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The foundation of quality healthcare is the reliable availability of medicines. Yet, in many hospitals across Nepal, patients and pharmacists face a recurring and frustrating problem: medicine shortages. While the causes may seem complex, the heart of the issue often lies in a flawed and opaque procurement and supply chain system.
Hospital pharmacists, who are at the sharp end of these problems, have voiced their concerns loud and clear in recent surveys. They point to a system that is often slow, rigid, and influenced by factors other than patient need. The Pharmacy Association of Nepal (PhAN) believes that addressing these flaws is not just about logistics—it’s about patient rights and professional integrity.
The Vicious Cycle of Shortages and Substandard Procurement
The current procurement process in many hospitals in Nepal creates a vicious cycle that directly harms patients. As our members’ feedback has shown, the problems include:
- Rigid and Delayed Processes: The public procurement system is often perceived as a bureaucratic maze. The time-consuming tender process, coupled with administrative delays, means that essential medicines can take months to reach the shelves. As one pharmacist noted, “the administrative process for procurement starts in the first quarter, and essential medicines reach service delivery points only in the third quarter.”
- Lack of Transparency: There are concerns about the involvement of “unnecessary interest groups” that can compromise fairness. This lack of transparency can lead to decisions based on commercial interests rather than on the quality, cost-effectiveness, and genuine need of the patients.
- Insufficient Budget Allocation: Insufficient and sometimes unallocated budgets, especially for essential and life-saving medicines, contribute directly to persistent stock-outs. This issue is particularly acute for medicines covered by government programs like health insurance, leaving patients in a vulnerable position.
- Focus on Cost, Not Quality: When the procurement process is driven solely by the lowest price, the quality and shelf-life of medicines can be compromised. This not only puts patients at risk but also results in the acquisition of near-expiry stock, which creates further waste and management problems.
A Prescription for Transparency and Efficiency
To break this cycle, a fundamental reform of the pharmaceutical procurement system is required. PhAN and its members are advocating for a system that is transparent, fair, and, most importantly, patient-focused. The solutions we propose include:
- Strengthening and Amending the Public Procurement Act: While Nepal’s Public Procurement Act aims for transparency, its application in the health sector requires a specialized and more flexible approach. We must advocate for amendments that acknowledge the unique, urgent nature of medicine procurement and prioritize patient outcomes.
- Involving Pharmacists in the Process: Pharmacists are the true experts in drug supply, inventory management, and patient needs. They must be given a central role in procurement decisions, with “full authorization including procurement,” as suggested by our members. Their involvement would ensure that procurement is guided by a hospital formulary and genuine patient requirements, not by external pressures.
- Implementing e-Procurement Systems: Adopting modern, digital procurement systems can significantly reduce delays and increase transparency. An electronic system can streamline tender submissions, track supply chains in real-time, and make the entire process more accountable to the public.
- Prioritizing a Service-Oriented Mindset: Hospital management must shift its focus from a pharmacy’s sales-per-day to its service quality. This means allocating separate, adequate budgets for pharmacy services and evaluating pharmacists based on their ability to manage stock effectively, prevent shortages, and ensure medicine availability for all patients.
The Direct Impact on Patient Outcomes
Ultimately, the flawed procurement system has a devastating human cost. When essential and life-saving drugs are unavailable, patients face delayed treatments, financial hardship, and compromised health outcomes. This is not just a logistical problem; it is an ethical and humanitarian one.
By fixing the flaws in our procurement and supply chain, we can ensure that every hospital pharmacy in Nepal operates as a reliable source of safe, quality, and affordable medicines. PhAN is committed to leading this charge, working tirelessly to create a system that truly serves the health and well-being of every citizen.
