that those who need the meds most get them first.
If other countries can do it, there’s no reason the Philippines can’t. It only requires purposeful management, not a haphazard approach.
This comes to mind when, upon returning to Manila, comes the news that we have an overstock of near-expiring drugs at the Department of Health (DOH). This is from a 2018 report of the Commission on Audit that around P20 billion in medicines are lying idle in the DOH warehouses.
Impulsive
I’ve always believed that our problem is not lack of funds, but the inability to use money wisely. Sometimes we decide on things impulsively, since remaining funds would just revert to the national treasury—so, might as well buy things even if they’re not needed. Sometimes, drug manufacturers offer huge discounts on slow-moving medicines.
I call this the “sale mentality.” We succumb to our consumerist tendencies and buy things we don’t need.
In other instances, we may have bought something we could have used, but did so without reading the operational manual. Such was the case of the Dengvaxia vaccine.
Given to the right set of children—as was clearly shown in the extensive clinical trials the Philippines was a major part of—the vaccine is effective and lifesaving. But since there was a rush to purchase it due to available funds, the vaccine was rolled out without much thought to which children would benefit from it most.
To make matters worse, we tried to correct a mistake by committing another mistake. We pressed the panic button and suspended, then subsequently banned the marketing and distribution of the dengue vaccine in the country.
The result is that we have thousands of new cases, and an increase in the number of deaths due to dengue fever.
The Dengvaxia scare has also created a resistance to other types of vaccination such as measles, causing a recent outbreak.
Overstocking of drugs and far-from-ideal distribution appear to be perennial problems in the DOH. It’s time we addressed this.
Products such as intravenous medicines for critical ailments like stroke or heart attack require training for health care providers to be more confident in using them. We can’t just purchase these expensive products and distribute them to government hospitals without training doctors and nurses on administration. Otherwise, they will remain in hospital storage.
Unused products
If we have billions’ worth of medicines in the DOH warehouses, there could also be a lot of unused ones in government hospitals and other health facilities. There are also many instances when medicines are improperly dispensed, and not given to patients who need them.
I often tell my high-risk but financially challenged patients to go to their local health centers and ask for free medicines they badly need. But most of them are told that there are no available supply. Yet, some patients with similar illnesses, but who are considered low-risk and could manage with diet and exercise, are given a month’s supply of medicines.
Our health workers must be trained in identifying high-risk individuals and prioritizing them.
To avoid overstocking, there has to be a computerized inventory and management system in our warehouses. With such a system, they can have a “just-in-time” ordering policy for supplies. They will know the lead times for procurement, and will just order when stocks run low.
With good inventory management, the DOH can even reduce its warehouse expenses. Most well-run organizations aim for the most manageable volume of inventory so they can reduce warehousing expenses and save a huge chunk of money annually.
Again, it could start from a decision to do things purposefully, which means pausing and determining the best way to accomplish one’s goals.
As Abraham Lincoln said: “If I had eight hours to chop down a tree, I’d spend six sharpening my axe.”