Tuesday, November 29, 2022

Sick and tired – Botswana’s health care system

Boehringer Ingelheim Consultants, commissioned by the Ministry of Health to plan the re-engineering of the Central Medical Stores, had to cover their noses, dodge piles of human crap and use torches to find their way around.

The team of German consultants was going about the stock taking exercise and suddenly Oops!: “Animal excretions in both the bulk and fine pick areas and human excrement was found in the fine pick areas,” states the consultancy report.
They found emergency exits blocked by rubbish packaging, fire extinguishers, in non-working condition, all packed under the stairs and burnt out light bulbs and lights fittings hanging by the wires from the ceilings.

In fact, the consultants related how they had to use torches to count stock because the light bulbs in the storeroom are not working.
This week, government officers at the Central Medical Stores were reported to be taking stock of their inventory. It is tempting to imagine them hunched under dead light bulbs, hanging precariously on frayed electrical cables, swaying gently over huge boxes of medical supplies, barely illuminating the dark room.

In reality, this is highly unlikely. Stock taking is frowned upon by Central Medical Store officers, most of whom, according to the consultants’ report, “have never seen a count sheet layout” and prefer to pass time warming office chairs. The consultants reported that “it was apparent that supervisors were not familiar with the stock count process and could not assist their staff with information during the count. It is claimed that cycle counts are done ÔÇô this is questionable ÔÇô from working with the staff, it was clear that they had never done anything similar before.”

The Central Medical Stores is at the center of a scandal which this week saw more than P20 million worth of expired medicine being trucked to the old supplies buildings to be destroyed with an additional P12 million worth of medical supplies still to be tested, while pharmacists at government dispensaries throughout the country are turning back patients without their doctors’ prescriptions because there is a shortage of medical supplies.
The Parliamentary Health Committee touring health facilities throughout the country last year was told how patients have to travel long distances for medical attention because clinics in their areas had run out of medicine.

Kang Village Development committee chairman, Kenyaditswe Tlhokwane, complained to the Parliament Health Committee that the perpetual shortage of medicines at the Kang Clinic resulted in patients traveling all the way to Hukuntsi. Indications are that government dispensaries may be turning away patients without their doctors’ prescriptions while much needed medical supplies are rotting on shelves at the Central Medical Stores.
Investigations by the German health consultants turned up hundreds of thousands of units of stock which could not be accounted for and is shown on the inventory register as “no stock.”

“From our analysis of the current stock listing, we have seen huge anomalies sitting in areas like NS or No stock area that are unaccounted for due to the confusion across all departments as to what the units of issue/sale are. This area currently contains 6188 lines of stock or 1,878, 959 units. Although many of these quantities could be the result of systems capture errors, many go back as far as 2003 which indicate that there is no apparent process to investigate these anomalies. There is no trigger in the system that highlights the discrepancies or raise awareness ÔÇô stock control is supposed to be checking on this. It is doubtful if the competence and knowledge exists in-house.”

The investigation by Boehringer Ingelheim Consultants further found that “stock description on the master file is wrong ÔÇô units of measure are also not indicated ÔÇô strengths and quantities of tablets are not indicated on the counting sheets; names of products and codes are unknown; only 10 percent of the stock has a PULSE label on it ÔÇôi.e. not all received stock is captured in the system. Labels are stuck on one box per pallet, once that box is issued, the identity of the remaining product is missing. There is no apparent knowledge of batch and expiry date management. The batch numbers and expiry dates reflected on receiving labels do not match actual products in the box.”

The German consultants also turned up stock that is well dated but mixed up with expired stock that is “lying in all areas within the facility. Expired stock was found in mixed boxes of rubbish, in bulk, in pick and storage locations. Currently there is P 21, 058,619. 79 in the expired stock area.”

Some of the medical supplies were stored in facilities that are not suitable for storage, and although still within the “use-by-date”, would have to be tested first to ensure that they do not expose users to health risks.

Noted the reported the report, “The outside facilities are not suitable for the storage of items. There is roughly 12 million Pula sitting across these three facilities. Items are dirty and full of animal bi-products. The majority of the stock stored in these locations is gloves and condoms. Both these latex based items would need to be stored below 25 degrees to ensure the integrity of the product. Evidence of high temperature is evident ÔÇô the insulation in the roof is badly disintegrated. We were led to believe that these items have been stored in these locations for over a year. Testing would need to be carried out to ensure that the products are still in saleable condition.”


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