News
Medical specialists under pressure to say “yes” to the cheapest, avoid TECs
View(s):- “We want the cheapest but with ‘acceptable quality’ for patient safety”
- Strong call for urgent stakeholder meeting
By Kumudini Hettiarachchi
Experienced and senior medical specialists in state hospitals are resigning from or fighting shy of being part of Technical Evaluation Committees (TECs) during the procurement process, fearing pressure by some health officials who are urging that the lowest bid is the best, without taking into consideration the best interests of the patients, the Sunday Times learns.
The main reason for this reluctance among specialists is that, in conscience, they cannot and will not recommend the cheapest if it is of a low quality, said many specialists on condition of anonymity, reiterating that they cannot endanger the lives of patients, neither can they be responsible for any resultant harm to them. Patients who seek treatment at state hospitals have immense trust in the system.
“Recently, we are facing pressure to buy the cheapest item but we know the consequences would be terrible in highly-specialized surgeries. What we need is the ‘cheapest’ but with ‘acceptable quality’,” said a visibly-upset specialist, a concern expressed by many more. They were “not” looking for the best or most expensive, but for acceptable quality.
A strong call also went out to the health authorities to speedily organize a wide-ranging stakeholder group meeting so that concerns can be thrashed out and a consensus on what is best for the patient can be reached.
Explaining the processes which lead to TECs being called in, doctors said that every unit in a state hospital does a general calculation on what is called the ‘annual indent’ (projection of requirements), which is an estimate of the requirements of that unit. This estimate is then submitted to the hospital Director who sends it onto the Health Ministry’s Medical Supplies Division (MSD).
“Already annual indents for 2027 (the year after next) are with the MSD,” said a doctor.
Thereafter, the MSD sends these estimated requirement lists to the State Pharmaceuticals Corporation (SPC) which calls for tenders and prepares a schedule to get them.
These requirements fall into three categories – medicines, consumables and devices. ‘Medicines’ would range from tablets to liquids and intravenous preparations. The ‘consumable’ range comprises sutures to scalpels to bandages, gauze, gloves, needles and more, while devices cover shunts for the brain or kidneys; stents, valves and pacemakers for the heart, replacements for joints, lenses for the eyes and more.
When the SPC, during the procurement process in response to the tenders, gets samples for specific requirements these samples are sent to the relevant TEC.
A doctor said that if it is a surgical item the TEC while comprising Health Ministry officials and others would also have two end-users, in this case, surgeons who would look after the interests of the patients. These medical specialists are nominated for TECs by the relevant academic bodies of the medical profession.
The TEC would then make its recommendations and the SPC would purchase the items and send to the MSD for distribution to state hospitals.
This is where the problem arises, many said, pointing out that the authorities are expecting the TEC to decide on the lowest bid, whereas that may not be good for the patient. A matter raised was that a cheaper suture good to stitch up the skin would be disastrous in skilled surgeries such as heart, orthopaediac, transplant, vascular or plastic surgery.
They fear that if they go for the cheapest item but of the poorest quality, patients would have to pay with their lives and they would be held responsible for this.
Others pointed out that a procedure which may usually last about four hours would go on for about eight hours, as the surgeon would be struggling with substandard sutures, using up valuable theatre time in state hospitals.
Much stress has also been caused to these highly-qualified and experienced specialists who get on TECs purely on an honorary basis by the vicious and unfounded attacks in the mainstream and social media.
“We go beyond the call of duty and to be at the butt end of serious allegations of corruption without any basis is unfair and unjust,” one said.
With regard to the crisis of shortages or shortfalls in medicines, consumables and devices, many said it is due to an ineffective and delayed procurement process, which is not considering priorities.
Local purchases which should take only a few days to access are taking months now, they said, pointing out that when bulk purchases are made through open worldwide tenders the medicines are cheap; when the state sector has to resort to local purchases, the same medicines would usually be more expensive and if patients have to purchase them from a pharmacy, they would be costlier still.
A simple analogy given by a doctor was a housewife going to the market and buying the cheapest rice which is stinking and not edible based purely on price, rather than getting rice which is reasonably priced but can be consumed. Then after some time, the inedible rice has to be discarded and the housewife would be compelled to go back and buy more stocks of another type.
The solution is for all stakeholders to get-together and scrutinize the bottlenecks and thrash out how these bottlenecks can be cleared effectively without recurrent problems, for the benefit of the patients who need and depend on the state health sector.
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