Addressing the shortage of medicines in public healthcare facilities.

A reporter from Nghe An Newspaper had a discussion with Pharmacist Tran Minh Tue, Deputy Director of the Nghe An Department of Health, regarding this issue.

PV:Sir, based on feedback from patients, some public healthcare facilities in the province are experiencing shortages of medications covered by health insurance, forcing patients to purchase them elsewhere. What can you say about this situation?

Pharmacist Tran Minh Tue:To ensure the supply of medicines for treatment in 2024, starting in 2023, the Department of Health requested units to actively and proactively develop plans and organize bidding for the procurement of medicines to serve medical examination and treatment. Following this directive, most units have developed projected drug needs, created plans, and conducted bidding for drug procurement. Only 4 units failed to do so in time during 2023.

The results of procurement and bidding for medicines, chemicals, and medical supplies at various levels are as follows: For national-level centralized procurement, the Department of Health compiled and reported proposals for 115 items on the national centralized bidding list with a total value of over 362.2 billion VND; 85 items were selected, with a total value of over 238.5 billion VND (achieving 73.9% of the list and 65.6% of the value)... For provincial-level centralized bidding, the Department of Health organized bidding for 232 items with a total value of nearly 522 billion VND; 182 items were selected, with a total value of over 429.2 billion VND (achieving 78% of the list and 82% of the value).

In Nghe An province, bidding processes for medical facilities involved the preparation of plans for selecting 266 bidding packages comprising 34,766 items, with a total value exceeding 3,770 billion VND; the results showed that 15,437 items were awarded through the bidding process (reaching 78% of the total tendered items), with a total value exceeding 2,110 billion VND (reaching 84% of the total tendered items).

Specifically for pharmaceutical products, establishments in the province organized bidding for 128 packages, covering 11,983 items with a total value of 1,725 ​​billion VND. They selected 9,037 items with a value of 1,427 billion VND, achieving 75% of the list and 83% of the value.

The bidding results show that some pharmaceutical products for treatment in 2024 could not have contractors selected due to various reasons. Twelve medical facilities in the province reported drug shortages, with a total of 668 items lacking, totaling over 55 billion VND (corresponding to 2% of the list and 1% of the value of the 2024 bidding packages).

To address this situation, the Department of Health has directed and guided units to actively and proactively continue implementing necessary measures to ensure compliance with regulations, timelines, and procurement schedules for medical examination and treatment services in 2024. Since the beginning of the year, the Department of Health has advised the Provincial People's Committee to approve and issue 12 decisions on the procurement of medicines, chemicals, and medical supplies; and 17 procurement plans for medicines, chemicals, and medical supplies. Simultaneously, the department has also held numerous meetings with relevant departments, agencies, and affiliated units to resolve difficulties and obstacles in the bidding and procurement process for medicines, equipment, and medical supplies.

Despite our best efforts, it must be said that currently, some medical facilities in the province are experiencing localized shortages of certain medicines (herbs, medicinal ingredients, some chemicals, specialized supplies, and some specially controlled drugs such as narcotics and psychotropic drugs...). This has, to some extent, affected the quality of medical examination and treatment and the rights of patients.

PV:Could you elaborate on the reasons behind the unsuccessful bidding process and the current localized drug shortages?

Pharmacist Tran Minh Tue:There are many reasons for the limitations and shortcomings in the drug procurement bidding process. Subjectively, some healthcare facilities are not proactive or flexible enough in planning drug supply. Furthermore, there is a shortage of qualified personnel involved in the bidding process. Healthcare workers are reluctant to participate in the bidding process.

Objectively, as we know, medicines used in medical examinations and treatments at public health facilities must go through a bidding process. During the bidding process, some types of medicines have failed to find a winning bidder (always about 10 to 20% of items have no winning bidder) for various reasons, such as bids being higher than the planned price; bidders not participating in the bidding for items whose prices have fluctuated and increased compared to the planned price; bidders not participating in the bidding for items with insufficient planned quantities; and even cases where no bidder meets the requirements of the tender documents.

Even when pharmaceutical products have been awarded through tenders – and suppliers have secured them – shortages can still occur for the following reasons: Some drugs may experience supply chain disruptions globally or within Vietnam, preventing suppliers from providing them. Some drugs may have expired registration numbers. Suppliers may refuse to supply certain items where the planned quantity is too small. Suppliers may stop supplying drugs until the healthcare facility's outstanding debts have been fully settled.

Furthermore, drug shortages also stem from the difficulty in accurately predicting the demand for each type of drug. This fluctuation arises from the constantly changing patterns of disease. The demand for drugs is not fixed. Meanwhile, purchasing drugs requires going through a very difficult and time-consuming bidding process.

In 2024, drug procurement bidding will be conducted according to the Law on Bidding No. 22/2023/QH15 (effective from January 1, 2024). However, ministries and agencies have been slow to issue guiding circulars. For example, the Ministry of Health only issued Circular No. 07/2024/TT-BYT on drug bidding at public health facilities on May 17, 2024. Therefore, during that period, health facilities lacked the basis to conduct supplementary bidding for missing drugs.

PV:Given the current drug shortage, what directives and forms of support has the Nghe An Department of Health provided to healthcare facilities in the drug procurement bidding process?

Pharmacist Tran Minh Tue:It must be said that the Department of Health and medical examination and treatment units have been trying to find and implement many solutions to ensure the supply of medicines for medical examination, treatment, and healthcare for patients.

Specifically, to address the risk of drug shortages, the Department of Health has directed units to proactively seek alternative products with similar effects, build a diverse list of goods to be purchased; proactively re-tender for items that were not awarded through the bidding process and for which there are no alternative products; and proactively organize the selection of contractors for items not included in the centralized procurement list... For scarce items, units must have solutions to stockpile enough medicine.

Currently, there are localized shortages of certain medications due to manufacturers ceasing production, global disruptions, or suppliers being unable to provide them (for example, some intravenous solutions, Vitamin K), causing considerable difficulties in medical examination and treatment in Nghe An province in particular and Vietnam in general. Regarding these items, the Department of Health has directed medical facilities to urgently prepare plans to find equivalent products in the near future.

In addition to directing units, the Department of Health also continuously updates information and promptly implements directives from the National Procurement Center regarding the organization of bidding and procurement for drugs on the national centralized procurement list; continuously improves the bidding capacity of medical facilities; regularly contacts medical facilities to promptly grasp information related to difficulties and obstacles in drug supply and propose solutions to overcome them; strengthens inspection and supervision of the planning and organization of drug procurement bidding by medical units, and promptly corrects units that have not performed well in planning and organizing drug supply, leading to drug shortages at medical facilities.

To support and enhance the bidding capacity of medical facilities, the Department of Health has developed bidding procedures for drugs, chemicals, and medical supplies; and organized guidance and dissemination of these procedures to medical facilities. The Department has also established professional bidding support teams for units lacking experience in bidding; and organized free bidding training courses for medical facilities on implementing bidding procedures... thereby helping units to implement bidding quickly and in compliance with legal regulations.

Currently, the Department of Health requires all medical examination and treatment units to report monthly on the supply of medicines to patients, including forecasts of potential shortages due to increased demand for medical services. Through this, the Department of Health will provide more decisive guidance and support to units in developing plans and purchasing medicines in the most timely manner. The Department also requires medical examination and treatment units to exchange information, provide guidance, and refer patients to other treatment facilities when necessary.

Regarding the issue of healthcare facilities delaying payments, leading to contractors ceasing supplies, the Department of Health has already received information. Based on this information, the Department of Health has been, is, and will continue to direct its units to contact, discuss, and resolve difficulties with contractors, balancing funding to ensure timely payment and settlement of drug purchases as stipulated in the contracts, so that contractors can continue supplying in the future.

PV:So, what are some fundamental, long-term solutions to definitively address the localized drug shortage and ensure patients' rights are protected, sir?

Pharmacist Tran Minh Tue:Currently, the Department of Health has submitted two recommendations to the Ministry of Health.The first,We need to develop a national centralized drug procurement list with a larger number of drug items.Monday,The time for selecting contractors and conducting national-level bidding has been shortened to meet the needs of localities in general and Nghe An in particular.

The Nghe An Health Department is also developing a list of drugs for local-level bidding. After this list is approved by the Provincial People's Committee, the department will actively and decisively organize bidding to ensure the supply of drugs for all units.

Increasing the list of key drugs in national-level centralized bidding is crucial. A larger number of these key drugs will reduce the burden on bidding organizations and limit situations where bidders do not participate in bidding and supply due to low demand.

PV:Thank you, sir!