New Era Senior Journalist Alvine Kapitako this week spoke to the permanent secretary in the Ministry of Health and Social Services, Ben Nangombe, on the challenges facing the public health sector. The wide-ranging interview will be published in parts due to space constraints. This is Part 1.

New Era (NE): The shortage of medicine in state facilities has been reported in the media time and again. We’ve also had many instances where the public complain to journalists about this shortage. Why is there a constant shortage of medicines in health facilities throughout the country? And it’s not just medicine, we have had nurses complain about the lack of toilet paper or even soap in clinics, for example. 

Ben Nangombe (BN): “The provision of sufficient pharmaceuticals to our facilities is of paramount importance. We want to make sure that at any given time, at any given facility we have the pharmaceuticals that members of the public need in order to be treated. 

There are challenges with respect to the procurement of medicine and this must be understood in the context of how we manage our distribution chain from the placing of orders, receiving of the orders and the distribution of the orders to the facilities and to the Regional Medical Stores. I wouldn’t want to say that there is a constant shortage. Yes, there are challenges and these challenges are related to sometimes the nature of our procurement system. 

What has happened in the past is we (ministry) would issue a public tender whereby companies bid and over a two-year period we have a secured arrangement with a particular supplier from whom we can order the pharmaceuticals when we need them. For the past two years, we have not had such public tender, therefore, the ordering of medicine is being done on an ad-hoc basis and as you know when we order the medicine we don’t necessarily order directly from the manufacturers. We have distributors and agents that we order from. 

We try as much as we can to manage our supply chain. By this I mean we have a system at the Central Medical Stores whereby we do our forecasting of the medicines that we order. For example, when we know that we have a quantity for a particular medicine that will run out in four or six months, we start the process of procurement. 

However, what happens in the meantime is that sometimes although we kick-start the process of procurement four months before, we sometimes run out of a particular drug/pharmaceutical. When we place the order the delay is caused by the fact that the company that may have been chosen to deliver is unable to acquire the required pharmaceuticals from the supplier, so that becomes problematic.

So, it’s not to say that we are not managing our supply chain correctly, it’s just that there are circumstances beyond our control that lead to a situation where we are unable to acquire the drugs. Sometimes, delays can also be caused when we request funds from the Ministry of Finance through the Treasury. If the funds are not released on time and we are unable to pay the suppliers then the drugs may not be delivered on time. Some of our facilities, for example, the district hospitals and the Regional Medical Stores may order greater number of quantities of drugs from the Central Medical Stores than what they really need and therefore when they do that you find that a particular drug is delivered to one Regional Medical Store or to one facility at the expense of other facilities. But that is something that we are addressing right now. 

We are refining our systems to ensure that our distribution channels are responsive and are able to detect when problems can be encountered to prevent situations of stock-outs. It should also be noted that there has in the past been cases where medicines were ordered and delivered and not accounted for. We are in the process of tightening our systems – our security systems, our surveillance systems at the Central Medical Stores to ensure that each and every unit of pharmaceuticals that is ordered and that is delivered is accounted for in terms of where it has been delivered. 

You may have read in the media (this week) that we have advertised tenders for pharmaceuticals and antiretroviral drugs that is being evaluated by the Central Procurement Board and this goes back to what I said at the beginning, that once you have a two-year tender you know that you are dealing with one supplier. 

So, if you are dealing with one supplier, you can order the quantities that you need and you know that the prices are fixed so we will do away with buy-outs. Buy-outs are situations where, because of a shortage of a particular drug, we are forced to go out and request companies to send in their proposals in terms of pricing and because of that, the ministry is taken advantage of; because the suppliers know you are in desperate need to acquire a particular pharmaceutical they can give you any price and because our decisions are life and death situations, we are obliged to buy these medications at sometimes unreasonably high prices but we are talking about human lives and we must respond to the needs of our patients who are in hospitals, we really have no choice.

With respect to the procurement of other supplies, whether it is cleaning materials, whether it is clinical supplies, the same applies. We want to make sure that we have quantities that we need and that we buy at reasonable prices. 
However, it’s a question of what is out there in the market. In order to empower our facilities, for example the district and the referral hospitals and these are Windhoek Central, Katutura State hospital, Oshakati State, Rundu hospitals and the district hospitals of Eenhana, Walvis Bay, Gobabis, Keetmanshoop and Katima Mulilo, a decision has been taken that we give these hospitals a specific amount of money, in order to be able to procure the items that they need themselves. 
In the past, to buy toilet paper or soap the facilities had to send their request to procure to the head office and that takes a long time. So, we have made it possible now to give a certain amount of money to the facility to be able to procure these things, as long as we make sure that they account. 

We are not going to give money for the sake of giving money to the facilities. We will give them money and we will make sure that they account for each and every cent of the money spent and on the items on which the money was spent on so that we ensure accountability.” 

NE: And, when was the decision to give money directly to facilities taken and how much will they be getting?
BN: “This decision was taken in August but I think the letter went out only in September, giving the facilities that authority to procure these essentials. This is with immediate effect. For the first round, the referral hospitals will get about between N$500 000 and N$750 000 monthly. Clinics fall within a district so their procurement will have to be done at a district level.” 

NE: We’ve also recently had complaints of equipment not working, the oncology department at Windhoek Central hospital is one example where patients are reportedly being sent home because some equipment are not working. Are you aware of that and what is being done about this?

BN: “We are aware that there are some equipment that are aged and that have not worked well. We have taken steps to repair – with specific reference to oncology there’s a machine called the Cobalt 60 machine which is used for radiation treatment. We have ordered the parts and they should be arriving anytime. I am told that the parts are coming from Canada. The machine was made in Canada and we are attending to the problem. 

I must say that we are heartened by the fact that the private sector has come forth to offer their assistance. The Namibian Oncology Centre, for example, has contacted me to say that if our machine is not working and while we are waiting for it to be repaired and there are those cases where it is really urgent that our people need to receive treatment, we can refer these patients to the Namibian Oncology Centre. So, Dr Tommy van Wyk spoke to me and that is the kind of partnership that we need between the public and private health sectors to deliver public health care.

Public health care must be seen for what it is and that it must be a partnership. Government cannot do it alone, the resources are limited, therefore when private institutions come in to lend a hand we welcome that.  We are also working with facilities like Lady Pohamba hospital, we are working with Ondangwa private hospital, we are working with Medipark hospital in Ongwediva and others. So, the private sector has really come forth to support our efforts and we know how costly it is, for example, to refer operations to facilities outside the country. But, if we have specialised facilities here at Medi-Clinic for example, or Catholic hospital or Lady Pohamba hospital where we can enter into arrangements with these facilities so that when we refer patients we get a discount on the rates, then it will be much cheaper to refer cases to these hospitals and this is going on already. 

Medipark has attended to some of our patients at reduced costs, and professionals from these facilities also visit some of our facilities on a reach-out basis to not only carry out procedures but also to aid our professionals in those facilities, particularly our new doctors.” 

To be continued…