{"id":68431,"date":"2024-05-10T17:52:36","date_gmt":"2024-05-10T17:52:36","guid":{"rendered":"https:\/\/www.africa-press.net\/namibia\/all-news\/healthcares-procurement-achilles-heel-as-namibia-battles-drug-shortages"},"modified":"2024-05-10T18:02:41","modified_gmt":"2024-05-10T18:02:41","slug":"healthcares-procurement-achilles-heel-as-namibia-battles-drug-shortages","status":"publish","type":"post","link":"https:\/\/www.africa-press.net\/namibia\/all-news\/healthcares-procurement-achilles-heel-as-namibia-battles-drug-shortages","title":{"rendered":"Healthcare\u2019s procurement Achilles heel…as Namibia battles drug shortages"},"content":{"rendered":"

Africa-Press – Namibia. <\/strong><\/span>The health ministry has confirmed a shortage of medicine and drugs at public hospitals, a situation that has left patients distressed, in limbo, and some at the mercy of private health facilities.<\/p>\n

The situation has led to calls for improved regulation and overhauled delivery models.<\/p>\n

Selma Nghipunya is a 70-year-old pensioner, who has been living with chronic hypertension for 15 years.<\/p>\n

She finds herself travelling between hospitals to obtain her complete medication regimen due to shortages at her nearest hospital in Eenhana.<\/p>\n

This patient, like many others reliant on public healthcare, has been unable to secure her full suite of necessary medications for two months now.<\/p>\n

This has forced her to either pay out of pocket at pharmacies, or face long queues at alternate facilities, away from Eenhana.<\/p>\n

Like Nghipunya, many Namibians who rely on prescription medications are grappling with unprecedented challenges.<\/p>\n

Over 80% of the Namibian populace relies on public health for their medical needs.<\/p>\n

The shortage, affecting everything from anti-retroviral drugs and antibiotics to essential diabetes medications, has stretched across urban and rural areas alike, leaving many patients in distress.<\/p>\n

Naemi Michael, a 64-year-old diabetic from Katutura, shares a similar plight.<\/p>\n

The pensioner shares her daily struggle with managing her diabetes without consistent access to insulin.<\/p>\n

\u201cSome days, I go to the hospital, not knowing if I\u2019ll find my medication,\u201d she said.<\/p>\n

Many, like Michael, spend most of their days trying to source medication.<\/p>\n

\u201cI have to travel from pharmacy to pharmacy,\u201d Michael said, with a sad face.<\/p>\n

Daily risks<\/p>\n

The drug shortage, which is attributed to supply chain disruptions and bureaucratic inefficiencies, has had a crippling effect on the nation\u2019s healthcare system.<\/p>\n

In some cases, patients like James Shilimela, who suffers from a heart condition, resort to rationing their medications, a risky practice that could lead to severe health consequences.<\/p>\n

\u201cI try to spread out my medication to make it last longer, knowing the next batch might be delayed or unavailable,\u201d Shilimela explains.<\/p>\n

His doctor has warned him of the risks of skipping medication, but with the current shortages, he feels he has no other choice.<\/p>\n

The issue of drug shortages is not confined to chronic medications alone.<\/p>\n

Patrick Moses*, a medical professional at Engela District Hospital, said the shortages are unpredictable and vary weekly, which complicates treatment plans and strains the already overstretched healthcare workers.<\/p>\n

\u201cWe sometimes have to mix medication manually or send patients to buy drugs from private pharmacies, which they can hardly afford,\u201d she added, highlighting the moral and professional dilemmas faced by many medical staff.<\/p>\n

Financial implications<\/p>\n

The financial implications are severe for patients.<\/p>\n

Mercia Goagoses, a patient suffering from alopecia, recounted spending about N$3000 out of her own pocket for prescribed medications unavailable at public hospitals.<\/p>\n

\u201cFor example, a bottle of Minoxidil [a prescribed medicine] is N$400, and I continuously had to buy it until I saw the results,\u201d she added.<\/p>\n

Unemployed and financially strained, Goagoses\u2019 situation illustrates the broader socio-economic impact of the healthcare challenge.<\/p>\n

Moses said other times when they run out of options, they buy medication for the patients from private pharmacies.<\/p>\n

\u201cThis is not an obligation, but we do it from the heart, as we cannot risk the lives of our patients,\u201d she added.<\/p>\n

Moses has observed patients experiencing complications due to irregular medication.<\/p>\n

\u201cWe are seeing more cases of patients coming in with severe complications because they haven\u2019t been able to take their regular doses,\u201d the doctor explains.<\/p>\n

\u201cIt\u2019s heartbreaking to see, especially knowing that many of these complications could be prevented with consistent treatment,\u201d he added.<\/p>\n

Procurement flaws<\/p>\n

On the policy and legal fronts, the crisis is exacerbated by the cumbersome procurement process.<\/p>\n

Brian Smith, a local physician, criticised the new procurement system as \u201ctedious\u201d and not fit for the urgent needs of the health sector.<\/p>\n

\u201cThe new procurement process is very tedious. I now have to wait for the new budget to come out \u2013 and once it\u2019s out, you need to budget for everything you are going to procure in the next financial year. With health, that can be a bit challenging because I don\u2019t foresee that a generator will break down or medicine will be in shortage before the next supply,\u201d he explained.<\/p>\n

The problems extend beyond mere procurement.<\/p>\n

\u201cWe are facing problems bigger than us,\u201d the doctor continued.<\/p>\n

\u201cPoor maintenance of the facilities is a significant issue. For instance, in the case of power outages, not only are you risking decomposed bodies and compromised oxygen supply, but also non-operational kitchens and aggravated conditions for psychotic patients.<\/p>\n

\u201cSometimes, the generator isn\u2019t working, and we have no maintenance system in place. Now we must run around like headless chickens trying to get solutions through emergency procurement,\u201d he added.<\/p>\n

These procedural delays and maintenance failures lead not only to drug shortages but also to a broader range of complications within healthcare facilities, according to the doctor.<\/p>\n

\u201cCurrently, the ministry of health is not recognised as an essential service, which is ironic because during the Covid-19 pandemic, we were regarded as essential workers,\u201d the doctor lamented.<\/p>\n

\u201cIf we were recognised as such, we could procure ourselves with our own budgets and prioritise better,\u201d he said.<\/p>\n

The absence of an effective system means hospitals often find themselves unprepared for emergencies.<\/p>\n

\u201cThere was an incident where a patient was stung by a scorpion, and they had systemic envenomation. We didn\u2019t have the necessary scorpion venom antidote, so we had to refer them to a specialist, which involved more expenses and logistical challenges due to a lack of available ambulances,\u201d he explained.<\/p>\n

Red tape<\/p>\n

The situation has not only left patients in distress, but health minister Kalumbi Shangula too.<\/p>\n

Shangula acknowledged the challenges posed by the current procurement laws, highlighting how bureaucratic red tape hampers timely service delivery.<\/p>\n

\u201cWe are left with no suppliers because the bidding process, managed by the Central Procurement Board of Namibia (CPBN), takes so long, and decisions are often contested, leading to further delays,\u201d Shangula explained.<\/p>\n

Before the CPBN\u2019s establishment, public procurement was managed by the Tender Board of Namibia.<\/p>\n

However, this system faced numerous challenges, including allegations of corruption, inefficiencies and a lack of transparency.<\/p>\n

While the new procurement system might have enhanced transparency, Shangula noted its lengthy nature impedes service delivery in his ministry.<\/p>\n

\u201cCurrently, we don\u2019t have suppliers from whom to buy because the bidding is conducted by the CPBN. It takes so long, and when a decision is made, other bidders investigate the offers, escalating it to the review panel and later to the court,\u201d Shangula said.<\/p>\n

Consequently, the ministry is left without any suppliers for medicines.<\/p>\n

Court brawls<\/p>\n

Recently, the ministry\u2019s supply of anti-retroviral medication was delayed after a local company, Africure Pharmaceuticals, sought a court order to prevent CPBN and the health ministry from entering into a contract with any supplier of anti-retroviral medication.<\/p>\n

Shangula said the bureaucratic maze not only delays the procurement of essential medicines but also leaves the healthcare system in a bind.<\/p>\n

The health ministry\u2019s hands are tight.<\/p>\n

\u201cWe only wait to be told that you can order from this or that company. There is nothing we can do right now because we can\u2019t change the law,\u201d he said.<\/p>\n

The ministry also faces high costs and logistical challenges associated with emergency procurement.<\/p>\n

\u201cWe buy them at emergency procurement at a very high cost, in small quantities and they last for just a week before running out again,\u201d he detailed.<\/p>\n

Middlemen<\/p>\n

Adding to this discourse, former health minister Bernhard Haufiku highlighted another dimension of the problem \u2013 the role of medical middlemen, also known as tenderpreneurs.<\/p>\n

He has been an ardent critic and opponent of the involvement of tenderpreneurs in public procurement.<\/p>\n

While he supports local businesses participating in government bids, he said the involvement of middlemen has often led to inflated prices and raised ethical concerns.<\/p>\n

Haufiku is convinced the ministry is well-positioned to directly engage with pharmaceutical manufacturers worldwide to purchase most, if not all, of their essential medicines.<\/p>\n

\u201cVaccines can also be directly purchased from manufacturers at a negotiated price,\u201d he added, noting that most pharmaceutical manufacturers recognise the public sector\u2019s significant role in health.<\/p>\n

\u201cUnlike middlemen, who are there to create unreasonable profit margins,\u201d he explained.<\/p>\n

He also highlighted the financial implications of the current system, where public hospitals often refer patients to private facilities due to inadequate services.<\/p>\n

\u201cThe cost of care in the private sector seems to have no ceiling,\u201d he commented, suggesting that investment in public healthcare capacity could reduce reliance on the private sector and save substantial amounts of public funds.<\/p>\n

For example, Haufiku explained, if a state patient requires magnetic resonance imaging (MRI), which is now a standard part of care, it costs around N$20000 per patient in the private sector.<\/p>\n

\u201cSome of these tests are performed two to three times, for instance, if a patient is suspected of or diagnosed with intracranial bleeding that does not immediately require surgery (craniotomy),\u201d he said.<\/p>\n

This can amount to N$60 000 for one patient, which he said is unsustainable.<\/p>\n

The former minister proposed a hybrid system for pharmaceutical procurement that combines direct purchases from manufacturers for essential drugs with a transparent local bidding process for other medical supplies.<\/p>\n

Dose<\/p>\n

Health executive director Ben Nangombe also highlighted the inherent complexities of the procurement process.<\/p>\n

\u201cProcuring medicine is quite complex due to various factors that may delay the timely availability of required medicines,\u201d Nangombe said.<\/p>\n

He detailed issues such as suppliers failing to deliver after being awarded contracts and last-minute price changes by manufacturers, which often lie outside the ministry\u2019s control.<\/p>\n

To address these non-delivery issues, the ministry has begun imposing liquidated damages on suppliers who fail to meet their contractual obligations.<\/p>\n

\u201cWe charge a penalty for each day you are late, and we deduct this from the payment due to you,\u201d he stated, hoping to incentivise timeliness and reliability among suppliers.<\/p>\n

Like Shangula, Nangombe also reiterated the ongoing challenges with legal disputes over procurement processes.<\/p>\n

\u201cWhen procurement activities are initiated and bids are received and evaluated, awards are granted to a particular company. Then, if the process is challenged in court, the delivery of medicine is delayed until the matter is resolved,\u201d he said.<\/p>\n

In discussing strategies to overcome these procurement challenges, Nangombe mentioned initiatives for direct purchasing from manufacturers, especially in countries like Egypt and Kenya.<\/p>\n

\u201cWe are currently in the process of signing a memorandum of understanding with the Egyptian counterpart to the Namibia Medicine Regulatory Council to explore direct purchases of medicines from that country rather than sourcing from outside the continent,\u201d he revealed.<\/p>\n

While this approach may bypass various middlemen, he noted their services would still be required in some instances.<\/p>\n

\u201cYou don\u2019t visit a Toyota factory in Japan to buy a vehicle. Similarly, sometimes you have to purchase medicines from local companies. That\u2019s just the nature of the market,\u201d he explained, highlighting the practical challenges of direct procurement given Namibia\u2019s relatively small market.<\/p>\n

Furthermore, the executive director said the ministry is actively investing in local healthcare infrastructure to lessen dependency on costly private sector referrals.<\/p>\n

\u201cWe have begun establishing dialysis centres across the country and are expanding ICU capacities in district hospitals,\u201d he added.<\/p>\n

This initiative is part of a broader N$16 billion five-year plan aimed at strengthening the public health sector to make healthcare more accessible and affordable for all Namibians.<\/p>\n

NB: Pseudonyms were used to ensure the anonymity of the doctors, as they are not permitted to speak to the media.<\/p>\n

This work was produced with support provided by the Wits Centre for Journalism\u2019s African Investigative Journalism Conference and supported by the Bill and Melinda Gates Foundation.<\/p>\n

For More News And Analysis About Namibia<\/a> Follow Africa-Press<\/a><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

Africa-Press – Namibia. The health ministry has confirmed a shortage of medicine and drugs at public hospitals, a situation that has left patients distressed, in limbo, and some at the mercy of private health facilities. The situation has led to calls for improved regulation and overhauled delivery models. Selma Nghipunya is a 70-year-old pensioner, who […]<\/p>\n","protected":false},"author":84,"featured_media":68430,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,3],"tags":[234,236,233],"class_list":["post-68431","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-all-news","category-community","tag-africa-press","tag-africa-press-namibia","tag-namibia"],"yoast_head":"\nHealthcare\u2019s procurement Achilles heel...as Namibia battles drug shortages - Namibia<\/title>\n<meta name=\"description\" content=\"The health ministry has confirmed a shortage of medicine and drugs at public hospitals, a situation that has left patien ...\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.africa-press.net\/namibia\/all-news\/healthcares-procurement-achilles-heel-as-namibia-battles-drug-shortages\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Healthcare\u2019s procurement Achilles heel...as Namibia battles drug shortages\" \/>\n<meta property=\"og:description\" content=\"The health ministry has confirmed a shortage of medicine and drugs at public hospitals, a situation that has left patien ...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.africa-press.net\/namibia\/all-news\/healthcares-procurement-achilles-heel-as-namibia-battles-drug-shortages\" \/>\n<meta property=\"og:site_name\" content=\"Namibia\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/AfricaPressTunisiaa\" \/>\n<meta property=\"article:published_time\" content=\"2024-05-10T17:52:36+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2024-05-10T18:02:41+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/static.africa-press.net\/nambia\/sites\/29\/2024\/05\/sm_1715351371.162297.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"720\" \/>\n\t<meta property=\"og:image:height\" content=\"476\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"cfeditoren\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"cfeditoren\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"10 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\/\/www.africa-press.net\/namibia\/all-news\/healthcares-procurement-achilles-heel-as-namibia-battles-drug-shortages#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.africa-press.net\/namibia\/all-news\/healthcares-procurement-achilles-heel-as-namibia-battles-drug-shortages\"},\"author\":{\"name\":\"cfeditoren\",\"@id\":\"https:\/\/www.africa-press.net\/namibia\/#\/schema\/person\/068c7ab4e9634ae78ec5d54ec46598bb\"},\"headline\":\"Healthcare\u2019s procurement Achilles heel…as Namibia battles drug shortages\",\"datePublished\":\"2024-05-10T17:52:36+00:00\",\"dateModified\":\"2024-05-10T18:02:41+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/www.africa-press.net\/namibia\/all-news\/healthcares-procurement-achilles-heel-as-namibia-battles-drug-shortages\"},\"wordCount\":1972,\"commentCount\":0,\"image\":{\"@id\":\"https:\/\/www.africa-press.net\/namibia\/all-news\/healthcares-procurement-achilles-heel-as-namibia-battles-drug-shortages#primaryimage\"},\"thumbnailUrl\":\"https:\/\/static.africa-press.net\/nambia\/sites\/29\/2024\/05\/sm_1715351371.162297.jpg\",\"keywords\":[\"africa press\",\"Africa Press-Namibia\",\"namibia\"],\"articleSection\":[\"all news\",\"community\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\/\/www.africa-press.net\/namibia\/all-news\/healthcares-procurement-achilles-heel-as-namibia-battles-drug-shortages#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.africa-press.net\/namibia\/all-news\/healthcares-procurement-achilles-heel-as-namibia-battles-drug-shortages\",\"url\":\"https:\/\/www.africa-press.net\/namibia\/all-news\/healthcares-procurement-achilles-heel-as-namibia-battles-drug-shortages\",\"name\":\"Healthcare\u2019s procurement Achilles heel...as Namibia battles drug shortages - 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